My personal #FlamingJune

On the last day of June 2015 I am taking a moment to reflect on what has been an overwhelming month.  It started just after my 35th birthday, in the middle of half term, and I had every reason to believe that it would be focused on #FlamingJune, the Month of Action for the #MatExp campaign.  It certainly started with a bang!

My partner in crime Emma Sasaru has written a fab round up of the activities of the campaign over the last month, but you would have to look on so many platforms to get a true feeling for just how much activity there has been since 1 June.  The Pinterest board has barely kept up with the pace of actions and posts, the Facebook group has been incredibly busy, Twitter has been FULL of #MatExp discussions and the website has had thousands of hits.  Oh and there have been at least four short films launched as well!!

Film Number 1: Improving Experiences Across NHS Maternity Services

Film Number 2: LSCN Maternity Experience

Film Number 3: #FlamingJune #MatExp #BloodtoBaby – Waiting before clamping and cutting the cord

Film Number 4: #FlamingJune #MatExp – #BloodtoBaby and Optimal Cord Clamping

I have been so very proud to be a part of all of this, and have contributed my own blog posts along the way.  I have completed 3 out of my 4 #FlamingJune actions, namely:

Spreading the Word!

Contributing to Sheena Byrom’s blog series on What the National Maternity Review team needs to know.

Continuing to campaign for better breastfeeding support on children’s wards.

My final action is to bring WhoseShoes to Manchester, and I know that Nikki Mather and Cathy Brewster have already mentioned this idea to Manchester CCG.  I am hoping to meet with Nikki and Cathy to discuss this very soon.

There have been such rich discussions on the MatExp Facebook group which a few of us have tried to capture in blog posts, and I have so far written up the group’s views and ideas on Anxiety, Dads & Partners and the pressure that Midwives are under.  I am hoping to write up a few more over the coming weeks, before collapsing in a big heap for the summer holidays!  Add to all of that the ABM Conference and the Breastfeeding Festival, both of which I was privileged to attend, and you have a month that looks something like this:

So from my perspective of one online campaign, June has indeed been FlamingBrilliant!

Life doesn’t just happen online though.  Away from the phone, the tablet and the PC, real life continues with precious little regard to what we have planned and mapped out.  You may have noticed the “I need a hug please” in the collage above.  That was a picture I tweeted on a day when the daughter of a friend of mine was fighting for her life in hospital, and one of my best friends was also struggling on ICU.  My friend’s little girl is now much more stable, although still fighting a hard battle in Alder Hey.  Sadly, devastatingly, my beautiful friend Jane Hanley passed away on Wednesday 17 June.

Jane had been living with chronic lung disease for some time, and her journey can be found here on her blog.  She was taken into Wigan Infirmary with an infection and it just proved too much for her.  I was privileged to be able to visit her on ICU on the day that she died, and whilst her body was working so very hard for every breath, her toes were still painted a beautiful sparkly silver.  Those who knew her will not be surprised that she was a glamorous patient.

Just like MatExp, Jane contributed to many online platforms, particularly once it became hard for her to get out and about.  She was a deputy admin on my private Facebook group for mums, and she was also active in discussing lung disease on Twitter – one doctor was planning to use her blog posts in training and presentations.

On Pinterest Jane welcomed in June just as she had welcomed in earlier months.

This afternoon I will be writing my speech for her funeral.

We never know what is just around the corner. And it is so important to remember that in the middle of any campaign, there are those people who are experiencing real life RIGHT NOW, away from the hashtags and postings.  People are being born today.  People are dying today.  Some of them, tragically, will be the same people.  All of us have the chance, TODAY, to make a difference to those lives.  And to our own.  Today is the day.  It is the only day that exists.

#hospitalbreastfeeding Action for #FlamingJune

Anyone following the #MatExp campaign will know that June has been a month of ACTION, with birth professionals, volunteers and families stating how they are going to act to improve maternity services.  I chose four actions for the month, and one of them was to continue to campaign for better breastfeeding support on children’s wards.

It seemed appropriate then to take a moment as we come to the end of #FlamingJune to update you on the #hospitalbreastfeeding campaign.

The campaign began as a way to have an impact on breastfeeding support services at Alder Hey Children’s Hospital, where my little boy is cared for.  You can read about how it all began in my previous blog posts #hospitalbreastfeeding part 1 and part 2.  At the end of part 2 I was awaiting a response from the hospital’s Chief Exec, Louise Shepherd, with regards to concerns I had raised with her about changes to the Health Promotions team and what that would mean for the progress that has already been made.

I am delighted to say that Louise’s response to me was considered and in depth and answered each of my points in turn.  I will share some of the information with you here:

• Management of the hospital’s breastfeeding policies to be moved away from Health Promotions to the Neonatal team.  Once the new designated policy lead has been appointed I will be meeting with them to discuss support in the hospital and to ensure that breastfeeding does not become an issue “just” for neonates.

• Training of the hospital’s Bosom Buddy Breastfeeding Supporters (nurses and healthcare assistants with responsibility for supporting breastfeeding).  There are currently 43 in the hospital and they all receive training on “breastfeeding the sick neonate” from either the Edge Hill University team or Medela.

• Introducing Bliss Champions to the wards: this would be a really positive step and hopefully something that can be brought together once Alder Hey is on its new site.

• Working towards Baby Friendly Status: Louise stated in her letter that “The Trust is committed to achieving Baby Friendly Accreditation when we move to the new hospital [in September 2015] as we will have a high level of breastfeeding facilities for parents and our Neonatal Unit will be shared with our Cardiac Unit which will ensure that neonates receive the best care possible.  We are keen to work with Baby Friendly to not just receive accreditation for our Neonatal Unit but to develop standards for a paediatric Trust as we believe that all acute paediatric Trusts should achieve the Baby Friendly Accreditation.”

I am delighted with the commitment to and understanding of breastfeeding support issues that has been demonstrated by the Chief Executive at Alder Hey, and am very encouraged by their commitment to gaining Baby Friendly accreditation.  There are only two areas of immediate concern that I have with regards to the hospital, and those are:

• Referral Pathway – What is the referral pathway if a Bosom Buddy is unable to resolve a mum’s issues?  Due to the level of training received by both Health Promotions and the Bosom Buddies I am wondering if they are equipped to deal with issues like IGT (insufficient glandular tissue), hormonal complications, tongue tie, tongue and palate abnormalities, infection and so on?  This was a concern flagged by Emma Pickett of the Association of Breastfeeding Mothers with whom I have been discussing #hospitalbreastfeeding, and it is something I have raised with Liz Edwards, Head of Patient Experience.

• Training Provider – a number of people I have spoken to have raised a concern with the hospital using Medela as its training provider.  Medela are not WHO Code compliant and as such are not viewed by many as a suitable training provider for one of the country’s premier children’s hospitals.  I do share this concern, but if the hospital is truly committed to achieving Baby Friendly accreditation this is something that will have to change in time as per the BFI Initiative’s own guidelines.  So I am hopeful that this will be addressed.

So what of the #hospitalbreastfeeding campaign in a wider context?  I had the great privilege of attending the Association of Breastfeeding Mothers Annual Conference in Birmingham this month, and have been asked to write something for their magazine later on this year.  I was able to contribute a poster to the fantastic display at the conference, and a flyer for the delegates.  These resulted in a couple of conversations with people new to the campaign, including a student nurse who has had some experience of families requiring breastfeeding support on a renal ward.  I look forward to furthering these contacts.

#hospitalbreastfeeding flyer

I also had the opportunity to ask a question of Baby Friendly representative Francesca and find out what are their plans for making Baby Friendly Accreditation available to children’s hospitals and departments.  As Louise Shepherd noted in her letter to me, it is currently available to maternity services, health visitors, neonatal units, children’s centres and universities, but not paediatric units.  This is a huge gap and recognition that there IS a gap is the first step to filling it.  Francesca was sympathetic to the issue and explained that BFI is a small team with a huge remit, but they will make inroads on this if we keep pushing them.  Emma Pickett dryly observed that “heartmummy is good at that!”.

The fact that Alder Hey are keen to work with BFI to fill this gap is fantastic to hear, and I hope that GOSH, Birmingham Children’s Hospital and other paediatric units feel the same. I received some encouraging tweets from Bliss nurse Cheryl Curson about progress being made in Birmingham:

I am rounding off this month with a trip to the Manchester Breastfeeding Festival on Saturday and I will be taking my flyers with me.  My job now is to continue to raise the issue of support for breastfeeding on children’s wards – not maternity, not NICU, but on the wards where babies are cared for alongside older children, and bearing in mind that those older children could well be breastfeeding natural term.  These families need support just as much as those on postnatal and neonatal wards.  For an insight into why, please have a read of the case studies on my website.

#MatExp – “Normal” Birth Is Not Always Normal

This is another birth experience of a member of my Facebook group, in her own words.

Help, help me, oh God help me.

Why is no one helping me?

Desperate to ‘escape’ I threw myself around the birthing pool, banging every part of myself. I know this because in the aftermath, once I’d had some coma like sleep in my own bed that night, my wreck of a body felt bruised from head to toe. I’d bumped my head on the taps, my chin on the side of the pool, my arms, my legs and my feet in my attempt to survive the tortuous experience.

As well as feeling as though each contraction would rip my body open, I also felt my hips and pelvis pulling down as though my spine was being pulled and stretched. I knew what torture felt like now, and I knew in that moment why people being tortured begged for death. With each building contraction I anticipated the next, wondering how I would survive this. As each got worse than the one before, I accepted in my mind that I must be dying; no one could survive this, least of all me. No-one was telling me I would survive this – my obvious conclusion was that I wouldn’t.

I lost sight of the goal, well more than this really; I’d partially accepted that I wouldn’t be getting a baby at the end. Well, what would be the point, when all I wanted was to die?

People talk about the pushing, the crowning, as the ‘worst’ bit. I’d have done that 3 or 4 times over. I pushed as if my life depended on it- because it did, I would die if this pain didn’t stop. Some rational part of me knew that it would stop if I pushed, but no-one was telling me to push. I asked the midwife in desperation, “Why aren’t you telling me to push?” She said, “Push if you want to.” So I did, but only to make it end, only because I thought I would die if I couldn’t make it stop, not because I had the overwhelming urge to push- maybe I wouldn’t have needed so many stitches if I’d been able to wait (to add to the list of things I blame myself for).

And when this thing, this tree trunk sized thing, emerged and it was ‘a baby’ (I said), and was placed on my chest I cried. I cried, and I cried and I’d waited so long for my ‘tears of joy’, but that’s not what I got. Not my joy; my relief, my exhaustion, my fear, my pain, my pain, my body breaking physical and mental torture was over. So I cried and cried.

After the stitches they let me sleep, coma like but not for long enough. Where was my baby? In the room somewhere, but I didn’t care, I couldn’t care. I fed him at their request. I slept some more, but not for long enough. They wanted me to go home. I could barely speak or walk. We went home.

He’s a baby, just a baby, I know he’s mine, I think I wanted a baby. Now I don’t anymore, I wish we hadn’t decided to have a baby. Why had we thought it was a good idea? This baby next to me, sleeping (at first) while I lay awake unable to sleep because the memories are so vivid and they haunt my every moment. I’m exhausted and I try to sleep but I’m gripped by fear and the physical pain just keeps coming waves, I’m reliving the torture. I fall asleep, I wake up crying. I fall asleep I wake up pushing. I fall asleep I wake up panicking. I’ll never do that again that’s for sure.

At this point I think it’s the same for everyone, that everyone feels this gripped by sheer terror, and I feel cheated by the conspiracy that has kept this knowledge from me. I message people I know with children, I cry for them and their pain, I’m so happy they survived this too but why did they go on to have more children? I warn other childless friends and family off, I won’t let them be fooled like I was, “Don’t do it, just don’t ever do it,” and I mean it. I cry for the people whose babies have died; those I know, and those I have never met. How horrifying to go through this without a baby to take home?

I look at my baby. I wish I felt something other than pain when I look at him. I talk about it, over and over. When will the crying stop? The midwives come and go, “You had a normal birth?” They ask me/tell me? I cry. How can this be normal? How can I ever be normal again? How can I complain when I survived and so did my baby? How can I go back and do it again but this time not fail?

My failure; to cope with the pain, to get my baby into the right position during pregnancy (he was sideways), to dilate more before getting to hospital (so they didn’t think I was a wimp), to supress my anxiety (which undoubtedly made everything worse), to breathe the pain away, to provide an amazing experience to all those in attendance, to be flooded with love at the sight of my son (and get my tears joy), to pull myself together just hours after the birth (other people do), to forget the worst of it in days or weeks (like everyone tells me will happen).

“Why couldn’t I do it?” I ask myself and others regularly. They say the same, “But you did!”

I hope that one day that will be good enough.

Just a final note to say that I am six months on from the birth and, although I am only just able to write this up, (and it took many months to write it down in the first place), things have got better. I am undergoing CBT to help me deal with the negative thoughts I have attached to the experience, so hopefully one day I can do it (childbirth but hopefully not this actual experience) again. I am also booked into the antenatal Birth Matters clinic at my local hospital to discuss my birthing options next time round. Unfortunately, my experience of having a debrief with the supervisor of midwives was not helpful, and made me question my care, when originally I only blamed myself. I hope to pursue this with the Head of Midwifery. Finally, I’d like to say that I love my baby! And I always knew that I did, it just took a while to feel like it. Thank you for reading my story.

#MatExp – Spreading The Word

We’re one week in to the #MatExp #FlamingJune Month of Action and it has been a BUSY week!  So much activity on Twitter and on Facebook – and of course, the brand new website.  In amongst all of the excitement, I have identified four ACTIONS that I will focus on this month for the campaign.  The first of these is to SPREAD THE WORD.

There are few things that excite me more than bringing people together, facilitating conversations, building up networks and getting people to communicate.  I spent a good chunk of my wedding dinner gleefully watching how well my table plan was working (hey, I never said I was normal!).  #MatExp has been fantastic for this.  The whole premise of the campaign is bringing all kinds of people together to have the important conversations, to find solutions and improve maternity experience.  As wonderful as it is to have discussions with people who agree with you, it is far more productive to have conversations with people who do not see the world from your perspective.  If you can make progress in those conversations you really can make a difference.

One person I have enjoyed bringing into the #MatExp conversations is Professor of Obstetrics Jim Thornton.  Jim frequently has a different position or opinion from the regular gang of people with whom I discuss maternity, and to me that makes him an ideal person to ask.  Jim’s blog about HBAC3 makes interesting reading.  He was also enough of a good sport to take on Florence Wilcock’s Lithotomy Challenge.

Back when #MatExp was primarily a part of NHS Change Day, I set up a simple Change Day Action to link up different parents and professionals every Friday as part of the regular “Follow Friday” theme on Twitter.  Every Friday morning I tweet #MatExp #FF and suggest one midwife, one health visitor, one doctor (obs or paeds), one nurse (paeds) and one parent that people might like to follow.  My reason for including the paediatric team is that for many families (including mine) paediatric staff are a part of the postnatal experience because children have been born needing medical attention.  I really love seeing the people I value on Twitter following each other and starting new conversations – it gives me the warm and fuzzies.

Did you say health visitors I hear you ask?  Yes I did, because health visitors are an absolutely vital part of the maternity team.  Particularly now that many teams are offering antenatal visits to families so that relationships can be built up before the baby arrives, it is so important that midwives and HVs work together.  “Jen the HV” student health visitor explains here what it is that health visitors actually do.  If you are not familiar with their remit please take a look.

The #MatExp Facebook group has been amazing for bringing together so many different voices in maternity care.  We have midwives, health visitors, neonatal nurses, GPs, doulas, hypnobirthing teachers, NCT professionals, breastfeeding peer supporters, IBCLCs and mental health supporters all chatting together on a variety of topics.  Most importantly, all of these people are chatting away with ordinary parents (and of course most of them are parents themselves).  It is wonderful to see the conversations and ideas being generated just by these people being in the same group together.  Milli Hill recently joined and has asked me to contribute a written piece for the Positive Birth Movement.  A “spreading the word” opportunity right there.

Because this campaign is grassroots and not a “top down” initiative it has sometimes been confusing for people to understand how to get involved, or how to describe the campaign to others.  FabObs Flo wrote this explanation to remind everyone that we’re all just people trying to generate change – we’re not funded, there is no “team” at the top, no one is in charge.  The phrase “who’s driving this thing?” springs to mind, but the truth is we’re all racing along together!

This issue was exemplified earlier in the week when I contacted Mark Williams of Fathers Reaching Out to ask him if he would like to help me to round up the discussions we’d had on Facebook about maternity experience from the perspective of Dads and Partners.  Mark replied that he’d “love to be part of the team if you need a person to do the dads work…..”  There is no team Mark.  It’s JFDI!

Of course, there is one team of people who are actively engaged in looking into maternity services, and that is the panel of the National Maternity Review.  I tweeted as many of the panel as I could find to encourage them to take a look at the #MatExp campaign, and I know that some of them are already not only aware of the campaign but are actively engaging with it.  I had an email conversation with Rowan Davies, Head of Policy & Campaigns at Mumsnet, where she agreed to take a look at the various #MatExp platforms as part of her work on the panel.  And of course Sheena Byrom is putting up a series of blog posts about What The National Maternity Review Team Should Know.  The first of these covers engagement with the #MatExp campaign.  Another of my ACTIONS for #FlamingJune is to write a piece for this series myself.  More of that another day!

#MatExp – Lights, Camera, Action!

On 12 May Leigh Kendall and I thought about starting a Facebook group for the #MatExp campaign. JFDI and all that, the group was started two days later. Three weeks in and we’re at 450 members. You’ve got to love this campaign, nothing happens slowly!

The group is administrated by Leigh, Emma Jane Sasaru, Susanne Remic and me, and is the Facebook outlet for a campaign that has already gained huge momentum on Twitter. Florence Wilcock, the obstetrician at Kingston Hospital who started the campaign, has always wanted it to be focused on ACTION and this theme is central to the group. Each day a group member starts a thread on a chosen topic with questions/talking points and a request for actions that families and birth professionals can take to improve maternity experience in this area. We ask that actions are S.M.A.R.T. 

Florence and Gill Phillips have a Month of Action planned for June, so we had originally hoped to do a blog post at the start of June detailing the actions put forward so far by the Facebook group and asking that people get involved. The snag is there have been so many fabulous actions put forward already on a number of important topics. The topics are being chosen in alphabetical order as a nod towards the #MatExp ABC that provided so much impetus on Twitter, and we are so far only on “H” – already the actions are numerous and thought provoking.

So we have quickly realised that it might be better for each of the admin team members to do individual blog posts on the topics that they have introduced to the group. These posts will start to come through soon, but for now we still wanted to give you a flavour of the suggestions and we hope that you will join us on Facebook or Twitter (or both) to get involved.

ACTION!

The actions that have been suggested on each of the threads can be divided into two categories:

1. Immediate – just get up and do it actions that anybody can take, here and now. These tend to be small things but they can still have an impact.
2. Long-term – group actions that require input and buy-in from different places and will probably require campaigns of their own.

Both are very important to the campaign. There are big issues that need to be addressed in maternity care and the NHS Maternity Review is looking at these right now. We are hoping to work with the review panel and to share our ideas with them. But we also need to remember that simple acts of kindness can change the experience of anyone with whom we come into contact. Sharing a piece of information could send someone down a different path. Signposting to a service could make the difference for that individual. No one needs to sit back and wait for a bandwagon to jump on. We can all of us get up and act today.

So what has been suggested so far? Here is a snapshot of some of the topics we have discussed:

A is for Anxiety

Immediate actions –

• Anxious mums to use hypnotherapy techniques in pregnancy
• Be honest about your anxieties and find out as much as you can on how to manage them
• Midwives please ask mums about their mental health throughout their pregnancy, not just on booking in; anxious mums to look into mindfulness techniques

Long-term actions –

• All health visitors need training in identifying and supporting pre and postnatal anxiety
• Subsidised doula provision for anxious families
• Continuity of care for anxious families
• Refer anxiety sufferers to specialist mental health support

B is for Bereavement

Immediate actions –

• The most important immediate action can be done by anyone, anywhere, anytime – acknowledge the baby the parents have lost. If you know the baby’s name, use it. If you don’t know the baby’s name, ask. Take the parents’ lead on whether or not they want to talk about their loss. Try not to worry about saying the ‘wrong’ thing. The worst thing you can do is to skirt around the subject, or ignore it completely. To do so insulting and upsetting to bereaved parents.

Long-term actions –

• Clear, concise, sensible, and up-to-date information to be provided to bereaved parents when they leave the hospital after the death of their baby. Parents need reassurance about the emotions they are likely to feel, and a few pointers about how to navigate grief, especially during the raw early weeks. The information also needs to clearly state how the parents can access appropriate support as and when they are ready.
• Access to counselling support. Too many bereaved parents have had to fight for the counselling and psychological support they need – or have gone without. Some hospitals do offer counselling services: hospitals need to make clear to parents that this is available, and how to access it. Funding issues mean that not every area is able to provide these services, but charities thankfully do exist to fill the gap. Hospital and GP practice staff need to know what support is available locally so they can signpost parents appropriately, or where appropriate make referrals for them. Leaving bereaved parents to source their own support at a time when they are least able to have the tenacity to deal with ‘the system’ is unacceptable.
• Training in bereavement care for health professionals. Surprisingly, many don’t receive this as standard practice. The vast majority of health professionals are caring individuals, but a lack of appropriate training means many are unsure about how best to deal with bereavement, which may lead them to saying things that are less than helpful to parents. What is said to parents at this sad time stays with them forever, so the importance of this training cannot be underestimated. This training should be extended to all staff involved with maternity/NNUs (including admin, housekeeping et al) to help prevent unnecessary upsets.
• Debrief/support to care for the needs of maternity, obstetric and NNU staff after the death of a baby. These staff are deeply affected by the loss of a baby in their care.

B is for Birth Trauma (families)

Immediate actions –

• Use of language when discussing birth trauma with families- lots of women have felt their feelings were dismissed, or that they were being ‘silly’. Women also felt that they had failed. Language in notes also very important.
• Immediate debrief after a traumatic birth; women felt that they were discharged and sent home without having the chance to talk through events.
• Communication- tell women and their families what is happening and why.

Long-term actions –

• Birth trauma support groups for women to access after a traumatic birth.
• Birth reflections and birth trauma counsellors to be accessed for as long as women and their families need them. Trained counsellors to support, and health visitors to be able to signpost the necessary services too.
• Better recognition of PTSD following birth trauma and better support for dads too.
• Emotional support for women in subsequent pregnancies.
• Ensure that women know how to access appropriate services following birth trauma.

B is for Birth Trauma (midwives)

Immediate actions –

• Make sure your colleagues know that they don’t have to “cope” – it’s okay to admit that they have been traumatised by a particular birth experience
• Ask if your Trust has guidelines in place for supporting staff after a difficult birth.

Long-term actions –

• Stringent debrief sessions put in place for each instrumental birth and any birth that is not straightforward
• Tackle trauma that accumulates from seeing the same things again and again – e.g. vaginal exams with inadequate consent, instrumental deliveries without compassion, loss of autonomy and consent.

C is for C-sections

Immediate actions –

• Skin to skin in theatre.
• Ensure that women are supported in their decision to have a c-section and help them to write a birth plan to feel empowered during surgery. Discussion of gentle c-section options.
• Help women to find comfortable positions to breastfeed.

Long-term actions –

• Identify reasons for c-sections and look to see where these can be reduced.
• Educate women during subsequent pregnancies, ensuring that up to date information is given with regards to VBAC. Ensure access to VBAC clinic is given.
• Better patient leaflets with more information on what happens during surgery and what recovery is like.
• Debrief from surgeon on how the c-section went and how subsequent pregnancies are likely to be affected.
• Better support for women after an emergency c-section.
• Provide emotional support and/ or counselling after a c-section for women who require it.

C is for Complications

Immediate actions –

• Communication was a common theme in the responses in this thread. Women – especially those who experienced complications around the time of the birth of their baby – wanted professionals to explain what was happening. Not knowing what was happening, and why, added to these women’s anxiety. Women (and their birth partners) need to be told as much as is appropriate at the time what is happening and why, in simple language.
• Health professionals need to remember that consent is still vital!
• Explain everything – as a health professional, certain things that you consider routine may be daunting or scary to a woman in your care. Make sure you explain everything that is happening, and be patient if they need the information to be repeated – it can often be difficult to take things in when you are in a crisis situation.

Long-term actions –

• Information: there is a lot of difference in the quality and content of information pregnant women receive from hospitals and community midwives. It can create confusion, especially combined with the wealth of information available from charities and the internet. While the internet can’t be controlled of course, it would make sense for hospitals nationwide to have consistent leaflets from a central source, with the ability to personalise information as appropriate.
• Connected to this point, knowing how much information to tell women about complications is difficult. We want them to know enough so they can recognise symptoms if they appear, but not so much they are stressed and scared. The balance is hard to strike. To compound this, there are women who do not attend antenatal appointments so are unable to receive this information.
• For A&E staff to be better aware of pregnancy complications, and to consult maternity/obstetrics staff when needed.
• For women to be proactively contacted when pathology (blood/urine etc) tests come back with warning signs, rather than relying on the woman to remember to phone for results.

C is for Continuity of Care

Immediate actions –

• Managers to talk to the independent midwives and social enterprise midwives who are knowledgeable in how case-loading can work
• Look at the Streatham Valley midwifery team in London for a working model
• If a woman is not receiving continuity of care, please ensure as a birth professional that you read her notes thoroughly and write good notes for the next person she sees.

Long-term actions –

• We need strong leaders at the helm of Trusts who understand how to lead midwives towards the implementation of continuity of care
• Join up with the RCM Better Births Campaign
• We need more midwives
• Look into personalised budgets where the NHS would allocate women funding to choose the service they want.

D is for Dads (and Partners)

Immediate actions –

• Birth professionals please keep Dads and Partners informed during the birth
• If Dads and Partners are not allowed on the ward at specific times please ensure the Bounty rep is not allowed on either
• Recognise that Dads can suffer birth trauma too.

Long-term actions –

• Keep families together, find ways to allow Dads and Partners to stay in hospital
• More paternal leave for fathers of premature babies – 2 weeks at birth and 2 weeks at discharge (the same for sick term babies too).

E is for Emotional Wellbeing

Immediate actions –

• Kindness, dignity and compassionate patient-centred care.
• Accurate information to support informed choice for families.
• Support for traumatic births, families that have a baby on NICU and paediatric wards.
• Good communication between staff, wards and with parents.
• Include partners and realise they need support too.

Long-term actions –

• More support services including peer support groups.
• Healthcare professionals aware of support services and therapies to signpost families to.
• Antenatal education to help parents prepare for parenthood and the impact birth has emotionally.
• Training for midwives and health visitors on all mental health disorders and how to spot/support.
• Specialist perinatal counselling available nationally.
• Continuation of care for families especially if previous trauma or mental health disorders.
• Peer support on NICU units to provide emotional support reduce risks of PTSD.

And before we started the ABC we already had a hot topic that grabbed our participants’ interest:

Tongue Tie

Long-term actions –

• Tongue tie assessment needs to feature in doctor and health visitor training
• Better postnatal care – need skilled assessment of baby, mother and feeding rather than families being sent home ASAP
• Tongue tie assessment to become a part of the newborn checks.

What would you add? What will you do? What have you already done? Come and join the conversation – and join in the ACTION! #MatExp #FlamingJune

Emma, Helen, Leigh & Susanne on behalf of #MatExp.