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Talking with strangers and unconscious bias in the NHS Maternity System

This blog is dedicated to Sandra Bland with love to her family #SayHerName ❤️

I have just finished reading the book “Talking to Strangers” by Malcolm Gladwell

The book is a critique of how we approach others through our body language speech, demeanour plus the various cues that we interpret or misinterpret according to our own life experiences, culture, colour , upbringing, religion or non religion , education , training ,inner feelings at that time and individual roles plus many other factors too numerous to list . One particular woman who in the book was Sandra Bland a black woman who was forced to change lanes on a highway because a police car was approaching with speed – the officer totally misinterpreted Sandra’s distress at being pulled over – he wasn’t kind with his words or approach and this led to Sandra being wrongfully arrested and she died in her cell three days later the verdict was suicide . When you listen to the recording of the officers first interaction with Sandra you can sense the irritation and suspicion in his voice as well as the tone he uses. He doesn’t see that Sandra may have vulnerabilities and that she is trying to calm herself by lighting a cigarette .

As a midwife I have witnessed disparity of care towards women depending on their social status, background, colour, culture and ethnicity- something I have challenged throughout my career . These experiences have often placed me in some difficult situations with colleagues. On one occasion I refused to allow someone from finance dept into the woman’s labour room . This years (2019) RCM International Day of the Midwife campaign was around Midwives as defenders and I wrote a blog about my interpretation of this . We must approach women placidly and an excerpt quote from the poem Desiderata by Max Ehrmann © 1927 illustrates this rather well.

GO PLACIDLY amid the noise and the haste, and remember what peace there may be in silence.

As far as possible, without surrender, be on good terms with all persons

Unconscious bias is something we all have – This animation by Professor Uta Frith of The Royal Society explains unconscious bias in a concise way . It’s the 21st Century – time for all NHS staff to be educated, assessed and held to account around the subject of unconscious bias plus to question their own personal identity around this issue .

Here is a photograph of part of the philosophy of the Royal Society panel members – a philosophy for the NHS .

Whilst writing this blog I also came across this refreshing blog post for By ‪@SuzRankin‬ CEO of Ashford and St Peters NHS Foundation Trust, Chertsey , Surrey .

If you are a midwife I want you to start to question the way you speak to women and families that you meet and whether you treat each woman or person exactly the same despite their background , culture , colour, sexual orientation and education. Make an attempt to hear yourself as the woman hears you – be patient and thoughtful with your words and actions . Watch how other midwives speak about the women they care for (at the bedside and in the office ) and monitor one another for unconscious bias .

Did you see someone give the woman everyone recognised from a TV programme better care than the woman who arrived unannounced from the local homeless shelter ?

Please question everything you see and if you talk about it more when reviewing cases of different women you might see a pattern start to occur – that’s what you need to change. Does your incident reporting system include statistics on race , sexual orientation, religion and ethnicity? If not how can such incidents be thoroughly evaluated ?

How do you talk to the women you meet as strangers ? When you show patience, kindness, compassion and understanding you are building on the relationship and helping the woman to feel safe . This behaviour has an effect on the woman’s oxytocin response as her adrenaline and cortisol will be reduced as well as her own fears . You are putting her at ease – becoming a friend . If on the other hand you are brusque , rushed , impatient and critical you will put the woman on edge and increase her fear , pain and cortisol which will inhibit oxytocin production.

Are you pre judging a woman when she phones up the hospital for advice ? Does that judgment impact on the way you interact with the woman ? Do you feel calm or under pressure? Are you more or less patient with her in comparison to someone else you’ve recently cared for ? Are you imparting information and evidence of equal quality or do you feel a change in your own demeanour which may make the woman feel uncomfortable without realising?

Reflect on a situation when you didn’t feel listened to – that may have been a complaint to a store or a the way an employee at a restaurant/ service / shop spoke to you – do you recall how you were made to feel or how you reacted?

Black and Asian women have a higher risk of dying in pregnancy as the November 2018 MBRRACE-UK triennial report shows and as midwives we must question why this is happening as well as campaigning for this tragic disparity to end .

I will leave you with a quote by Paul Coelho

Further reading…

Thank you so much for reading

– Jenny ❤️

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Does the NHS need to rethink the way health professionals are made to approach their work ?

It’s been a while since my last blog. This post is to help those in the NHS whatever their role or position to consider that positive individuality makes for a better NHS . In embracing positive individuality all care will improve , status quo will be rocked and the NHS will develop doing things differently within your workplace.

Predictive text steps in as you type on your phone . Wikipedia have a link about predictive text CLICK HERE and surprisingly personal data in the way we write and assemble sentences means that each device is personalised to the user . This has set my brain off thinking that actually we are all diffferent generally. Sadly NHS management would like us to work in the same way a sort of “predictive” way of working . However humans are unpredictable that’s just how we are made. Are personalities and individualism therefore disregarded ? Let’s take for example shift work – some Trusts have a better family and also life friendly approach to staff . The Kings trust have researched that staff who are cared for and well-engaged make for a more successful NHS – that in turn has a positive effect on the people being cared for .

Midwifery cannot be like predictive text eg this is the way we do it , this is the length of time you need to help a woman, new offspring & partner postnatally before transfer to the ward and so on .

It’s time for managers to realise that each woman is as individual as the midwife who is “WITH” her . An acceptance that “this is the way that Midwife B works . Each midwife’s Way of working is in fact data. The midwife who spends longer explaining to the family who are going home (eg explaining symptoms of wellness , symptoms of illness , to contact the labour ward not the emergency department for advice , self care , and current evidence) is perceived as slower but in fact this is the midwife who probably is more thorough and probably a perfectionist who raises awareness in the women and families she meets .

If you ever get told you’re too slow – don’t take it as an insult take it as a compliment

You are dedicated , perceptive, compassionate, thorough and you promote self awareness to women and families

Keep on keeping on

Sending love to all the THOROUGH midwives nurses and other health care professionals out there in the NHS

Love , as always

Jenny ❤️

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#BirthLeadership ©️ is Born

Today is an exciting day for me . I have just registered a new hashtag that I hope will influence every woman and midwife . The hashtag is

#BirthLeadership ©️

As a midwife one of my aims is to display leadership towards women in order to support them through their labour and birth . I hope that this cascades onto future midwives so that they too can show leadership. This process may involve eye contact , holding hands , a hand on a shoulder , researching,debating decisions, reading information, challenging the system BUT together as a team to help make women feel like they are the leaders of their own births . Whatever the mode of birth it’s right that midwives let go and give the lead control to the woman . This can be through education and sharing views but first and foremost it must be about midwives listening to women’s hearts, voices, dreams and plans.

Midwives begin by championing women’s choices so that birth is given back to women .

Sheena Byrom OBE and Professor Soo Downe of UCLAN co-wrote an research article called “She sort of shines” Click here for PDF

in Box 1 as above the midwives interviewed were asked about the connection between leadership identifying commonalities between both .

The huge psychological impact of having no voice in a birth is well documented and can have long term physiological effects on a woman’s mental health . Studies on post birth PTSD (Post traumatic stress disorder) often highlight the lost voice of the woman and her fear of speaking out .

Birth leadership is created so that every midwife questions her own practice in order to ask herself “am I displaying birth leadership skills?” – in other words “what am I giving to this woman and her birth to relinquish my control and give her the lead in her own birth”

Let’s take for example coached pushing in the second stage of labour something which is neither evidence based practice or conducive to effective care – yet still it goes on. Click here for NICE guidance in 2nd stage of labour April 19

Some midwives FOLLOW this tradition and their fear of changing practice influences others negatively, preventing birth leadership in some NHS maternity units.

We must become champion challengers and this doesn’t mean loudly-it can be quite subtle and indeed this quiet way is less likely to disrupt a woman’s oxytocin flow – promoting both a sense of security and safety .

Let’s talk optimal cord clamping – and how Amanda Burleigh knew in her midwifery bones that immediate cord clamping wasn’t quite right – it didn’t sit well in her midwifery skin- @OptimalCordClamping showed Birth Leadership and started to challenge research and change practice which led to optimal cord clamping (OCC) being included on NICE guidance – Quality statement on OCC Amanda’s Birth Leadership is ongoing and she has inspired others to talk about OCC by inspiring them for example Hannah Tizard who is @BloodToBaby on Twitter . This is true practice change for women and babies . Here’s Amanda’s twitter feed .

The way you act in and out of work shows the person you really are . Your aim should always be to help others as much as you’d help yourself – keep that formula equal every minute in your midwifery career and you won’t go wrong .

Women need to know we care ❤️

Try and wear a new pair of glasses when you go into work – sit in a different chair for your lunch , ask colleagues “what are my good and bad habits?”, question your usual behaviour and remember why you became a midwife – to give the lead to women.

Birth leadership is about small steps or huge steps beginning with the next woman you are with as she gives birth .

If you have shown birth leadership of any kind use #BirthLeadership and tweet about it

Here are a few Birth Leadership examples

SkinToSkin in the operating theatre

Not weighing a baby until after it’s first feed

Leading a woman to change position in the second stage to avoid lithotomy

Helping a woman to birth and hold her stillborn baby and making the family a safe space ❤️

Helping a woman who has been constantly monitored on CTG to the bathroom for a walk and a wash

Being silent as a woman is in the second stage of labour

Supporting a woman compassionately through a difficult birth

Helping a woman to avoid unnecessary internal examinations

Being a baby’s advocate when the woman is having a GA Caesarean

Holding a woman’s hand in an emergency situation

Caring for a woman’s relatives as well as the woman herself

Here is an uplifting reply from @FWmaternity co-founder of MatExp and inspiring obstetrician who is supportive of Midwives and promotes her Trusts home birth team ❤️

NB please don’t think this about starting a campaign yourself although that would be great it’s about sharing the little things that signify BirthLeadership to inspire change – so please add yours on Twitter ❤️

Thank you for reading

Yours in Birth leadership love

Jenny ❤️

PS

Please add your comments to my blog – I welcome all feedback

❤️Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say, “We did it ourselves!”

Tao Te Ching – ancient Chinese quote about what being a midwife means ❤️

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Raising perceptions of midwifery ©️

This is a current drive in the NHS so I’ve decided it’s time for me to blog about it .

We are often told as midwives that it’s not about working harder but working smarter .

I’d like to try and find out if there is data collected about individual Trusts . The data would perhaps identify times when staffing was low , what the risks were to the women and the pattern of incident reports on those occasions . I also suggest that all maternity units have a duty of care to their staff to maintain accurate , exact records on how women are allocated to midwives, midwives individual workloads and time spent on NHS computers for work and personal use – this should be reviewed on a monthly basis and as part of FOI be available to the public . Do NHS Trusts that are using their own full time maternity staff to supplement staff absence and sickness assess the wellbeing of those staff? Is there a collaboration with occupational health , organisational development and Human Resources departments to review whether or not satisfactory and timely breaks were given. When this is quantified does it identify a distinct association with lack of breaks , working unpaid overtime , poor culture and is there a correlation with staff sickness and absence ?

it’s time now to look at the bigger picture and collect data on these topics as well as birth statistics , outcomes , morbidly and mortality .

Thank you for reading

Yours in midwifery love

Jenny ❤️