When I started this site, I’m not sure what (if any!) long term plans I had. All I knew was that I felt quite isolated and labelled in my ‘obese’ pregnancy. After a perfectly uneventful pregnancy, labour and birth, I felt that a lot of information I received was unnecessarily alarmist. In some cases, it was downright misleading. I was sad that a lot of the joy was sapped from me in various interactions with services. Someone, somewhere, ought to address this balance, surely? I soon realised that that someone was probably me – and so BigBirthas was born. But what’s been happening since then? I thought it was time for an update for what’s been happening in 2023. I’ve been busier this year than I ever believed possible!
The Big Birthas organisation
I have to address this first. More than once in a meeting people have assumed that there IS an organisation! While it’s absolutely true that I don’t do this alone; I have some excellent help in moderation with the Facebook group by some wonderful people. I also call on the services of some others as a sounding board from time to time (you guys know who you are, I won’t embarrass anyone). But in reality, Big Birthas is mostly me – Amber Marshall. I fund the site, I write all the text (unless it’s a guest blog post). I do the research, and I fix the site when it breaks. So when I get a request to ‘ask my comms team’ about X Y or Z, I can only chuckle. It’s also not actually my job (though I get a bit grumpy when my husband suggests BigBirthas is a ‘hobby’!).
So, when I say ‘what’s been happening in 2023?’ really, what I mean is ‘what have I been up to?!’. That’s not to say I wouldn’t welcome anyone else getting involved. If you would like to, feel free to drop me a line, make a suggestion!
Patient and Public Involvement (PPI)
One massive change over the last few years, (for the better, in my opinion!) is the growth of PPI or Patient and Public Involvement. Where previously, patient groups were largely faceless and voiceless when it came to research priorities and treatment, with decisions being made solely by professionals, this is now less likely to be the case. Funders now usually insist that service users and ‘experts by experience’ are meaningfully involved as a condition of funding.
I’ve worked on PPI projects for a few years now, putting the BigBirthas perspective as a ‘lay member’. Initially, the engagement was quite awkward and stilted, with project leads and researchers not really knowing how to involve us. However, as time has passed, PPI has become much more established and embedded. I think most professionals would agree that there is huge benefit in engaging with service users in this way. Patients and other lay representatives bring unique insights which may otherwise go unnoticed.
More than once, I’ve been in meetings where something I’ve said, that any member of the BigBirthas Facebook Group would likely agree is commonplace or completely obvious, comes as a revelation to the professional(s) involved! We may have different priorities to professionals at times, but usually our goals are aligned.
So, what HAS been happening with Big Birthas in 2023?
NICE – National Institute for Health and Care Excellence
Big Birthas (as an organisation) is a registered stakeholder for NICE and has been for a few years. This means we receive regular updates about guideline developments, and our comments are noted and published. I usually post relevant ones on the Facebook group for members to make their comments for me to feed back. I’m also on the NICE Guideline Committee for Maternal and Child Nutrition. I attend roughly one meeting per month as lay representative. This will continue into next year.
RCOG – Royal College of Obstetricians and Gynaecologists
I’ve been asked to act as one of the lay representatives reviewing the RCOGs Obesity in Pregnancy Guidelines. This is early in the process, so not much to report at this point, but very exciting! I also got the opportunity to travel to their London office to represent BigBirthas regarding informed choice around elective caesarean birth.
RCM – Royal College of Midwives
This is the first year I’ve had any involvement with the RCM. I was delighted to be invited as a lay member to join their steering group looking at research priorities. Again, this is early in the process, so not much to report as yet.
I attend a couple of meetings each year as a lay representative on this steering group. UKMidSS enables national studies of uncommon conditions and events, and national surveys of practice in midwifery units.
I gave a talk on Trauma from a High BMI Perspective at the 8th Annual Birth Trauma Summit, hosted by Make Birth Better*
Guest Lecturing Midwifery Students
I have given talks about my pregnancy and birth experiences, and the issues faced by BigBirthas more widely, to first and second year midwifery students at the Universities of Staffordshire and Birmingham. I have also been a lay representative on interview panels for prospective midwifery students.
Involvement in Research
I’ve taken part in PPI groups with researchers from Birmingham City University, Kingston University, Lancaster University, Liverpool University, Manchester University, Oxford University, Oxford Brookes University, and HQIP.
On average, I’m having about one meeting a week connected to Big Birthas. So forgive me if it’s been noticeable that I haven’t been writing as many blog posts this year! I only have a limited amount of time spare for BigBirthas stuff. But hopefully you’d agree that the projects I’ve been involved in means that sacrifice is potentially very worthwhile!
How can I get involved?
Firstly, if you’re active in the BigBirthas Facebook group, you already are! All your stories and queries paint a picture of the on-the-ground maternity experiences of us BigBirthas. There are clear themes (some of which are unchanged since I was pregnant!) about respect, consent, and choices (or the lack of them) in high BMI maternity care. There’s also clear indications of postcode-based inequality. Equally, it’s important to note that we’re also hearing examples of great maternity experiences and care. Feeding back this essential information (anonymously) about what issues prevail and how to do it better is so important if we want to improve the experiences of those who follow behind us!
Secondly, thank you for supporting your fellow BigBirthas in the group. It’s such a lovely, nurturing, respectful community, it’s a pleasure to admin. How wonderful to see so many people offer up insights, hints and comments of solidarity from their own maternity journeys. It’s the one thing I really wanted from setting up BigBirthas; a safe space for people to get information and feel supported.
Please do speak up if you have any thoughts on NICE Guideline reviews or similar I post for comment in the Facebook group as I don’t always have time to read them fully and comment myself, even though I intend to! Or post any news stories or research studies you’ve seen that might be of interest to the group. I’m absolutely happy to amplify your voice if you have spotted something and want to speak up on behalf of the BigBirthas Community!
Tell Your Story
If you’re interested in telling your birth story, we’d love to read it! If you’re not confident writing it yourself, maybe we could have a chat over Zoom and I could write it up for you? I found reading about other people’s genuine birth experiences one of the most helpful things when I was preparing for my births!
We’ve mostly heard from people who were lucky enough to get the births they wanted… But births that didn’t go how you’d hoped are also really powerful and informative too, so don’t think “I didn’t have a ‘perfect’ birth, they won’t want to hear from me!”, far from it! It might be just the story someone needs to read to feel empowered to push for their birth choices.
Spread the word!
If you’ve found this site or the Facebook Group to be a helpful resource, share it with others who may benefit! Retweet (or whatever we’re supposed to call it now!?) us, tag us on social media, post links to BigBirthas.co.uk in online discussions. Mention it to your healthcare providers, perhaps? Maybe they’d like to read How To Be A Plus-Size Friendly Professional – or encourage a colleague to? Some healthcare professionals have even begun recommending the site as a resource to patients and service users, which is lovely to hear.
Get involved with research
Nothing about us, without us! The more we tell our stories to people who will listen, the more chances we have of changing the system for the better. I regularly post calls for research participants, and the good news is that most now give a voucher or some other payment in recognition of your time.
Tell people about our findings in the Parenting Science Gang research, and how poor maternity experiences can lead to withdrawal from wanted care in subsequent pregnancies.
Or maybe you’d like to be involved in a way I’ve not even considered?
If so, just get in touch! I’ll be happy to hear from you. The more voices we have calling for change, the better! For example, you might like the idea of applying for a NICE Guideline Committee position yourself for example – and I’d be happy to support your application. Or maybe you’re interested in pursuing some relevant research, working with BigBirthas members? I don’t have time myself to push this agenda in all the ways I’d like to, so happy to help however I can!
It’s a long slog, but we ARE making a difference!
It’s slow going, but if I reflect for a moment, we have definitely seen improvements in care over the past decade as a result of making our voices heard.
For example, a decade ago, most Midwifery Led Units (MLUs) had a blanket closed-door policy for people with higher BMIs. I literally could only choose between a hospital obstetric suite or a home birth (against medical advice!) for my second baby born in 2012. I chose Home Birth, and it was amazing, but that wasn’t what I wanted! Really, I was forced into it because my first choice, birthing in an Alongside Midwifery Led Unit (AMU – a MLU on the same site as a hospital maternity suite) wasn’t an option.
Then we started to see some AMUs take a more individualised approach. Possibly because of their discomfort at the incongruity of fat folks like me threatening to home birth, if denied access! It didn’t work in my case, but in the early to mid 2010s, it became a viable technique we regularly recommended people employ to gain access to an MLU, even if they weren’t serious about home birth. And it worked, a lot of the time.
A squeaky wheel gets the oil!
Gradually, previously inaccessible AMUs began opening their doors on a limited case-by-case basis, often for people who had already had one or more uncomplicated birth. Then this expanded a little more to those who hadn’t given birth previously. Then research by UKMidSS (before I was involved!) showed that outcomes in MLUs for people with BMIs 35-40 who had already had one baby were no more likely than other women admitted to MLUs to experience problems. Even in women who had not given birth before, the difference in outcomes was not statistically significant.
So thank you to all those who birthed before, and pushed to make the system a little more accommodating to those of us in bigger bodies. We will keep up the good fight in 2024, and beyond, for our daughters who come after us!