Some time ago now Sheena Byrom very kindly sent me a copy of the book The Roar Behind The Silence, and asked me to review it. I set it to one side and put it on my ever expanding to do list. The first bit that I read I found fascinating but then it was a question of finding the time to read more. Finally I sat down expecting to be captivated. But the first emotion I experienced when reading more fully was frustration.
Not frustration with the messages in the book so much as frustration that the book needed to be written at all. So many of the points being made ought to be a given in maternity care:
“Health professionals need to model compassionate, respectful and effective care to students and trainee doctors working with women in developing health professionals and a service for the future.”
You mean that doesn’t happen already?
“All Heads of Midwifery should ensure they are visible and accessible so that students feel able to discuss practice.”
“Don’t sit and watch when you feel something is wrong: do something about it. Stand up for what you believe in, if you can.”
These are messages that as a citizen outside of the NHS I would expect to already be engrained.
But of course they are not. I have been involved in the #MatExp campaign for nearly a year now, and I have been listening to the birth stories of women for over four years, and I know that these messages do, unfortunately, still need to get through in some areas. There are wonderful, compassionate, amazing birth professionals out there, in all levels and professions, but yes these messages do still need to be heard.
A midwife of my acquaintance told me that the book inspires her, and if she is having a difficult time she uses it to refresh her and embolden her anew. With that in mind, I approached the book again, and put aside my frustration.
It is impossible for me to read this book with “fresh” eyes if you like, as I have come to know so many of the contributors over social media. I have discussed many aspects of birth and healthcare with them, and have found areas of agreement and areas of distance. It is also inevitable that I will see the book through the lens of #MatExp, especially as the campaign’s stated “heart values” have much in common with the messages in ROAR.
One thing I do love about this book is that it focuses on action. Again, it has this in common with #MatExp. Each chapter ends with clear messages and action points for readers to take forward, making it very clear how individuals can make a difference and put into practice the suggestions of the authors. In their chapter on human rights principles, Diana Bowser and Mande Limbu state “Each individual maternity care practitioner, service provider and service funder needs to think ‘what can I do in my everyday job to reduce disrespect and abuse for mothers and babies’, and to put the resulting solutions into action every day.” Hard to argue with that. Tracey Cooper in her chapter on promoting normal birth tells us that “YOU CAN make a difference.” Each one of us has the capacity to influence change, no matter how small.
“The rights of women, midwives, and all frontline staff should be mutually respected in maternity care design and delivery”
“Find and connect with the right people: people who share your values”
“Work across boundaries and disciplines, looking at issues from as many perspectives as possible and really listening to others”
“Fathers also deserve to be treated with compassion and respect, as they are vulnerable in their own way”
“Notice how you feel when you are stressed and what situations make you feel stressed. Manage self-expectations and those of others!”
And of course Teresa Chinn‘s excellent advice to “sign up to Twitter and start or join in a conversation about compassion and reflect on your experience.”
In truth there are many many messages in this book with which I agree, and then again there are some I would question. It is undoubtedly an answer to a particular perspective on maternity care and the experience of those working within it. It may not be your perspective, but it is nevertheless important to reflect on why the authors felt it needed to be written. The title itself is very telling – there are people who feel the need to “roar” like lions yet feel that they are silenced.
Sadly there are many people who perceive themselves to be silenced, or feel that others wish that they would be. I remember a conversation on Twitter some time ago about how some people may feel more able to “squeak” than to ROAR, but they are still making their voices heard. We have joked before that #MatExp is something of a “carnival of the animals”, and as a parent this all reminds me of one of my family’s favourite books, “Giraffes Can’t Dance.”
For those of you not familiar with Giles Andreae and Guy Parker-Rees’ work, it centres on Gerald the Giraffe, who goes along to the annual Jungle Dance and bravely steps up to have a go. He is laughed off the dancefloor because “when it came to dancing he was really very bad.” Gerald then of course discovers that he doesn’t have to dance to everyone else’s tune, and the book concludes that “we all can dance…when we find music that we love.”
The Roar Behind The Silence might not be the music that you want to dance to, but it is a compelling tune. Whether you want to roar, squeak, trumpet or squawk your message, it is important that all of us join the dance. This was articulated brilliantly in a slide by The Family Nurse Partnership from yesterday’s BfN conference:
Moving together in partnership, being responsive, not trying to assert force over others…. These are messages that #MatExp and The Roar Behind The Silence certainly have in common. This is not a book that has all of the answers (nothing does). But it is hard to see how anyone can engage in debate about modern maternity services without having read it.
So if you are a healthcare professional working with birthing families, a commissioner of those services or an advocate for those who use maternity services please do read this book. Please also join #MatExp, on Twitter, Facebook or via the website. Let’s find the music that we love and move together.