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.



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

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.

H&M Plus-Size Maternity

Preface: this was written before the covid-19 situation reared its head. (I try to release something every 3 weeks, and like to have articles scheduled for release several weeks/months in advance!) but then I kept ‘bumping’ it because it seemed frivolous and there were other things to tell you. I’m still really happy to report that there’s now a H&M plus-size maternity range. Maternity? Plus-size? In a high street store!?

It still seems a bit frivolous for the current climate, but the high street is opening up again, and if you need clothes, you need clothes! Goodness knows, my children seem to have grown out of all theirs! So anyway, here’s the article. If you’re looking for maternity wear right now, it might be useful!

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I’ve complained before several times about the lack of plus-size maternity options. I even wrote an article on how to work within ‘standard’ clothing ranges for a fashionable maternity wardrobe if you’re bigger.

I recently saw an advert that H&M had started offering maternity clothes – but I wasn’t expecting much, to be honest. The last high street range I saw was only offering a handful of plus-sized options and they were super bland. Searching online today, I discovered 205 items sized 2XL in the H&M plus-size maternity range! And not just plain leggings and a shirt! Woohoo!

Now, before I get too excited, I’m looking forward to hearing feedback on the cut, fit, quality etc. but for now, I’m just happy that another large retailer has decided we’re a group they want to cater for. Representation matters! With fashion, more options and more choice can only be a good thing.

We now just need them to hire models who are a bit more representative of the range of sizes of their customers, but this is a good start!