Of Priests, Bishops and Midwives

Today I am returned from the service of celebration of the 20th Anniversary of women being ordained at St Asaph Cathedral, Wales. To remind us that we are still radical we had a small picket of people calling upon us to adhere to the scriptures ‘that women should keep silence in churches’. We were there because we had been there 20 years ago when our good friend Kath Southerton was ordained as one of the first women priests in Wales. We took our 2 year old daughter who is photographed in the arms of the presiding Bishop Alwyn.

It is significant for me that we were there 20 years ago and it is significant that I was there today, because this is part of the struggle we face as women to be treated as of equal value with in the world including within our faiths. And misogyny and discrimination remain and most particularly in the two areas of my life I am most passionate about: the maternity system which deals exlusively with women birthing and in the Church whose starting point is God’s love for all regardless of gender and creed and status in life.

Bishop Rachel, first woman Bishop in England gave the sermon. She took as her readings the story of Ruth(!) and the resurrection story of Mary Magdalene in the garden. These were both women, she said, whose context was shaped by the decisions of others.

In the story of Ruth we have a woman whose context is shaped by the decisions beyond her control. A Family of two parents and their sons migrate for work to a neighbouring country. The sons grow up and marry two local girls. This is in a culture where marriages are financial and social contracts where women are commodity as much as people. Tragedy strikes and the Father and sons die leaving the women without the protection of a legally recognised (male) head of household and means of living. Naomi, the mother in law decides to return to her own people where she maybe able to afford some living and protection amongst family and tribes people. Her daughters she releases to return to their families where they would be married off (perhaps as second hand) to another man/family. Ruth looks at the choices she has – shaped by her context and the decisions of others. None of the choices are easy but she chooses to take the risk of going with Naomi, setting aside her own culture and nationality to, in effect, become a daughter of Naomi – her people, her God – taking the risks of an all female household. All ends well for Ruth as with some more courage (and the cunning and audacity of the two women) she marries a wealth relative of Naomi – Boaz – becoming one of the very few women to be named as an ancestor of Jesus in Matthews Gospel. Rachel said that this was a woman taking life changing chances in a context limited by the decisions of others – this is the context of all – men women and children – but very much so for children and women.

Bishop Rachel is the first woman Bishop, but over the last 20-25 years since women were ordained priests in the British Anglican Church there have been many women as clever, as wise as suited to the role of Bishop who have not been ordained due to the ongoing discrimination of the Anglican Church. This will continue to be the case for many years until Women Bishops are the norm. The context of women priests is framed by the decisions of others’, individual women priests face this truth as they follow the path of their vocation.

And so I want to say to my daughters and to my female friends out there. We operate in a context framed by the decisions of others. This can empower us (such as anti discrimination legislation, some maternity laws and the mentoring of women ahead of us) but the decisions can also be limiting – many women I know, myself included have injured ourselves against the glass ceiling – and historically this has often been the case. Our efforts are in the context of a millennia of patriarchy – if we think our steps forward are very small we have to set them in this context – the story of Ruth set in the second millennium BC reminds us of this.

And sisters and daughters, if you have worked hard, you are talented and qualified but you don’t achieve what you should, do not blame yourself (as we so often do!), look at the context shaped as it is by the decisions of others. If you seek to bring about change to benefit women – and I think here of the midwives, birth workers, maternity activists and mothers themselves and you fail ( as I have) or your victories are not great and soon eroded, or you burnout ( as I have), then do not blame yourselves, remind yourself that you have been taking life enhancing action, taking life changing risks in a context that is shaped by the decisions of others.

Today we celebrated 20 years for the women who made it to ordination in the Welsh Anglican Church, whilst remembering the many more who worked, campaigned who suffered much and received little in the years before and since. Today we celebrated with the first woman Anglican Bishop of England celebrating in a few days the consecration of the first woman bishop in Wales, commemorating 20 more years of missed opportunities for the gifts and talents of women in Wales.

Today I also remember the many women priests of birth, the midwives and the doulas, who have empowered and enabled women to make their own healthy choices for birth. I celebrate we who have campaigned so women can choose a birth at home, in water, in a midwifery led unit, with a midwife she knows and trusts, to have impartial information and support whatever her decision. Our successes and failure speak of courageous selfless women taking life changing risks in a context shaped by the decision of others. Sisters we do what we can, we do not blame ourselves for what we can’t and we call on our daughters to stand on our shoulders to take the work forward. Amen

A Midwife I know and Trust: Why I campaign for one mother one midwife care

Over many months I have been thinking a great deal about the importance of one to one midwifery care  or personalised care as the Government calls it.  Why am I so passionate and committed to seeing one to one midwifery happening in Bradford?

I am passionate about one to one midwifery care because I know what an enormous difference it can make to the experience women have during the childbearing weeks and months.  I really don’t think it is good enough for health services to say to a woman: ‘There you are!  You and your baby are alive and reasonably  well’.  And send them off to an unsupported home environment traumatised, exhausted, barely breastfeeding and with the minimum NICE visits to look forward to.  Similarly, it is unfair to expect that many women in the deprived areas of our city and district will be able to turn up to hospital to birth a baby, maintaining the best health and wellbeing of themselves and their baby and their wider family, on the minimum and fragmented care offered by the medical led NICE guidelines.

The evidence shows us that women supported by one to one care of a midwife, are more likely to have a normal birth, experience less pain in childbirth, are more likely to breastfeeding and continue to breastfeed and are less likely to have post natal depression.  Breastfeeding babies are 5 times less likely to be hospitalised for gastroenteritis, are less likely to be obese, less likley to suffer eczema,  less likely to have heart disease or diabetes.  Not breastfeeding a baby starts cost the NHS money from 8 weeks old, and new evidence shows that cutting the investment in maternity increases drop off rates for breastfeeding.  Moreover, we now know that personalised maternity care significantly reduces the risk of premature labour, miscarriage before 24 weeks and still birth.  Having a midwife you know and trust can save your baby’s life.

My Story:

I would not class myself as a vulnerable woman but I lived for 9 years in the deprived community of Girlington and 10 years on the Allerton council estate, my husband worked away and was on a minuscule salary as an archaeology PhD student(!) and so for most of this period I was having to manage a home, up to three small children, and a baby  –  all on a very low income.  Unsurprisingly I suffered from post natal depression and so I know the difference one to one care made for me.

With my first child, 19 years ago I was not referred to midwifery care by my GP and only found a midwife late in pregnancy.  Case loading was in operation then in the local teams and so not only did I  have continuity of care from my midwife, it was likely she or a midwife I knew and knew me would be attending my birth at home.  My birth was a long and difficult one and although I had a dream baby I was traumatised by the birth, regularly having flashbacks.  I remember with gratitude the care I received from this midwifery team – but most of all the couple of hours I was able to spend with my midwife 4 weeks after the birth going through what happened and why – debriefing we would call it today.  I had a lot of emotional work to do after that – not least because I was still struggling with loss of a previous child, but it helped move me forward: I did not get stuck at the birth.

Contrast this with another difficult birth – my fourth child.  I had a midwife who did not really support my choice of homebirth ( when I saw her which was not often), I had one in sixty midwives on call so had to accept a complete stranger into my home and birth, there was a fiasco because I was having a water birth and she did not know  how to deal with this.  I was transferred in for bleeding with another set of midwives.  I returned home that evening unbelievably exhausted. Within a week my husband was back at work ( no paternity leave in those days) I had 2-3 perfunctory visits from 2 different midwives ( I remember just 2 visits but cannot believe this is all I had but it could have been) I was discharged at 10 days.  I had no opportunity to debrief or  talk through what had happened with the midwife who attended the birth which I desperately wanted/needed to do.  My husband started working away again at 4 weeks.  At 8 weeks both he and I were utterly exhausted and depressed.

Because of that experience, with our fifth child we took the advice of the supervisor of midwives to whom I had complained during the pregnancy of my fourth child, when I realised the level of the fragmented care that I was supposed to accept for my fourth child: we booked an independent midwife.  Better late than never! My husband was training to be a teacher at the time, the cost represented 20% of our then income and it took us 2 years to pay it off but it was worth every penny.  We were given timely information, the birth went smoothly because there was no interference.  The difference in postnatal care was enormous:  Our independent midwife kept us in check, visiting us daily until I begged her not to because I did not need it.  We were not discharged for over 2 months because they wanted to ensure we did not suffer postnatal depression – she had the knack of ringing me on the day I had done too much so she could gently remind me of my priorities and I would go to my bed and leave my job.  Michelle always said self employed women were the worst for taking too little time off around the baby!

I tell my story because I want to demonstrate in my own life – as much as others – why personalised care is so important and why I am so passionate and committed to seeing it happen on the NHS before my daughters have children.  Not every woman needs the kind of care I needed.  Different women have different social and emotional needs.  BUT women and babies NEED the investment of one to one midwifery care in order to remain healthy, to care and guide them when they are not, and to help us pick up the pieces and to carry on if it all goes horribly wrong.

Up until now whenever I have raised the possibility of case loading in Bradford I have been told it is impossible, too expensive, too difficult for midwives, women will just have to live with the (unacceptable) levels of care I faced for my fourth child.  But now we have a practising NHS midwifery team with a solid  business plan who can do it and are doing it to Tariff; and making a difference to the lives of ordinary women living at the rougher end of the Wirral.  I want this to happen for women in Bradford, especially for the women living in Girlington, Manningham, Little Horton, Barkerend where rates of infant mortality are high and many women struggle as I did to make ends meet..  It makes such a difference, SUCH A DIFFERENCE.

I know that midwives cannot wave a magic wand and give us the money to fix the car and pay the bills, they could not give my husband paternity leave or bring him home from working away.  But what they did was bridge the gaps  – of the understanding and skills I needed, give me some social and moral support so I could keep going, get me to a place where my social network could take over.

If we invest in this one mother one midwife project, if the CCGs take the needs of women seriously enough to ensure it happens, we will be investing in the health and wellbeing of not just women and babies but their families and their communities.  It makes that much of a difference.  19 years ago I was a young traumatised mum living in Girlington and my midwife was Julie Walker. Julie Walker is head of midwifery.  I have just stepped down after four years as chair the MSLC and I own an international birthpool business.  It really does make that much of a difference.Image

Find out what YOU can do to make a difference: http://m4m.org.uk/takeAction.php

The UK’s Agnes Gereb

” I think Becky Reed has become the UK’s Agnes Gereb, victimized for giving exemplary care to women.”

read her story below and support her cause: http://www.facebook.com/JusticeForBeckyReed

JUSTICE FOR MIDWIFE BECKY REED: WITCH HUNT OF ONE OF THE UK’S MOST RESPECTED MIDWIVES

 From 1997 to 2009 the Albany Midwifery Practice offered a unique midwifery service to the women and families of Peckham, South London.  The Practice was evaluated several times with excellent results. The outcomes for the women were recognised as outstanding, including over the first ten years a perinatal mortality rate, for an all-risk caseload, of 4.9 per 1000. This compared with a local perinatal mortality rate of 11.4 per 1000, and a national perinatal mortality rate of 7.9 per 1000 (The 2000 Women Study, 2008). The Albany midwives offered continuity of carer and choice of place of birth to the women, and the Practice achieved the highest home birth rate in the country within the NHS.

 Following an adverse outcome at a home birth in September 2009, King’s suspended Becky from duty, even though representatives of King’s subsequently told the Lambeth Health Scrutiny Committee that they had ‘no concerns in relation to individual midwives’ and had offered all of them jobs following the termination of the Albany Practice. In December 2009, King’s Healthcare Trust terminated the contract of the Practice without consultation, citing ‘safety reasons’, based on inaccurate data and statistics that have been challenged by several experts including Alison MacFarlane, Professor of Perinatal Health at City University, London.

 The unexpected closure of the Practice prompted a range of protests, including a large march and rally in London in March 2010. The ‘Reclaiming Birth’ march was called by the Albany Mums Group both to protest the closure of their valued local midwifery practice and to push for better, more women-centred approaches to childbirth.

 Becky Reed was the only midwife to have been with the Albany Practice since its inception. A very experienced and internationally respected midwife, she has written extensively about the Albany model of care and is currently co-editor of the well-respected academic journal, MIDIRS Midwifery Digest.

 In January 2010 Becky was referred, without her knowledge, to the Nursing and Midwifery Council (NMC) by the Head of Midwifery at King’s, Katie Yiannouzis. The referral cited seven cases, spanning a period of over three years, dating back to July 2006.  Becky was primary midwife in only two of the cases.  Katie Yiannouzis had been Becky’s midwifery supervisor until February 2009 and had raised no concerns with Becky about her practice.

 In September 2010, following an Interim Order hearing, Becky was given a Conditions of Practice order by the NMC, requiring her to undertake 450 hours of supervised practice (the maximum). She successfully completed this at Barnet and Chase Farm Hospitals, and in April 2011 an Interim Order Review hearing took place where, on the basis of reports from her supervised practice and many testimonials from women and practitioners, the Conditions of Practice were revoked in their entirety and she was deemed fit to practise.

 Unbelievably, the NMC investigation continues.

 In March 2012 Becky was sent draft charges by the NMC relating to five cases out of the original seven (two of the cases had been mysteriously dropped). In three of the remaining five cases, Becky was the second midwife.  The primary midwives have not been referred to the NMC. N.B. In the two cases for which Becky was primary midwife, she has successfully completed supervised practice (and been deemed fit to practise by the NMC itself).

 On 20 December 2012 Becky was given notice of an NMC hearing which is scheduled to commence at 9 am on Monday 11th March 2013 and continue until Friday 22 March. For each of the cases the charges are introduced as follows: When providing care for Mother XX and baby you: failed to comply with or practice within the Kings College Hospital Clinical protocols in labour and / or nationally recognised clinical guidance from the Royal College of Obstetricians and Gynaecologists and / or National Institute for Clinical Excellence.

 The Midwives Rules (Rule 5) direct the midwife to ‘work in partnership with the woman and her family, providing safe, compassionate care’. Clinical guidelines, therefore, should be considered an important aid to clinical decision-making, but not as rules to be followed in every case.

 There is no question that the public needs protection should there be midwives who are dangerous and negligent. This investigation, however, is nothing to do with protection of the public, but symptomatic of an entrenched medicalised and rule bound culture at the NMC. Becky is certainly not the first woman-centred, skilled and dedicated midwife to undergo bullying and victimisation. For Becky, one of the UK’s most respected midwives, to be treated in this way constitutes an attack on midwifery autonomy.  If she is ultimately sanctioned, it will make it more difficult in the future for midwives to confidently support women’s birth choices.

 It will be obvious on reading this that the NMC, which was described last July as ‘failing at every level’ by its own regulator, has completely mishandled this case. For Becky, this process has lasted for well over three years – she and her family have suffered both financially and emotionally. We, Becky’s support group, will be asking (if you live in the UK) whether you could spare some time to come along to a session of the hearing during the 2 weeks commencing 11th March. Visible support will indicate the strength of feeling women and midwives have about Becky’s mistreatment, as well as highlight the wider issues raised by Becky’s case.

 If you are able to come along, you will need to book your place online at http://www.nmc-uk.org/Hearings/Attending-a-hearing/#emailbooking. We would be grateful if you could also email Vicky at thebirthiwant@gmail.com<mailto:thebirthiwant@gmail.com> with details of the day/time you book so we can ensure every session is covered.

 We also plan to hold a peaceful protest gathering outside the NMC offices at the Old Bailey during the 2 weeks, probably on the first day. We will send further details of this nearer the time.

 Please email messages of support to thebirthiwant@gmail.com<mailto:thebirthiwant@gmail.com> or post them at the Facebook site Justice for Midwife Becky Reed http://www.facebook.com/JusticeForBeckyReed

 If you would like further information please email Vicky at  thebirthiwant@gmail.com<mailto:thebirthiwant@gmail.com>, or Sarah at sd889759@gmail.com<mailto:sd889759@gmail.com>

 With best wishes

 Sarah Davies, Vicky Garner, Nadine Edwards (Vice Chair of the Association for Improvements in the Maternity Services- AIMS), Beverley Beech ( Chair of AIMS) and members of the Justice for Becky Reed group.