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Postnatal transfer to the ward from labour ward – my thoughts

A DM (Direct Message) on Twitter is a message you receive from someone that no one else can see – apart from the people included in the message.

In the past four weeks I have received 7 DMs from a mixture of midwives , future midwives and women all with the same subject matter . This subject is mainly about ‘who decides when a woman is transferred from the room she gave birth in to the postnatal ward’ This seems to be a hot topic at the moment as the variation in time from birth to transfer is huge – especially when comparing Caesarean birth transfers to other birth transfers (and it might surprise you to know that the variation in birth to transfer time to the ward for women who have Caesarean birth is also vast – some units care for these women on the labour ward until their spinal has worn off , some units transfer to ward within a short time in recovery which leads me to question that support with breastfeeding must be patchy).

Just the other week at Salford University Midwifery Society Conference ‘Transforming Birth’ click HERE for a summary of the day – I asked a question to the audience “are you, as future midwives pressured to move women to the postnatal ward (after they have birthed their babies) faster than the women themselves would like or you as a future autonomous practitioner would like ?” The result was that over 80% said YES.

Do we as Midwives consider our own autonomy enough when we are working ? In order to give the woman a sense of feeling cared for and nurtured individualised, compassionate, holistic midwifery is paramount . Each woman is different- some may prefer a rapid transfer , others may not . Some women may need extra support to establish breastfeeding or be debriefed post birth or some women may want to rest in a quiet place with minimal noise before they are moved to the ward . If a birth takes place in a birth centre which doesn’t focus on time , women will stay in the same room post birth until their discharge home.

In the NHS patient care sadly revolves around the concept of time . If a patient is not seen , admitted or discharged within a four hour time frame (see photo below ) it is considered a “breach”

Certain procedures have a standard time frame in which so many can be done – this is how operating theatre lists are generated and how the NHS deals with waiting lists .

However birth is and must be a positive experience – even though it has coding costs and some births are planned to the day -we must give women more than they expect – stand up for them , be their advocates. Challenging the system is one of the ways we can make change happen – if we all accept each day “this is the way we do this” we cannot be developing our roles or our practice to improve woman centred care . I’m not saying it’s easy but I want you to imagine what care you would want for your sisters and your daughters ? Then give the women THIS care – I am in the NHS as I nursed my own mother until her death at home – I see the connection between care at birth and care at death . I have been a nurse to the dying and that experience has impacted on the care I give to women in a most human way .

Whatever care you give , whether you transfer a woman in your fastest time or not is all rather irrelevant when you focus on the bigger picture – YOU are responsible for the care you provide , or you don’t provide -if you tell a student to do something that is YOUR responsibility and I suggest referring to this NMC publication which I look at each day The NMC CODE . If advice or suggestions are not kind , caring and have a direct clash with your duty of care , if a more senior Midwife tells you to do something this should be documented in the notes and be evidence based, kind and resonate with your trust guidelines plus the NMC code.

Sometimes we are stretched short staffed , rushed and under pressure but at no point should this be the woman’s problem.

So the next time you are preparing a woman for transfer to a ward just think

  • Have I given her & her partner enough time alone with their newborn
  • Have I helped initiate feeding
  • Am I rushing her ?
  • Do I feel under pressure ?

Then if necessary give her some more time – and when you arrive on the ward give continuity of care to the woman and her newborn by transferring in SkinToSkin contact , admitting them both to the ward environment yourself , taking and recording observations , checking the woman’s pad and fundus ,getting the woman a drink and this will also help your colleagues on the ward immensely.

❤️Be a holistic professional caring Midwife ❤️

Thank you to the student of Salford University and those who DM’d me on Twitter – you inspired this blog

Thank you for reading

Yours in midwifery love

JennyTheM

❤️

Against the odds, Anaesthetics, Antenatal education, Babies, Being a mum, Birth, Breastfeeding, Caesarean section, Change management, Communication, Compassion, Courage, Giving information, Helping others, Hospital, Human kindness, Human rights, Intra-operative care, Kindness, Labour , birth, Labour and birth, Learning, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, Newborn attachment, NHS, NHS Systems and processes, Obstetrics, Patient care, Postnatal care, Respect, Skin to skin contact, Student Midwives, Teaching, Women's health, Women's rights, Young women

Birth imprinting – SkinToSkin contact

As a child is born to a mother there are emotional , hormonal, physical and psychological needs that are satisfied when SkinToSkin contact occurs and these will give both short and long term health benefits to mother and child .

A mother should be the first person to touch her newborn and that is one of the reasons that midwives should wear gloves. The mother’s skin will imprint the newborn with her smell, touch and love – the newborns face, smell and skin will imprint onto the mother and these are processes which are golden moments not to be missed .

If a mother is feeling unwell or anaesthetised the midwife should hold the newborn next to the mother’s skin for her , taking photographs with the mother’s phone or camera will enable the first sight of the baby to be saved and also surpass consent issues around photographs- the parents can then choose what they show to others and what they keep .

A Midwife is the woman’s and the newborn’s advocate and it’s crucial that the Midwife finds a way to involve the second parent in skin to skin contact somehow after the mother has held her newborn for a sufficient time to enable the first breastfeed .

If a woman wants to breastfeed once this has the benefit of giving colostrum as a gut protector and immuniser- colostrum contains immunoglobulin.

In cases of premature birth courage , knowledge, dexterity and skill are needed to enable skin to skin to take place . The value of collaboration (as discussed by @CharleneSTMW at a recent MatExp event at Warwick Hospitals cannot be understated – all members of the team must be aware of the benefits of SkinToSkin contact at Caesarean or instrumental birth .

We must all sing from the same sheet and share the same values so that everyone agrees that skin to skin with mother takes place before any other intervention .

Skin to skin is not an intervention it is something as natural as putting your key into your front door without thinking about it . However it seems that women and newborns are in a postcode lottery – where you live and which hospital you attend for your birth can determine and influence your chance of skin to skin .

I receive many requests from midwives from the NHS and across the world asking me to help them overcome barriers to facilitating skin to skin contact within their workplaces especially in the operating theatre . Some are stopped by anaesthetists, obstetricians , some ridiculed as strange by their colleagues and told “it’s not happening here” . We must remember that nothing is final and show the evidence which is growing by the day that skin to skin contact is not something that can be measured , it’s a primitive response which comes as second nature to a new mother – if that mother is out of her comfort zone she won’t have the strength or courage to question why – that’s OUR JOB !

Many ago I recall being told by some midwives “it won’t be happening – it’s too complicated ” and now I smile as I see midwives like @jenistevenssts in Australia studying skin to skin in the operating theatre for her PhD thesis, NICE GUIDANCE CG190 even includes SkinToSkin thanks to midwives like @drtraceyc who campaigned for its involvement and birth activist @millihill writing about it in her book (picture below)

The priceless value SkinToSkin is spreading across the world and if it’s not happening I’d like YOU to question why

This blog is dedicated to my mum Dorothy Guiney 22.2.1925 – 22.9.1978 ❤️

Anaesthetics, Antenatal education, Birth, Breastfeeding, Caesarean section, Change management, Communication, Compassion, Helping others, Hospital, Human kindness, Human rights, Intra-operative care, Labour , birth, Labour and birth, MatExp, Midwife, Midwifery, Midwifery and birth, New parents, Newborn, NHS, Nursing, Obstetrics, Paediatrics, Patient care, Respect, Skin to skin contact

The operating theatre tea party – read on to find out more 

This week I was lucky enough to be in the multi-disciplinary team involved in the care of women pre peri and post – Caesarean section . 

Lucky you say ? Aren’t midwives supposed to only be focused on PHYSIOLOGICAL  birth ? well yes that’s one of our roles but we also care for women in the antenatal period – we run triage clinics with the fab support of a skilled maternity support worker – running tests on women then contacting the Dr for advice with the results – pure team work . We also care for women in labour who have complex medical needs , complex mental health issues and we work WITH the obstetric team to find the best plan of care – we do this together with the woman’s input . I am proud of everyone I work with – they give me hope . We also work on birth centres and attend pool births . We are community midwives we attend home births , we support women who have safeguarding issues , women who live under the threat of Domestic violence and women who have disabilities. We manage wards , units , we are heads of midwifery , we are ward midwives , labour ward midwives , specialist midwives  and we are mothers , fathers ,single women/men  , gay women/men  , straight women/men  , married men/women , we are spinsters / bachelors but most of all we are HUMAN BEINGS .  

Each birth I see means a lot to me as a woman, a midwife and a human . I don’t judge a woman because she has a more complex or simple birth than the births I had – I’m in MIDWIFERY because I want women to feel positive about their birth experience and EVEN after this weeks news I am still determined to try my best to promote physiology in all birth settings . 

Anyway back to the operating theatre . 

The team in the operating theatre where I work are so together with the families they meet . They all know the importance of #SkinToSkin contact and how utterly important it is for the woman involved to hold her newborn asap . So the ODP makes sure that the woman tucks one sleeve of her theatre gown under her arm , places the ECG electrodes on the woman’s back and adds a mini – extension to the top of the theatre table so as to give the woman a greater sense of space to hold her newborn . The scrub nurse prepares a sterile space on the cot for the obstetrician to place the baby onto AFTER delayed cord clamping has taken place . The baby is dried on the theatre table and then placed on a sterile sheet on a cot with wheels – the Midwife assesses the baby’s condition at the side of the parents – so they feel involved and the baby is not weighed – we aim for skin to skin contact prior to 5 minutes of age – unless there are concerns with the baby’s health – both parents see the baby immediately and one of them cuts the cord . The other parent is then helped with placing the newborn on the mothers upper chest safely in a prone position and the midwife STAYS next to the woman and her newborn supporting them so that skin to skin can continue for as long as possible , I have piloted this and women who are supported hold their babies for longer – so I leave my records until we go into recovery area . Photographs are encouraged (as many as the family want to take) and also music . This week we asked a woman which music she’d like – we don’t yet have a Bluetooth speaker in  theatre just yet (watch this space)  so I put my phone on as Coldplay was requested . The consultant anaesthetist (Dr Richard Cross ) left the senior registrar in anaesthetics in charge whilst he was away for two minutes . When he returned he was holding a metal NHS supply teapot – we all looked puzzled 😕 . Then he carefully placed my phone into the empty teapot – this acted like a mini speaker and it was just the right volume for the family – but not too loud to disturb the surgeons and the safety in the theatre . 

What I’m trying to say is that this kind gesture was all for the family – especially the woman – we were making memories for her – she’ll always remember that she held her newborn , whilst listening to Coldplay from a teapot – what could be better than that 

Once safely in recovery (transfer to recovery area takes place with skin to skin ongoing ) we encourage birthcrawl by the newborn and praise the infants behaviour as this helps with the maternal connection . The woman is offered water quite soon after (unless she has had a general anaesthetic- in which case we wait until she is safe to tolerate water ) and then a cup of tea ( two half cups so none has the potential to spill onto the newborn ) and some toast which helps with enhanced recovery – we try to take our time with being in recovery as the woman needs more time to bond with her child due to restrictions on movement due to theatre drapes & position . 

Thank you Richard Cross and all the team in theatre for your kindness , laughter , compassion and care 
I hope you enjoyed reading this latest blog 

P.S what I didn’t mention was that there was a language barrier , but kindness , compassion and communication still took place – and the music connected us all ❤️

Happy Saturday -with love  Jenny xx 

Anaesthetics, Antenatal education, Anxiety, Being busy as a midwife, Birth, Change management, Communication, Compassion, Fear of Birth, Giving information, Helping others, Hospital, Human kindness, Kindness, Labour , birth, Labour and birth, MatExp, Midwife, Midwifery, Midwifery and birth, Newborn, NHS, NHS Systems and processes, Obstetrics, Paediatrics, Psychology, PTSD, Respect, Women's health, Women's rights, Young mothers, Young women

Loss of control – a reason for fear of birth ? 

When any of us are admitted to hospital we lose control . We are unable to get a hot drink when we want one , eat what we want when we want to ,take simple pain relief , go to the toilet , sleep as well as we would at home , get up in the night or stay in bed longer . We are also unable to control what we hear , what we see . We lose our safe place of home and being surrounded by friends and family – it feels lonely and alien to us . This doesn’t mean that we are not able to adapt to new situations it’s just that more than a few things change and this throws a curveball towards us .  The fear we feel is because we feel we are handing ourselves and our bodies , our routines and home comforts over to others, they are dismissed  – this has quite a destabilising effect on our psyche . 

A key part of NICE CG190 guidelines for care in labour encourages midwives to set the scene for women. The section I am going to focus on is COMMUNICATION – which is part of 1.2 Care throughout labour (click on the following numbers to be taken to the site)  CG190 

I have copied and pasted the exact words and written the key words in CAPITALS below to help highlight their impact – does it make you think about them differently ? 

COMMUNICATION 

1.2.1 Treat ALL women in labour with RESPECT . Ensure that the woman is in CONTROL of and involved in what is happening to her, and recognise that the way in which care is given is key to this. To FACILITATE this, ESTABLISH a RAPPORT with the woman, ASK her about her WANTS  and EXPECTATIONS for labour, and be AWARE of the importance of TONE and DEMEANOUR , and of the ACTUAL WORDS used. Use this information to SUPPORT and GUIDE her through her labour.

1.2.2 To ESTABLISH communication with the woman:

GREET
the woman with a SMILE and a personal WELCOME, establish her LANGUAGE NEEDS , INTRODUCE yourself   “#HelloMyNameIs”

explain your ROLE in her CARE .
Maintain a CALM and CONFIDENT approach so that your demeanour REASSURES the woman that all is going well.

KNOCK
and WAIT before entering the WOMAN’S ROOM , respecting it as her PERSONAL SPACE , and ask others to do the same.

ASK
how the woman is FEELING and whether there is anything in particular she is WORRIED about.
If the woman has a written BIRTH PLAN , READ  and DISCUSS it with her.

ASSESS
the woman’s KNOWLEDGE of strategies for coping with pain –PROVIDE  BALANCED INFORMATION to find out which available approaches are ACCEPTABLE to her.

ENCOURAGE the woman to ADAPT to the environment to meet her INDIVIDUAL needs.
Ask her PERMISSION before all PROCEDURES and OBSERVATIONS, FOCUSING  on the WOMAN  rather than the TECHNOLOGY or the DOCUMENTATION .

SHOW the woman and her birth companion(s) how to summon HELP and REASSURE her that she may do so WHENEVER  and as OFTEN  as SHE NEEDS to. When LEAVING  the ROOM, LET her know when you WILL return.

INVOLVE
the woman in any HANDOVER OF CARE  to another professional, EITHER when ADDITIONAL EXPERTISE has been brought in or at THE END OF THE SHIFT. 

Every person who cares for (no matter how short a time ) a woman in labour should follow this guidance and I feel there should be posters up on maternity units in all languages which emphasise that this will happen . 

There are many barriers to communication and one that most midwives, student midwives , maternity health care assistants , obstetricians and anaesthetists agree on is that time, pressure and NHS systems restricts our practice. I want to have laminated cards that go with the analgesia cards to explain why kindness and compassion will also help ease women’s pain . Fear is a huge factor in the perception of pain and if we try to reduce fear we might help reduce not only  pain but also anxiety and then by this we will gain trust and build on positive care. 

As the  midwifery workforce we must start to say to ourselves “how would I feel ? ” another question which is used on the Nye Bevan leadership module is this …. 

Lets keep sharing our ideas and thoughts and if you have any more relating to CG190 – tweet using #CG190 or why not write a blog or design a poster ? 
Thank you for reading and please leave comments , I always value them and they help me to reflect and grow . 


Yours in midwifery love 

Jenny ❤️

Against the odds, Anaesthetics, Antenatal education, Babies, Birth, Breastfeeding, Caesarean section, Change management, Children, Compassion, Courage, Giving information, Helping others, Hospital, Human kindness, Human rights, Intra-operative care, Kindness, Labour , birth, Labour and birth, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, Newborn attachment, NHS, NHS Systems and processes, Obstetrics, Paediatrics, Patient care, Postnatal care, Respect, Skin to skin contact, Student Midwives, Teaching, Women's health, Women's rights, Working from the heart

The Caesarean experience 

How good is the approach to women who have a caesarean to birth their babies ? Do all NHS trusts routinely give the same care to each woman and newborn or is it tailored to each individual ? 

I am passionate that the caesarean procedure is also a positive uplifting experience for the woman her partner and their newborn . 

I get upset when I hear stories from different midwives at various NHS Trusts that skin to skin contact at Caesarean section isn’t routine or perhaps not discussed antenatally . From today I’m championing that skin to skin contact should be a priority for ALL WOMEN AND BABIES in the operating theatre and I’m doing this for several groups of women including those who

1. Were totally unaware that  skin to skin contact at caesarean was possible . 

2. Hear stories of women who held their baby skin to skin perioperatively when own their babies are older and they missed out on it which leaves them feeling robbed and upset. 

3. See photographs of babies in skin to skin contact during caesarean and they didn’t know they could take photographs 

4. Realised that skin to skin is possible but they weren’t given the choice 

5. Feel sad that the baby’s other parent wasn’t encouraged to hold their baby skin to skin during the caesarean operation . 

And this blog post is also for any woman who has an assisted birth in an operating theatre – I’m going to help you challenge NHS systems and change the birth discrimination between normal birth and birth in theatre . 

Why am I calling this BIRTH DISCRIMINATION

In my opinion every woman who gives birth should have the chance to hold her newborn in skin to skin contact even if only for a few minutes perhaps because the newborn requires transfer to neonatal unit or the woman feels unwell peri-operatively . 

Women who have a normal vaginal birth are more likely to hold their newborn for longer and separation from their newborns during the ‘golden skin to skin  hour’ will be less likely to happen. However, if a child is born in the operating theatre separation will occur within half an hour because of risk assessments meaning that the baby is moved as well as that within some NHS Trusts phones or cameras are not allowed in theatre and here are my thoughts on this matter which is close to my heart . 
We can no longer ignore the birth discrimination that exists between normal birth – where the woman has prolonged uninterrupted skin to skin contact – and assisted birth . It’s the role of everyone who is involved with birth in the operating theatre to work together to reduce and / or eliminate this birth discrimination.  I’m talking about midwives , anaesthetists , paediatricians , obstetricians , neonatal nurses , ODPs , maternity support workers coming together to form multi-disciplinary teams to plan how skin to skin contact length and opportunity can me maximised and separation minimised . 

We are all aware that skin to skin contact is beneficial in numerous evidence based ways (just go onto google scholar and search “skin to skin contact at birth”  to both mother and baby. It is NOW time to take action and assess each woman and baby individually instead of adhering to a ‘one size fits all’ approach . Of course there are women who may have to have a general anaesthetic – so consider this from the baby’s point of view – and work out a way that the other parent might be able to provide skin to skin for the newborn . 

We are in 2017 and now is the time to make change happen – talk about this to your MSLCs , the labour ward forum meetings , MDT meetings and be pro-active – together we can all make a difference 

Thank you for reading – jenny ❤️

To be continued ….. 

Against the odds, Caesarean section, Cancer, Care of the elderly, Change management, Community, Giving information, Helping others, Hospital, Human kindness, Human rights, Learning, Media, Midwifery, NHS Systems and processes, Nursing, Social media health care, Surgery, Teaching, Working from the heart

r – Evolution in the NHS is happening right now 

Let’s go right back to 1980 the year I joined the NHS . I was a student nurse . My first ward was E1 a male surgical ward which was run like a tight ship. The captain was the sister and she ruled the seas – quite literally especially when I flooded the ward because I’d left the metal bed pan steriliser running during a ward round !!! 💦💦The consultant was paddling in his leather shoes, his trousers suspended at half mast like sails  – he never spoke to me but I was told off , humiliated and belittled. I wonder if that’s when I first saw the value of humour at work ?  Because suddenly the patients adored me ! Fast forwards 33 years to 2013 , you’d think I’d have learnt my lesson ! A busy shift and I was working on the beloved birth centre , women were spilling  into it because the delivery suite (a term I do not like – birth ward would be better) was full . A midwife friend asked me to keep an eye on the birth pool she was filling and I forgot as the woman I was with was overflowing with oxytocin and gave birth . So the best thing I hear is someone shouting ‘flood!’ Oops a daisy – run outside the woman’s room (not the room or my room – take note!) to find Mr Amu our lovely consultant standing in water laughing at me and saying “how do we sort this ?” My friend Carol the cleaner in hysterics with me as we rallied water suction machines , towels , sheets ANYTHING to stop the water moving further . Do you see the difference between 1980 and 2013 ? Now those of you who know me well know I’m a joker as I regularly shout to lovely Carol the cleaner “quick I’ve had another water incident !” Of course I’m joking and of course we laugh out loud and Carol tells me off – giggling . 

The evolution is happening because  as the years have passed social media has been accepted as a form of communications and is effective connecting more staff and service users than emails and/or phone calls. However much more than that NHS staff can find out what’s happening (or not as the case maybe) either within their own trusts or in other trusts they may never ever visit or work at . By sharing evidence, good practice  , learning from others and communicating openly we are slowly stamping out poor practice and improving quality . Patients talk to staff within an open forum , staff read more articles and are constantly trying to improve the patient experience . 

For me I think the lightbulb moment has been that I can make a difference , I can challenge practice and I allow myself to keep learning, growing and connecting . I’ll take you back to 1980 – all I knew was where I worked – now I see so much more-  and the wonderful people I’ve met on social media ? Well we would have never met ! So thank you social media from the staff and families of the NHS.

Let’s keep on evolving 
Thank you for reading 

With love  , 

Jenny ❤️

Change management, Compassion, Giving information, Helping others, Hospital, Kindness, MatExp, Midwife, Midwifery, Midwifery and birth, New parents, Newborn, NHS, NHS Systems and processes, Nursing, Obstetrics, Patient care, Respect, Smoking cessation, Women's health, Working from the heart

Sharing evidence in the NHS 

We’ve all been there – in a busy clinical area and a person or family  are advised there is a change in care due to clinical findings, investigations, laboratory results . Time is limited but each person being counselled varies in their knowledge, understanding, intelligence and how they process the facts that are  imparted to them. It can’t be a one size fits all but how exactly do health professionals communicate quality evidence to the people they care for and maintain an individualised approach? 

Several NHS trusts are going paperless with leaflets available on line. This is a way forward but we must ensure  there is access  to computer or a phone with wi-if access . Some health care users may not want to admit they are technophobic, don’t have a computer or laptop or perhaps cannot read and/or write. I promote the use of libraries and also show how to access the hospital free wi-fi . It’s important to flag the hospital wi-fi which should be available for all staff ,visitors and patients – Trusts that don’t provide this are failing their patients and staff . Access to wi-fi has been jokingly added to the Maslow triangle 
  

but on a serious note it’s standard in cafes, restaurants and hotels so please NHS follow suit – our business is hospitality after all . 

Questions to ask about giving information 

  • Is it relevant ?
  • Is it current ?
  • Does it link to evidence and research ?
  • Who decides how in depth it should be ? 

Giving a leaflet is simply  a starting point for a wider discussion it’s not a final statement . As health care professionals we should be constantly asking women and families “is there anything you need to know ? Any questions you have? ” as well as promoting a learning environment . We are helping women to become leaders for other women when we give valid , useful information out . There is no excuse for us to say  “I wasn’t asked” anymore. 

Health professionals must start the spark that gives the public a thirst for knowledge about their own health . I recently counselled a woman about carbon monoxide(CO) – she didn’t smoke but two of her close family members did . I offered them all Carbon Monoxide screening . The two family members CO levels were 1. Above 30 2. Above 25 . The non-smokers was 19 and wait for it I also measured my CO as a control – mine was 15 . I then realised I’d been in a closed room with the family for over an hour . The CO had affected all of us . This led to a discussion about the effects of smoking , the safety of nicotine but the dangerous effects of carbon monoxide and the way the tobacco industry makes an addictive product with hidden perils . The family chose smoking cessation as the results of the screening test surprised them (and me !)  I didn’t nag them I befriended them and helped them to focus on how they could remove the product from their lives and not their guilt . 

Below is a recent article by Jonathan Cliffe Midwife about personalising care for every woman – published in the British Journal ofMidwifery August 2016 . 

 

The current financial status of the NHS is forcing many  trusts  to cut back on small things, but I believe that it’s the small things that make the NHS wonderful. The fact of the matter is we are here to provide a priceless service to families, parents and people. If we keep our focus on doing the best we can do each and every day by imparting the evidence which applies to the individual , looking at how the individual might help us to gain new knowledge, opening our minds to  improving outcomes, valuing staff and patients alike  then the only way  that the NHS can possiblY move  is in a toward direction. 
I suggest you google “How to share evidence –  NHS”  you might find some valuable information to help your own NHS trust . 

Thank you for reading , please leave a comment .
With love , 

Jenny ❤️

Against the odds, Care of the elderly, Change management, Community, Compassion, Courage, Discharge from hospital, Helping others, Hospital, Human kindness, Human rights, Kindness, Learning, Media, NHS, NHS Systems and processes, Patient care, Psychology, Respect, Surgery, Women's health, Women's rights

 The role of L❤️VE in healthcare 

I recently rewatched    THIS FILM   of Dr Donald Berwick giving the keynote speech in London 2013 to The International Forum on Quality and Safety in Healthcare. This presentation struck a chord with me . 

In the NHS there are many systems and processes which promote working within the confines of guidance and staffing  . However, time and time again there seems to be omissions about how guidance can encompass love . When people love their job and they feel valued within their particular role the result is better health care . It can’t be a coincidence that this is because if you love your job then in effect you love the people you care for .  

When we talk about “love” it’s sometimes misunderstood – actually being human is about loving others .

 I was once in an orthopaedic ward as a patient following an accident and had to have major surgery on my lower leg – a pin and plate and internal fixation , tendon repairs . This operation left me non-weight bearing for 12 weeks . My mobility was severely compromised . In the bed next to me was an elderly woman let’s call her “Sophie”. Each day I’d watch some staff forget to put Sophie’s drink within her reach and this troubled me greatly . I’d ask staff to move her drink closer and I was usually given ‘the look’ i.e “what business is it of yours?” In fact it was totally my business as a human to care about another human . So I made a decision that I’d make Sophie’s hydration my job and also the job of my visitors . Sophie had no visitors , she was confused and didn’t really talk much . I asked my family to bring her a few bottles of sugar free cordial and set about my mission . On a daily basis I hopped to her bed and made her several drinks over the course of the day – usually out of sight of the staff . I began to recognise when she wanted the toilet as she’d shout out , then I’d alert the staff . This went on over about 6 days and with my visitors helping Sophie was soon rehydrated and talking – in fact she was well enough to go back to the nursing home she had been admitted from . 

So what made me do this ? I didn’t know Sophie and I could’ve just focused on my own recovery. In fact Sophie helped me to find the courage to use my crutches (something I was petrified of using) and she took my mind off my own pain and frustration . Much more than this however I saw myself as Sophie in years to come – ‘sat out’ in a chair unable to move or communicate , hoping for the staff to be kind , for the kindness of strangers to aid my recovery or to ease my loneliness in some way . 

“We are all one another” 

I never told anyone about this before except my family who were also directly responsible for Sophie’s recovery . You see the truth is we didn’t do it for recognition – we de it because we are human 

Thank you for reading 

With love , Jenny ❤️

Babies, Being busy as a midwife, Birth, Breastfeeding, Caesarean section, Care of the elderly, Change management, Children, Community care, Compassion, Courage, Helping others, Hospital, Human rights, Kindness, Labour and birth, Learning, Media, Midwife, Midwifery, Midwifery and birth, New parents, Newborn, Newborn attachment, NHS, NHS Systems and processes, Nursing, Obstetrics, Patient care, Respect, Surgery, Teaching, Women's health, Young mothers, Young women

#LeadToAdd 

LeadToAdd click HERE to learn more is the latest NHS England campaign # is #LeadToAdd. As a Caremaker I will be linking this on Twitter with my work on #skinToskin , #futuremidwives and #couragebutter to inspire others to see themselves as leaders regardless of their role . Patients, women, families and non-clinical staff are also leaders .  
I feel this will inspire/activate different meanings to different people

Here are some of my thoughts around it

What does to lead mean ? 
To take charge , to be at the front , to inspire , to educate, to be diverse 
Leading is about being at the front and CONSTANTLY looking back to bring others with you

Leading is about being the first to begin something but not necessarily holding onto that but looking at how your actions impact on the way others fulfil their role. Leading is being a positive role model, leading is about looking inwards at your own behaviour and also looking outwards at the behaviour of others . 

In the NHS all staff need encouragement to recognise themselves as leaders and also to see that some behaviours do not embody leadership. We are all learning each day, so don’t stay still – question yourself and the way you speak to others . Ask a colleague to listen to you talking to patients and staff and to give you feedback -what could you change ? Integrate telephone conversations into drills training-  talk to your practice development team – think outside the box . 

Someone who leads others into poor practice is a poor leader but a leader non the less so be aware of your own commitment to pass the positive leadership baton . We are human and it’s ok to make mistakes , however we must learn, evolve and change .

The other day I had a car journey with Joan Pons Laplana (@ThebestJoan on twitter) and once again he made me think hard about how the 6Cs are integrated into practice . Joan said to me that as a health care professional all tasks and procedures must embody the 6Cs – even answering a telephone call. 
As a form of reflection I’d like you to read passage one and then passage two
Passage One 
Busy labour ward – phone ringing , midwife answered the phone – we will call the person making the call Tony and his partner who is having a baby is called Dolores. The midwives name will be Darcy . 
Midwife ( confident and cheery) ” hello labour ward , midwife speaking how can I help you?”
Tony (nervous voice) ” oh hi – err my partner thinks she’s in labour , it’s our first baby and we are a bit nervous . Could I ask you some questions , she’s here but having a contraction right now and then she feels sick for a few minutes after its gone. 
Midwife “oh right well I need to talk to her please and decide what’s happening’  
I’m not going to continue this but could the midwife change her approach ? Is this midwife you ? A colleague? This approach has been learnt from a peer
Passage Two 

Busy labour ward – phone ringing , midwife answered the phone – we will call the person making the call Tony and his partner who is having a baby is called Dolores. The midwives name will be Darcy . ….

Midwife ( confident and cheery) ” hello labour ward , my name is Darcy Jones I’m a midwife and how can I help you?”
Tony (nervous voice) ” oh hi Darcy – I’m Tony – err my partner Dolores thinks she’s in labour , it’s our first baby and we are a bit nervous . Could I ask you some questions , she’s here but having a contraction right now and then she feels sick for a few minutes after its gone. 
Midwife “ok well I would like to take some details first whilst Dolores has a contraction . Thank you so much for ringing us . How are you feeling ? This is your first baby ? How exciting for you both!” 
I’m not going to continue this but could the midwife change her approach In either scenario – which is the best one in your opinion ?  ? Is either of these scenarios you ? A colleague? This approach has been learnt from a peer. 
So you see two examples each one leaving the person contacting  the service with different emotions . 
Start your journey as a #LeadToAdd leader today  ❤️
Thank you for reading 
Love , Jenny ❤️

Antenatal education, Babies, Being busy as a midwife, Birth, Breastfeeding, Caesarean section, Change management, Children, Compassion, Courage, Helping others, Hospital, Human rights, Intra-operative care, Kindness, Labour and birth, Learning, Manual removal of the placenta, MatExp, Media, Midwife, Midwifery, Midwifery and birth, New parents, Newborn, Newborn attachment, NHS, NHS Systems and processes, Obstetrics, Patient care, Post traumatic stress disorder, Postnatal care, Respect, Skin to skin contact, Surgery, Teaching, Women's health, Women's rights, Young mothers, Young women

The natural caesarean / the gentle caesarean 

There’s a debate on Twitter this morning about the ‘natural caesarean’ as a term that promotes a positive experience of birth by caesarean. I don’t agree with the term and I think as health care professionals working in the area of birth we should ensure that every birth is a positive birth . Milli Hill started the The Positive Birth Movement  with this goal in mind (@birthpositive on Twitter ) 

Bearing this in mind I’d like to ask the following questions for you to consider and share with with your colleagues, family , friends , midwives and obstetricians . 
1. How many women who have an emergency caeserean and/or instrumental birth (forceps or ventouse) are given information in the antenatal period about the far reaching health and psychological benefits of skin to skin contact in this setting to both mother and baby ? 

2. Compare the above with how many women are given information about  skin to skin contact around normal birth ? 

3. Compare both to how many woman are informed that skin to skin is possible during manual removal of placenta and repair of any perineal trauma in the theatre setting ? 

4. Are women informed 

  • They can TELL midwives to defer the weighing of their newborn in order to enjoy the benefits of prolonged skin to skin contact 
  • That they should never be separated from their baby unless a clinical situation becomes apparent or they themselves choose not to have skin to skin contact despite being FULLY informed
  • That their baby could ‘self latch’ at the breast without any handling by staff and also correct its own acidosis and stabilise its own breathing because of skin to skin contact ? 
  • That skin to skin and early breastfeeding “Pronurturance ” is linked to a reduction in the incidence of  postpartum haemorrhage?  CLICK RIGHT HERE for the Pronurturance paper 
  • That if babies could talk they would choose skin to skin contact despite their birth environment 
  • That skin to skin contact is the building block for a persons social and psychological development 

The midwives and staff on social media who talk about caesarean are not promoters of it , they are giving women information about choice – so that if the operation (which is major surgery) does take place then these women are able to not only enjoy their birth experience but give their relationship with their baby the best possible start . 

I suppose it’s similar to the question “does having a teenage pregnancy strategy increase teenage pregnancy rates ?  (and I much prefer the term  “young women”to ‘teenage pregnancy’) 

Does having full information about your choices if you do go on to have a caeserean increase caesarean rates ? I don’t know the answer to either of these questions but I do know that the women I have assisted and sometimes fought for to have skin to skin contact with their newborns in different birth situations have all told me this 

 
-that they never realised the positive impact it had on them as a successful mother

To me this is enough .   
Thank you for reading 

With love , Jenny ❤️

I am also promoting #MatExp as a platform which enables and encourages discussion between women, families and health care professionals .