Is it Everyone? Or is it Just That Person?

The #MatExp campaign has always been about “all voices”.  All healthcare professionals, all families, hearing from everyone who has something to say or an experience to share.  And whilst we all know that listening to others and putting ourselves in their shoes is a wonderful thing, sometimes our natural prejudices get the better of us.  When we read yet another story of birth trauma it is so easy to get on to social media and ask “Why can’t obstetricians just do…….”, “Why can’t midwives be more……”, “Why are consultants all so…….”  And the result is more division, more hurt, more defensiveness, as professionals totally unconnected to the original story seek to defend themselves and their colleagues and prove that they are not culpable for the wrongdoings of another.

As we have seen so many times with #MatExp, Language matters.  What we say and how we say it matters.  There are only a few words between “obstetricians are so…..” and “this obstetrician was so…..” but they make a world of difference.  And the important thing to remember is that not only do generalisations cause hurt and offence, but they also do maternity users a disservice.  Because if “all midwives” are such and such or “all doulas” are like X then what is the point of picking up on the poor behaviour of one or two?  They’re all like this, so it’s a lost cause.  Might as well pack up and go home.

I see this online in a different context, I see it when talking about parenting and relationships.  Every now and again there is a spate of discussions about the aggravating qualities of somebody’s husband or partner, and inevitably there will be the comment: “that’s just men for you.”  “They’re hopeless aren’t they?”  “Mine’s like that, men just think differently.”  “Men don’t get it.”

All men?  Really?  Just shy of 50% of the population of the planet all think the same way and do (or don’t do) the same things?  None of them have any empathy or compassion or basic common sense?  Hmm.

And again, whilst this is clearly offensive and ridiculous, it is also dangerous.  Because if “all men” are thoughtless and uncaring then why would anyone bother to extricate themselves from an abusive relationship?  It’s not emotional abuse, it’s your own fault for taking up with a man, because apparently they’re all dreadful and that’s what you get.  There are no good ones out there so there’s no point getting angry when he tells you that you’re worthless.  That’s just what they do.

Of course, it is a valid life choice to go through the world without a man in tow.  Just as it’s a valid life choice to freebirth with no support from maternity services.  Not everyone wants a relationship, or a relationship with a man.  And not every pregnant woman wants obstetric care, or NHS maternity care or anything at all.  But it cannot be a good idea to suggest to anyone that discounting these things is their only valid choice.  A different choice could be to seek out good, compassionate, worthwhile people who make the world a better place.

Such people exist in every profession and across the genders.  Every time we make a generalisation we push those people away.  And we make it easier for the bad ones, the rude ones, the abusive ones to get away with it.  Do not put everyone in the same bracket.  Shine a light on those whose practice leaves a lot to be desired, do what you can to bring about change.  And celebrate those who provide exceptional support or just good quality care every single day.  Because in the current climate of healthcare those people deserve a medal.

#MatExp – Women’s Voices

As a result of my tweeting about #MatExp and my involvement in the Salford University Maternity User Group, I was asked by midwifery lecturers Sarah Davies and Lesley Choucri to speak to their third year students at the start of this week.  The topic was “Women’s Voices” and I had over an hour to discuss whatever I wanted under that heading.

None of what I said will be new to anyone who follows #MatExp, and indeed there was at least one student there who is active in the campaign.  But I have been asked to blog about my presentation, and I think it is useful to put together here in one place all of the things I have learned over the last year or so when it comes to women and their experience of maternity care.

I started off by explaining who I am and why I was talking to them at all.  Whilst a lot of things in the presentation came from #MatExp there was also plenty of feedback from my own private Facebook group for UK mums, so I explained a little bit about that.  I then started with “my voice”, which seemed a fair place to start when it comes to women and maternity.

I have had two positive, albeit very different, birth experiences, one of which eventually led me to start the Hospital Breastfeeding campaign.  You can read about my birth experiences here but suffice to say that it was the care I received, far more than the method of giving birth, that made them positive for me, and for my husband.  This is a theme that ran through my presentation – what women want above all is individualised, compassionate and respectful care.

So then I asked where we can hear women’s voices? (and are we really listening?)  This is where my evangelism about social media took over:

“…….it provides a quick and easy way to connect with vast numbers of people, all of whom have something to contribute. I often hear health professionals say that they are limited in what they can say on social media. That is something I totally understand, but what is not limited is your capacity to LISTEN. Join the #MatExp Facebook group, follow #MatExp on Twitter, follow the Positive Birthing Movement, join some breastfeeding forums, take a look at all of the platforms about perinatal mental health. The stories and the voices and the viewpoints are out there, women’s voices are never hard to find. What can sometimes be challenging is to listen to them, particularly when they are questioning the things you have been taught or are maybe angry about the care they received. But listening to these voices with compassion will only improve your practice.

The other place where women’s voices are heard loud and clear is on MSLCs around the country. As well as being valuable meeting points for those involved in local maternity care, many MSLCs are producing research and collaborating on national projects. Again, if you don’t have a local organisation then you can follow many MSLCs on social media to get ideas and find out what they are prioritising. Doula Rachel Gardner has produced a fantastic report on perinatal mental health experiences in Sheffield, I recommend you get in touch with her to request a copy.”

Then the all important question: What Are Women Saying?

My first answer was based on this blog post that I wrote for Sheena Byrom last year, as part of her series on What We Want The National Maternity Review Team To Know.  This was put together from feedback from my own Facebook group, and these themes came out loud and clear:

I read out some quotations from the wealth of feedback I had received from my group, some of which I had used in the original post and others I had not.  To give  you a flavour:

“I felt like I had to seek a lot of information out for myself, it was very much “if you don’t ask I won’t tell”. Whether that’s because they are wary of bombarding us with information or they are just overwhelmed and are reluctant to spend too much time getting in to conversation, I don’t know!”

“Post-natally, more actual time spent with new mummies would be great. I understand that budgets and short-staffing are not something that is in your control. However, 10 minutes of time to show a petrified, pained and knackered lady what to do with an umbilical cord whilst putting a nappy on, and the importance of a good latch when BF, is absolutely crucial.”

“I feel there should be more help for breast feeding. When I had my son, we were sent home without him having a proper feed, and then we had to return the next day because he hadn’t had a feed. I felt a little brushed off by the hospital midwives about helping me with breast feeding, and i lost confidence. My community Midwife was great and helped me breast feed for a hour, she then suggested i went back in for a little more help. I stayed the night and had different midwives come into help me but they all suggested different techniques. In the end I had a midwife come in to me in the morning and said she thinks its best if i put him on formula, which reluctantly I did as he wasn’t feeding much, I think it would be great if midwives were more helpful when it comes to BF. Maybe it was just the hospital I was at, but thinking back it annoyed me I didn’t have much support.”

“My first birth the first midwife was fantastic, she was patient, tired to instil in me that I could do this, she was so supportive and I think if she had stayed with me I wouldn’t have ended up with a c section. She stayed 2 hours later than her shift, she came and found me the following night, gave me a massive hug and said that sometimes these things happened and it absolutely wasn’t my fault. I’ve not forgotten her and we must remember there are some really passionate people out there with maybe some misguided red tape they have to follow.”

I then took each heading one at a time and gave my own overview.  A whistle stop tour of what I wanted to get across:

Continuity of Care – not under the control of individual midwives, but smooth handovers and reading someone’s notes thoroughly can give a woman the feeling of consistency.

Individualised Care – whatever her priorities, you will never find a woman who wants to be treated just like everyone else, who is happy with her label of “first time mum”, “high risk”, “mum of multiples”, “older mother”.  If you have children then I am sure that like me your Christmas was full of repeats of Stick Man.  “I’m Stick Man, I’m Stick Man, I’M STICK MAN that’s me!”  The woman you are caring for is Helen Calvert, or Mrs Bloggs, or Lady Chatterley or “his stick lady love”….  She has a name and a life and a history and she wants you to care for HER.  Not for her label or a set of highlighted issues in her notes.

Presentation and Provision of Information – making sure that information is available, and given in a non-biased way.  How the language you use can make it clear that you are advising and informing, not dictating.

Listening, Respect, Control – how a woman is treated, how much she understands of what is happening to her, how much people listen to her concerns, however minor or ridiculous those concerns might seem to others.

Compassion and Communication – tell her that you understand.  Tell her that she is doing well.  Tell her that what she is facing is hard.  Tell her that she is doing a good job.  And remember that for most women the labour ward might as well be a spaceship for how much we understand about how it works, its shift patterns and where people go when they are out of the room.

Collaborative Working – keeping the woman in the centre of the picture by building up good working relationships with your colleagues and other birth professionals.

Postnatal Care – this is where mothers end up feeling abandoned.  Anything you can do when on shift to make women feel as though someone is paying attention to their postnatal experience would be appreciated.

Breastfeeding – the existence of specialist breastfeeding midwives and lactation consultants should not lead to the de-skilling of other midwives when it comes to breastfeeding support.  Every single midwife needs to be up to date with breastfeeding information.

And are the same themes coming out from the #MatExp campaign?  Absolutely.  Loud and clear.  So instead of going over them again, I looked at some additional areas where the #MatExp campaign has had useful feedback to give.

I talked about the term “normal birth” and how we had had many discussions on the campaign about whether or not that language is helpful.  I talked about the pervasive myth that induction leads to a cascade of interventions and then caesarean section, a common narrative that Kirsty Sharrock discusses in her excellent post on the subject.  I talked about last week’s #MatExp Focus topic of Anxiety and some of the actions that had been suggested to improve experiences for sufferers.

Finally I referenced Emma Jane Sasaru’s excellent post about What Matters to Women in Birth, and also the summary of our #MatExp “Heart Values” that Emma put together for the campaign.

One item I wanted to explore further was collaboration between midwives and health visitors.  I have provided a lot of feedback to health visiting services, and picked up this issue at a presentation to health visiting leads in Greater Manchester last summer.  This quote is from a mum on my group:

So I discussed the actions and suggestions from two #MatExp blog posts, one discussing collaboration between the professions, and one explaining how students at UCLan are taught together to give them a better understanding of each other’s roles.

One thing that the #MatExp campaign has taught me is that there should be no discussion of Women’s Voices without the voice of midwives.  All of the things that parents want – compassionate care, informed consent, skin-to-skin, optimal cord clamping, breastfeeding support – these things are taught on midwifery courses up and down the country.  So why are the same complaints coming from families time and again?  I strongly feel that the experience of midwives in the NHS is one of the answers.

So I talked about the experiences of midwives once they have graduated, and some of the suggestions from midwives in the campaign as to how these experiences can be dealt with.  I based this on my round up of discussions we had online last year, and finished with a recommendation that any students who had not yet done so should read The Roar Behind The Slience, edited by Sheena Byrom and Soo Downe.

And yet some voices still seemed to be missing.

“……we realise that “women’s voices” also covers the voices of obstetricians, doulas, antenatal teachers, grandmothers and peer supporters. All are represented in #MatExp and all have a valuable contribution to make. The campaign itself was started by FabObs Flo – or as she was previously known obstetrician Florence Wilcock at Kingston Hospital. Not only are obstetricians not the enemy but many of them are women and many of them are mothers. Their voices must not be discounted when we think about “women”, and nor should the voices of other birth professionals and maternity workers.  It benefits families when all of these people come together.”

And STILL some voices were missing….

“There should be no discussion of maternity care and family’s experiences without including men. Dads and Partners – their experiences and their role are vitally important. From a personal point of view, my husband Phil bonded with our babies far sooner than I did and was their main caregiver in the early days, not counting breastfeeding. Women regularly and loudly call for partners to be able to stay on maternity wards, as breaking up the family unit in those crucial first 24 hours is upsetting and traumatic, and goes against everything we are told about family bonding and attachment. Dads report being sidelined and left with no information during labour, or patronised and belittled by staff. Men can and do suffer from post natal depression and post traumatic stress disorder, and many are campaigning for this to be recognised.”

If we are thinking about voices we need to be thinking about All Voices.  We need to step into other people’s shoes.

As a result of this and discussions we have had online, I have approached a number of different birth professionals to blog for the #MatExp campaign about maternity services from their point of view, or from their shoes (a shameless but appropriate “borrowing” from the inestimable Gill Phillips’ blog series).  Watch this space for midwife, doula, obstetrician voices and more……

I realised that my presentation might make it feel as though there is an enormous amount to be done in maternity care, and it is of course impossible for any one student midwife to address all of these issues.  Feeling overwhelmed leads to inaction so I finished my presentation with a story that means a lot to many in #MatExp.  We can all save one or two starfish.  And thus change the world.