The reality check

It is the eve of Christmas Eve and I am back on form writing after midnight. I have delivered all the cardboard houses (a mad idea which is it's own story!), wrapped nearly all the presents, its just the butcher, the baker, the Asian supermarket and the co-op for David's whisky tomorrow and I am done for Christmas. I have tied up the loose ends I can at work and the rest will just have to wait until after Christmas.

And I finally got our Christmas letter (the special Christmas edition of the Allerton Bugle) ready for publication. And then I sat there and read 3 journals: - one the local 'Streets Ahead' newsletter - which made me feel guilty that I am not more involved in my local community, the second, the Christian Socialist Movement's Christmas edition of Common Purpose - which made me feel guilty about not being more involved in national and party politics to change things! Finally the November edition of the AIMS journal. And there I found my speech at the Sheffield Homebirth Conference in print! I had forgotton about that. Well yes, I am doing something I thought - but of what real worth is that? And I read some of the fantastic articles and stories there of women doing so much where they are - and women who know so much as well. Oh how I wish I had read the NICE guidelines, Maternity Matters, Maternity Doesn't Matter, the local tPCT strategy - I really want to, I really should.

At this point I took a reality check. I have five children between 14 and 4 years, I have no parents or relatives nearby to share regular childcare, just a fantastic hubby. Not do I/we have the luxury of a private income or a hubby who goes out to work leaving me relatively free to pursue my mission - we both work really hard, fulltime, on our small business building it up. I do 40 plus hours on the business and then there are the children.

This is not a get out, this is not an excuse - it is a hard look at the reality - the gifts and limitations of my current position. It is about saying 'I am doing what I can, where I can. I am making a difference and doing it on a limited budget of time and resource. And that is OK.'

And for anyone out there reading this, my litany of limitations and achievement is not a stick to beat yourself up with. It is a reflection on the limitations and gifts we bring. I reckon there are women out there with the time and knowledge to read NICE guidelines etc when I can't and decant them into manageable bite-sized pieces for people like me - if this is your gift please contact me! But maybe speaking at events, asking questions at meetings, running a social enterprise is not. It is about doing what we can, when we can; not doing (or worrying about) what we can't.

And of course the best we bring to this campaign is passion and enthusiasm and the love of life, life in all its fulness. And as mothers we have bags of that - you can see it in our children.

Have a wonderful yuletide if you can - and celebrate the life we have given birth to.

Ruth

p.s. thankyou to those lovely people who have sent comments. Technology is one of my limitations (or rather the time to spend on understanding it, I suppose) and I have not yet worked how to respond to them successfully. But thank you and keep them coming, sisters!

The journal contacts are as follows:

Streets Ahead in Allerton has been read and used for kindling by my hubby, so can give no more info!
www.Thecommongoodmagazine.org.uk
www.aims.org.uk

Building Cathedrals - our invisible work

I was forwarded this story and it made me weep - as I too feel that my real work goes unappreciated and I constantly feel guilty for not achieving the heights of super-mum. I share it, hoping that it will encourage and inspire you as it did me. Otherwise find another story that suits you better.


Invisible Mother.....
It all began to make sense, the blank stares, the lack of response, the way one of the kids will walk into the room while I'm on the phone and ask to be taken to the store. Inside I'm thinking, 'Can't you see I'm on the phone?'
Obviously not; no one can see if I'm on the phone, or cooking, or sweeping the floor, or even standing on my head in the corner, because no one can see me at all. I'm invisible. The invisible Mom. Some days I am only a pair of hands, nothing more: Can you fix this? Can you tie this?! ; Can you open this??

Some days I'm not a pair of hands; I'm not even a human being. I'm a clock to ask, 'What time is it?' I'm a satellite guide to answer, 'What number is the Disney Channel?' I'm a car to order, 'Right around 5:30, please.'

I was certain that these were the hands that once held books and the eyes that studied history and the mind that graduated summa cum laude - but now they had disappeared into the peanut butter, never to be seen again. She's going, she's going, she's gone!?

One night, a group of us were having dinner, celebrating the return of a friend from England . Janice had just gotten back from a fabulous trip, and she was going on and on about the hotel she stayed in. I was sitting there, looking around at the others all put together so well.
It wasn't; hard not to compare and feel sorry for myself. I was feeling pretty pathetic, when Janice turned to me with a beautifully wrapped package, and said, 'I brought you this.' It was a book on the great cathedrals of Europe. I wasn't exactly sure why she'd given i t to me until I read her inscription:

'To Charlotte , with admiration for the greatness of what you are building when no one sees.'

In the days ahead I would read - no, devour - the book. And I would discover what would become for me, four life-changing truths, after which I could pattern my work: No one can say who built the great cathedrals - we have no record of their names. These builders gave their whole lives for a work they would never see finished. They made great sacrifices and expected no credit.

The passion of their building was fuelled by their faith that the eyes of God saw everything.
A legendary story in the book told of a rich man who came to visit the cathedral while it was being built, and he saw a workman carving a tiny bird on the inside of a beam . He was puzzled and asked the man, 'Why are you spending so much time carving that bird into a beam that will be covered by the roof, No one will ever see it.. And the workman replied, 'Because God sees.'

I closed the book, feeling the missing piece fall into place. It was almost as if I heard God whispering to me, 'I see you, Charlotte. I see the sacrifices you make every day, even when no one around you does. No act of kindness you've done, no sequin you've sewn on, no cupcake you've baked, is too small for me to notice and smile over. You are building a great cathedral, but you can't see right now what it will become.

At times, my invisibility feels like an affliction. But it is not a disease that is erasing my life. It is the cure for the disease of my own self-centeredness . It is the antidote to my strong, stubborn pride.

I keep the right perspective when I see myself as a great builder. As one of the people who show up at a job that they will never see finished, to work on something that their name will never be on. The writer of the book went so far as to say that no cathedrals could ever be built in our lifetime because there are so few people willing to sacrifice to that degree.

When I really think about it, I don't want my son to tell the friend he's bringing home from college for Thanksgiving, 'My Mom gets up at 4 in the morning and bakes homemade pies, and then she hand bastes a turkey for three hours and presses all the linens for the table.' That would mean I'd built a shrine or a monument to myself. I just want him to want to come home. And then, if there is anything more to say to his friend, to add, 'You're gonna love it there.'

As mothers, we are building great cathedrals. We cannot be seen if we're doing it right. And one day, it is very possible that the world will marvel, not only at what we have built, but at the beauty that has been added to the world by the sacrifices of invisible women.

The Acorn has sprouted

Well my charismatic customers would have described this evening as 'awesome'. I am not sure if I can say why - too close to the evening to have integrated all that was said.

Tonight was Choices night. Let me introduce Choices. Six years ago as NCT Homebirth co-ordinator I set up a homebirth group and after some scouting around found not an NHS midwife to facilitate the meeting - but a breed of midwfe I had never met before - the 'independent midwife'. It was not long before people not wanting a homebirth asked if they could come along, and anyway, we did not just talk about place of birth but birth support, the third stage of labour, Vitamin K, to suture or not to suture and much more. And so we decided to call our group something else - a Choices in Childbirth Group' - or Choices as it is known.

And so for six years month by month we have been meeting - sometimes there is one woman, or one couple, sometimes there are 15 of us - and in a simple informal way we talk around the issues that concern those present.

And tonight was such a night. There was a single Mum, who brought along her young partner, slightly embarrassed, but good for him he was there. Last month she told us that she had been told that she could not have a homebirth. She had been surprised to find someone else there who had been given a similar statement for similar reasons but had decided to have a homebirth as it was the place she would feel most safe and relaxed and therefore most likely to be safe and without complications. This month she told us she had negotiated a homebirth with her midwives. But she now had lots of other questions about pregnancy and birth she needed answering.

Another second time Mum needed to talk about her previous birth and the care which she had received which to say the least had not been always good. These things need to be said and acknowledged. Looking forward to this new baby, she wanted things to be different.

Another woman was moving on from a difficult early pregnancy and looking at possibilities, and looking for better care than she had received in those first 4 months.

And we had the Head of Midwifery at our group. And she was so good, she listened, and it must have been hard to listen and not butt in, but she listened and said some things. And I wanted her to tell the group about the changes planned and the things they wanted to do to improve things. But the people here tonight needed and wanted to talk and every attempt I made was quoshed as they continued to discuss the things that mattered to them. And the Head of Midwifery demonstrated her midwfery skills of reassuring presence, so women talked and were reassured by her presence.

I am on the learner slopes when it comes to these things so I sat with my crochet and watched and listened with awe to the discussions around me, interjecting sometimes with a question or comment or occasionally my passion got the better of me and I said more!

And afterwards I was stunned by the hugs and the thanks. What had I done? I had made this happen, set up the group, publicised, kept battering at the gates of the NHS Trust until they openned a little and then jammed my foot in the gap to make sure it did not shut again! Oh! I had not realised i had done that - I was too busy to notice, and too exhausted to be really honest.

And of course I could not do it without the people who had said thanks - Catriona who had hosted it and invited her firends, her house mate who made the tea and openned the door for everyone, for Kajsa who supports the La Leche League in Bradford and breastfeeding stuff now I do so little of that, and so many others passing on the messages of empowerment and hope to other women. And of course IM Michelle Whittle faithfully turning up to share in 2 hours her knowledge and passion for good birthing month after month, year after year. And tonight, to Julie Walker for coming to our group and respecting us and listening to us, and not trying to defend the service but accepting the criticism and seeking ways to take things forward.

From such little acorns do mighty oaks grow. Maybe this little group is yeast in the dough helping to transform dough to bread. Maybe it is not. But tonight, some of us caught the amazing potential of our births to change not just our own lives but those of our community and city. I hope so.

Choices matter because, to make a choice people need to know they have one in the first place, and they need the resource to access that choice. As far as we are able we try to do that by providing information and offering support. And then using these women's stories to ask/demand better maternity services.

Already we have grown - from 1 group to three or four, with an emailing list of 250. Yes Choices is now an online monthly newsletter as well. So you can sign up and get information on events, latest research, websites, petitions and campaigns, and anything else that maybe relevant. You can sign up at http://www.aquabirthsathome.co.uk/ . We also have links with groups in Manchester, Sheffield, York and Liverpool.

Tonight was awesome not because it was an earth shattering event - but because tonight I could look back and see how far we had come from where we were six years ago - and be reminded by women there of the importance of this groups in their journey to birth. That was awesome. The acorn has sprouted.

Selling innovation to the NHS - and how!

Sorry it has been so long folks. With my nose to the grindstone I had not realised where the time had gone. But enough! Let me quickly run through some interesting information gained from a short speech at the White Rose Partnership's Health Innovations day.

This was a winding up, showcase of achievements conference for a project to bring Universities, NHS Trusts and commercial companies together to work in partnership to take forward innovations for the health sector. It was a long day with many talks - some of them more intersting and understandable than others, and I do not have time to outline all I learnt. However there is one talk well worth blogging to the stroppy women out there because this is useful information for those of us looking to change the way the NHS works.

The talk was by a charming and articulate man called Dr Chris Herbert, from a Government agency aiming to get innovations into the NHS. You can find his talk on the website linked to below.

Chris re-iterated the oft quoted observation that the NHS is a slow adopter of medical technology. Too right! but then he began to unravel the NHS system and you can see why - and of course by seeing what is making the NHS tick we can on the one hand challenge the system to change but on the other, have strategies to effect change whilst the systems are still in place as they are.

Chris's talk in a nutshell:

There are three levels of procurement in the NHS:

1. the national level ( now a private company called DHL)
2. regional level (Regional Collaborative Network. the Regional level do no not buy anything they just set up framework contracts for hospital trusts to buy into)
3. and local or Hospital Trust level

The Hospital level is where it is at and here there is also complexity and further levels to penetrate.

The Hospital procurement process runs along the following lines: a need is identified, a solution is sought and suppliers identified, then a long procurement process ensues (he did not go into detail here!) which can last around 18 months to 2 years. The key decision maker in the process is the Directorate Manager and his/her only criteria for decision making is COST.

Directorate mangers have only an annual budget which they must spend or lose on the one hand but not overspend on the other. This is a very territorial system therefore with your fiefdom defined by the size of your budget. A purchase which has cost savings but outside of their own budget is of no interest to the directorate manager.

The key drivers to the 'not best but cheapest' criteria for decison makers are the Government tools of Commissioning and Payment by Results.

Commissioning has been dealt with in a previous blog around PCT commissioning. Basically the needs of a population are identified and priorities set from these and then health services are bought in to supply these health needs and priorities.

Payment by Results is a mechanism for calculating what is paid to hospitals for the work they do. In maternity services, say in the delivery suite, there is a fee paid for a normal birth, a fee paid for forceps and a fee paid for ceasareans. The fee set is said to be the average cost for these procedures. This is a strong force in driving down costs because you won't want your costs per procedure to be higher than the fee you receive! In fact you will aim for the reverse!

This has implications for those of us wanting to promote normal birth and choice and innovation in maternity care. Trusts get more money for doing lots of Ceasereans than they do for normal births, water births etc. This has been an issue in our local PCT area as it is a driver for the medicalised high tech birth. This payment by results also discourages innovation and innovative practices because if you are on a set fee you will want to do what is easiest and fastest - there is far more risk costwise for innovation.

So in sum, the key levels of procurement are national level, regional level and hospital level. At hospital level the key decision making is at directorate level and their over riding criteria is cost (against a one year budget allocation!). And the drivers in this system are the systems of thecommissioning process and Payment by Results.

So how do you introduce innovation and innovative practice into this scenario - not without difficulty it is clear, however Dr Herbert had a few pointers:

Directorate managers say they are in favour of innovation - but as you see the drivers mean that their practice penalises it, so

• Plan strategically
• Look at how to maximise chances of take-up over a wide area
• Intervene early in the process of procurement to enable things to move forward

When looking at an innovation or new practice ask yourself the following:

• Will it solve a problem the Trust has?
• Will it fit the current practice (if it does not then it won't be adopted because changing current practice cost s time and effort that cannot be afforded)
• What is the tariff (in the Payment by Results) for the procedure or service you want to innovate? (You need to show cost benefits or at least neutrality for your innovative practice)
• Identify data and evidence to support you innovation.

Also:

• The key to procurement is hospital uptake so start with them - get to the clinicians and end users.
• Do a trial help set up a tiral - even if there have been research trials done globally they will want to do a trail in their hosital
• Help staff write their business plan to get the money/go-ahead from the management (directorate and remember cost)
• Remember it is not all over until the fat lady sings - until there is a contract signed then nothing has changed
• Once you have got a hopsital or two under your belt then you can start to tackle the strategic health authority. Look for tender calenders on their websites and start negotiating - remembering that price is the big issue - not quality.

And that is it: a whistle stop tour of the NHS for the innovator.

It makes me wonder why I do it! But do not be de-moralised - we can change things because the other great driver in current Government policy is patient satisfaction and patient choice. So it really is time to get stroppy because policy is on our side.

Good luck to you all!

Ruth

For all the conference papers for the day (20th October in Harrogate) and slides go to the White Rose Health Innovation Partnership website: www.wrhip.org

Changing the Way the Wind Blows: Notes and Comments on an official briefing

Notes and comments on Official Briefing of Maternity and Children’s Services on Bradford NHS Trust Corporate Strategy to 2015

See post script to understand the phrase 'the way the wind blows'

I was invited by someone recently appointed to Equality and Diversity work at the BRI to a briefing. I could not find any briefing in the building entitiled Equality and Diversity and came to this one as it was the nearest one that fit the bill! I was the only user present except for a brief entrance of a colleague from a local ethnic minority organisation. I have to say I felt uncomfortable at times – was I really supposed to be there hearing this? Having said that,I stayed in my seat because it was really useful to hear it and as you can imagine I took advantage of the opportunity to ask questions and make comments especially privately. As always these events are as much about making contacts within the organisation as they are about finding out about what is going on from the front, as it were.

I have to say that I was impressed by the briefing. It was upbeat and positive about future developments and improvements. It was positive about achievements but Miles Scott, the speaker and Chief Exec of the Foundation Trust, was also candid about the weaknesses within the organisation and particularly in regard to patient satisfactions surveys. This pleased me no end because it felt like an acknowledgement of my constant complaint over recent years.

These notes do not by any means give you a full picture of what was said. There was no printout of the power point and all I could do was take down rough notes whilst also listening carefully to what was being said. The notes are not comprehensive in terms of the coverage of the briefing either – the notes focus solely on what I thought most relevant, at the time, to maternity services and maternity care. This means that inevitably I will have missed other important points made and for this I apologise to anyone who was there and heard things differently!

The briefing was almost entirely attended by staff and as far as I could tell these staff included midwives ( including senior management), peaditiritions ( community) and nursing staff. I did not see anyone I recognised from obs and gyn - so I doubt that there were any senior doctors there as I recognise most of them now.

NOTES on the Briefing given by Miles Scott:

This briefing was to introduce and explain the new corporate strategy for the Foundation Trust up to 2015.

The strategy takes into account stuff that has happened within the hospital or at PCT/National level eg. developments in community midwifery in 2008/9 [Ruth: they have taken on more midwives to try and alleviate the appaulling lack of continuity of care]

It also takes into account things in the pipeline such as Maternity Matters Implementation

The Strategy begins with a mission statement whose basic points are:

Our mission is
to provide quality healthcare in Bradford and West Yorkshire
teaching and research is central to what we are about
(and whilst recognising that we are a centre for sick people) we want to improve the health of the local population

Aims and Priorities to 2015:

The key priorities of the strategy are patient satisfaction, quality and safety of care

The strategy wants to respond to patient feedback and improve patient satisfaction rates. Indeed the strategy's aim is to be in the top 20% of patient satisfaction rates of hospitals nationally

Miles Scott's comment was that in too many areas of the service the patient experience was poor. When feedback was sought from patients (rather than waiting for them to complain) people were clear about their experience. He pointed out that Bradford (unlike Harrogate!) was not the kind of community that wrote letters of complaint and volunteered comment but he said where views had been sought, people had readily participated and the feedback was not good.

He went on to say that this is not just about people(ie staff) but about processes - we need the right people but also the right processes ( now known as ’the patient pathway’) to make it a satisfying process for the patient. He gave an example of one form of treatment where a ‘process map’ was done: there were 71 steps from visiting the GP to getting the treatment - needless to say there was plenty of scope for things going wrong and the patient experience was poor. Processes need to be simplified.

So another aim of the strategy is to provide the right staff, with the right training at the right time.

Another major priority in the strategy is for patient care to be as close to home as is practical
My comment: this is as close to a charter for homebirth as it is possible to get. If home is convenient for birth then surely there should be provision? And what about community based midwifery care, what about antenatal and postnatal care in the home?

The strategy sees the implementation as requiring:

work with GPs
delivering 50% of out patient care at treatment centres
developing homebased specialist services
teaching cutting edge techniques in Bradford ( I think this refers to medical procedures being in our local hospital instead of going elsewhere)

The strategy also wants to see BRI as being a specialist centre for West Yorkshire. It is already a specialist centre for some things but wants to develop other specialist services where it is appropriate to do so (eg. maternity and children amongst others . . . ), and provide a centre for specialists services that by their nature require greater centralisation across West Yorkshire - as a result of Lord Darzi's 'next steps review' - these might include peadeatrics and neonatal critical care, obstetrics etc (I think this is about the fact that for some critcial neonatal and maternity care women and babies have to be transported distances - sometimes long distances - and maybe we need to prevent this happening by having those specialist services here.

My comment: Wouldn’t it be good if we became a specialist centre for normal birth? A place where more women have normal low tech births than any other large Hospital Trust? How about lowest induction and CS Rates, specialist centre for vaginal breech deliveries and VBACs . Why just be a specialist centre for the high intervention medical end – why not hone the fading skills of enabling normal birth?

The strategy also wants to be a nationally recognised centre of excellence for education and applied health research and it wants to increase research output.

My comment: Midwives doing research projects in Bradford - is this happening - can this happen? Is it happening anywhere else in the UK? A centre for excellence for normal birth techniques and skills????? – could this be Bradford????

Miles Scott said that the way the Government policy and funding is going is towards applied health research - something we ( Bradford) are good at
My comment: something that midwives excel in - so why not do some of it?

Research and Development, the Fieldhouse project - although the big things have been agreed he said there is still alot to play for - so find out what you can and have your say!

My comment: Fieldhouse is the teaching building for the Hospital, a genteel manor of former glory, which will be developed into a 21st century university building for 21st century teaching. Any ideas what I should say here?

The payment on results scheme for hospital trusts is going to be calibrated to patient satisfaction so it is going to be important to find out appropriate ways of getting the feed back from patients and then implementing the learning points.
Comment: this is where we as users come into our own.

Feedback for Birth in Bradford
After the briefing there was a discussion between myself Alex Horsfall and Julie Walker (senior midwifery managers) about the effective ways of women commenting on the care they have received.

Bradford has the back pages of the notes which women can complete. I need to have a copy to comment on it – they are going to forward me a copy.

However, few women complete this page, and when women are being signed off the midwives do not routinely go through this section to ascertain feedback of the service.

My comment. This is particularly important as many women in Bradford would not be comfortable either about writing in English or indeed about writing itself (many white working class communities are mainly oral). I think midwives going through the feedback page as they should with the birth plan is fundamental to making the back page work at any level. I also think that the 10 day discharge is part of the problem - many women are just getting their head around the baby and feeding and recovery from birth etc. Maybe there needs to be a discharge or debrief interview at 4 weeks postpartum this would have benefits for both mother and maternity services.

What to do with the information here and what I am going to do with it:

1. If you are in Bradford then get writing a letter to the Chief Exec, Miles Scott or head of midwifery, copying it to your MP of course. Detail your experience of the service and what improvements and priorities you would like to see. I would love a copy to if you can mange it.

2. I am going to write an email to Miles Scott based on my notes raising the issues above.

3. Find out what consultation is going on in your area and join it! The MSLC has just started up in Bradford and it is an excellent time to join!

4. If you are not in Bradford maybe it is worth finding out what is happening at your local Trust – do they have a corporate strategy and what is it saying about maternity care? How are they implementing Maternity Matters? If it does not say anything write and express your dismay, and state your personal priorities for care particularly those the Trust is not currently meeting. Copy to your MP and a campaign like AIMS or Save Independent Midwifery.org.

5. Use the information here to lever your own Trust. For instance, if they do not have a target to be in the top 20% for patient satisfaction then point to Bradford and say why not? (Of course they may already be in the top 20%!) By networking what is happening in different parts of the country / regions we can play off one Trust against another to raise standards and change policies that are detrimental to normal birth and quality of care. And the networking starts here. So if you have any information about what your Trust intends to do – I would like to know! Especially if it involves continuity of midwifery care, homebirth and postdates inductions

6. I am going to follow up the patient feedback thing because customer feedback is fundamental to improved customer care. And for too long maternity services across the country have not as a routine exercise sought customer/user feedback nor taken it really seriously – and it shows! Users need to be at the centre of care not on the periphery. It sounds awfully thatcherite but I sometimes think this is where the NHS could do with some real market forces – customers/users need to count in the service in a way they currently do not.

(Ruth gets off her soap box and bows)

p.s. why changing the way the wind blows? because Jim Wallis says all politicians are wet fingered - holding up their finger to see which way the political wind is blowing. We do not change things by changing the personnel (although this may need to happen also) but by changing the way the political wind is blowing.

Super Mum: the myth

Once again the devil farts in my general direction! don't you find that when it comes to trying to make the world a better place - or at least birth a better experience for Mums and babies (lets keep things focussed and specific!) - then technology can just let you down, in cahoots with a brain that has far too many things to juggle?



The joys of the summer holidays! I don't mind them really it is just that spending time with the children interferes with the smooth running of campaigns, work and generally getting things done. I juggle childcare, rehearsing with my hubby who is to be where and when until it spins in my head.



And then I do something really brilliant - knowing the pressure I am under - I type up notes from a meeting on my return - before life pulls me off in another direction, email them to myself so I can apply them to the blog when I next have chance. But ahh, I come to said blog 2 weeks later and can I find these emails? Can I heck! - well yes - one of them - the helpful introduction i wrote afterwards in a fit of ultra organisation. The thing is I am at home where all good blogs tend to be written in the wee night hours when the house goes quiet but my mind is still busy, and the computer I tpyed everything up on so labouriously is at the office - and I am not driving there in my dressing gown!



And I just want to rant in sheer frustration because I just can't do anymore in my over crowded life! But of course I demand more of myself because because I want everything to be right. And every campaign to be effective and my personal committments to be reliable.



And so the super mum rises and falls - because as that great author of 'Women who run wild with Wolves', Estes, says - the super mum is simply an archetype and archetypes are not real and the sooner we as women and mothers realise that, the healthier we shall be. Because we set ourselves up to manage everything - partly because we have to to achieve what we want to achieve (I have to look after the kids and change the world!) and partly because we think that is what we should be able to do. But let me tell you girls - it ain't possible! it is a myth! We can do so much more than we think but so much less than we expect of ourselves.



I needed to hear that, again! I shall go to bed and sleep more peacefully and tomorow I will seek out that errant email and write another blog as planned.



God Bless to all you super mums out there - you are not archetypes - just mums like me, doing their best to make their corner of the world a better place. Take comfort and sleep peacefully, too. You are doing OK doing what you can.



Ruth

P.S. As I wrote this blog, the cat came in and was sick next to me. What a wonderful way to end my day!

Writing Letters - tips and ideas

I got this email the other week:

Hi Ruth

I have been reading your blog and loving it, well done, I'm not sure how you have the time to do everything?!

I have a bundle of postcards to go to a couple of Sussex PCTs, I thought that a covering letter would be a good idea to help them 'get it'. Have you done this and if so what do you think are the important points to get across to them?

Many thanks Louise

And I responded with a few ideas which I hope to share with you, plus a letter I sent to my MP a few months ago which may illustrate the technique.

The postcard campaign is a really effective and easy way of making our concerns clear to policymakers in the health service and politics. To learn more go to www.saveindependentmidwifery.org

I can tell you what I would write and in what style but in the end you have to be comfortable with what you are writing.

Say clearly in the first three lines what your letter is about (this particularly important if it is being copied to the media as they will only read the first 3 lines to see if the rest is worth reading)

Using the postcards I think you need to explain/expand on the message of the postcards – that we are ‘only’ asking for them to implement the promises of 'maternity matters' – particularly in regard to continuity of midwfery care and homebirth ( or whatever your pigeon is).

Then what I do is point out the current situation in Bradford in relation to these demands – for instance that that are too many women seeing a different midwfe at each appointment, the Trust admits that a community midwife in Bradford has 170 women per year – an impossible number. Women are regularly having homebirths turned down simply due to staffing issues.

Then you can basically reiterate the point on the postcard which says women having one mother one midwfe care have increased likelihood of a normal birth, higher breastfeeding rates etc etc. And research has shown that women are half as likely to have a CS if the book for a homebirth.

And that is it! Letter should not be more than a page and half, if it squeezes on to one page all the better. Do copy it to your MP or even all the MPs in the PCT district – if you are going to the effort of writing a letter you might as well make the biggest splash you can. I think it might be worth copying to Ann Kean MP. As a midwife you may not be comfortable about copying to the local paper /media – but If you want to go the whole hog then that is the way to go.

It maybe that your letter will open doors - but don’t be disappointed if you are stone-walled or even given a bit of a rough time. Some places are not yet ready to hear and respond to user feedback but just doing it anyway can make an impact even if you are unaware of it. That is why copying it to your MP is good – it provides some kind of protection to you if they are nasty and it gives you another outlet for your concerns and demands – a higher autheority as it were. Even if I have not put letters directly into the press I regularly forward my latest letter to the Chief Exec to journalists and others in key positions just to keep the whole thing rolling.

So good luck with your letter writing and don't forget that if we don't start asking for what we want and complaining if we don't get it, there is no chance we will ahve the maternity care we want.

All the best
Another stroppy woman

Grumpy Old Woman or Wrung out Dish Cloth

No I haven't posted for a couple of weeks. And those of you who receive the monthly 'Choices News' Emailing will note that it also, is two weeks late.

And I have no excuses. None at all.

I just did not want to do it any more. There was no dramatic or tragic event, there was no overwhelming increase in my work load, I was not particularly distressed or depressed.

No, I just ground to a halt like a pushchair in the sand. I wanted to go no further.

I just wanted to close the blinds on the world out there, do my own thing, hide in my hidie hole, pull the douvet over my head.

In fact I still do. And it has taken considerable effort, and the lack of too many distractions today to make me write this blog.

Hmmm. Methinks there is a touch of burnout here. What do you think?

Burnout can hit us like a bulldozer into a wall, but often it slips into our lives silently as a shadow crosses our path, and we are not aware of it until we are quite literally curled up in bed with the douvet pulled over our heads.

And it can hit us when we have a sudden increase in workload - or like me, here, it is a slow accumulation of the pressures experienced in daily life. And one day something inside you 'puts her barrow down' and won't budge.

Good for her! - I say. At least one part of me was listening to my body and soul screaming for a break!

It is interesting that my yoga classes finished about 6 weeks ago for the summer and my slow deterioration can be marked from then. My weekly yoga was the discipline of relaxation, and detachment. It gave me space to breath and relax, but it enabled me to put my busy life demands in proper perspective.

How we need those spaces in our lives! And if we are doing over time because we want to make the world better as well - Sisters! don't we need some space to just breathe the air!

Summer yoga classes begin again on Monday next week. And I am going to away for the night after this blog, and finally it is school hols so no more 6 am starts for a few weeks.

And I have written my blog at last. And the Choices mailing is done.

And I must take time to breathe this summer time, to hear the birds sing, watch the children play, take my shoes off and breathe the air.

And dear readers! Banish the shadow of long tapered, slow burnout. Take time this summer to breathe and you will bloom.

Much love

Ruth

P.S. To subscribe to the monthly Choices emailing go to www.AquabirthsAtHome.co.uk

A Call to be Bolshie

At the birth of my third baby the midwife commented "Third time around Mums are so bolshie - they won't do as they are told". This was when I yet again refused to sit up to have my pulse or blood pressure done until 'the next contraction was over'. I had a deep sense of well being and was focused on birthing my baby with ease - these 'examinations' were an irritating and painful distraction. And I had the confidence to tell the midwives to push off ( with all due respect of course!)

Last week I went to a fab waterbirth study day done by Dianne Garland (cf details below) and the evening before I had the opportunity of dining with her and the organisers. Well as happens tends to happen, as the food went down and we relaxed the funny stories came out - Dianne told us about her colleague only just managing to retrieve her computer (with all her lecture and resources in it)from the Israeli bomb disposal team, when she left it at the local post office. And Sarah told us how she send an 80 year old couple on a 24-30ies holiday.

I can't remember recounting my own embarrassing incidents(!) but I found myself telling the tale of having a 'how to breastfeed my baby video' pressed upon me by my then midwife, when I was pregnant with my fourth child - having breastfed the previous three! My response was just that - and to comment that it was not videos that would raise breastfeeding rates but proper support (ie postnatal care) for breastfeeding - and women are not getting this. Needless to say this exchange was a symptom rather than the cause of our difficult relationship.

But then again I found myself talking ( not all the time this was over the course of an evening!) about the postcard campaign and my plans to present the cards en masse with a flourish, of standing up at the Foundation Trust AGM and asking why the Trust was not supporting Homebirths or why the appalling lack of continuity of midwifery care was being tolerated. And in the humour of the meal it was pointed out that I was a stroppy woman.

And I reckon I am. Not because I am bitter or unhappy. I love life and have faced up to many of the tragedies and difficulties of the past, and enjoy the good things I have now. I reckon I am stroppy because I know how easy it is to offer good customer service - because it is my daily job - I know how easy it is to give choice, and options even within a limited range. I know what it means to be treated and listened to, with respect. And because I do it, and because I receive it from many areas of my life I expect it from those working in maternity care - consultants, doctors, midwives, auxiliaries - and I expect that as the woman carrying the baby that I should be the centre of care.

I am impatient, with a system that punishes and castigates good practice in midwives and hacks away the choices women can make. I am impatient with the continuing hegemony of doctors and consultants too many of whom continue to act like gods and do not listen, understand or respect either the women or the midwives they see every day. I am impatient because I know how costly bad maternity care is to the women and children who suffer under it, both personally in my own experience and as I listen to the pain and the stories of others.

We women do not deserve this and neither do our babies. And it needs to change, and we as women have to be responsible for our own liberation. And so we need to be stroppy if that is what it takes, we need to ask questions, write letters, demand the care we and our families deserve - because our unborn children, our daughters and daughters in law depend upon it.

And so utterly exhausted with another day of being bolshie (in my spare time of course over and above work and family) I crawl to bed. In the last couple of days I have sent out 20 cards and added 8 to my pile. I have met with three other 'user reps' to look at an effective strategy to have real user involvement in consultation - focusing around the formation of the required Maternity Services Liaison Committee. I pray God this will not be a committee but a movement, a working party towards understanding, mutual respect and positive change for women - because O Lord save us from another bloody committee! Finally tonight it was the Choices group - a fantastic evening where women felt empowered realising they had more options than they had been offered or were aware of. These women are wanting to take responsibility for their own health and birth and babies, and why should the maternity system not let them?

And this time I really should go to bed!

Dianne Garland, Midwife Expert and International Waterbirth Lecturer. Her website is www.MidwifeExpert.com

Confessions of a Campaigner:of Postcards and PCTs

Menstrual cycle hit me like a hurricane and I woke up from it yesterday realised once more there was a world out there!

Last Tuesday (I can't believe it is so long since I posted!) I went to a training seminar on PCT Practice based third sector commissioning run by our local CVS ( Council for Voluntary Services) bless them. Amongst the jargon and the unfamiliar acronyms I got flashes of understanding about what was going on. I share some of the most relevant bits for the postcard campaign:

Skip this bit if you have no time to read it all:

This is a new system and everyone is trying to get a handle on it and alot of the commissioners are newly in post.
The stated aim is to deliver world class commissioning ie. health services to citizens.
The framework of health reforms is stated as being about more choice for patients, a stronger voice for users , money following the ‘paitient’, more diverse range of care provision and providers, better patient experience, value for money, quality of care.
There was much talk about the patient pathway becoming a seamless package of social and medical care delivered where and when the patient needs it most. Lord Darzi’s report not then published was alluded to with his recommendation that we should not move the patient closer to care but the care closer to the patient.
The key drivers of this reform were stated as: Local Government and Public Involvement in Health Act 2007, Local Area Agreements, Vital Signs (these are the criteria the Department of Health have for a good PCT), Joint Strategic Needs Assessments (what?), Operating Frameworks, Local Delivery Plans. I know what some of these are – the rest I will ask about as I go along.
They need the third sector: to deliver information for their needs assessment and to deliver care that the nhs cannot provide because a) it is too innovative and b) they cannot get that close to the user to provide appropriate care.

And now for the bit that made real sense in terms of what we need to achieve locally:

We now have a district-wide PCT with overall goals agreed with central Government (35 agreed targets out of a Government menu of 198 to choose from). Within the PCT, however, there are 'divisions' which ironically in Bradford are along the same lines as the old PCT boundaries. Each division sets its own key priorities according to its population mix. Checking through the divisions in Bradford and Airedale PCT, 2 of the divisions have priorities/targets around maternal and child health. It is worth checking what the stated health priorites of your PCT are, and its individual divisions.

Third sector groups can tender to do work that fulfills these priorities and targets. There is a big recognition of social needs and there was much reference to 'social 'prescribing' recognising that social situations affect peoples health and health choices (or non choices) and that third sector organisations in the community can have a positive effect especially here. (YES I know this has been said before but lets take them at their word and demand delivery)

There is a cycle/process to arriving at these priorities and this is a key to us effecting policy and priority decisions. The starting point in the cycle is the 'needs assessment' that is assessment of the needs of the population. How is this done? By the old fashioned networking method - commissioners talk to people they know, who are recommended to them, who turn up on their doorstep. they go to community and neighbourhood forums. At Practice level commissioning is also very much about what GPs get coming through their surgery doors. This work is combined with national health frameworks and priorities coming from central Government. Mixed together, these ingredients are formed into local priorites and targets which form the basis of the commissioning process.

Once the priorities are set the PCT welcomes agencies to approach them and tender to do work to fulfil certain priorities - this can be about medical and social need. The amounts tendered for can be small eg. £5000 or huge, say £145 000. It is a three year cycle to provide stability of care to the patient and funding for the organisation.

The key thing for us is to get in there at the needs assessment stage, getting commissioners to talk to groups of women and understand their experience - I keep banging on about one mother one midwife for instance. This is the key as I understand it, users need to voice their needs loud and clear to the PCT because the Government is telling them that they need to be sensitive to the needs of users. Even if you have appeared to miss the initial needs-priority-commissioning faze, we were assured (on questioning) that the needs assessment is ongoing - so get in there girls!!!!

How do we get in there? I think the answer is any which way you can or want. For instance, at the event I went up to the Head of Partnership Commissioning (I think that includes third sector) and asked him for the names (and spellings) of every commissioner who had responsiblity for maternal and baby welfare, childbirth and breastfeeding. What was clear was that childbirth issues are spread around alot of commissioners - which can be looked on as a problem, a challenge or an asset - because you can work with the ones you can work with. My aim is to write to them all in the next couple of weeks to see if I can kickstart some progress on needs assessment that talks to users.

My question in regard to childbirth issues to everyone I speak to is: What is current user involvement in commissioning services? Where is the needs assessment being done? How can users get involved? Where I am asking the questions - there is some interesting responses - I guess because there is no significant user involvement. I don't think they know how and where to begin in involving users at this stage - so maybe we need to approach them and start offering them some solutions? This is what the PCT commissioners were saying to us – we need your input, your information to make the process sensitive to people’s needs.

This is a very potted assessment of commissioning based on a seminar in Bradford, however, it comes it simpler terms than what I received it! Hopefully it gives a flavour of what may be going on in your area. I would strongly suggest getting in there and asking around and finding out the names and contacts of commissioners responsible for childbirth issues and start approaching them. Users need to say what they want and independent midwives need to look at how they can tender for services not being currently rendered. It is a steep learning curve - but in a new system we can start to define and challenge how it works by using it.

As always, it needs to be fun. Getting all those names out of that guy was fun. by the time he had finished he had a twinkle in his eye as I had in mine - he knew what I was up to and he knew I meant business. And it amused both of us. Result! He also told me that a piece of work was being done on needs assessment in childbirth at the present time - finishing in October. A good time to get in there then - and all this was achieved with a twinkle in the eye, a smile and a bit of cheek.

Ruth Weston is a mother of five children who runs her own business, building, hiring and selling pools. She is passionate about giving her daughters the opportunity of giving birth at home with a midwife they know, without a fight or a campaign. contact her at ruth@aquabirths.co.uk or sign up to her email newsletter ‘Choices in Childbirth’ at www.AquabirthsATHome.co.uk . for more information on the postcard and other national campaigns see www.saveindependentmidwfery.org

The roller coaster

There I was doing my bit and wondering whether it was going anywhere and then - whoosh!, swept off my feet and carried along by a tide of things. Can't tell you them all because I don't keep a diary and I would need to post every day.

Last Tuesday it was the Choices group - an information and support for parents having babies who are looking for natural options for birth. Midwives come along too and one took away 20 postcards for her surgery - I had already got the GP at her practice to sign a card.

Wednesday I was on Radio Leeds - fluffed promotion of the campign here because was having a hilarious time - and that is the point really of the show and you get to fly your flag in return for making a fool of yourself - which i am pretty good at. But did talk alot about normal birth, being in control, birthstory of no. 5 and placenta curry . . . .does anyone have any recipes? And we got asked back and booked in for September so good work there.

Thursday it was Cash for Trash on TV where I took leave of my senses and de-cluttered my home on camera for charity and a family holiday - and to promote AIMS. Wish the postcard campaign had been going but there again they did not like controversial - we had to clothe it appropriately to make it palatable. Can see it still on BBC website iplayer - well at least until Thursday.
Thursday, wondered whether I had really pushed it too far in my candid reflection on the discusssion of the women who had attended the Choices meeting - to the head of midwifery. But women do need professionals to take account of and actually fully respect our perspectives because after all we live with the consequences of what happens like no one else does. Anyway her reply today showed her to be the big person she is and maybe there is a way to take things forward.
Friday went to the AIMS national committee and handed over most of the Cashfor Trash money and found myslef volunteering to do stuff - ahgg! where is the time? I need a couple of lifetimes to do what I want to do.

I spent the weekend falling asleep all over the place utterly exhausted but managed to drag myslef to a friends welcome to the the world party for babe. it was worth it - she took 50 postcards off me and told me that her hubby had met the PCT commissioner and told her in no uncertain terms why they had opted to pay for midwi
fery care rather than use the local nhs for babe no. 4.

and now the week begins again.

Years ago I remember a colleague telling me that you can only see about 10% of what needs to be done and the possiblities there, and of that you can only humanly manage 2%. As I strain to do yet more for the cause I am so passionate about I have to keep reminding myself of those words and chill a bit. My faith would ask me to call on the communion of saints - we are part of a team - they would say. Hmmm something to reflect on . . .

"No cause was ever won . . ."

This has been a challenging week and I thought I would not achieve anything for the postcard campaign. It was the second week of the children's school holidays with David and I taking shifts to cover a busy office and childcare. That was difficult enough but then suddenly we could download no Aquabirths emails - a bit of downer when it is your business and your main means of communication. And then the 'crowning turd in the waterpipe': David's computer died taking all his emails with it. I looked at the 1950 postcards and was defeated by the enormity of the task in the face of the sludge of life.

When I feel like this I always think of that amazing woman, mother and suffragette. Born into a poor farming community in 1871 and living and working in the northern industrial towns. Despite working long hours, she educated herself and became involved in the suffragette movement and political justice campaigns of the time. Hannah knew what it was like to be a working Mum working for social change. She once said: "No cause was ever won between dinner and tea, and those of us who were married had to fight with one had tied behind our backs . . . ."

And then I know that, it has always been the same. Attending meetings with a child on the hip and another sat on the floor next to you. Fitting your day between school runs, tea time, bedtime. Writing and organising with constant interruption from life and children. I remember realising I could not even have a baby without planning around such things! 4 days overdue with my 5th child I realised this baby could only be born between 9.30am-2.30am and 8.30pm and 6am, because David had to be available to do the school run!

But in the midst of despair the tide turned: I got a phone call from Radio Leeds, would I like to come on an evening chat show and talk about the latest stuff going on in my life - would I! And a local GP signed a card and said he would be happy for me to have them displayed at his surgery - mind you i want more than that - he is an active Lib Dem - and what is the Lib Dem's policy on Maternity Matters implementation? independent midwives? and how do I get the message across to the PCT? And finally next week I am de-cluttering my home on TV to promote AIMS, Thursday, BBC1 11.30am. I wish I had had the postcards when they were filming that - mind you they were jumpy about anything 'controversial' - but it provides another excuse to talk.

Now for rhubarb crumble and tending Stan's 'hurtie foot'! " No cause was ever won . . . .

Hannah Mitchell quote in 'Women and Politics' by Ann Kramer, Wayland 1988 - a book that ever girl should read, or have read to them.

Summoning up the apathy

Is it the time of the month? It could be. But that usual bounce at the end of a holiday with new ideas and new energy for exciting things is not there. I think of that box of 2000 postcards - now less 50 - and groan. What did I say I would do with them all? The thought of accosting 800 people for postcards makes me want to hide under the duvet and sleep for a thousand years.

I know that energy and enthusiasm go in cycles, menstrual cycles as often as not, but it is still depressing when it happens!

Still tomorrow is another day and latest steps forward are:
Visited head of midwifery at local trust, told her about the postcards - she wanted to see some so dropped off 20, this maybe just the start. Told her about the Rikki Lake documentary: the Business of Being Born and wondered if we could have a showing in the Lecture Theatre there. It would be another way of stimulating a discussion about what kind of maternity services we want - 'not a bad idea' was the response. So plans are afoot to bring the film into the heart of West Yorkshire - watch this space. I notice that Denis Walsh is going to the showing in blackburn - so it is a quaestion of what we do for ours?

And that is the best enthsuiasm I can muster - until tomorrw perhaps - but not bad eh?

To learn more about the postcard campaign visit www.saveindependentmidwfery.org or sign up to the monthly Choices in Childbirth e-newsletter on www.aquabirthsathome.co.uk ]
Business of Being Born: for preview and national showings go to saveindependentmidwifery.org

A stab in the dark

10 more postcards in the box today but need to do another big push this week. Some of the student midwves have really got the bit between their teeth - hoping I get a good few from them. Meanwhile await couriers and delivery of more postcards as have about 50 left out of the 500 sent so far. that works out about 1 in 5 coming back to me to give to the chief exec in person.

Anyway it is late and the real reason for this blog is to tell you what I did today. I found a piece of paper buried on my desk with a contact on it with PPI on it. I rmembered I had been given this contact ages ago at a woman's event at the Born in Bradford stall where as usual I was sounding off on the need for some qulity midwfery care in Bradford - the research is there we just need action! I was not really sure who I was emailing - was it the NHS Trust or the PCT contact I had been given and what does PPI mean. Anyway I took a deep breath and emailed a general concern and asking how her department might work to help mums. She emailed back promptly with concern and forwarded me to the head of midwfery and PALS - having been around that track already I went back to her with genuine thanks for her response but saying:

"Thankyou or your kind and prompt response.
However, I am already in touch with Julie and indeed with others within the Trust regarding the lack of midwives and the standards of care that are resulting. There is however a resource issue which goes beyond PALS and the Maternity Services Management team and is about the commissioning and priority of services for mothers. This is the level at which we seem to be stuck at the moment and I am wondering how PPI may enable mothers like myself to be involved. Are mothers involved/participating in the commissioning and shaping of maternity care in Bradford? And how do they get to effectively participate? This is perhaps the key question needing an answer."

And the answer I got? "Hi Ruth, You're welcome. You have raised some excellent issues. I will be in contact with you in the very new future to discuss how we can work together to enable PPI to be successful in this area."

Fab. And I can follow up on this in a few weeks if I hear nothing.

Sometimes a stab in the dark works . . . . .

See yous all later

Getting started

As I found myself telling another poor soul in an email about the latest step forward/back in my personal campaigning - just because I needed to tell SOMEONE, I thought maybe it is time to start a blog. Then no one person bears the burden of my story but anybody can. This then is a very personal account of a very personal journey and in no way does it necessarily reflect the views and opinions of the campaign groups I am part of.

This is a blog to inform, encourage, to inspire and to commiserate, with a mother who wants to leave the world a better place by giving my daughters the freedom to birth surrounded by love, at the time and place of her choosing and that of her baby. And while we are on the subject of dreams I want my daughters to have midwives who they know and trust through pregnancy, through labour and postnatally. And those midwives to be part of a truly independent professional service acknowledged and respected in the health service as the specialists in normal birth. We will have obstetric nurses - but that is what they will be called, not midwives. Midwives will be serving the interests of the mother not the doctor.

Slowly and incrementally I have been drawn into campaigning for all women to have proper midwifery care, a real choice about where and how they have their baby. Today women can choose to have a hospital birth and a medical birth - this is the default in many areas. In Bradford where I live, for instance, homebirth is a 'bolt on' extra - even though I am half as likely to have a Caesarean and reduce the chances of a serious infection for me and my baby - we can only have a home birth if staff are available. And continuity of care here is a joke, the nearest most women get to their midwife is knowing her name and having her team's mobile number.

After I took over Aquabirths I began to realise that it was not just me that was struggling for the care and choices I needed. This was happening over and over again, we were being picked off woman by woman, birth by birth, and my feminist hackles rose: there was a historical patten being played out here. The feminism of the 20ies brought universal suffrage, the feminism of the sixties paved the way for equal employment rights and equal opportunities for women, but here in the new millennium we still have a misogynist maternity system, designed and largely controlled, by medical men with a mechanistic and a narrowly medical understanding of both women and birth. And much practice is not even scientifically based; as my husband is wont to comment - "Don't let science get in the way of medicine!"

And because the personal is political and my births became the political football of the local Trust, and because although we need to think global we must act local, I am finally admitting to the world and myself that yes I am a mother and I am campaigning for change in Bradford, in the UK and if possible the world (there is nothing like aiming high!). And yes I have been doing it for years but now I am out in the open, the head clearly raised above the parapet, and campaign postcards in hand marching towards the chief exec of the local PCT, the latest focus of our attention.

That is more than enough from me for one night. So for more information on the postcard campaign go to www.saveindependentmidwfery.org