Ruth Weston, co-owner of Aquabirths, speaks powerfully of her concerns about partners being banned from scans and consultations. She was forced by hospital policy to go into her scan alone when she had a miscarriage 27 years ago.

This story posted on instagram cuts to the heart of the matter:

“Today I went in for my 10 week scan, alone. Due to COVID, spouses aren’t allowed at your appointment which meant when the tech said ‘I’m sorry, there is no heartbeat’ I had to process that information, alone.

I had to get off the chair and collect my things in tears while nurses asked me questions I couldn’t even comprehend.

I had to hold my composure and walk to another room alone to wait for the doctor to tell me what I already knew.

I had to sit, alone, in a room by myself until they finally allowed my significant other to come inside.

How are we allowed to go shopping, drink at bars, and eat at restaurants, but I can’t have support with me when someone tells me my baby is dead? That moment was absolutely soul shattering and I had to do it alone, with no one to turn to because the clinic says “spouses cannot attend ultrasounds”.

Today is a terrible day and it’s one I’ll never forget. Sadly, my significant other wasn’t there to experience it so he will never fully understand what it felt like to look at our baby in real time and see no heartbeat. I saw it, alone, and it was heartbreaking.

If I can shop, dine, and drink, my significant other should be able to attend the appointment to see his child.

✌️❤️ Rest in peace little one.”

Birthrights statement regarding care during the pandemic says:

•One of the most important aspects of respectful care is a woman’s right to companionship of her choice during labour. It is a profound restriction on women’s rights to isolate them from essential support during a life-changing experience. 
•Partners also have a right to family life and to be present at the birth of their child. Birth is a critical moment for the formation of a family with lifelong psychological and emotional impact. Prohibiting birth partners would be a serious infringement of their right to family life. (1)

Women and their families understand the need for restrictions to reduce the spread of Covid 19 but surely there is the creativity and kindness within our maternity services to prevent this kind of life changing suffering for women and their families?  Surely the ‘care’ in Maternity Care includes this?

Along with midwives, doulas, radiographers and parents we have been calling for a more flexible and compassionate approach to the attendance of partners/supporters at scans and consultations  – especially those where bad news is involved. And especially where women have disabilities. Yes, we have intervened in a case where a deaf/blind woman was being denied her chosen supporter at her scan.

We are also calling for the wholesale acceptance of video calling at scans and appointments as this poses no health risk to staff.  We don’t think the fear of litigation is an adequate reason for allowing the suffering expressed above, the denial of women their right for support, and the denial of the other parent their right to family life.

We also note that recording of all medical appointments with or without permission is a legal right that hospitals staff may not refuse. Women also have the right to have their partner or support person on the phone, video or call. Health care staff who refuse to continue with the appointment if the woman is recording it or is on the phone would be breaching their duty of care, and may be liable if a poor outcome occurs due to a delay in the care offered.

We hope this view is shared by all readers and would urge you to do what you can to ensure creativity, flexibility and compassion are the marks of the maternity care delivered in your area.

With love,
Ruth

Resources:
(1) https://www.birthrights.org.uk/news/press/

https://www.birthrights.org.uk/campaigns-research/coronavirus/

By Ruth Weston

The Maternity Department of Leeds Teaching Hospitals Trust is experiencing an object lesson in what happens when you don’t structure listening to your patients into your decision and policy making systems, and using management speak when you do not include your clients as stakeholders in your decision making.

What is so upsetting from my point of view is that the lessons should have been learnt – look at Telford and Shrewsbury NHS Trust’s problems over the intermittent, then final closure of the Midwifery Led Units, and then the baby death scandal there. Look at Morecambe Bay and Kirkup.  The lesson is VERY, VERY CLEAR: If you don’t systematically seek feedback from your clients and your frontline staff, when you don’t listen to the concerns of patients and families and midwives and treat them seriously – particularly if concerns are repeatedly raised, and when you isolate, control and silence dissenting voices within your staff – then things can go badly wrong.

In my view, the action – or rather inaction – of Leeds Maternity is many things, but from their own point of view it was foolish.  Foolish, because in a situation as sensitive as this, with so many people affected, it only takes one small incident for the whole issue to ignite into a massive row and mess over which you no longer can have control. The initiative is completely wrested from your grasp.  Like a hydra, as fast as you cut off one head of controversy another two erupt forth.  This is what has happened, and the Trust is floundering as it is hit by waves of anger from women, their families and their supporters.

Listening means having compassion and empathy for the service user.  Seeing it from their point of view and responding with kindness to their concerns.  It means taking seriously concerns which are raised about service user wellbeing and engaging with it. Sympathetic posts on social media are not enough. You have to engage with the issues raised and find solutions. Leeds Maternity, I think, suffered by being too centred in its own organisation and was not able to see their policy and actions from any other perspective.

Listening means engaging with the issue and finding solutions that work for all stakeholders – and one of the key stakeholders are your service users.  Women understood and were sympathetic to the ban on partners being present at the beginning – agonising though this could be.  But then they had a solution – if I cannot have my partner holding my hand, surely I can hold them in my hand via my mobile? To say no to this without giving a reasonable reason was a big mistake by Leeds Maternity. Service users, staff and birth activists are intelligent people. We can tell an excuse, an obfuscation when we see one.

Listening means telling the truth and not hiding behind vague, non-specific terms.  An infographic that claims that “medico-legal reasons” meant that recording or video calling during a consultation wasn’t possible, without being willing, when asked, to say what they are, enrages rather than calms the growing discontent.  Particularly after FOUR weeks of waiting for an answer to the question. It is clear that the Trust would rather change the policy than tell us what those “medico-legal reasons” are!

Looking around for medico-legal advice on video and recording we found advice from the MDA saying that patients not only have the right to record their consultations but should, whether openly or clandestinely.  Such evidence is admissible in court.  So, for my money, I would say that the medico-legal advice is that the trust must protect itself from litigation by preventing wholesale recording of consultations during lockdown.  If I am right and I think I am, then the policy of Leeds Trust starts with the word shoddy and goes from there.

Listening means including the service user voice systematically into the decision making process at every level, not at the end, or as an add-on, or as a token voice, but as intrinsic to the process itself.  The feedback loop of policy impact HAS to include the service user response.  This prevents bad user response and anger, but also provides an early warning system so managers are not taken by surprise when everything erupts in their face – as it did here.  Leeds did not include the user voice in the process, did not listen to the concerns raised by midwives, women and other birth workers and so did not act how they should when they should.  And now they are overwhelmed, with one poor midwife having to field the anger and discontent of hundreds of people on Facebook alone (one Leeds Trust Maternity Facebook page has only one midwife admin).

Listening means being timely.  It means recognising that if you are going to allow visiting across the hospital then it is going to be expected that it is also safe for partners from the same household to attend antenatal consultations and scans.  It means putting out an infographic, but then answering the clarifications and requests for more detail within seven days max. Four weeks and still counting is not good enough when every day women and families are being so badly affected.  Being timely is finding technical solutions such as video conferencing to enable both parents to engage with antenatal appointments.  And it means not being complacently content with things as they are because it does not harm you – even though it harms the women and families in your care.

Listening, ultimately, is an act of compassionate care, but also an act of self-interest to ensure that all stakeholders are taken along the policy path and that the path taken is the right one for all stakeholders. This balances the needs of all stakeholders reasonably, rather than leaving the least powerful in the system uncared for.  Leeds did not act from a compassionate heart. In doing so, whilst believing it was acting in its own self-interest, it was not, because as a public body it ultimately is accountable to the public. And we are angry and appalled at what is happening, and we are even more angry at the complacent and slow response to reasonable questions.  Leeds has not learnt the lessons of Telford and Shrewsbury and Morecambe Bay, and I fear for everyone involved as a result.