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.

Birth in a time of Covid-19

I think most people are a bit anxious right now. There’s a lot going on and a lot to get your head around. But if you’re pregnant, it must be especially worrying. Particularly if it’s your first and you already don’t know what to expect. Pregnancy and birth keeps you on your toes at the best of times, but birth in a time of Covid-19 comes with further considerations.

You can read the Royal College of Obstetricians & Gynaecologists advice on coronavirus infection and pregnancy here.

We’ve had a couple of recent births in the BigBirthas Facebook Group. With permission, here’s a birth story from someone who just did it four days ago! Hopefully this will give a bit of information and reassurance on what to expect if you’re nearing your due date:

Kay’s birth story

I gave birth to my little legend on Friday 27th March.

newborn wearing a hat and clutching a finger -
birth in a time of Covid-19

I was induced at 37+5 due to obstetric cholestasis. (OC is a liver condition which affects 1 in 140 pregnancies in the UK. It is characterised by excessive itchiness, often on the palms of your hands and/or soles of your feet. A bit of itchiness in pregnancy is normal, particularly on a stretching tummy, but always worth getting checked out. – Big Birtha)

He came at 38+1. They kept me in hospital due being high risk with OC and high BMI and the midwives were absolutely amazing. They really put my mind at rest. The consultant and the anaesthetist were pushing for a c-section because of my size, but I rejected and carried on. I knew that I could do it.

In the end I managed all but the last hour without any pain relief at all and the last hour I allowed myself some gas and air. He was born at 2.10am on the 27th weighing 7lbs 14oz and is perfect.

My advice to everyone is to not let them put time pressure on you. If you choose a c-section, that of course is your choice and I am fully supportive, but I am so glad I didn’t let them hound me into one. The ward they put me on (postnatal) I was the only one that had a natural birth. It was so hard watching everyone else struggle even picking up their newborns, whereas I was up and walking about straight away.

Birth in a time of Covid-19 – Kay’s experience

They are taking the upmost care due to current situations, and I am generally a bit of a worrier. If you’re like me don’t let it get you down, I cannot express how safe they made me feel!

The midwifes were only allowed in that section of the hospital. Birthing partners were limited to one and had to take their own food etc. Once they were on the ward they couldn’t leave and come back again. It’s reduced the risk and made everyone feel more comfortable. We all washed so much too, mums, dads, and staff.

All in all it was a very positive experience, even in the circumstances.

Good luck everyone, from one very happy mumma. 💜

*****

Thanks for taking the time out to share that Kay, and congratulations!

Birth in a time of Covid-19 – highlights from the RCOG guidance

The Royal College of Obstetricians & Gynaecologists is carefully monitoring all evidence as it’s released. So for up to date information, it is definitely best to read the advice on their page. The below is current as of 31st March 2020:

Generally, pregnant women do not appear to be more likely to be seriously unwell than other healthy adults if they develop the new coronavirus.

Based on the evidence we have so far, pregnant women are still no more likely to contract coronavirus than the general population.

What has driven the decisions made by officials to place pregnant women in the vulnerable category is caution.

It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

If you think you may have symptoms of COVID-19 you should use the NHS 111 online service for information, or NHS 24 if in Scotland.

Our advice remains that if you feel your symptoms are worsening or if you are not getting better you should contact your maternity care team or use the NHS 111 online service / NHS 24 for further information and advice.

The most important thing to do is to follow government guidance [to reduce the risk of catching coronavirus].

It is really important that you continue to attend your scheduled routine care when you are well.

If you have any concerns, you will still be able to contact your maternity team but please note they may take longer to get back to you

There is a long FAQ section in the Royal College of Obstetricians & Gynaecologists advice so it’s likely most questions you have may be covered there.

Stay safe, and look after yourselves.

x

Big Birtha

Fat Vaginas

I’m sorry. There’s no point beating around the bush. This happened yesterday, and now fat vaginas are on the agenda:

Milli Hill, author of Give Birth Like A Feminist, spoke on BBC Radio Scotland for a discussion about induction rates. With her was Dr Marco Gaudoin, brought in for the ‘expert’ perspective. However, it turns out that Dr Gaudoin’s expertise is in fertility, not obstetrics or gynaecology… which may explain why he said this:

‘With obesity you’ve got increased fat tissue in the birth canal, which makes the birth canal that much narrower, which makes it harder for the baby to squeeze through the birth canal. So you are more likely to end up with what is called an “obstructed labour”‘

Dr Marco Gaudoin, speaking on BBC Radio Scotland 12th November 2019

What’s worse was that this happened at the end of the interview! Milli had no opportunity to challenge the doctor on his statement, or ask for evidence.

Fat Vaginas – Fact or Myth?

It’s no surprise that Milli had never heard this before, because there is NO EVIDENCE for Dr Gaudolin’s words whatsoever. They echo a theory suggested in a research paper back in 1997, and no-one has provided any evidence for it since.

It’s just more fat shaming.

Fat Vaginas: a display of inside-out purses looking remarkably like a selection of vaginas.
Vaginas come in a plethora of different shapes and sizes… image courtesy of The Vagina Museum

Ugh. Makes me want to beat some people over the head repeatedly with a copy of Give Birth Like A Feminist. Shame it didn’t come out in hardback.

You’d really hope that a qualified doctor would stick to established, evidence-based information. Sadly (too often, in my experience) when some doctors feel under pressure, they dredge some half-truth they heard somewhere from the back of their mind and present it as fact, rather than admit they don’t know.

It’s why I recommend anyone embarking on a high BMI pregnancy journey do their research and ensure they’re informed.

I have spoken to countless midwives (who have extensive experience of actual vaginas giving birth) and most agree that with the right support, there is no reason why a high BMI pregnancy shouldn’t proceed as with any other. Indeed, most of them do.

What Happened Next?

On Twitter, plenty came forward to challenge the “expert’s” ill-informed and misogynistic statements.

Then to my surprise, for once, the print media responded positively to the story! This may be thanks to Milli Hill knowing the right people to approach, but it was a refreshing change! The resulting article was comprehensive and well written.

Screenshot of Grazia online article on fat vagina comments.

Then other media outlets picked up on the story, including the Sun, who got an actual expert in obstetrics and gynaecology to comment!

Dr Virginia Beckett, consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists clarified that having an “obstructed labour” has nothing to do with “fat vaginas”. Which we knew, but it is nice that someone well qualified to address the issue has done so.

Screenshot of the Sun online article about fat vaginas

Next Up to fight our corner was the Daily Mail!?

Yes, really! Asking lots of people with much more experience and expertise… and me. So, yeah. That happened. I was tempted to be indecent and suggest that if our vaginas are so ‘restricted’, how lucky must our husbands and partners be? But I behaved myself. And contrary to my expectations, the journalist didn’t twist or change what I wrote at all, bar removing a paragraph that had already been covered by a previous interviewee. You can read what I wrote here:

https://www.dailymail.co.uk/femail/article-7680527/Doctor-claims-obese-women-fatter-vaginas-likely-experience-obstructed-births.html

Jaw on floor.

The article came with the usual stock headless belly image, naturally! But as soon as I realised and offered an actual picture to replace it, it was quickly swapped.

Of course, the article goes on to report the bloody relative risk stats rather than the true percentages, as always. So there’s still a way to go, but feeling strangely positive at how this story has turned out, for once!

As I have said before and seem to need to keep saying; having a higher BMI while pregnant is associated with a slightly increased risk of some less desirable outcomes. But there is also evidence that the precautionary way high BMI labours are managed may contribute to this.

There is no evidence that fatter people have fatter vaginas. There is no evidence that having a fat vagina (if such a thing exists) is a cause of birth obstruction.

If you want to read more about how micromanaging our births can cause a spiral of negativity and interventions – see article I wrote on The Impact of Negativity on Labour and Birth.

Time To Have Your Say!

The Royal College of Obstetricians and Gynaecologists is seeking feedback from women on its new leaflet ‘Being overweight or obese during pregnancy and after birth‘.

The closing date for comments is midday on Friday 18 May.

Click on this link to access the RCOG page where you can read the draft leaflet and then feed back your thoughts via their online questionnaire. Make sure you feed back on the right one – NOT the hysteroscopy one (unless you happen to be interested in that too!)

I don’t want to prejudice your thinking, so I’m not saying what I wrote, but I will say that it’s nice to be asked our opinion at last!

Aaand… while you’re busy having your say, let me do another shameless plug for our Big Birthas Parenting Science Gang over on Facebook. We’ve been discussing the topic and what we might research for a little while, spoken to some really interesting experts to get their views; this week we’re talking to experienced midwife and waterbirth expert Dianne Garland (SRN RM ADM PGCEA MSc) of www.midwifeexpert.co.uk. We’re nearly at the point of deciding what we’re going to research – come along and get involved, you don’t have to be a scientist (I’m not!) to get involved in citizen science!