Disappointed in the RCM #ButNotMaternity Response

I’m disappointed and angry today. This year has been difficult for everyone, but for people accessing maternity services it has been particularly traumatic and unnecessarily anxiety inducing. When the NHS released new guidance on Wednesday, clarifying that (at last!) people should “have access to support at all times during their maternity journey“. It finally seemed like someone was listening, and some of this stress may begin to ease. But no. I’m really disappointed in the RCM response, who say “safety is being sacrificed in favour of popularity” and that they cannot support it.

We all understood the situation in March, and reluctantly accepted that lockdown restrictions were necessary. But when those restrictions relaxed, when we could visit pubs and theme parks, fly on planes and eat in restaurants, with the government encouraging us to Eat Out To Help Out, and with children returning to school, strangely we did not see much easing of restrictions in maternity services.

Pregnant Then Screwed have been raising this issue (and several others about the inequitable treatment of pregnant women and those with kids during Covid) for months.

Pregnant Then Screwed website

When still nothing had essentially changed for most people accessing maternity services by 5th November, MPs in the All Party Parliamentary Group on Baby Loss shared some very personal experiences as a call to action for NHS England and the Department of Health and Social Care.

Pregnant Then Screwed letter to the CEO of the NHS

On behalf of BigBirthas.co.uk, I was one of the signatories on this letter of 14th November;

Dear Simon Stevens (the Chief Executive of the NHS),

We are writing to you as a group of academics, healthcare professionals, politicians, charities and campaigners and MPs to ask that the NHS recognises pregnancy and birth as one of life’s most significant events and not an illness or medical procedure. We ask that you consider the evidence which shows that women have fewer complications during childbirth if they have a trusted partner with them, and we ask that you take into consideration the increased levels of stress and anxiety amongst pregnant women who are forced to go through other parts of their maternity journey without a trusted companion.

A recent survey of 15,000 pregnant women and new mothers by the charity and campaign group, Pregnant Then Screwed found that 90% of pregnant women say hospital restrictions are having a negative impact on their mental health, with 97% saying that the restrictions have increased their anxiety around childbirth. Worryingly, of the women who gave birth in a hospital which prevented partners attending until they were in established labour, 17.4% said they felt forced to have a vaginal examination and 82% cited that this felt like a requirement so that they could be reunited with their partner. This is a breach of women’s human rights when they are at their most vulnerable. The long term impact of these restrictions for new mothers and their family could be catastrophic.

We firmly believe that no-one should have to hear that their baby’s heart has stopped beating without their partner’s hand to hold. No one should be induced while their partner sleeps in a bike shed in the car park for days on end. No one should be left to look after a newborn baby whilst recovering from major abdominal surgery.

In addition to ensuring the 15 minute rapid COVID-19 tests are swiftly rolled out in maternity settings, we ask that you direct Trusts in England to treat maternity as a special case where women have the right to be supported and partners have a right to be present during each step of their maternity journey. Coronavirus has stolen so many precious moments from so many people. It doesn’t have to be this way in maternity services. Where other precautions are in place there is little evidence that partners increase the infection risk to staff or other service users. Please ensure that parents-to-be can have the birth they deserve even during the pandemic.

Yours sincerely

So, of course, I was delighted when the NHS guidance recommended partners be accommodated!

The Royal College of Midwives’ Response

Sadly, that delight didn’t last. The Royal College of Midwives chief executive Gill Walton has responded: “With more areas moving into tier-three restrictions, many will question the common sense of releasing this new guidance now.

No I don’t Gill. I question the lack of common sense and humanity in your not supporting a change in policy before now!? The RCM could have issued guidance long ago and chose not to. After all you were able to swiftly issue this public letter to all maternity staff that you don’t support the NHS position on the same day!

What’s baffling is if you read the two press statements, they both sound pretty aligned? The RCM states that they believe attendance of partners is a priority, after all. But it took several readings to realise that while the NHS guidance recommends partners should be able to attend all appointments, the RCM conspicuously mention attendance during labour and birth only, and even then, they want Trusts to retain decision making on this at a local level.

On the surface of it, the RCM say it’s ‘because the NHSE has not completely adopted all 10 of the principles’ the RCM suggested. I mean, I can’t legitimately see how the NHSE could, when two of the RCM principles say they’re the most important principle…?

Grammatical concerns aside, the RCM could have chosen more positive, supportive language. They could have reassured users of maternity services and said they support the guidance in spirit. They could have said they would hope trusts would read this guidance in conjunction with their own 10 principles, and while being mindful of local risks. I can only guess that the confrontational tone hints at some tension between the DoH and the RCM at the moment?

This response will not have helped ease pregnant families’ anxieties. Some reports of success when waving a copy of the new NHS guidance have filtered through, but others report no change in their area, adding to further feelings of injustice.

Positives of restricting partner access?

What’s even more galling is that the RCMs own website boasted about the positives of the current restrictions, in a response to a Times article in October entitled “Covid rules have gone too far“. Rather than acknowledge the multiple genuine stories of trauma and distress experienced up and down the country, Gill Walton dismissed them out of hand as situations “few women who have given birth over the past six months would recognise” and then go on to make unsubstantiated claims that women report “benefits of fewer visitors on postnatal wards: finding it easier to start breastfeeding, and opportunities to bond with other new mothers”.

When I’m not rolling my eyes at this, I’m hearing from other sources that the rules restricting partner attendance at maternity appointments have been good, because they’ve helped victims of domestic violence to come forward and receive help. Forgive me, but it’s hard to believe that this is all done with perinatal safety as the primary concern. After all, no-one seems to be considering the long term safety implications of perinatal mental health for these families? And surely it just begs the question what lessons can be learnt from this period, without metaphorically throwing the baby out with the bathwater and banning partners altogether?

Is there another, hidden agenda?

I, and many others with close links to maternity services have heard from midwives up and down the country at all levels about how many midwives prefer the current ‘woman alone’ setup. Their jobs are much easier with fewer people to accommodate. Of course that’s also fewer people to ask questions, and fewer people to advocate for the pregnant/labouring person when there are concerns (and fewer people to argue with when they don’t want to do what you think they should). While certainly not all midwives agree, it seems plausible that could also be a factor in explaining the RCMs slowness to react.

I don’t wish to be cynical, but better support for victims of DV and RCMs boasts of ‘bonding mothers’ notwithstanding, there certainly don’t seem to be widespread better experiences for people in maternity care right now. I’m hearing too many tales of trauma, coercion from clinicians, even of people having panic attacks while being separated at the door from their trusted supporter, and having to make difficult choices between their place of birth and their own mental wellbeing.

I’m not seeing positives represented in the stats published from multiple trusts either. Poor rates of skin-to-skin & breastfeeding initiation, fewer vaginal births, and more inductions. If support and advocacy in pregnancy were ever needed, it’s clearly now.

Of course, some inductions are necessary! An obsession with ‘natural birth’ was highlighted by the media as being at the heart of poor decision making at Shrewsbury & Telford Trust in the recent review of poor care there. But there was also a lack of a culture of listening to women, and poor continuity of care. It’s a shame that the media have focused more on the ‘reluctance to perform c-sections’ and less on the lack of compassion that was a key finding in the independent review.

My call to action for Gill Walton and the RCM

Unsurprisingly, given this background, a recent study by King’s College London, who surveyed 1,754 women who were either pregnant or had given birth since the beginning of lockdown, have discovered huge increases in the numbers of families considering freebirth.

The study, and the potential reasons for the shift are covered in this excellent Guardian article:

https://www.theguardian.com/lifeandstyle/2020/dec/05/women-give-birth-alone-the-rise-of-freebirthing

So why is the RCM not responding with concern to this worrying rejection of their services in far greater numbers than ever seen before? I really hope they can swiftly recommend a solution to this problem that brings partners and supporters back into maternity services ASAP. Pleas and complaints have been ignored for too long, and there simply is no good evidence that partners increase risk to staff or other service users, and plenty of evidence that this is causing very real trauma and potentially long-lasting repercussions for families.

If Gill Walton doesn’t recognise this, and wants to continue asserting that its a situation “few women who have given birth over the past six months would recognise” I recommend she check out https://www.theysaidtome.com/ (if she’s feeling strong). The submissions to that page starkly illustrate the myriad ways in which women and birthing people report they are being poorly served by health care professionals right now, and by extrapolation, why birth partners are absolutely essential in helping return the balance of power in the birthing room.

I’m really disappointed in the RCM that instead they’re ignoring these reports and gaslighting the people who’ve experienced them. It’s worth remembering these stories are not everyone’s experience of hospital birth, but they are occurring all too often and the RCM needs to recognise and address this issue, and fast.



Pregnancy & Cardiovascular Health Research

I’ve spoken before about the importance of Patient and Public Engagement in research and policy decision making. So I’m excited to let you know there’s another project on the horizon that needs your input! This one is Pregnancy and Cardiovascular Health research, and run by Imperial College, London.

This year I refused to publicise a study seeking participants where I felt the materials were patronising and judgemental. Sadly, that researcher expressed no interest in finding out how their flier offended me, which just about says it all!

In contrast, it’s really lovely that we’re regularly getting requests from researchers at the planning stage asking for our views. Read on if you’d like to be involved.

Hands making a heart symbol on a pregnant tummy

What is the Pregnancy and Cardiovascular Health Research?

People with a higher BMI and/or high blood pressure can be at slightly increased risk of complications such as pre-eclampsia during their pregnancy. This study will look at pre-pregnancy cardiovascular health with the aim of testing interventions to lower blood pressure and hopefully improve heart health prior to pregnancy. 

Researchers need to put together an online focus group to look at the general research topic, the proposed research questions, and research design.

Who are they looking for?

They want to involve up to 12 people who are:

  • considering becoming pregnant / planning a pregnancy
  • are pregnant
  • have been pregnant

and have/had the following risk factors:

  • high BMI and/or
  • high blood pressure

What would I need to do?

The meeting will be an online discussion group which will take place either on Zoom or Microsoft Teams. It should last between 1 and 2 hours and take place before Christmas. It will be a one-off, however there may be opportunities later in the project for further involvement.

Interested? If so, click the button below to go to their webpage and click on the “I would like to take part” button to input your details.

Will I get anything for taking part?

The project will reimburse you for your contribution on an hourly basis inc Wi-Fi costs as per NIHR Centre for Engagement and Dissemination’s Reimbursement Policy.

Anything else I should know?

Researchers will review all the applications. However, if the number of applications exceed the quota it may not be possible to involve everyone who applies. The priority will be to establish a diverse group of people who bring a wide range of experience and perspectives.

Those who meet the involvement criteria and represent a diversity of perspectives will be contacted inviting them to the online discussion group.

Registration will close on Monday 7th December 2020.

Your Rights in Pregnancy and Birth

AIMS (Association for Improvements in the Maternity Services) are pleased to announce the third book in their Guide series: The AIMS Guide to Your Rights in Pregnancy & Birth. This replaces their book ‘Am I Allowed?’. I’m a big fan of AIMS’ work, and not just because they published my Water Birth article last year!

I haven’t read a copy as it’s not published yet, so I do need to caveat this recommendation. But everything AIMS produces is well researched and evidenced, so I have no doubts this will be of high quality.

Their blurb:

“Not only does this book provide clear information about your rights in pregnancy and birth, but provides the tools to assert those rights.”

The book is currently available for pre-order so that you get a copy hot off the press in November.

Asserting your Rights

In terms of rights in pregnancy, Birthrights are also very good for information and they’re currently looking for people who would be interested in legally challenging visitor restrictions in maternity services at their local Trust. You could be in the early stages of pregnancy and concerned about the fact that your partner will not be with you during scans or at other crucial points during your maternity care.

You could also be a partner who is keen to be at their loved one’s side. Or you could already have been affected by the restrictions, for example, having received bad news on your own, having asked for your partner to be there. You are unlikely to receive financial compensation, but Birthrights will ensure your legal costs are covered. To find out more with no commitment you can contact them at [email protected]

Making Decisions

If you’re trying to make decisions, it’s always worth remembering that everything suggested to you is an offer. You’re only being offered treatment, you don’t have to accept it, if you don’t want it! (It may not seem like it at times, but it’s your body and your decisions to make). It’s also helpful to use the BRAIN acronym to make sure you’re getting all the information you need.

Front cover for The AIMS Guide

Give Birth Like A Feminist

I don’t usually post on weekends and I don’t usually publish posts so soon after another has published! I try to keep to a 3 weekly schedule, which is generally manageable. But this morning on Twitter I saw that Give Birth Like A Feminist is now £1.99 on Kindle. The offer is only until the end of August, so I didn’t want to waste any time letting you know!

Book Cover of Give Birth Like A Feminist by Milli Hill
Give Birth Like A Feminist – £1.99 on Kindle

**Full Disclosure** If you buy a copy from the link, BigBirthas will get a few pence for referring you. It’s not much, but referral fees do help to pay for the hosting costs of running this site. If you’d rather not, just open the Amazon site in another tab and search for Give Birth Like A Feminist yourself and buy it that way.

So many people have found this book really helpful and empowering.

Here is a quote:

Giving birth like a feminist doesn’t mean giving birth a certain way, just as doing anything else – career, relationships, parenting – ‘like a feminist’ doesn’t require a one-size-fits-all approach.

You can give birth like a feminist in any setting and in any way, from elective cesarean in a private hospital to freebirth in the ocean. All that’s required is that you have somehow moved from a passive place where you view birth as something that happens to you and over which you have no control, to a place of understanding that you may get a raw deal in this experience if you don’t wake up and get yourself into the driving seat. Essentially: take charge, take control, and make conscious choices.

Here are some of the reviews:

My copy arrived yesterday and whilst I’m only up to page 29, my heart is singing! This book needed to be written and more importantly needs to be read. Birth is a critical and pivotal life event, not only because new life begins but, of equal importance, because it creates a mother/parent. How that birthing person is made to feel is so important because the experience stays with them. Looking at the stats: 1 in 3 suffering some sort of birth trauma? This is totally unacceptable. We need to rise up and reclaim birth and change the power dynamics. This book is not about turning our backs on medical advances but about giving a damn about the human experience. This will be a slow process. Turning a juggernaut takes time. Can’t wait to read more! Milli, I’m with you

Amazon review by doulabud

This book is absolutely everything. Every pregnant person, father-to-be, mother-to-be, midwife, doula, obstetrician, nurse, hospital administrator, law-maker, and human being should have this in their library. This is such a fundamental issue and fixing the broken system of birth in most cultures in the 21st century is essential and life-saving for everyone. This book takes a completely non-judgmental approach to birth choices, focusing on the history of childbirth and how women’s rights to control and understand their own bodies has been stripped from them in the past century. And best of all, it’s an easy read- it’s approachable and straightforward. Incredible read- and so, so important. Thank you for your work, Milli Hill!!

Amazon review by Linsay

I apologise in advance if this book makes you angry.

Sadly, some of the stories, quotes, statistics, and research presented will frustrate and infuriate. But I’m guessing if you found this site, you’re already a bit frustrated and infuriated by the pregnancy and birthing experience!