Our Big Hairy Audacious Goal

Fantastic ARM Study Day at Wigan on Midwifery Regulation (18th March 2017).  This is what I said in my bit.

We want to set up a new Council for the Regulation of Midwives based on strong values: beginning with the wellbeing of the mother and her family.  We want all mothers to feel supported throughout their maternal pathway and we believe that good quality evidence is at the centre of midwifery practice- for this is what public protection most properly means for maternity.

So my call to you at the end of this day as mothers and midwives of this generation is to set about making this happen for the benefit of the midwives and mothers to come.  It will take work and cunning and more work and political wheeling and dealing and a hell of alot of campaigning but it can be done and we can do it.  And this is what is called a BIG HAIRY AUDACIOUS GOAL.

A BIG HAIRY AUDACIOUS GOAL is based on vision but is not itself a vision – vision is about values such as the stuff I have just said.  A Big Hairy Audacious goal is what you want and what you are determine to achieve.  That all mothers are supported through the maternal pathway is our vision, that the centre of our practice is nurture and good evidence is a value, but  OUR BIG HAIRY AUDACIOUS GOAL – to achieve this vision and these values – is to set up a new Regulatory Council for Midwives.

It is AUDACIOUS: it makes one raise ones eyebrow, it makes others sit up and think, it may keep some of us awake at night wondering how the hell we are going to do it.  It is audacious but it is a concrete outcome and it is achievable so it is a goal.  And it is BIG and HAIRY because ALL Audacious Goals have to be Big and Hairy.  It is more fun that way.

And fun is a big part of this BHAG.  Because it is not much fun being a midwife with a regulatory body that does not have a practicing midwife on it, has a one day a week midwifery advisor to the CEO and does not know the difference between a private midwife and an independent one. It is not fun to lose your practise because your regulatory body can’t be bothered to go through your insurance policy in detail. Fragmentary factory care is not fun!  Coming off a 12 hour shift feeling like you have given your all but not met the needs of the women you have cared for is not fun.  It is not fun to find that supervision, the independent professional support for midwives and mothers has now been seceded in England to the employers – where we are already seeing conflicts of interest come into play.  It is not much fun if you have ever had the misfortune to be hauled infront of the NMC to be tried ( because that is what it is) by judges who do not know or understand your profession – or anything much about maternity.  It is not fun to pay more in regulatory fees than other better paid professions. It is not fun to watch what you hold precious in your profession de-valued so much that it is abolished as has happened with the midwifery code.  It is not right – that is for sure – but it takes all the FUN out of being a midwife.

So our BIG HAIRY AUDACIOUS GOAL is about putting the fun back into our profession.  And so I do suggest that whatever we do whilst achieving this goal, that we ensure that we have FUN whilst achieving it.  Some activists in the Netherlands recently spoke of working with ‘unrealistic optimism’ for the eradication of poverty and injustice.  And that is the attitude we must now have.  In the face of all challenges and setbacks we must work diligently with unrealistic optimism, because that is why we have a BIG HAIRY AUDACIOUS GOAL.

OK so how do we go about achieving our BIG HAIRY AUDACIOUS GOAL? That would be a 2 day course I think so some pointers.  We need a strategy and it needs to be simple and clear.  And then from it we have tasks – things we have to do to take the strategy forward.  A group of us have started working on a strategy and it is simple there are 3 initial key lines (more will emerge and other will fall back).

ONE

We need a research  group – These are our scouts who will find out, what happened last time, what has gone wrong now (digging into papers and minutes), what examples and models are there out there which we could use or partner with etc.  Lots of reading homework for those so inclined. Could do with a lawyer or two as well.  Also some formal meetings and networking work too – they may need to be different people as visiting people is not just about information it is about politics – its not just information we seek but a bond and a political position. We want to get all our ducks in a row all our evidence in place all our arguments formulated, the key people nobbled,before we go in there with our formal proposals

TWO

We need our campaign group to become a movement.  Currently it is small it can be ignored, laughed at and derided – this is currently the outward attitude of the NMC and the Government to the Save Independent Midwifery Campaign and this move against the NMC that has come out of it.  That is fine – they are behaving just as expected.  What we need to do now is make it so big, have so many stake holders in it that it cannot be ignored – this is when we will find the real opposition in and outside midwifery because this is when the fight really begins.

How do we build a movement?  By talking and educating everyone. So we set up meetings, we speak at meetings, we set up study days and conferences. We set up websites, and FB groups blogs and memes (notice the plural – let every flower bloom is my view).  We have meetings with our MPs and our counterparts in other professions.  We talk to consumer groups and parents.  We just talk to everyone who will listen – all the time.  I talk to drunk men coming home on the train from a foot ball match for God’s sake!  Never pass up an opportunity. Yes you become a regulatory bore but make it fun – it is BIG and HAIRY after all – unlike the guy on the train I might add.

Remember Caroline Flint talking about the vow to tell someone everyday about being a midwife and having a homebirth?  Well this is it!  That is how you make a campaign group into a movement – when everyone in the campaign starts telling someone anyone, who crosses their path that they want midwifery to be regulated by midwives and mums, and why. And we have social media which means you don’t even have to go out of your front door to do it.

THREE

The technical organiser in me says we will need to constitute a proper organisation at some point – just because this is going to be too big for any small group to hold.  Also we need buy in, leadership and input from a wide cross section of people.  An organisation will keep things relatively orderly when and where it matters which is when we approach funders, ministers, professional bodies and so on and so forth.  Don’t get me wrong the nature of movements is that there will be a happy and at times unhappy chaos.  But at the steely core there has to be a strong structure that can hold things together.  This will take a bit of time and effort but is not hard to do, but running this organisation will take over the lives of the people involved as the ARM has taken over the lives of some of the people involved and as Aquabirths took over my life.  But the group who do this will be making a difference and contributing a big chunk to the BIG HAIRY AUDACIOUS GOAL.

Now the next level down from the big strategy above is the detail – and I certainly aint boring you with that at this time of day!  Join the campaign group choose which bit of the strategy you want to go for and linking in with others get on with it is what I say. Except for one thing: One detail you could all help the campaign with TODAY, is to write a letter of support for a new regulatory body for midwifery.  We need letters of support – hundreds of them – so we must start now.  With you.  Like at school, I need you to write a short letter stating your support for new regulation for midwifery and why.  It does not have to be long – two paragraphs will do – one saying what you want and the other saying why.  Sign off with your role and position – eg Midwife and mother, Big cheese midwife, professor midwife with big hat, Baroness Nobody and mother etc etc  you get the idea anyway.  We can bank these and collect many more for when we need to demonstrate that there is a seriously big mandate for change.  Email to me for now: ruth@aquabirths.co.uk or message me:  ruth Aquabirths Weston – my colleagues who support me selling pools will go mad as they wade through  all the emails.  But hey  – the price of success.

Yes and the price of Success.  This BHAG/Project cannot and must not rest on the shoulders of one person or even of a small few.  And this is a warning to my lovely ARM colleagues here and also to myself.  This is a massive project – it could take years if the movement stays small and we get no money.  So we have to build structures into our movement that ensure that as one falls there is another to take her place.  Not because we are all going to drop off the peg but because we are all ordinary folk here – we have jobs, we have children, we have aging parents we have life in all its fullness.  We will all need to deal with stuff other than Midwifery Regulation and so to box clever we need to ensure that the whole thing rolls on without one particular person having to be there.

This is so important to the achievement of this goal and why constitution of an organisation is part of the initial strategy.  One suffragette who was also a mother and a mill worker said – ‘We fight with one hand tied behind our back because seldom has a cause been won between dinner and tea!’  The suffrage movement – and it became a movement with several organisations within it – was forced to organise in this way to achieve its BHAG.  And these are the women on whose shoulders we stand today.

If you need to learn some lessons on changing constitutions then go and read up on the suffrage movement, we have all their barriers: a profession dominated by another professions, a patriarchal culture still in existence within and outside maternity, our room for manoeuvre limited by our place in society and the expectations and decisions of others.  Do not underestimate the subtle and pernicious ways this affects us and our opponents in the achievement of our goal.  I am not saying this to get you down but to be realistic.  For instance one of the points made at our formative meeting was that midwives are so overworked and crushed by their working conditions they won’t want to know or do anything.  Yep that is so true – and has been true for other movements for change like suffrage – but it is a challenge to be overcome not an eternal barrier – so we must seek out fun ways to meet that challenge in our colleagues. In Peace and Justice circles it is called ‘empowerment’..

And just like this job isn’t just for one person or one group of people, so we cannot do everything at once and won’t achieve everything at once – so we must be focussed.  As a group and as individuals we must recognise what we can do now – choose our priorities and do those few things we can do, the next step will enable us to do more, and so will more people, but ultimately it is choosing our priorities doing what we can do and not worrying about what we cannot.  Really and truly this is how big changes happen.

Remember the cycling team success for the Olympics? – they decided their focus was to be fixing the small things that got in the way of achieving their BHAG and in fixing the small things by degrees they arrived at their BHAG and gold medals.

I remember learning my lesson as a University chaplain many years ago.  My senior colleague told me – there is so much work to be done here, you can only see 10% of it, and of that you can only do 2%.  You have to learn to live with this fact and not try to do everything but do your 2% well.  And he was right – do what you can well and don’t worry about the rest.  This still enabled me to run a national campaign on student poverty, it still enabled me to set up and facilitate a student housing group, that achieved a cross professions task group with council and university reps that ultimately set in place policies that are still in place today keeping students safe.  And I bailed out half way through to have a baby and then was made redundant. But I had facilitated the change from a campaign group to a movement and it did not need me anymore to make the change actually happen.

I despair when people give up on the small thing they could do because it won’t change anything – because I know and so do other change-makers that it is doing the small things everyday that changes EVERYTHING.  If everyone here does the small things they can do – I am telling you we will be well on our way.

Okay, so my time is up and we need to recap to remember.  What is a new regulatory body for midwifery?  A BIG HAIRY AUDACIOUS GOAL – it is big and hairy because it is fun, and it is big and audacious because it is a mighty challenge but it is a GOAL because it is achievable.  And we can and will achieve it.

We achieve it by having fun and having a strategy.  Our strategy is simple 123. 1 Build a movement – and the key action today is to tell everyone and any one – and all of us can do this, 2. Do our homework and get all our ducks in a row before heading down the M6 to march on Westminster, 3 make sure we have an organisational structure that will keep order and ensure no one person or persons becomes critical to the achievement of our GOAL

We know that we are human that we are women with LIFE and responsibilities but we know that other women before us have faced the challenge of change-making in the midst of life and faced greater discrimination that we do.  So we will be focussed and do what we can well, we will be focussed boxing clever with our priorities, we will be patient because this could take a long time, but we will be confident that change can happen – because this is our  BHAG and we are working stolidly to achieve it.

And today’s actions by this group are: 1. to write a letter of support for this big hairy audacious goal, 2. to make a personal vow to tell someone each day about this by whatever social means, and 3. to think about setting up a public or private meeting and inviting one or two of us to talk about it so we can grow our campaign through the maternity communities of our land.

No big deal then!  Small steps and Big Hairy Audacious Goal – I am looking forward to the fun – and I hope you are too!

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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.