This story tells the world why we need professional independent midwves who are with woman and not with the medical systems. Read and be inspired! Then go to www.independentmidwives.org.uk/?node=8765 to find out what you can do to save them.
"Having Michelle there gave me confidence and she did that through allowing me to birth my own way, to be the expert on my own body and not taking that body and not taking that power away from me. "
Birth Story – Owen Conor
Ok, some back story to my choices. My first son was a planned homebirth. He had been three weeks late and I had a real battle with the NHS. I had a really positive 1st stage but a difficult second stage due to him being back to back with the cord wrapped twice around him. I went into hospital afterwards as his apgars were low and it was the most horrendous experience and made me vow to never go in again!
This time round I decided to take no chances with the NHS and booked an independent midwife. Michelle is the most amazing woman, experienced, knowledgeable, calm, confident and utterly convinced that women will labour instinctively and positively if allowed to do so.
Michelle visited the day before Owen was born and we joked that I had decided to labour the next day, after breakfast, and be done before Niall’s bedtime so he could meet his baby brother.
The next morning was a beautiful sunny Saturday. We all got up, had breakfast together and began to potter. At around 10am I had a brief achy feeling in my lower back which made me stand up. I got a few more of these before starting to experience some random tightenings with mild cramps. This made me really hopeful, but I tried not to get too excited. Just after noon we went for a walk to the local shop and they became more frequent, between 5-7 minutes apart but not very intense. I phoned Michelle to let her know that things were starting and agreed to ring when they were more regular. Dermot began assembling and filling the pool and I put the TENS on.
I then started reorganising my kitchen in between contractions! My friend Debbie popped over and joined in with me. Niall went over to a neighbour’s house to play. By 2pm the surges were becoming more intense and regular – every 5 minutes and by 3pm I was making low noises and concentrating with each one. I rang Michelle who said she’d be straight over and then put on some music. At this point I just started dancing. I had a playlist with lots of stuff like Faithless, Basement Jaxx, Chicane, Moby etc. It felt so right just to be dancing round the kitchen, swaying my hips. I had my clary sage oil burning on the work top and bent over that rotating my hips to each contraction, then carried on dancing. I would recommend this to anyone especially as I was later told that belly dancing was originally a birth dance! My system was flooded with endorphins and I felt so high. Both Debbie and Michelle had a dance with me before Debbie went home.
At around 6pm the surges started to be felt more in my lower back and I was asking Michelle and Dermot to put counter pressure to the base of my spine – heaven! At 6.25pm I decided to get in the pool. The warm water was lovely and I got on all 4 fours swinging my hips and lowing with the surges. Both Michelle and Dermot continued with the counter pressure, putting their full weight into it. I’m surprised I’m not bruised back there! Derm told me at one point he released pressure to change position and I growled at him ‘BACK!’ It was the voice of command apparently.
I soon began to feel mounting pressure as Owen began to descend, I stayed very relaxed and made positive noises, saying ‘yes’ and other words of encouragement. My waters eventually went in the pool at 6:55 and were clear. Over the next 15 minutes I could feel Owen’s head moving down and at 7:10 I could feel the top of his head with my hand. The contractions were now very strong expulsive ones and I knew with some help from me I could birth him quickly, however, I was conscious of not wanting to tear and took it very slowly. I talked to him all the way through, telling him what a good boy he was and how well he was doing and what I was doing. I went easy on the next few contractions, easing him out slowly and holding the top of his head. I pushed the sides of my labia over his head and felt him crown. I remember telling him over and over ‘it’s ok’ and I was also telling myself, reminding myself not to panic but to stay calm and relaxed. Two minutes later the next contraction moved his head out and with the next one he was born. He did a bit of a corkscrew and shot out. Michelle pushed him back between my legs and I lifted him out of the water for his first cuddle! Michelle and I blew on his face and talked to him as he cried and gasped a couple of times before breathing and pinking up.
10 minutes later Niall came home and met his little brother for the first time. He seemed quite impressed! Owen and I stayed in the pool together for another hour. Owen latched onto my breast like a pro and had a good half hour feed. At around 8:30 I had still not birthed the placenta and was having lots of cramps. Dermot cut the cord once it had stopped pulsating and had his first skin to skin cuddle with his new son. I eventually turned onto my back and manually removed the placenta. It slid free with a little pressure on the cord. I then got out of the pool to be checked over by Michelle. Owen was weighed and surprised us all by being 9lb 6oz! We’d all guessed lower. Niall’s grandparents took him to theirs for the night and Dermot and Michelle emptied the pool whilst I had a well earned glass of fizz! We were then tucked up in bed together with our little treasure to spend the first of many sleepless nights.
All in all I could not have wished for a better birth experience. I had one small 2nd degree tear but it’s healing nicely on its own. I felt happy and relaxed throughout and this is what made it so manageable. Having Michelle there gave me confidence and she did that through allowing me to birth my own way, to be the expert on my own body and not taking that power away from me. She checked Owen’s heart rate periodically but that was the extent of her intervention (besides the counter pressure).
I would advise anyone wanting a natural birth to look at hiring an independent midwife, they are fantastic. I had great care from the team at Yorkshire Storks throughout my pregnancy, a wonderful birth experience and the post natal care has been outstanding. Michelle made me stay in bed for a week after the birth, and despite my initial reluctance I am so glad I listened. 3 Cheers for babymoons!
Rhian
Michelle can be contacted via Yorkshire Storks Midwifery Practice http://www.yorkstorks.co.uk/ or telephone 01423 360 460
Tuesday, 7 July 2009
Have your say! (Again)
This is another consultation that the Government has put out about 'nursing and midwfery'. Don't fret, mothers, just put in your workbasket, get some needles and some brightly coloured wool and knit your response. We have until 10th Augst (and beyond) - so hit the link and say what you think! Love to you all!
Ruth
Commission on the Future of Nursing and Midwifery
Core Script - June
The Prime Minister launched the Commission on March 10, 2009. It will report by March 2010. It covers England, and considers midwifery and all branches of nursing, in all settings, services and sectors. Partly in recognition of her previous experience in nursing practice, management and leadership, Ann Keen MP was asked to chair the Commission in her current role as Health Minister. The Commission is made up of 20 leaders in nursing and midwifery practice, management, education and research.
Lord Darzi in High Quality Care for All rightly identified nurses and midwives as key to providing quality care. The Commission has been set up to ensure that frontline nurses and midwives have the support, skills, and competencies that they will need to design and deliver 21st century quality services for those that are in need of health and social care and to promote health and well-being.
The Commission has been asked by the Prime Minister to:
· identify the competencies, skills and support that frontline nurses and midwives need to take a central role in the design and delivery of 21st century services for those that are sick and to promote health and well-being. In particular, to identify any barriers that impede the pivotal role that wards sisters/charge nurses/community team leaders provide.
· identify the potential and benefits for nurses and midwives, particularly in primary and community care, of leading and managing their own services.
· engage with the professions, patients and the public in an interactive and robust dialogue which will identify challenges and opportunities for nurses and midwives.
Commissioners will also receive advice from expert advisors in relation to specific aspects of their work including independent sector, workforce planning, regulation and international perspectives on human resources issues.
The Commission met for the first time on the 28th April and considered how the NHS Constitution linked to the role of nurses and midwives, identified their priorities for the coming months and agreed that the first phase of their work would be to kickstart a process of listening to the views of the NHS, patients, public and wider stakeholders.
The Commission met for the second time on 2nd June and discussed patients’ views of nursing and degree-level nursing registration.
Commissioners agreed to form five workstreams to take their discussions forward. Workstreams, which will be led by Commissioners will focus on: quality and innovation, the vision and image of nursing and midwifery, the socioeconomic case for nursing and midwifery, helping and hindering forces, and workforce and leadership issues. (The attached table shows which Commissioner will be leading and working on each workstream.)
The first phase of the Commission’s work is to engage with the public, patients, professions and organisations to hear their views on the what the challenges and opportunities will be for nurses and midwives in the 21st Century.
The Commission will work with an external agency (Opinion Leader Research) to shape the engagement process, which will include national events, events hosted by the NHS/organisations, to engage patients, the public and voices from seldom heard groups.
As a first strand of this engagement the Commission has launched a call for the views of patients, the public, staff and organisations.
Questions centre on:
1. What are the knowledge, skills and attributes that nurses / midwives require to take a central role in the design and delivery of 21st century services?
2. What would you like to see nurses and midwives doing more of and/or doing differently in the future - whether in people’s own homes, in the community or in hospital?
3. What might be preventing nurses and midwives from doing this now?
4. How can these barriers be overcome?
Members of the multidisciplinary team or those who have particular expertise are also being asked their views on:
5. What is the potential for, and benefits of, nurses and midwives leading and managing their own services and the framework and support that would be needed to for this in the context of the multi-disciplinary team?
People are encouraged to submit their views via the website at: http://www.cnm.independent.gov.uk/ although views can also be submitted via email to contact@cnm.independent.gov.uk or by post to the Commission on the Future of Nursing and Midwifery, Room 159, Department of Health, 79 Whitehall, London, SW1A 2 NS. Views are sought by the 10th August.
This date will not be the end of dialogue, however. All responses will be studied and will inform the Commission’s key messages. We will check these messages back through the website, public events and the media to see whether we have got them right, which in turn will shape our final recommendations to the Prime Minister.
Composition of Workstream Groups
Title
Lead Comm
Other Comm
1 Quality and Innovation
Janice Sigsworth
Peter Carter, Claire Rayner, Tamar Thompson
2 Vision & image
Eileen Sills
Dawn Chapman, Anne-Marie Rafferty, Laura Serrant-Green
3 Socio-economic case
Ray Walker
Judith Griffin, Heather Lawrence, Kathy Warwick
4 Helping and hindering forces
Gail Adams
Liz Fradd, Donna Kinnair, Jo Pritchard
5 Workforce and Leadership
Audrey Emerton
Chris Beasley, Sue Bernhauser, Kuldip Bharj
Lines to take written by the sender not by me:
We’ve just had High Quality Care for All, why do we need another review?
Lord Darzi rightly identified nurses and midwives as being key to providing quality care, and the Commission has a timely opportunity to take a longer-term view on how we can ensure that the nurses and midwives of the future will be trained, and supported by the whole healthcare system to continue to provide quality care in the future.
How can I get involved?
We want to hear your experiences of nursing and midwifery. We want to hear your views on what makes a good nurse/midwife. We want to hear your thoughts about how the role or nurses and midwives should change in the future. Please go to www.cnm.independent.gov.uk today to get involved.
What will it achieve/what difference will it make to nurses?
The Commission will ensure that frontline nurses and midwives in the future continue to have the support, skills, and competencies that they will need to design and deliver 21st century services for those that are sick and to promote health and well-being.
What difference will it make to patients?
As set out in the new NHS Constitution, patients have a right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality. The Commission will look to the future to ensure that in the future the NHS fulfils this right to patients by ensuring nurses continue to have the support, skills, and competencies that they will need to design and deliver 21st century services for those that are sick and to promote health and well-being.
For more about this see the July choices mailing at http://www.aquabirthsathome.co.uk/. You can also sign up for the monthly Choices e-newletter
Ruth
Commission on the Future of Nursing and Midwifery
Core Script - June
The Prime Minister launched the Commission on March 10, 2009. It will report by March 2010. It covers England, and considers midwifery and all branches of nursing, in all settings, services and sectors. Partly in recognition of her previous experience in nursing practice, management and leadership, Ann Keen MP was asked to chair the Commission in her current role as Health Minister. The Commission is made up of 20 leaders in nursing and midwifery practice, management, education and research.
Lord Darzi in High Quality Care for All rightly identified nurses and midwives as key to providing quality care. The Commission has been set up to ensure that frontline nurses and midwives have the support, skills, and competencies that they will need to design and deliver 21st century quality services for those that are in need of health and social care and to promote health and well-being.
The Commission has been asked by the Prime Minister to:
· identify the competencies, skills and support that frontline nurses and midwives need to take a central role in the design and delivery of 21st century services for those that are sick and to promote health and well-being. In particular, to identify any barriers that impede the pivotal role that wards sisters/charge nurses/community team leaders provide.
· identify the potential and benefits for nurses and midwives, particularly in primary and community care, of leading and managing their own services.
· engage with the professions, patients and the public in an interactive and robust dialogue which will identify challenges and opportunities for nurses and midwives.
Commissioners will also receive advice from expert advisors in relation to specific aspects of their work including independent sector, workforce planning, regulation and international perspectives on human resources issues.
The Commission met for the first time on the 28th April and considered how the NHS Constitution linked to the role of nurses and midwives, identified their priorities for the coming months and agreed that the first phase of their work would be to kickstart a process of listening to the views of the NHS, patients, public and wider stakeholders.
The Commission met for the second time on 2nd June and discussed patients’ views of nursing and degree-level nursing registration.
Commissioners agreed to form five workstreams to take their discussions forward. Workstreams, which will be led by Commissioners will focus on: quality and innovation, the vision and image of nursing and midwifery, the socioeconomic case for nursing and midwifery, helping and hindering forces, and workforce and leadership issues. (The attached table shows which Commissioner will be leading and working on each workstream.)
The first phase of the Commission’s work is to engage with the public, patients, professions and organisations to hear their views on the what the challenges and opportunities will be for nurses and midwives in the 21st Century.
The Commission will work with an external agency (Opinion Leader Research) to shape the engagement process, which will include national events, events hosted by the NHS/organisations, to engage patients, the public and voices from seldom heard groups.
As a first strand of this engagement the Commission has launched a call for the views of patients, the public, staff and organisations.
Questions centre on:
1. What are the knowledge, skills and attributes that nurses / midwives require to take a central role in the design and delivery of 21st century services?
2. What would you like to see nurses and midwives doing more of and/or doing differently in the future - whether in people’s own homes, in the community or in hospital?
3. What might be preventing nurses and midwives from doing this now?
4. How can these barriers be overcome?
Members of the multidisciplinary team or those who have particular expertise are also being asked their views on:
5. What is the potential for, and benefits of, nurses and midwives leading and managing their own services and the framework and support that would be needed to for this in the context of the multi-disciplinary team?
People are encouraged to submit their views via the website at: http://www.cnm.independent.gov.uk/ although views can also be submitted via email to contact@cnm.independent.gov.uk or by post to the Commission on the Future of Nursing and Midwifery, Room 159, Department of Health, 79 Whitehall, London, SW1A 2 NS. Views are sought by the 10th August.
This date will not be the end of dialogue, however. All responses will be studied and will inform the Commission’s key messages. We will check these messages back through the website, public events and the media to see whether we have got them right, which in turn will shape our final recommendations to the Prime Minister.
Composition of Workstream Groups
Title
Lead Comm
Other Comm
1 Quality and Innovation
Janice Sigsworth
Peter Carter, Claire Rayner, Tamar Thompson
2 Vision & image
Eileen Sills
Dawn Chapman, Anne-Marie Rafferty, Laura Serrant-Green
3 Socio-economic case
Ray Walker
Judith Griffin, Heather Lawrence, Kathy Warwick
4 Helping and hindering forces
Gail Adams
Liz Fradd, Donna Kinnair, Jo Pritchard
5 Workforce and Leadership
Audrey Emerton
Chris Beasley, Sue Bernhauser, Kuldip Bharj
Lines to take written by the sender not by me:
We’ve just had High Quality Care for All, why do we need another review?
Lord Darzi rightly identified nurses and midwives as being key to providing quality care, and the Commission has a timely opportunity to take a longer-term view on how we can ensure that the nurses and midwives of the future will be trained, and supported by the whole healthcare system to continue to provide quality care in the future.
How can I get involved?
We want to hear your experiences of nursing and midwifery. We want to hear your views on what makes a good nurse/midwife. We want to hear your thoughts about how the role or nurses and midwives should change in the future. Please go to www.cnm.independent.gov.uk today to get involved.
What will it achieve/what difference will it make to nurses?
The Commission will ensure that frontline nurses and midwives in the future continue to have the support, skills, and competencies that they will need to design and deliver 21st century services for those that are sick and to promote health and well-being.
What difference will it make to patients?
As set out in the new NHS Constitution, patients have a right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality. The Commission will look to the future to ensure that in the future the NHS fulfils this right to patients by ensuring nurses continue to have the support, skills, and competencies that they will need to design and deliver 21st century services for those that are sick and to promote health and well-being.
For more about this see the July choices mailing at http://www.aquabirthsathome.co.uk/. You can also sign up for the monthly Choices e-newletter
Wednesday, 3 June 2009
Because of those hands . . .
Birth Matters made by Dr Nadine Edwards is an immensely moving montage of pictures, quotations and music which communicates the importance of treating birth with care and compassion. As I watched the film I read the words:
"Birth is not just about making babies
but about making mothers
strong competent mothers"
And I heard and saw no more as I was caught up in the powerful memory of the birth of my second child and the photograph I have of those hands - my midwife's hands. And then I wrote:
Because of those Hands
Dear Madge,
I will never forget you taking me by the hands, looking me straight in the eyes and saying, "We are going to do this, woman to woman!" And we did. You will never know how much strength and confidence you gave me to birth my first son. And what a healing birth that was.
I do what I do now because of your hands.
Thank you Madge Boyle.
To find out more about 'Birth Matters' or contact Nadine Edwards see her website: http://www.nadineedwards.org.uk or visit www.aims.org
As
"Birth is not just about making babies
but about making mothers
strong competent mothers"
And I heard and saw no more as I was caught up in the powerful memory of the birth of my second child and the photograph I have of those hands - my midwife's hands. And then I wrote:
Because of those Hands
Dear Madge,
I will never forget you taking me by the hands, looking me straight in the eyes and saying, "We are going to do this, woman to woman!" And we did. You will never know how much strength and confidence you gave me to birth my first son. And what a healing birth that was.
I do what I do now because of your hands.
Thank you Madge Boyle.
To find out more about 'Birth Matters' or contact Nadine Edwards see her website: http://www.nadineedwards.org.uk or visit www.aims.org
As
Friday, 22 May 2009
Questioning Nick Clegg
Just a quick missive to the world and my friends out there!
I managed it! I took my work basket to Idle Parish Church, BRADFORD, today, where, I learned, Nick Clegg, Leader of the Liberal Democrats was going to have a question and answer session. And I challenged him to do something for maternity services in this country.
I wanted my question to be well delivered and have maximum impact so I wrote out my question in advance. My question was the last one and I got a round of applause for asking it. the text is below.
And because questions at a public meeting like that are less about the response and more about raising an issue I have followed up our exchange with a letter reiterating the question. And for your interest and inspiration here it is!
If anyone out there is a Labour or Conservative Party supporter/member. Please go out there and do the same. It is not about changing the men in suits at the top of our country, it is about changing the way the political wind blows!
Ruth Weston
c/o Aquabirths
Unit 3, Carlisle Business Centre
Carlisle Road, BRADFORD
BD8 8BD
ruth@aquabirths.co.uk
07 824 990 345
Dear Nick,
I am writing to follow up on the question that I raised today regarding maternity issues at Idle’s Parish Church 22nd May 2009 (I was the woman with a purple cardigan!).
First of all, thank you for your time and discussion. I was most impressed. I wished I had brought my 14 year old daughter along who is talking of going into politics and would have enjoyed the exchanges. Another time.
In these sort of settings it is much more about asking the question rather than getting an answer and so I wanted to re-iterate my question so that I might have a fuller response from you (and the party) and that there might be a more comprehensive discussion of the matter.
My question is this:
Although the World Health Organisation recommends an 8-10% Ceaserean Section rate for 1st World countries, the UK figure as I saw it on Monday of this week, was 25% nationally.
Although Ceaserean Sections cost around five times more than a Homebirth, and research ( in UK of 5000 births) shows that a woman is HALF as likely to have a CS if she books for a homebirth (even if she subsequently births in hospital), homebirths are actively discouraged in many parts of the country and women give birth in high risk, high intervention obstetric units.
Although research shows One Mother One Midwife Care reduces length of labour, pain experienced by women, intervention rates, Postnatal Depression, and increases normal birth rates and the likelihood of a woman breastfeeding; midwifery care has deteriorated so much that women in Bradford for instance can see a different midwife at each appointment and receive conveyor belt care in hospital.
Although the only alternative to accepting this kind of care is employing an Independent Midwife (we hired one for our fifth child, the cost was 15% of our small income and worth every penny!) this Government is outlawing them by the back door by insisting they have insurance but not providing the means to obtain it.
Birth and maternity issues are not just a woman’s issue but an issue that effects the whole community – a good or bad birth and good and bad maternity care can have profound effects on the wellbeing of mother and baby, her husband and family. Through the knock on effects of community mental and physical health service provision and social security this issue affects us all.
I am therefore asking what you, Nick, and the Liberal Democrats of which I am a member, are going to do about this.
Obviously this was a complex question for you to answer at the time but I just want to pick up on a couple of points you made to feed into your more considered response:
I do advocate homebirth but the point I am making is not really about homebirth per se but the lack of healthy choices women have when giving birth. It is less healthy for healthy women to give birth in an obstetric unit than to give birth in a stand alone birth centre or at home. Yet most healthy women in our PCT area as well as many parts of the country do not have (in reality) the choice of having either a homebirth or a birth in a midwifery-led or independent ( from the obstetric unit) birthing centre.
You spoke the system not being set up for homebirths – and this will take time to sort. I agree but there are two immediate actions that can take place:
1) The current ‘tariff’ system rewards high CS rates as it is based on the cost of the procedures – rather than being paid on population risk and rewarding higher normal birth rates. This means that Trusts who do fewer CS and more homebirths get paid less, although the Trust is saving us a lot of money and sparing hundreds of women and babies the trauma of an unnecessary major operation. We need to reward Trusts for promoting normal birth.
2) The Independent Midwives Association have put forward the Community Midwifery Model (cf.http://www.independentmidwives.org.uk/?node=8766) as a model that can run alongside current NHS provision which enables women to choose midwifery-led, low intervention care from a known midwife. As a user this system is particularly attractive because the money follows the woman – not the procedure putting her at the centre of care rather than where she is now – at the bottom of the hierarchy. I would commend this model to become a central plank of Lib Dem maternity policy. It is not as radical as changing to election by proportional representation!
You spoke of the dangers of homebirths being advocated where the system and training is not in place and implied ‘it would be dangerous to advocate homebirths until the system can bear it’. I would warn that as the system deteriorates further and the option to engage an Independent Midwife is closed, women will take the matter into their own hands and will opt out of the system altogether and free birth (birthing without a trained professional present). The movement is growing in the US and is already in evidence in the UK, masked by I suspect (but I do not have the evidence as yet) a rising rate of ‘Born Before Arrival’s’ where the midwife is called ‘too late’. I know this is happening now. If women cannot choose to have the birth and care they want within the NHS a small but growing number WILL free birth – this is the danger of not providing low tech compassionate care for birthing women where they need/want it.
Finally, in the light of the above, we urgently need YOU to take action to save my fabulous Independent Midwives from being outlawed by a crazy policy which insists they have insurance but makes no provision for it. The current insurance system for midwifery is a mess as it is mixed up with obstetrics (the care of abnormal births) where the highest claims are made. Independent Midwives are poorly paid, highly committed, highly competent professionals and I find it immensely upsetting to see them once again treated in this way whilst consultants continue to work privately and lucratively with NHS insurance. Patriarchy and discrimination are therefore, still in evidence in our maternity services. With this point in particular I would like your urgent attention.
I speak as a mother of five children born in Bradford, and a user of maternity services. I speak also as someone who lives and is active amongst our diverse community in Bradford, is a Bradford Breastfeeding Peer Supporter and Trainer and the Acting Chair of the Maternity Services Liaison Committee. I want answers to my questions (and I raise these regularly with the local Trust and PCT) but I also want to be part of the solution – and offer that to you as someone with an interest and expertise in the subject.
With every good wish and looking forward to being in contact
Ruth Weston
ruth@aquabirths.co.uk
07 824 990 345
Unit 3, Carlisle Business Centre, Carlisle Road, BRADFORD, BD8 8 BD
I managed it! I took my work basket to Idle Parish Church, BRADFORD, today, where, I learned, Nick Clegg, Leader of the Liberal Democrats was going to have a question and answer session. And I challenged him to do something for maternity services in this country.
I wanted my question to be well delivered and have maximum impact so I wrote out my question in advance. My question was the last one and I got a round of applause for asking it. the text is below.
And because questions at a public meeting like that are less about the response and more about raising an issue I have followed up our exchange with a letter reiterating the question. And for your interest and inspiration here it is!
If anyone out there is a Labour or Conservative Party supporter/member. Please go out there and do the same. It is not about changing the men in suits at the top of our country, it is about changing the way the political wind blows!
Ruth Weston
c/o Aquabirths
Unit 3, Carlisle Business Centre
Carlisle Road, BRADFORD
BD8 8BD
ruth@aquabirths.co.uk
07 824 990 345
Dear Nick,
I am writing to follow up on the question that I raised today regarding maternity issues at Idle’s Parish Church 22nd May 2009 (I was the woman with a purple cardigan!).
First of all, thank you for your time and discussion. I was most impressed. I wished I had brought my 14 year old daughter along who is talking of going into politics and would have enjoyed the exchanges. Another time.
In these sort of settings it is much more about asking the question rather than getting an answer and so I wanted to re-iterate my question so that I might have a fuller response from you (and the party) and that there might be a more comprehensive discussion of the matter.
My question is this:
Although the World Health Organisation recommends an 8-10% Ceaserean Section rate for 1st World countries, the UK figure as I saw it on Monday of this week, was 25% nationally.
Although Ceaserean Sections cost around five times more than a Homebirth, and research ( in UK of 5000 births) shows that a woman is HALF as likely to have a CS if she books for a homebirth (even if she subsequently births in hospital), homebirths are actively discouraged in many parts of the country and women give birth in high risk, high intervention obstetric units.
Although research shows One Mother One Midwife Care reduces length of labour, pain experienced by women, intervention rates, Postnatal Depression, and increases normal birth rates and the likelihood of a woman breastfeeding; midwifery care has deteriorated so much that women in Bradford for instance can see a different midwife at each appointment and receive conveyor belt care in hospital.
Although the only alternative to accepting this kind of care is employing an Independent Midwife (we hired one for our fifth child, the cost was 15% of our small income and worth every penny!) this Government is outlawing them by the back door by insisting they have insurance but not providing the means to obtain it.
Birth and maternity issues are not just a woman’s issue but an issue that effects the whole community – a good or bad birth and good and bad maternity care can have profound effects on the wellbeing of mother and baby, her husband and family. Through the knock on effects of community mental and physical health service provision and social security this issue affects us all.
I am therefore asking what you, Nick, and the Liberal Democrats of which I am a member, are going to do about this.
Obviously this was a complex question for you to answer at the time but I just want to pick up on a couple of points you made to feed into your more considered response:
I do advocate homebirth but the point I am making is not really about homebirth per se but the lack of healthy choices women have when giving birth. It is less healthy for healthy women to give birth in an obstetric unit than to give birth in a stand alone birth centre or at home. Yet most healthy women in our PCT area as well as many parts of the country do not have (in reality) the choice of having either a homebirth or a birth in a midwifery-led or independent ( from the obstetric unit) birthing centre.
You spoke the system not being set up for homebirths – and this will take time to sort. I agree but there are two immediate actions that can take place:
1) The current ‘tariff’ system rewards high CS rates as it is based on the cost of the procedures – rather than being paid on population risk and rewarding higher normal birth rates. This means that Trusts who do fewer CS and more homebirths get paid less, although the Trust is saving us a lot of money and sparing hundreds of women and babies the trauma of an unnecessary major operation. We need to reward Trusts for promoting normal birth.
2) The Independent Midwives Association have put forward the Community Midwifery Model (cf.http://www.independentmidwives.org.uk/?node=8766) as a model that can run alongside current NHS provision which enables women to choose midwifery-led, low intervention care from a known midwife. As a user this system is particularly attractive because the money follows the woman – not the procedure putting her at the centre of care rather than where she is now – at the bottom of the hierarchy. I would commend this model to become a central plank of Lib Dem maternity policy. It is not as radical as changing to election by proportional representation!
You spoke of the dangers of homebirths being advocated where the system and training is not in place and implied ‘it would be dangerous to advocate homebirths until the system can bear it’. I would warn that as the system deteriorates further and the option to engage an Independent Midwife is closed, women will take the matter into their own hands and will opt out of the system altogether and free birth (birthing without a trained professional present). The movement is growing in the US and is already in evidence in the UK, masked by I suspect (but I do not have the evidence as yet) a rising rate of ‘Born Before Arrival’s’ where the midwife is called ‘too late’. I know this is happening now. If women cannot choose to have the birth and care they want within the NHS a small but growing number WILL free birth – this is the danger of not providing low tech compassionate care for birthing women where they need/want it.
Finally, in the light of the above, we urgently need YOU to take action to save my fabulous Independent Midwives from being outlawed by a crazy policy which insists they have insurance but makes no provision for it. The current insurance system for midwifery is a mess as it is mixed up with obstetrics (the care of abnormal births) where the highest claims are made. Independent Midwives are poorly paid, highly committed, highly competent professionals and I find it immensely upsetting to see them once again treated in this way whilst consultants continue to work privately and lucratively with NHS insurance. Patriarchy and discrimination are therefore, still in evidence in our maternity services. With this point in particular I would like your urgent attention.
I speak as a mother of five children born in Bradford, and a user of maternity services. I speak also as someone who lives and is active amongst our diverse community in Bradford, is a Bradford Breastfeeding Peer Supporter and Trainer and the Acting Chair of the Maternity Services Liaison Committee. I want answers to my questions (and I raise these regularly with the local Trust and PCT) but I also want to be part of the solution – and offer that to you as someone with an interest and expertise in the subject.
With every good wish and looking forward to being in contact
Ruth Weston
ruth@aquabirths.co.uk
07 824 990 345
Unit 3, Carlisle Business Centre, Carlisle Road, BRADFORD, BD8 8 BD
Thursday, 30 April 2009
A patchwork of political lobbying
The other week I got hold of the Green Party's policy on Maternity Care. I quite like it. however, I am actually a member of the Liberal Democrat Party - well on the very edges of it. Hmmm me thinks "I wonder what the Lib Dems are saying on the subject. And somewhat reluctantly (as I really have nothing else to do at all!) I must set about finding out what my party says, with a view to scrutiny, comment and lobbying for change.
Seeking change within political party structures is not something all of us can or want to do - but some of us need to do it. It is part of the strategy for change. We need to build a patchwork banner, mother led, midwife empowered, created from the experience of us all, sewn with love and compassion for ourselves and our families. And it needs to be so large and enveloping that wherever our country's leaders turn they will see another segment of our calls for care and compassion to our birthing sisters and daughters.
Writing letters, sending emails, asking questions, reading policy documents all felt so drab until a minute ago when I began to weave in womanly terms the work we need to do. It takes it from my crowded desk and puts it in my work basket overflowing with yarn and potential!
the lobbying of political parties needs to be done to keep our births safe after the next election. And to do it and do with it creatvity energy love and flair we need to think of this work in different terms: I need to think of it in different terms: not another policy document to read but a patten weaved, not a letter written but a piece of fabric linked in.
And so, with renewed vigour, I invite you to read the Green Party maternity care policy below with a view to using it as a lever to lobby for better maternity services in the political landscape you are situated whether from within or without a political party or pressure group, whether it be locally or nationally. Let us use all the tools in our work basket to change the patten of birth.
Green Party Policy:
SYNOPSIS
In 25% of NHS trusts, intervention rates are double the targeted
level. Lack of continuity of care, a shortage of midwives and
consultants and beds contribute to high death rates and threaten
mothers' and babies' health. About 11 million UK women have suffered
post-birth trauma.
MOTION
Insert a new section after H302, titled "Maternity Services" and
subsequently renumber.
H303: All women should be entitled to the highest standards of care
during pregnancy and birth, and post-natally. We will ensure that
women are given the information they need to make appropriate choices
about how they wish to give birth, and that a full range of options,
including home birth and a range of styles of hospital delivery, is
made available to all women.
H304: The incidence of medical intervention in childbirth has
escalated in recent years, particularly the rate of caesarean
sections, which are expensive and, when not medically required, risky.
We will work to reduce the number of interventions in childbirth, and
change the culture of the NHS so that birth is treated as a normal and
non-medical event, in which mothers are empowered and able to be in
control.
H305 All women will be entitled to the care of a single midwife
through prenatal care, birth and the first month of post-natal care,
in line with the model of care currently provided by independent
midwives. This will be made possible by initiatives to improve the
recruitment and retention of midwives.
H306 We will ensure that the NHS embraces the current quality and style of care as offered by Independent Midwives so that they are able to work within the NHS system and offer this type of care to all women in a single tier system. We shall ensure that midwifery training places are increased to meet medium and long term needs. This will be achieved by: ensuring that terms and conditions for midwives are improved, increasing investment in midwifery services to ensure that these policies are delivered, specific funding for midwife training along with targeted recruitment drives, and ensuring that the culture of midwifery services is supportive for both mothers and midwives.
H307: All women and their partners will be offered a full range of
psychological support after birth to help deal with trauma and
post-natal depression. The party will ensure that baby clinics are
open for adequate hours, so that women can get access to health
visitors and take their babies for regular check-ups at a location
that is convenient for them.
H308: Maternity units should be sufficient in number and located so
that all women are within reasonable reach of one. Special Care Baby
units will be expanded in line with the increasing number of babies
that need intensive care, but special attention will also be given to
preventative efforts to reduce the number of low birth weight and other
problems that contribute to this need. Funds allocated for maternity
services should be ring-fenced to ensure that they are used for the
intended purpose.
H309: Throughout maternity services the focus will be on compassion
and on providing a safe, supportive environment. Complaints will be
treated with sympathy, and systems arranged to ensure that complaints
can be registered easily and are investigated properly, challenging
the 'conspiracy of silence' that discourages women from speaking about
their traumatic experiences for fear of frightening other women.
ENDS
Seeking change within political party structures is not something all of us can or want to do - but some of us need to do it. It is part of the strategy for change. We need to build a patchwork banner, mother led, midwife empowered, created from the experience of us all, sewn with love and compassion for ourselves and our families. And it needs to be so large and enveloping that wherever our country's leaders turn they will see another segment of our calls for care and compassion to our birthing sisters and daughters.
Writing letters, sending emails, asking questions, reading policy documents all felt so drab until a minute ago when I began to weave in womanly terms the work we need to do. It takes it from my crowded desk and puts it in my work basket overflowing with yarn and potential!
the lobbying of political parties needs to be done to keep our births safe after the next election. And to do it and do with it creatvity energy love and flair we need to think of this work in different terms: I need to think of it in different terms: not another policy document to read but a patten weaved, not a letter written but a piece of fabric linked in.
And so, with renewed vigour, I invite you to read the Green Party maternity care policy below with a view to using it as a lever to lobby for better maternity services in the political landscape you are situated whether from within or without a political party or pressure group, whether it be locally or nationally. Let us use all the tools in our work basket to change the patten of birth.
Green Party Policy:
SYNOPSIS
In 25% of NHS trusts, intervention rates are double the targeted
level. Lack of continuity of care, a shortage of midwives and
consultants and beds contribute to high death rates and threaten
mothers' and babies' health. About 11 million UK women have suffered
post-birth trauma.
MOTION
Insert a new section after H302, titled "Maternity Services" and
subsequently renumber.
H303: All women should be entitled to the highest standards of care
during pregnancy and birth, and post-natally. We will ensure that
women are given the information they need to make appropriate choices
about how they wish to give birth, and that a full range of options,
including home birth and a range of styles of hospital delivery, is
made available to all women.
H304: The incidence of medical intervention in childbirth has
escalated in recent years, particularly the rate of caesarean
sections, which are expensive and, when not medically required, risky.
We will work to reduce the number of interventions in childbirth, and
change the culture of the NHS so that birth is treated as a normal and
non-medical event, in which mothers are empowered and able to be in
control.
H305 All women will be entitled to the care of a single midwife
through prenatal care, birth and the first month of post-natal care,
in line with the model of care currently provided by independent
midwives. This will be made possible by initiatives to improve the
recruitment and retention of midwives.
H306 We will ensure that the NHS embraces the current quality and style of care as offered by Independent Midwives so that they are able to work within the NHS system and offer this type of care to all women in a single tier system. We shall ensure that midwifery training places are increased to meet medium and long term needs. This will be achieved by: ensuring that terms and conditions for midwives are improved, increasing investment in midwifery services to ensure that these policies are delivered, specific funding for midwife training along with targeted recruitment drives, and ensuring that the culture of midwifery services is supportive for both mothers and midwives.
H307: All women and their partners will be offered a full range of
psychological support after birth to help deal with trauma and
post-natal depression. The party will ensure that baby clinics are
open for adequate hours, so that women can get access to health
visitors and take their babies for regular check-ups at a location
that is convenient for them.
H308: Maternity units should be sufficient in number and located so
that all women are within reasonable reach of one. Special Care Baby
units will be expanded in line with the increasing number of babies
that need intensive care, but special attention will also be given to
preventative efforts to reduce the number of low birth weight and other
problems that contribute to this need. Funds allocated for maternity
services should be ring-fenced to ensure that they are used for the
intended purpose.
H309: Throughout maternity services the focus will be on compassion
and on providing a safe, supportive environment. Complaints will be
treated with sympathy, and systems arranged to ensure that complaints
can be registered easily and are investigated properly, challenging
the 'conspiracy of silence' that discourages women from speaking about
their traumatic experiences for fear of frightening other women.
ENDS
Monday, 9 February 2009
"It was like a hotel!"
“It was like a hotel!” said my (Aquabirths at Home) York agent Lis, describing the relatively small Swiss hospital she stayed in after breaking her leg on her ski-in holiday. And being an assessor for British maternity units and the maternity unit being just opposite her ward . . . she could not help hobbling across and asking if she could have a look around!
Her report was this.
70% water birth rate in this small 2 room suite. The birthing pool is at the centre of the room and the bed is tucked away in the corner. The rooms are beautiful with a lovely bedspread on the (hospital) bed and ordinary curtains and net curtains in subtle pink and blue stripes (!) at the window. Not costly or adding to infection risk but looked lovely. The floors were bare but there were tables and chairs and an easy chair for relaxing or for partner. The medical kit was around but seemed very much in the background.
There is just a 2% homebirth rate (this is nonetheless greater than Bradford’s where needless to say the water birth rate is much lower also). My agent said that she did not blame women for having a hospital birth in the circumstances with such stats. and 5 days of first class care in hospital and no quibbles about staying longer if the woman needed more support with breastfeeding. Post natal accommodation was mainly 2 bed rooms with babies in with the Mums.
Lis was told that they never induced prior to 42 weeks without a real medical reason. Induced women were still allowed to use the pool. Access to the pool was just a simple step. They didn't worry about hoists or fancy kit for lifting women out of water: Everything kept very low tech. Seemed much less of a culture of claims if anything went wrong.
Generally CS rates are low both here & in general through Switzerland. If women had high blood pressure or just a few minor problems they still stayed in this local hospital. They were just monitored more closely or moved down to a room in a different area of the hospital to be monitored. If they knew that baby might have problems then had to be moved to different hospital as didn't have intensive cots for newborns at Frutigen hospital.
In terms of staffing the head midwife there said that they enjoyed their work and had a good relationship with the doctors who took a great deal more interest in normal birthing than do our doctors but tended to interfere less. The doctors would see women on admission and pop down later to check how things were going but unless called in would otherwise leave the midwives to it. Needless to say it is ‘one mother one midwife care’ during labour. Women could, in this unit, even choose the MW who they wanted to have for the birth prior to the birth - though this is not true of all Swiss units
Midwives only care for women in the intrapartum period (birth). General nursing staff admit the women and care for the mother and baby dyad during their 5 day stay. Nurses who looked after new Mums & babies saw it as their role to get the new dyad/partnership established well prior to departure - for best start in life. Breastfeeding rates: Lis does not know the figures but they were good and breastfeeding seemed to be accepted normal more than in UK.
The health insurance support is generous with 5 days full accommodation with excellent food and care (my agent said the staff were amused that she kept referring to the hospital as a hotel – she responded to them that the care and food etc were more akin to hotel quality and she had never seen anything like it at any hospital in uk she had visited). However, the monthly statutory health levy for this care is substantial for say the average family. (Well, don’t we say: ‘You get what you pay for?’)
I leave with you this picture of how one small hospital in Switzerland cares for birthing women. Liz, asked many questions about what happened elsewhere to which she got relatively general or vague answers, as although midwives may have worked elsewhere before coming to this maternity unit turn over was low, and there seemed to be no plans to leave. Nevertheless, the impression she got was that things were not all that different in other parts of this region.
My motto is: Ask for the moon – you can always settle for Doncaster. Here is one very down-to-earth example of the moon - that is to say the care mothers deserve in the UK. Why not ask for what we deserve? And is it not worth paying for?
Post Script. Lis (being the canny lass that she is) says that she has an email address for the hospital and the MW she spoke to. So if you have more questions then you can contact Lis through me: ruth@aquabirths.co.uk
Her report was this.
70% water birth rate in this small 2 room suite. The birthing pool is at the centre of the room and the bed is tucked away in the corner. The rooms are beautiful with a lovely bedspread on the (hospital) bed and ordinary curtains and net curtains in subtle pink and blue stripes (!) at the window. Not costly or adding to infection risk but looked lovely. The floors were bare but there were tables and chairs and an easy chair for relaxing or for partner. The medical kit was around but seemed very much in the background.
There is just a 2% homebirth rate (this is nonetheless greater than Bradford’s where needless to say the water birth rate is much lower also). My agent said that she did not blame women for having a hospital birth in the circumstances with such stats. and 5 days of first class care in hospital and no quibbles about staying longer if the woman needed more support with breastfeeding. Post natal accommodation was mainly 2 bed rooms with babies in with the Mums.
Lis was told that they never induced prior to 42 weeks without a real medical reason. Induced women were still allowed to use the pool. Access to the pool was just a simple step. They didn't worry about hoists or fancy kit for lifting women out of water: Everything kept very low tech. Seemed much less of a culture of claims if anything went wrong.
Generally CS rates are low both here & in general through Switzerland. If women had high blood pressure or just a few minor problems they still stayed in this local hospital. They were just monitored more closely or moved down to a room in a different area of the hospital to be monitored. If they knew that baby might have problems then had to be moved to different hospital as didn't have intensive cots for newborns at Frutigen hospital.
In terms of staffing the head midwife there said that they enjoyed their work and had a good relationship with the doctors who took a great deal more interest in normal birthing than do our doctors but tended to interfere less. The doctors would see women on admission and pop down later to check how things were going but unless called in would otherwise leave the midwives to it. Needless to say it is ‘one mother one midwife care’ during labour. Women could, in this unit, even choose the MW who they wanted to have for the birth prior to the birth - though this is not true of all Swiss units
Midwives only care for women in the intrapartum period (birth). General nursing staff admit the women and care for the mother and baby dyad during their 5 day stay. Nurses who looked after new Mums & babies saw it as their role to get the new dyad/partnership established well prior to departure - for best start in life. Breastfeeding rates: Lis does not know the figures but they were good and breastfeeding seemed to be accepted normal more than in UK.
The health insurance support is generous with 5 days full accommodation with excellent food and care (my agent said the staff were amused that she kept referring to the hospital as a hotel – she responded to them that the care and food etc were more akin to hotel quality and she had never seen anything like it at any hospital in uk she had visited). However, the monthly statutory health levy for this care is substantial for say the average family. (Well, don’t we say: ‘You get what you pay for?’)
I leave with you this picture of how one small hospital in Switzerland cares for birthing women. Liz, asked many questions about what happened elsewhere to which she got relatively general or vague answers, as although midwives may have worked elsewhere before coming to this maternity unit turn over was low, and there seemed to be no plans to leave. Nevertheless, the impression she got was that things were not all that different in other parts of this region.
My motto is: Ask for the moon – you can always settle for Doncaster. Here is one very down-to-earth example of the moon - that is to say the care mothers deserve in the UK. Why not ask for what we deserve? And is it not worth paying for?
Post Script. Lis (being the canny lass that she is) says that she has an email address for the hospital and the MW she spoke to. So if you have more questions then you can contact Lis through me: ruth@aquabirths.co.uk
Sunday, 1 February 2009
Super woman business tycoon meets hassled Mum!
It was 16th January and it had been a good week for super woman and business tycoon – I felt like I was really going to change the world!
Monday a big invoice had finally been paid so our cashflow could flow again.
Wednesday I led a seminar with third year student midwives. With hubby’s help I had restructured the whole thing and I was rather nervous – but it went so well – they were such a brilliant class and I learnt so much. These midwives are questioning practice, questioning evidence, reflecting on their practice and that of their mentors, Passionate about good birthing and good care. I left Huddersfield inspired and proud!
On Thursday, four of us met to plot the expansion of the Choices network (to subscribe go to www.aquabirthsathome.com ). How fab! To finally be planning what I have dreamed of for years - to take Choices to the next level. We made plans and took minutes.
Friday, at short notice I was asked, and accepted, a place on the interview panel for a Consultant Midwife in Normality for Bradford, to take place on Monday. How fabulous is that – a Consultant Midwife in Normality! And to be privileged to be part of the selection process. And if that was not enough I had an interesting and fruitful conversation with Huddersfield University again.
At the end of this conversation, however, I looked at the time and the mother in me gasped in horror – 3.30pm – I was late collecting the children from school again! My super woman cloak was exchanged for harassed mother hat and I abandoned office, swearing at the rush hour traffic. I begged apologies yet again at one school as I collected one child and crept quietly into the second to collect the rest, trying to avoid the frosty gaze of the staff member in the office.
I returned home in a turbulence of triumph and chaos for the weekend, to be met by my matronly neighbour: “ You daft *****! Did you know you left your front door wide open this morning?” 'No I had not', being the honest answer, since I am not into open invitations to burglars. “You never came back, so we shut the door in the end and have had to keep an eye on your house all day!” It never ceases to amuse my neighbours that this business woman and mother of five can be so scatty.
And so that was the end of the triumph of super woman and business tycoon, Ruth the harassed mother of five, Ruth the modern embodiment of the old woman in the shoe – was home for the weekend. Throw your laptop in the cupboard and tie on your apron!
But I want to shout from the roof tops – I want it all! I want a career, I want to run my own business, I want to have a large and happy family, I want a happy marriage, I want to save the world. And I am so proud that I am having a fair stab at it all! And so what if I can’t keep all the plates spinning! So what if I leave my door open by a mistake (the delivery man kindly left the parcel in our living room!), so what if I am late picking up the kids! (This is not the 1950ies – most women work now so we need schooling that caters for real life work) If that is what it takes to make the whole thing happen then so be it. I am proud of what I achieve and proud that I try. And I am just glad that I have a loving patient husband and five fab kids who think my antics are very funny and love the fact that as my hubby put on a ‘welcome home’ poster years ago: ‘Ruth, about to save the world, as soon as she finds her bus pass.’ We all need clay feet I say. It keeps us humble.
Monday a big invoice had finally been paid so our cashflow could flow again.
Wednesday I led a seminar with third year student midwives. With hubby’s help I had restructured the whole thing and I was rather nervous – but it went so well – they were such a brilliant class and I learnt so much. These midwives are questioning practice, questioning evidence, reflecting on their practice and that of their mentors, Passionate about good birthing and good care. I left Huddersfield inspired and proud!
On Thursday, four of us met to plot the expansion of the Choices network (to subscribe go to www.aquabirthsathome.com ). How fab! To finally be planning what I have dreamed of for years - to take Choices to the next level. We made plans and took minutes.
Friday, at short notice I was asked, and accepted, a place on the interview panel for a Consultant Midwife in Normality for Bradford, to take place on Monday. How fabulous is that – a Consultant Midwife in Normality! And to be privileged to be part of the selection process. And if that was not enough I had an interesting and fruitful conversation with Huddersfield University again.
At the end of this conversation, however, I looked at the time and the mother in me gasped in horror – 3.30pm – I was late collecting the children from school again! My super woman cloak was exchanged for harassed mother hat and I abandoned office, swearing at the rush hour traffic. I begged apologies yet again at one school as I collected one child and crept quietly into the second to collect the rest, trying to avoid the frosty gaze of the staff member in the office.
I returned home in a turbulence of triumph and chaos for the weekend, to be met by my matronly neighbour: “ You daft *****! Did you know you left your front door wide open this morning?” 'No I had not', being the honest answer, since I am not into open invitations to burglars. “You never came back, so we shut the door in the end and have had to keep an eye on your house all day!” It never ceases to amuse my neighbours that this business woman and mother of five can be so scatty.
And so that was the end of the triumph of super woman and business tycoon, Ruth the harassed mother of five, Ruth the modern embodiment of the old woman in the shoe – was home for the weekend. Throw your laptop in the cupboard and tie on your apron!
But I want to shout from the roof tops – I want it all! I want a career, I want to run my own business, I want to have a large and happy family, I want a happy marriage, I want to save the world. And I am so proud that I am having a fair stab at it all! And so what if I can’t keep all the plates spinning! So what if I leave my door open by a mistake (the delivery man kindly left the parcel in our living room!), so what if I am late picking up the kids! (This is not the 1950ies – most women work now so we need schooling that caters for real life work) If that is what it takes to make the whole thing happen then so be it. I am proud of what I achieve and proud that I try. And I am just glad that I have a loving patient husband and five fab kids who think my antics are very funny and love the fact that as my hubby put on a ‘welcome home’ poster years ago: ‘Ruth, about to save the world, as soon as she finds her bus pass.’ We all need clay feet I say. It keeps us humble.
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