ARM Study Day 2018: Conference Review by Ruth Weston

The 2018 ARM study day in Wigan was described by Dr Lesley Choucri as “Midwifery Nourishment” and I couldn’t agree with her more. This was a wonderful day of learning, sharing and refilling our cups ready to go back to our own regions “Stronger Together”.

“Stronger Together” was one of Kathryn Gutteridge’s themes, which came out of her desire to remind us all that we need to stand together during these challenging times. She pointed out that all midwives are midwives, whether they work for the NHS, private companies or as independent midwives. For the good of the profession – and every midwife – we MUST support each other. There is so much horrific bullying, and areas of practice which are lacking in compassion. Can each person make a change by reflecting on their own practice?

Of course, Better Births was an essential part of the ARM study day, and Claire Mathews , deputy Head of Midwifery for NHS England, outlined its implementation with a focus on Continuity of Carer. Because this was a midwifery audience, Claire focused on the understandable worries that some midwives have of how continuity will work for them, especially as some midwives have experience of continuity services where they were given entirely unreasonable caseloads. With a short-term target of around 20% of women to have continuity, Claire recommended that initially trusts worked on encouraging those midwives who were interested in offering continuity to jump in and have a go, lighting the way for others to follow.

I was particularly struck by Jo Dagustun’s talk on her research into women’s experiences of birth which was an uncomfortable listen for the audience of midwives. Jo explained her PhD research which included women’s experiences of  the maternity system.

The key messages I heard in this excellent, many-layered reflection were:

  • That for women the key antenatal teacher/education was their experience of the maternity system itself.  What women are told in antenatal classes and by professionals about what they can choose, the care they can ask for or receive is over written by actual experience.
  • That women’s experiences of the maternity system, including birth, is of a ‘hostile’ environment; spaces and interactions that do not feel friendly towards the health and wellbeing of mother and baby. Women therefore made decisions on what they saw as the best way of protecting the physical and mental well-being of themselves and their child. Far from this resulting in choices for midwifery led care it often resulted in women choosing a medical birth. It also resulted in women providing partial information or telling professionals what they think is expected rather than the truth.
  • Finally, the women interviewed did not see midwives as a distinct profession with in maternity. Indeed they were not clear what midwives are. Processed through a fragmentary system and seeing multiple professionals, midwives did not stand out. In this context women did not want continuity so much as kindness from the professionals they were with.

This final point provoked a lot of reflection. It is shockingly sad that kindness is not standard in the maternity system. It is also disturbing to realise that midwifery does not stand out to most women in the maternity system. Is this how far the profession has faded? Just another health care professional doing their job? It also has some real consequences for continuity, for instance, who would want continuity from a midwife who did not show kindness?

Finally, Jo, with admirable tact and honesty, presented an example of an interaction between a service user and professionals on social media. What came through to me were professionals who thought they were being kind and helpful but from the service user’s perspective were not. Also, she showed health professionals who wanted the service user to see it from their point of view but did not themselves ‘stand in the shoes of the woman’ – surely a mark of the with-woman profession of midwifery. We need to reflect on how much the maternity system has broken the midwifery tradition of being with-woman and made the midwife a just another health care professional.

In better news, a big shout out needs to happen to Airedale Hospital Trust who have been a shining light on the issue of Independent Midwives and their ability to offer intrapartum care, as Airedale is providing them with indemnity to ensure that they can continue to practice. In return the Trust has these amazing and skilled midwives sharing their experience and knowledge, leading to improved services to women and happier staff. Airedale join several other Trusts across the country who are supporting Independent Midwives in a similar way, as is outlined in the recent IMUK blog.

Aquabirths Hi-Lo Keeling Birth ChairMargaret Jowitt’s Hi-Lo system was on display alongside the Aquabirths stand (see photos to the left for two ways that the Hi-Lo can be used). Also known as the Osborne Kneeling Chair, this wonderful piece of kit is a must for every obstetric room. It is a simple, strong and easily cleaned frame with cushioned supports which women can kneel, lean or sit on. The Hi-Lo is designed to ensure that midwives can easily access women for observations, and the small footprint means that it will fit into most obstetric rooms with ease. A video explaining how the Hi-Lo works is hereSoftbirths Mini birth couch

Aquabirths also had their Softbirths mini birthing couch on display which midwives Deborah Hughes and Deborah Neiger had fun modelling as you can see!  A smaller version of the full birth couch, the mini couch fits into smaller spaces to provide comfort and support to women in different upright birthing positions.

ARM Coordinator, Katherine Hales, rounded off the day with an update on ARM’s campaign for an independent midwifery regulator. The NMC is not fit for purpose as has been discussed on this blog multiple times. ARM now believes that it is essential that midwifery is separated from nursing, and has regulation which focuses on the needs of midwives, which the NMC simply does not do. The focus now is on the midwifery code and midwifery panel being managed by midwives under the umbrella regulation of the Health and Care Professionals Council which oversee many other similar sized groups, such as physiotherapists. This regulator seems to work better to support the professionals it oversees than the NMC does.

All in all, an exceptional day – many thanks to ARM for all their hard work!

#WiganARM18

 

 

 

March on the NMC: What Bornstroppy said

The NMC is not fit for purpose when it does not understand the profession it is regulating and does not work with the people it is supposed to be protecting.

This was the message Ruth gave at the demonstration outside the NMC headquarters on the 5th May 2017.  Led by Caroline Flint on International Day of the Midwife, mothers and midwves partners and children from all over the country came to protest at the actions and attitude of the NMC. A small delgation of mothers and midwves also met with NMC’s CEO, Jackie Smith and two members of her team.

It  was Ruth’s, first open air speech with a megaphone so here is what she would have said if she had not been up a ladder shouting over the traffic!

Her speech was captured on video here.

Our vision is for families in Britain to be happy, healthy, strong and stable.  We need a midwifery profession to be there to nurture, enable and empower mothers and their families to be just that.

In the words of Margaret Jowitt former editor of Midwifery Matters :

“Women need a strong midwifery profession with autonomous midwives backed up by a governance system NOT paid for, or supplied by, the Trust for which they work. Midwives keep birth safe. Midwives treat women as individuals. Midwives respect women’s right to choose.”

And so we want a regulator that understands this.  We want a regulator who nurtures, empowers and supports midwives so they can nurture, empower and support mothers.

Midwives keep birth safe and a midwifery regulator is there to keep midwives safe and midwives respected.

We therefore need a midwifery regulator that has an open and transparent culture, which is accountable both to the mothers and their families it serves and also the midwifery profession it regulates .  Do we have this? NO! Do we want it? YES!

We need a regulator that is supportive rather than punitive, a regulator that does not run on fear but on mutual professional respect, a regulator who midwives can ring up for advice and guidance without fear of retribution.   Do we have this? NO! Do we want it? YES!

We want a regulator that rather than increasing litigation by its activity reduces it!  And we don’t want a regulator who just bans attendance at the births of family and friends to try and get itself out of a tight spot. We want a regulator that acts reflectively and with sensitivity for best practice and compassion.  Do we have this? NO!  Do we want it? YES!

And we want a regulator that knows what a midwife is for goodness’ sake!  We want a regulator that knows the difference between employment and self employment in the profession! That understands and discourses with midwives from all branches of the profession – Do we have this ?NO!  Do we want it? YES!

I am a mother.  A mother of five children, and where I had good quality continuity of carer I remember the names of my midwives – they are etched on my heart.  Thank you Ann Devanney, Thank you Madge Boyle.  Thank you Michelle Irving.  Independent Midwife Michelle Irving was my midwife for Child number 5 because the NHS care I was being offered was no longer safe and my complaint had been ignored and refuted.  Independent Midwifery was a choice for safety and it cost 20% of our income and it took 2 years to pay it off – but we decided that a good, safe birth is priceless.

The NMC knows the cost of everything but the value of nothing. It speaks the language of legal regulation and public protection but does not speak to or listen to the mothers who know the real cost of their policies and the real value of a safe and compassionate midwife!

The NMC is not fit for purpose when it does not understand the profession it is regulating and does not work with the people it is supposed to be protecting.

NMC reform yourself, or we, the mothers and grandmothers of this nation, will TAKE YOU DOWN!

And we WILL take you down, Jackie Smith, if you do not start talking with us and listening to us. Julia Cumberlege talked to parents all over the country as part of her Maternity Review – the NMC should be doing this as part of their engagement and accountability programme.  It is courtesy to the public you say you protect.

So my call to you here today as mothers and midwives of this generation is to set about making the regulator we need and deserve for the benefit of the midwives and mothers to come.  It will take work and cunning and more work and political wheeling and dealing and a hell of a lot of campaigning but it can be done and we can do it.  That all mothers are supported through the maternal pathway is our vision, that the centre of our practice is nurture and good evidence is a value, but  OUR BIG HAIRY AUDACIOUS GOAL is to have a fit for purpose regulatory body for midwives.  And if you won’t do it, NMC, we shall do it ourselves.  Because we, the public, want to be protected and to be protected we need a strong, autonomous, respected midwifery profession.

Follow me – Bornstroppy – on my blog.  Join the #savethemidwife campaign on FB.  Write to your MP AGAIN!  And tell your family, friends and neighbours, your sisters, cousins, children, tell your colleagues at work, the people in the supermarket queue, the people you meet on the train tonight.  This is about our babies, our bodies, our births!  It is about our profession, our good practice, our future autonomy. We do not ask for it because it is a nice thing – we demand it because it is our human right to be respected and nurtured to birth safely how we choose.  And a strong respected well supported compassionate midwifery profession is required to deliver this.

#SavetheMidwife!

#NMCNotFitforPurpose!