Patient and Public Engagement

Let’s talk about PPE. No, not *that* PPE, I’m talking about Patient and Public Engagement, also known as PPI – Patient and Public Involvement!

I’m pleased to announce that lately, organisations have been approaching BigBirthas to get involved in projects at the planning stage. This is great news!!

It is no longer acceptable (why was it ever?) for organisations; bosses, politicians, researchers, and healthcare professionals to make decisions about us, without us. People in positions of power, if you’re not asking about our lived experience, if you’re not listening to our stories, in whose name are you working? Are you really the experts here?

These sorts of scenes are just not acceptable:

Engaging with your audience (or representatives of it) at the outset has some very tangible benefits.

  • There’s a good chance that if you’ve overlooked something, service users will spot it. It’s our lives you’re talking about after all, and we’re literally the experts!
  • You can get the language right. You’re much less likely to draft something patronising, presumptuous, implausible, or antagonistic if it’s co-written/proofread by members of the intended audience.
  • You’ll understand what’s important to us; what floats our boat and what gets our goat. If your clients connect with what you’re saying, they’re more likely to listen. Honestly, if you want us to listen to you, it’s only reasonable that you hear us too!
  • Getting the language and tone right in documents encourages staff to do the same in their interactions.
  • Engaging with your audience at the earliest stages means you’re asking the right questions at the outset.

I’ve read so many hospital policies and research where it’s clear no representation was present at planning, drafting, or proofreading stage! It’s very easy for phrasing to become ‘us and them’, paternalistic, and ‘we know best’ in style when you’re external to the group in question. There are very few people for whom that approach yields the best engagement! Even worse, that language feeds into the psyche of those acting on your words.

How to find your audience

Therefore, if you want to do best by your clients, you need to get your audience involved, preferably as early as possible in the project. But how do you recruit your service users? If you’ve tried putting up posters and putting a link on your website and that’s not getting you anywhere, what next?

Reach out.

Former service users may have even more insight than current ones, but are less likely to see your invitation. If it’s too costly to contact previous service users directly, could you advertise in baby and toddler groups, with health visitors as well as maternity clinics? What about maternity voices partnerships?

Are the service users you do engage sufficiently representative of the diversity of your clients? Do you need to try thinking more out of the box to reach more of the people you should be speaking and listening to?

Have you considered why people aren’t engaging? Are you offering expenses or any incentive for people to give you their time and effort? Is it something super simple like the time you’re trying to connect? Avoid daytimes and particularly the school run, provide creche facilities, or reimbursement for childcare. For in person meetings, make sure parking is good and preferably free, and there are good public transport links.

Are you clear about what you’re asking/offering, and who the work will benefit?

If You Represent An Organisation

Big Birtha is always happy to give an opinion, and is on several advisory and oversight committees already. If you want more than one person’s input (you really should!) we have a BigBirthas Facebook Group of 300+ members, from which you could recruit participants. Or if you just want to ask a few general questions, and sound out some ideas we could facilitate a Q&A style open meeting and see what happens. We’re passionate about this stuff, and changing maternity services for the better, so you’re likely to get some great engagement!

Just get in touch via the Contact Big Birtha link. Explain what you’re up to and we can discuss how Big Birthas can get involved to help you make your next project as engaging as it can be, which is in all of our best interests.

Weight Management In Pregnancy – Nursing Practice

New article on weight management in pregnancy in Nursing Practice magazine:

It highlights some interesting points:

  • UK data suggests that between 40-65% of women gain too much weight in pregnancy.
  • International research suggests that women who gain too much weight in pregnancy irrespective of pre-pregnancy BMI, have an increased risk of pre-eclampsia, caesarean section, and delivering larger babies.

So while we know that being overweight before pregnancy confers slightly higher risks, it is interesting to note that for any pregnant woman, controlling weight gain is important.

  • A large UK trial recently found that limiting weight gain in pregnant women with obesity did not result in a lower risk for gestational diabetes, indicating that there is no strong evidence for what constitutes appropriate healthy or safe weight gain in pregnancy.

This is very interesting, because I have had concerns ever since the Royal College of Midwives started receiving income from Slimming World as a ‘partner’ and then the next thing I knew, larger pregnant women left, right, and centre were being packed off to Slimming World, despite the advice, from the Royal College of Obstetricians and Gynaecologists always having been to not try to lose weight while pregnant.

Now the argument for sending people to Slimming World is that by making healthy changes to your diet you may not gain any weight during pregnancy and you may even lose a small amount, which is not harmful. And I can hardly complain, I lost weight in both of my pregnancies through a variety of factors – more exercise (I LOVED aquanatal), consciously trying to eat more healthily, but predominantly because I felt sick as a dog for the first trimester and felt constantly full for the third!

My issue is – is sending pregnant women who are expressly advised not to try to lose weight to an organisation called Slimming World sending the right message? Given that the setting of Slimming World meetings and the entire focus for most of the rest of the participants in attendance is all about losing weight, is that the right environment for someone who is expressly not supposed to be trying to lose weight because it could be harmful to them and their fetus? Ho hum.

  • Midwives often report feeling anxious or worried about discussing weight with pregnant women.

This is probably true for many midwives. And may actually be the cause of some of the tactlessness we encounter. If we already anticipate resistance before we discuss something (think of a dispute you’ve had to raise with a friend or significant other) often our anxiety about raising what we perceive will be a difficult topic clouds the way we deliver the message, and so we start off on a bad foot before we’ve even got anywhere. Phrasing difficult questions or topics sensitively and non-judgementally is an incredibly important and underestimated skill.

  • NICE recommends that all women should be weighed at the start of pregnancy, but weighing should only continue throughout pregnancy if there is a clinical reason to do so; women should not be weighed repeatedly during pregnancy as a matter of routine.

So feel free to mention this if you’re seemingly getting on the scales every five minutes.

  • As there are no UK guidelines regarding pregnancy weight gain, healthcare professionals are advised to focus on supporting women to eat healthily and keep active. This advice is the same for all women regardless of their weight category.

So if you’re feeling like you’re being nagged, remember, you may not be. The same advice is supposed to be given to all pregnant ladies.

  • Moderate physical activity in 15 minute bouts three times a week is advised before increasing this activity to 30 minutes every day of the week. Women who have kept active regularly before pregnancy should be advised that they can continue this activity. If women struggle to keep active in pregnancy, they should be advised to avoid being sedentary, i.e. avoid sitting for prolonged periods of time.

This is another bugbear of mine, so glad there is an implication that questions should be asked about pre-pregnancy activity levels. It drives me bananas when women are automatically told they need to ‘get more exercise’ before the healthcare professional has actually ascertained what exercise level they are already at!

I know of fitness instructors who do a ton of exercise but are still overweight and even officially obese. Obesity does not necessarily mean inactivity. I got told to ‘slow down!?’ in a surprised manner when I galloped up the stairs ahead of my midwife once, and there were remarks at how sprightly I was at getting in and out of the birth pool too…

  • This support needs to be delivered in a sensitive manner taking the woman’s circumstances into account.

Hurrah for them making this point! So don’t forget to remind your healthcare professionals of this if you feel they’re overstepping the line at any time.

Big Birtha x

For the full text, click here:

www.nursinginpractice.com/article/weight-management-pregnancy