Thursday, 23 December 2010

Of Birthdays and Government White Papers

This is an odd day.  My eldest child is 16 today, and it is therefore, the sixteenth anniversary of becoming a mother to a term baby: bittersweet memories vie with the present day realities leaving me feeling somewhat disorientated and bewildered.

At 8.20 16 years ago after 24 hours labour, being transferred into hospital, having labour augmented, suffering agonies without anaesthesia with those synthetic contractions, giving birthing yelling in animal agony as I birthed my baby in fear and pain facing a blank hospital wall and a drip machine because I was not important enough to be faced.  That memory haunted me for many years and my body remembers even if the joys of subsequent births have healed the wounds.

And yet despite this my baby was born miraculously calm and cheerful, she fed right away and easily and we both took to breastfeeding as ducks to water.  This was the joy of motherhood for me, and it continues to be. 

And then the weeks of challenge, nursing a baby learning the art of motherhood alone with a husband working away, building a new life outside of employment which had been the centre of my life up until then.

And as winter turned to spring and then to summer, I would sit in our tiny garden overlooking the park, with my tiny daughter playing at my feet, and as she grew older how I loved to sing and to read to her.

These memories partially suppressed bubbled to the surface through this day 16 years on.  Sixteen years old, my child was woken by her four siblings, being sixteen years old she curled her lip at our practical present, being sixteen she had already got her birthday money out of us some days earlier, being sixteen she wanted to spend her birthday not with us but with her friends at a sleepover.  And I realised I was clinging to a daughter I no longer had.

“How do you mother a teenager?” I ask the memory of a mother struggling to come to terms with her new role 16 years earlier.

And today I went to a meeting where CS rates were discussed and professionals talked of women as ‘them’ as opposed to ‘us’ the professionals.  I thought this does not feel right – ‘should it not just be ‘us’?’  Was this the attitude underyling my experience of becoming an object in the hospital system 16 years ago?

And this afternoon, in another meeting I learnt that the Government has changed its mind and Maternity Services will be commissioned by GP’s.  And I wanted to cry with frustration and fear.  16 years ago I had to change GPs twice to find a GP who would cover my homebirth (despite the evidence even then that supported my choice). Dr Eisner (now retired) and her practice were the only ones to really specialise in maternity care in the area.  Certainly Dr Eisner was the only GP who ever turned up to one of my births – and 16 years ago she turned out at 4am and stayed with me until her surgery began – so just missing the triumph over adversity which was my first birth.

I so fear  GP’s who have no interest and no committment for good birth, whose knowledge is limited and partial, taking control of the budgets and purse strings, using their power to stop the progressive investment in normality, not understanding the importance of ensuring a good start to motherhood and a good start to those little lives.  GPs who care but don’t understand because in the last 20 years they have progressively handed over all the work and knowledge and experience to midwives and centralised maternity services based in hospitals.

I was so looking forward to midwives as independent professionals in partnership with their medical colleagues and service users having the chance to be part of the commissioning of the care they see as necessary for the wellbeing of women, and now we have GPs – General Practitioners being given the role – who asked for that?

I feel tonight that if we all pull together, work hard and campaign well, we might just stave off the worst  - but that is no where near good enough!  I want the best, the best for my daughter  - my daughter who is sixteen today - not the make-do, not the maybe if we have enough staff, but the world class services that have been abolished in the new terminology of the new Government.  I want my daughter to have world class midwifery and maternity care – because she deserves it and so do I!

And so today past and present collide. The personal is so painfully the political.  And with bitter sweet memories, and anger borne of experience and determination borne of love, I pull on my boots, roll up my sleeves, paint my placard and light my candle in the dark.

Sisters I hope you may join me, I cannot do this alone. And tonight I feel as alone as I did all those years ago staring into the abyss of a blank hospital wall.

Monday, 13 September 2010

Sir Ken Morrison, former chairman of the Morrison's supermarket chain and native of my adpted city Bradford.  He started with a market stall and ended his working life with anational supermarket chain.  He is now developing his interest in farming.

I found this little bit of advice in an article I found today.  I think it is worth keeping these thoughts in your head whatever you want to succeed in - from supermarkets to birth resource centres to any social enterprise or project.  It takes and heart and soul to achieve anything worht achieving.  Heart and soul.

Over to you Ken:

1. Have confidence in what you do

2. Do your research

3. Respect your competitors

4. Expect to work hard

5. Expect to work continuously

5. No one person has all the good ideas, there are still plenty of good ideas around

6. You can learn from others - seek them out

7. Look at other industries for tips that could help your business

8. There are no short cuts

9. Application, dedication and hard work – no substitutes

10. Success is hard won

Monday, 6 September 2010

Kes: a metaphor for an ambition

We went to watch Kes at the Oldham Coliseum on Friday night. It was a fabulous production and it has disturbed and gripped me ever since.

Kes, the feral boy. Father left home when he was six, neglected by mother, bullied by big brother. The food he eats is largely stolen from others. Picked on by anyone who feels like it. In trouble with the police.

And then he finds a baby Kestrel and becomes absorbed in training the bird. It takes patience and skill. A boy who never reads, reads voraciously in order to learn.

A teacher is able to pull this out of him and he is transformed into a lad full of enthusiasm, respect and joy as he talks about his Kes. A person with purpose.

But the story is a tragedy. Because in revenge for not putting a bet on a winning horse (Billy spent it on chips for himself) and he because he could not find and beat him up his bullying brother kills the bird.

All this was played out on stage and in my soul. The playright Lawrance Till says: “The bird is a metaphor of his ambition – what he delights in, what he is reaching for, what he runs towards.” The tragedy is the destruction of a young boys ambition, which with life so stacked against him, was as fragile and as vulnerable as himself - and as beautiful.

Lawrence continues: “We may not have the extreme events happen to us as happen to Billy Casper, but we all have ambitions, we all have passion, invest in something and, unless we are very lucky, we all have a sense of loss in our lives – divorced parents or the loss of a pet or maybe something more tragic than that.”

What are my dreams, my ambitions, what do I run towards, what do I invest so much of myself in? Do not allow the bully destructiveness of the bullying big brother to kill it, nurture and protect it – do not show the indifference and neglect of this story’s mother. Be the English teacher, empowering, enabling, interested, mentoring, listening respecting – so that your dream might with patience be tamed and trained and one day take flight but always come back to you.

For it occurred to me last night that each character in this story could be an aspect of oneself – if the kestrel was a metaphor for a boy’s ambition then the mother should have been nurturing it.

And I wonder, for myself and others whether if we treat our own ambitions with such violence. If we do, then whether we also treat the dreams, ambitions, delights of others with similar violence - even without realising it.

And it reminded me of growing up in a Lancashire industrial town in the 1980ies with the miners strike, the decimation of manufacturing industry in the area.  The state, Government and policy of the time did not care how this crushed and destroyed the communities, the families, and above all the kids of our town - the kids I went to school with. Let us never forget the Billy’s of this nation when we make policy and investment, when we make swinging cuts and take austerity measures. Let us not be a state that kills Billy’s Kes.

Wednesday, 21 July 2010

The chime of the anniversary bell

Why is it that when the hot summer weather comes and everything in the garden is in full and healthy spate, I begin to mourn. There is that heavy feeling. I don’t know what it is, for a while, and then I remember: it is 2 weeks away from the 4th August - again. The 4 th of August, the death day for all my lost babies. Why did I always lose them on the same day? the same time? What is it about this time of year? I don’t know.

What I do know is that as the seasons turns from winter to spring from spring to summer, each year I have a moment when I must turn and remember, remember my little lost loved ones, speak to their souls, and speak to mine too.

And I have to do it. My body compels me, even in my busy happy life, it compels me with gentle but firm tug, to turn aside, be still and remember. My friend tells me her African friends would say I need to visit my bush spirit. It is not to be morbid, not to drag up the past, but in a sense to ensure that it stays in the past. Acknowledged, remembered, and given its place, the losses of the past need not spoil the future or dominate the present. Except today of course, when the call comes.  It is to stay well that I need to pay attention when my body chimes the anniversary bell.

I reflect that it keeps me human too. Working on a strategic level, campaigning and lobbying, running a business, I can lose touch with Real Life, Real Things –  that is, where humanity touches humanity, where mother reaches to mother, woman to woman. These days, these special days when my bush spirit calls me to sit down with my dead loved ones, keep me human, keep me listening, keep me whole.

Monday, 5 July 2010

We cannot lose our precious progress to normality!

I am really concerned about what is going to happen next. We have just had the budget and all the rhetoric is about cuts, cuts, cuts. It is the rhetoric that worries me in some ways because it is about pushing the boundaries of what cuts are acceptable. We have no choice they say but to tighten our belts – but they do not specifiy what they mean. And in the post budget rhetoric it is to slam the poor and the sick rather than taxing the rich and the bankers, to cut spending rather than raise taxes to protect services. To be a fair budget and to be fair rhetoric we need to hear both.

Of course cuts are not just about benefits it is about our public services. Services are used disproportionately by the poor and disadvantaged. This is where my greatest concerns lie and this is not being highlighted in the media or in political speeches. I know that Bradford Maternity Services have been asked to cut about a million and half pounds from its budget. With a rising birth rate, investing in midwives and normality – I wonder where the cuts are going to be made? The Birth centre is not happening because, I am told, maternity services have made only half the cuts that they need to make – and the ‘stick’ for compliance is the money not being released for the birth centre.

And reader, you must understand that these cuts are made from UN-RINGFENCED budgets, that is from budgets that can be reduced by the acute Trust anyway because it gets a lump sum of money for all the hospital (and community) services in its care and then it divides it out between the departments. The PCT may give the Hospital say £100 for maternity services but the Trust is not obliged to give that money to maternity services – it can give £70 to maternity services and spend £30 elsewhere. And then ask the Maternity Services to cut their budget from £70 to £50. I don’t know yet whether this is what is happening in Bradford – but it could be.

What worries me most in this situation is that what will be cut, what will be lost, is our precious progress to normality, increasing and welcoming homebirth, supporting breastfeeding in communities, reducing CS rates and other interventions, increasing the numbers of midwives to meet national recommendations on woman to midwife ratios. Readers, it is my fear that progress here will be lost when we are only just beginning to feel the benefits. I fear a return to the bad old days of me knowing personally anyone who has a home waterbirth in Bradford, of CS rates of 30%, of decreasing breastfeeding rates, of midwives burning out or battening down the hatches because of the immense pressure they are under.

The thing is, that cutting investment in normality, quality midwifery led care, breastfeeding will actually increase costs in the short medium and long term: Lower breastfeeding rates raises re-admission rates for babies and young children (Eg. gastro problems, excema) and has an impact on health and wellbeing stretching for decades afterwards; CS costs about 4 times as much as a home birth (tariff), research shows that more doctors mean higher intervention rates ( which costs more money, source Denis Walsh’s excellent presentation at ARM conference Oct 2009), quality midwifery reduces the need for analgesia, raises breastfeeding rates and lowers postnatal depression rates to name but a few. Midwives save money whilst saving lives

So this is a call to arms. Albany for All! We want good quality maternity care, which means continuity of care from midwives. But folks, if we have any chance of getting this or even retaining the progress we have now made, we need to get out there NOW and start making a noise, waving the shroud, reminding Governments, MPs, PCTs and Hospital Trusts what cutting investment in quality care and progressive normality for birth will cost in terms of money and unnecessary suffering.

It is time to organise, strategise and get those dandelions growing!

Tuesday, 22 June 2010

A blessing on Midsummer night (21st June 2010)

And did the Great Mother pass my house this evening? Did her skirts not brush my cheek? And did I not catch her scent? Surely it was Her who touched my soul as I watered the garden in the dusk of the day, bringing me to a standstill, gazing into the copper heart of the buckthorn, wrapt, amazed. Awed by beauty, blessing, wholeness; being part of the whole yet having a unique place in it. For a few precious minutes of eternity I lived in paradise and the cares and fetters of my life did not bind or bother me; like paper streamers they fluttered weakly in the wind. I gazed upon my garden lit in the subdued hues of midsummer night, so new, so young, yet so vibrant with the birth of a dream, and I saw her hand scattering her seeds of life and love.  I gazed once more into the buckthorn and saw her smiling face. And I smiled.

And there I would have stayed for ever and become a tree myself, but the door opened and a voice of love called me back into my world (‘Aren’t you coming to bed?’). Could he not see her? I turned slowly and came in.

The great Mother passed my home tonight and her skirts brushed my face, and she turned and smiled upon me and I carry her blessing in my soul.


Saturday, 12 June 2010

The Midwife, the Prophet and the Broom Tree

Funny how you send out a cry for help into the universe and the answer comes back to you.  I found this article written as a speech for the ARM Conference Oct 2009.  I needed to learn the lessons again, so I share it with you.

Let me tell you a story. It is a story from the Jewish and Christian traditions – it is not feminist, it is not PC but in the tradition of Estes the Jungian psychologist and writer of Women who run with the Wolves, a psychological reading can give us food for thought and tips to help us take the things we have learnt today into our real lives.

I am calling it restoring the burnout midwife

For refreshment and recreation the man in my life enjoys choral singing. The corollary of this creativity is that his good wife must attend a variety of choral concerts. This is the concert season and last weekend I attended at the performance of Elijah. I like music of all kinds thankfully but most of all I love stories. And as I listened, I began to think and as I began to think I got out the original tale – I can really use this I thought.

The Elijah cycle are a series of traditional tales from the Jewish and subsequently also the Christian traditions. They are macho tales of daring-do really, formulated and written in an ancient patriarchal tradition, but in these tales, as I have discovered, are some real gems for women and men of the 21st century trying to transform the birthing world.

A bit of context before telling the tale and pulling it apart. Elijah was one of the old prophets of the North of Israel post partition. Unlike later prophets who wrote books or certainly caused their words to be written down, what Elijah left was a collection of stories and historical encounters - a bit like Robin Hood or King Arthur and his knights - I guess, but in his context it had such an impact on the history of the state that they were chronicled in the history books of the Kingdom and so we come to have them today. Elijah comes over as an archetypal figure striding across the country, telling off Kings and countrymen alike before having to flee for his life and then returning again to cause more political havoc – a sort of prophetic gorilla.

Now I don’t want anyone here to think that I am trying to bring religion into midwifery because this is not how I want to use the story. I want to delve into it in the way Estes does, Blue Beard and the girl with the red shoes or the crescent moon bear – using the ancient tale to teach us good lessons to be effective in our lives – whoever we are and whatever faith we do or don’t have. So if you are Christian or Jewish, please forgive the unorthodox treatment of this piece of scripture

The story that that I want to use today is one of those in-between tales. Elijah has just had the big show down with the priests of Baal imported by the wicked Queen Jezebel (who performs the function of the wicked Step Mother of English fairy tales). He lone prophet of God challenges all the priests of Baal to meet him on a holy mountain for a holy dual. They each build an altar to their God, set up a sacrifice and then must call down fire from their respective deity to burn the sacrifice. The Baal prophets go first and call and wave and shout, but nothing happens. Elijah one imagines, arms folded, mocks them – maybe he’s gone to toilet, maybe he is asleep, maybe he is on holiday? The prophets get more and more frantic using every trick in the book to arouse their deity, until Elijah says – enough! It is my turn. He restores the ancient altar of Yahweh, digs a trench, pours water all over the altar and sacrifice until the trench is full, then calls on God to answer his prayer. Fire comes down from heaven, the people of Israel are called back to their faith, and Elijah orders and oversees the execution of all 450 Baal prophets.

Needless to say Jezebel is unhappy with this outcome and in her fury puts a price on his head and sending a message to him says “May the gods deal with me ever so severely if by this time tomorrow I have not ended your life like theirs!” And here is where our tale begins. Elijah is fleeing for his life – this is not that unusual, as a gorilla prophet he is used to appearing and disappearing from the public scene for personal health reasons shall we say. But in this story it is different because Elijah has (in the words of one translation) “had enough”, he is tired, he feels old and alone and wants to die – and tells his Lord so.

Elijah, flees for a day, leaves his servant behind and carries on alone. Finally exhausted he sits under a lone broom tree. “I have had enough, I want to die” he tells his Lord and then falls asleep. - AS I hear these words my heart aches. Anyone here tonight who has birthed a babe, brought a babe to birth as a midwife, worked, campaigned, negotiated to make the world a better place, surely we have all sat under the broom tree at one time or another and said “I have had enough, I want to die”. - It is enough! I want to die! All is vanity!

Burnout. I have had enough. I want to die. All is vanity. We work and work, we give everything of ourselves, we may win, we may lose, we take the knocks we may get a heavy knock, we may see things change for the better or not as the case may be. But there comes a day when we go to the barrel and it is empty, there is nothing left, we have used up all our resources. Burnout. And then we may want to flee or maybe we want to shut ourselves in, but we sit under the broom tree and say “I have had enough . . . . .

This story is about first aid for burnt out midwives/activists but I also want us to take that further because prevention is better than cure - and think about how to keep our energy and passion flowing in the joys and challenges of bringing babes and mothers to birth. So let us return to Elijah asleep under the broom tree and see what happens next:

“All at once an angel touched him and said “Get up and eat”. Elijah looked around and there was a bread cake warm and ready to eat, with a jar of water. He ate and drank and went back to sleep. Then again, later, he was roused “Get up and eat, the journey is too much for you.” So he got up and ate and drank once more.

What was Elijah’s first aid? Food, drink, sleep. When we get sucked into our mission we can forget the essentials of keeping healthy, balanced and well. And in a crisis, in our dark night, when we want to die, we forget the building blocks of life: food, drink and sleep. When the journey has been too much for us we need to feed the body in order to restore the soul. I know it is basic stuff but make sure that in a busy challenging life you take the trouble to eat and drink well, to stay well. Beware of too much fasting on the one hand and comfort glutton on the other. And in a crisis, in despair eating and drinking properly is an essential and sometimes comforting focus.

But under the broom tree Elijah was not just offered food he was given friendship – the food and drink was a gift, a gift of compassion.

I often wonder who this angel was. Was it a golden figure with wings and halo? Or could it have been his manservant, unable to abandon his master, secretly following him so he could minister to his needs. Or, since the angel was clearly a stranger to Elijah, could she have been a woman, learning of Elijah’s distress, a woman who took 2 days leave of her family to provide for his basic needs. She could not heal this tortured soul but she could cook a meal to restore an exhausted body and provide sustenance for the journey ahead of him, she could light a fire to keep him warm and watch over him while he slept. Surely these are the skills and duties of a mother, a midwife and nurturer?

In the big sweep of the traditional tale telling and the drama of Mount Carmel and Mount Horeb this detail is missed – as the role of mother, midwife and nurturer is often missed amongst the high drama of clinical action. But if you want to understand a mothers lasting gratitude to the good midwife, the child’s loyalty to a mother then here you have it: the glass of water brought to your lips, the believing you can do it when you have given up hope, the food set beside you where you can reach it, the kind face that appears when you open your eyes. And if you think back to your darkest hour, was it an angel who helped you through? Or was it the figure or figures in your life, who listened and loved, who gave you food and drink, who believed in you when you did not, who watched over you until you had the strength to carry on?

This is the sisterhood, the communion of saints, the comradeship, the team spirit – whatever you want to call it and it is essential to effective midwifery within and without the NHS and essential to any mother, midwife or other who wishes to be a changemaker in the world. We need to nurture, and support one another in fostering good births whether in the birthing room, in the management meeting or in the parliamentary lobby, whether we are mothers, midwives or full time activists. One night we may be sat under the broom tree with an angel ministering to us, another day we may be that angel. That is the way it is and the way it should be. And by being angels to one another we can prevent burnout and help restore those who suffer it.

Two short angel tales for midwives. One: a midwife told me how after an adverse outcome as they seem to be termed these days she tortured herself for weeks as to whether she might have spotted something earlier, that she could have done something different. At last one day a more senior midwife, quite a brusque character, talked to her about it and said “ Years ago I made a mistake that caused the death of a baby. You live with it for the rest of your life. But you have to carry on; there are more babies to birth. It is the risk we take in doing what we do.” The midwife who told me this tales said that it was not just her words that picked her up but the courage of this midwife both to carry on after that awful experience and to be willing to tell her story to encourage another midwife. Second. New birthing pool, the first midwife takes the plunge and - agh! -A third degree tear. And Oh! How it travelled about the unit – “ooh, hear you had a third degree tear in the pool”; you put a lady in the pool and had a third degree tear.” You know the stuff – natter, natter, natter. : The stuff that kills innovation in a birthing unit. One midwife said we should not be doing this so she went up to the midwife and said – “Hear you had a third degree tear in the pool – that’s tough but I heard you spotted it and dealt with it really well. Well done!” Angels. Sisters. Sweet tea, listening ear, homemade bread, words of encouragement, believing in someone when they don’t. This is first aid for burnout and prevents long term damage.

And the story continues. Strengthened by this sustenance he journeys on – forty days and forty nights – that old term for a long time – to the holy mountain of Horeb, where Moses received the stone tablets centuries before. There on the mountain side he finds a cave and sits in it all night. A lone figure returning to his roots, to the source of his faith . . . and he has a complaint to make.

There are a few things to learn here for the prevention and cure of burnout.

First of all, he could not sit under the broom tree for ever - in order to sort himself out he had to move on. Years ago, after 10 years of giving my all to a particular life and vocation it came to an abrupt and bitter end; a full stop. I was utterly devastated and spent some weeks and months in despair, broken. And then I heard a story about a man lost in the desert and suddenly in his wanderings he came across a beautiful desert flower blooming large and red, where there is a flower there must be a little water, and there was. And there he sat sustained by a little water, gazing at this beautiful flower. And it was such a beautiful flower, large and lustrous, deep red with a black centre. But the water could not sustain him and this beautiful flower and the flower began to wilt and he had to choose whether to stay and die with the flower or to journey on to the nearest city where he could find sustainable life. I remember realising that if I stayed gazing at the beautiful flower of my loss I would die there, and so I got up and started to make the long journey (500 miles) through my desert to find a new and sustainable life. We cannot sit under the broom tree for ever - we have to deal with the challenges we face one way or another.

Elijah’s solution was to retreat to his God’s holy mountain and to make a complaint. Retreat! - is the cry of an army losing a battle. It is no failure, faced with something that overwhelms you to retreat to a safe place where you can regroup, and redeploy your resources. It is a necessity of survival and if you don’t do it often your body will call time and shut down on your behalf. And this can be the cause of much illness and debility in some of us – it is the way we get a break. First Aid for burnout then is retreat, shut down, get away to gain some time to be refreshed, sort yourself out, work out a new plan.

If you recognise this in yourself as I did then a solution is to book your retreats in advance so you can miss out on the misery of being ill. Twenty or thirty years ago when the Basic Communities were in full action in Latin America, empowering peasants to gain justice over land, water and pollution as well as political emancipation, the leaders of these communities faced immense pressure and persecution. The sisters and religious that supported them in one area, taught and practiced regular ‘retreat’ or withdrawal to ensure the activists did not burn out. It was something like this – one hour in the day, half a day in the week, one day in the month, three days in the quarter, one or two weeks in the year.

I think this is a brilliant strategy to stay sane under pressure, it provides space at different levels and different intensities and in chunks that an ordinary person can manage. So much of monastic tradition in all religions is pretty aspirational for us ordinary folk but here is something we all can do – and indeed must do if we are changemakers wanting to avoid burnout.

I am always one for taking a good recipe as a guide and then making the rest up as I go along and so taking that structure as a guide I have found a way of structuring ‘retreat’ time, soulspace into my hectic life. I share this as an example; you will have to find your own way. So every day I try and do a couple of rows of knitting or crochet – I find this works better than meditation because it keeps my hands and chattering brain busy on the one hand and I look busy to the children so they don’t tend to interrupt! For years my daily retreat was listening to the Archers! I go to yoga on a Thursday and a meditation on a Sunday evening. Recently the pressure in my life has increased and I am finding that I need to make an hour’s knitting at a knitting group on a Wednesday morning also a priority. Notice the busier you get the greater the stress, the more breaks you need to keep a balance. Once a month I visit a therapist for massage or acupuncture or such like. I may not need to see her each month but I would need to see her if I didn’t go – if you know what I mean. I also spend an evening a month with some good nurturing friends where we consciously talk about deeper things. Every eight weeks we try to get away as a family for a either a weekend or 5 days depending on the seasonal nature of our business. Very recently we have had the courage to shut down the business entirely for two weeks in August and spend two weeks away together as a family – part of the retreat plan!.

This is no great shakes – this is survival rations for a mother of five children who runs a business, chairs an MSLC and is trying to change the world! It prevents burnout, prevents ill health, and manages stressors. And if something overwhelming does happen a restorative retreat is rarely too far away. Retreating isn’t failure it is the key to successfully maintaining our campaign for good birth.

But back on Mount Horeb, things still aren’t good for Elijah. He has retreated, back to his roots, back to the faith roots of his nation. This is then a physical and emotional journey to a Holy place - to the source of his strength and courage and his powerful and effective work. And in this special place, at the root of his soul he pours out his troubles: I have been very zealous for the Lord Almighty he declares, I have done all the right things, – but look my countryman have given up on their heritage and persecuted those who have tried to maintain it – and I am the only one left.

When we are overwhelmed, when we have lost our sense of purpose and vocation, when we are pulled in too many directions, when we do not feel we can cope any longer we need to return to the roots of our belief, what makes us who we are, whatever or whoever that may be - for some of us that includes a physical journey to a special place or person, for some of us it just takes time and space. But we all have roots and when we have had enough we need to go back to that place to find the answer to what we need. An answer we shall surely find, but as Elijah finds out the manner and the content of the answer may be unexpected and unlooked for.

Elijah says he has done his bit for God and some and for his pains he sees his brethren killed and has to flee yet again for his life. And he can’t do it anymore. And maybe he was looking for big show from his Almighty God, maybe he expected a dramatic vision, a proof of power and strength - but his God was not in the earthquake or the fire, his God was found in a gentle whisper. In A still small voice Elijah converses with his soul and finds his needs supplied, – a new mission, a friend and successor and a message to take to the King. And then once more Elijah bestrides the nation and his dramatic tale continues.

We need to return to our roots from time to time but when we do so at the point of despair I find that what I get is reassurance of my calling and a new mission. I am not retired - but empowered to carry on! I am not given laurels to rest on but walking boots for the next journey – and amazingly it works!

Some of you here today maybe be suffering burnout or be close to ‘jacking it all in’ because you have ‘had enough or maybe you have a friend who is going through it at the moment. So using the story of Elijah as a tool, here are some first aid tips to tackle and prevent burnout so you can survive and thrive amongst the challenges of today’s world:

Pay attention to the basics – food drink sleep

The care of an angel – be an angel receive and angle

Do not sit under the broom tree and die – get up and look for a way out

Retreat! Ensure times and places for recovery and refreshment in your busy life

Go back to your roots – the roots of your soul, strength, or vocation whatever it may be

The answer may come to you in unexpected ways from unexpected places

And you won’t be given laurels to rest on but a new journey, a new mission, a new task, a new inspiration.

I hope that this helps other burntout activists as it helped me - let us apply the lessons of Elijah of the lonely Broom Tree.

Tuesday, 8 June 2010

Fragments of Soul

What has happened?  Where did April and May go?  They flashed past in a flurry of activity and chaos.  Our busiest Easter followed by our busiest Whitsun.  Every pool out.  Working flat out.  The birth resource centre planning and action dropped and lost in the overgrowth of the business.  Where do the days go?  Another day and I have not read stories to the children.  Another day and the consititution is unfinished, the funding bids unwritten, another day another week and the blog goes unwritten.  Yoga class missed, meditation missed, lunch with hubby missed.

And slowly slowly inexorably I am worn down, pared away until I wake up one morning and there is nothing left, nothing left to give, creativity dried up, sense of humour abandoned, fragmented unfocussed.

Time to pay attention.  Time to read the story of Elijah - and how to deal with burnt out activists.  Time to go into the garden, time to sit on the bed with the children, time, time there is no time.  And yet if there is no time for the soul - there really is no time for everything else.  Soul time spins the yarn of time, it is how you find time, time for what is important.

And we who are mothers at home, we who are mothers dividing ourselves between outside work and the home, we who live lives of interruption and fragmentation, we will not grasp the bigger picture, we will not stay focussed on what is our true visions, we will not keep our balence and perspective, unless we learn the art of soul time.

Soultime is time in the garden, reading a good story with a child, a cup of tea stood by the open back door, a 2 hour slot doing an art class or a yoga class or a singing class, breastfeeding, listening to muisc, meditating, lighting a candle, gazing into an open fire.  Soul time is what nurtures and heals the bumps and bruises of the day and that is what I need, you need, we need - or else we will spend our time without really Living - and that would be a tragedy.

Tonight, was Choices, where several women and men got together and shared our knowledge of birth, and our visiting Independent Midwife, for the first time talked and talked about birth, everything everything and we all left at ease with the gift we have been given, the gift to birth.  And I thought this is really living,, this is the soul of birth, this is why I do what I do, and this is why I need soul time - so that these soul things can happen.

The birth of a birth centre needs SOUL.

Monday, 22 March 2010

Of Fatigue and Foundation Building

And tonight I am tired. So tired.

Life maybe a roller coaster sometimes but with a roller coaster it stops at each end and there is an end – this is a roller coaster that just keeps going.

As I lie in bed and listen to the generator of the road works outside, I sometimes think – is this what we have signed up for? a life of constant change, of crises queuing for attention, of juggling too many responsibilities?

It is the 17th March when I write this. Three months to our first day in our new home, dream now fully launched and the snow began to fall. And we have survived the coldest winter for thirty years in a Victorian edifice without central heating, and double glazing.

We move into an area with four primary schools but with no school places at all for my reception and year 2 children and so end up with one at home and one being educated on the other side of Bradford for all that means in terms of time and fuel and his unsettlement. Meanwhile the bath leaks (not the plumbing – though that leaked as well but we could fix that – a hole in the bath on the other hand . . . .) so we have to remove it because we found the cable for the lights of the bathroom below run under it. Hmmm.

So now we have a house with no central heating, lacking double glazing at the majority of windows and a house without a bath and with a rather disgusting shower. And then Balfour Beaty, bless ‘em, are laying siege to two sides of our house so you can only gain access to the side entrance and we get phone calls from firms saying they tried to deliver the package but could not locate an entrance due to the roadworks . . . good for business then!

Meanwhile because they have dug a long stretch of road for electrical work the water pipes are on the surface on the ground and in the coldest winter for thirty years we find our water is frozen many mornings in the week. So not only are we cold we can’t warm ourselves either with a shower or a cup fo tea.

And then there was the generator situated outside out bedroom window which would rumble into action at 3am each morning waking us up as its vibration shake the house. I know I have done the 3 am feed as a breastfeeding Mum but I no longer have the hormones or the lifestyle to withstand chronic sleep deprivation. At the end of a week of this I am desparate and my sense of humour has ebbed. After two weeks of this . . . .I take to ringing Balfour Beaty at 3am in the morning to inform them of the noise. They finally move it away so we can hear the noise but are not disturbed by the vibrations. But some other poor sod must get it instead – hopefully they have double glazing.

And of course there is the saga of the electrical meter . . . . and so the list goes on, and these are the things I can remember – I can’t remember week by week the litany of disasters to be overcome. And this does not include the challenges posed by the business which have not been inconsiderable especially not having staff for six weeks over Christmas due to the big freeze. I would wake at 6am to get the children off to school ready to start work and by 8.30am all the schools would have closed and I had to re arrange my day to accommodate it. I could do this for a couple of days but it went on for 2-3 weeks. And to wake up to that and the water frozen in the taps – it gets wearing.

I know I am moaning but I am not really complaining. Writing it down gets it out of my system and I feel less tired and worn down. Yes it has been very tough and still is tough. We are coming up to Easter and the pressure is on to deliver umpteen baptisteries and get them back over the next three weeks whilst holding down the rest of our chaotic life.

But . . . . but . . . . , today the sun shone, the roadworks have moved down the road and people began to walk past us and they were curious at what or who is happening to this house. The daffodils in the pots have come out and cheer me with hope, and my sons went to play in the park. Yesterday I was told that the PCT are reconsidering their policy regarding funding the MSLC and its chair – until the fat lady sings - I won’t say it is sorted - but at least it is a positive move forward. And I am begining to get my joy for cooking and baking back – the mental siege is lifting - I feel able to invite people to lunch or dinner confident that we can give them ‘a good do’ as my grandparents would say. Choices met at 89 this month and it was not a disaster – though 20 people rather touched the capacity of the room! My to do list includes setting date for a meeting to take forward the birth resource centre theme as a steeringing group. We are getting there, we are moving forward, this dream can be earthed in reality.

Henry David Thoreau in Walden or Life in the Woods says in his concluding chapter:

“If you have built castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them”

Yes, I am digging the foundations to earth the castle in the air. And to you my readers I hope you too have a castle in the air and a spade to dig the foundations under them. And I wish you well.

Thursday, 11 February 2010

Green shoots in the winter earth.

Another step forward. Green shoots in the winter earth.

This weekend we had a painting polishing and planting weekend.  We invited friends and family to come along and help us reduce the mountain of little jobs - hanging curtains, moving a bed, building a desk, rehanging a couple of doors, polishing the stairs, staining the wood work, stripping and painting the therapy room etc etc.  We offered food and drink and good company in return.

And they came, on their own, as  a couple, with babies and children.  Some stayed for 2 hours some the whole day.  Some could do loads of practical work others could barely move to make a cup of tea such were the demands of their children.  One couple took all day to arrive with their 2 week old baby - but what a joy! What a gift to receive them!  And how important for us that they came.

And it was wonderful, wonderful.  And yes nearly all the jobs got done but that is not why it was wonderful.  The house came alive to the sound of children's laughter and adults chatter, the walls echoed to feet and hands doing creative work and the place was filled with love and joy and fun and real people and real stories.

And this house which had felt so silent and sad when we moved in was full of light in the right places, and this house that had felt so very very cold glowed with warmth.  I thank all my friends who came in body and spirit that day and gave their hands and heart to give our home soul.

This truly was the birth of a birthing centre, born in love, born into community.

This week, perhaps for the first time, it has felt like a gift and a privilege to live and work here.

Tuesday, 26 January 2010

Right Care, Right Place, Right Time

I attended a HSJ ( Health Service Journal) seminar on 26th January 2010. It was actually about using or selling a data tool called Interqual (registered trademark) and it was clearly aimed at A&E and acute illness scenarios (heart illness etc). However, applied to maternity services and birth its principles, I think, could be an eye-opener. If it was seriously and rigorously applied to maternity services and birth services I wonder if they would be structured very differently? AS Gary Lane said at the end of his presentation – short term pain for long term gain – restructuring services to give appropriate levels of care at the appropriate time will have long term benefits for patients and Trusts.

The seminar began with a quick overview of the financial situation of the NHS:

• NHS nationally has a shortfall of £20billion. This amounts to a big cash crisis.

• Trusts and PCTs have been informed that they will only receive 30% of 2002 levels ( this needs to be checked as was not on the slide) of the money they received for Acute admissions.

• Just 10% of PCTs have managed to reduce A &E admissions accordingly

• There is a continuing demand for quality assurance through QIPP (Quality, Innovation, Productivity and Prevention) and CQUINN

The Solution

Reduce acute level of care (ie in hospital, in patient care) and providing as much care as possible in patient’s locality and community.

My comment: Surely this is the nub of the issue with regard to how maternity care is structured? The complaint of many women is that their care is inappropriately centralised and clinicalised, and not there at the right time, place and level that they really need. From maternity services point of view women are going into hospital for birth inappropriately – the system is set up for care only to be in this location. So, for example, women turn up to hospital and complain that they keep being returned home in early labour – why not assess women at home and keep them there until they wish to go in or give birth? Homebirth services are provided as optional extras by maternity services rather than being structured into the care pattern for all women as, for instance above. For many women this would be appropriate localised care at an appropriate level, and would reduce acute admissions to hospital – unnecessary acute admissions to hospital.

Postnatally, regular midwifery and social care visits to establish breastfeeding and general wellbeing of Mum and baby dyad in first 2 – 4 weeks post partum could reduce acute admissions (eg for gastroenteritis of baby) and post natal depression. The question being does saving in one departments budget offset the extra spend in another? Ie If investment in low level social care (to establish breastfeeding for instance) has big payoffs in the acute budget ( readmission of babies for instance for preventable illness) will this be acknowledged and supported within the NHS structure?

A case example given was Rotherham – this was not maternity services but hospital acute care generally – however, if read applying to maternity services it is thought provoking.

The key issue to be tackled in Rotherham: Patients in acute beds who do not need to be.

The tool was the Interqual tool.

The objectives:

• Right care, right place, right time

• Admission avoidance ( patients being admitted into hospital that do not need to be)

• Developing Alternative Levels of Care

• Better care with better value (for money)

• Building locally based care

(Taken from the HSJ Rotherham Case study PDF  )

• Rotherham Partnership began implementing InterQual in February 2009 initially on three wards covering emergency admissions; trauma and orthopaedics; and healthcare for older people. It was also implemented in the community in a purpose built facility for people with chronic obstructive pulmonary disease.

• Case Managers assessed patients both on admission and throughout their hospital stay and where they identified that patients could be cared for more appropriately elsewhere, they worked to facilitate a supported discharge.

• All patients are reviewed against InterQual’s admission criteria and then against the continued stay criteria while they are on a ward using the system. In the first16 weeks (16 February 09 to 8 June 09), 3631 reviews were undertaken on 892 patients.

• .The hospital found that 49% of the admission reviews met the criteria for an acute admission; 45% did not.

• The continued stay [in hospital] reviews show that 15% met the acute criteria and 77% did not.

• This data shows that the 77% of continued stay reviews and the 45% of admission reviews which did not meet the criteria resulted in patients occupying an acute bed. This meant a total of 1574 days, when patients could have been cared for at a sub-acute level if that level of care had been available in Rotherham.

• InterQual has subsequently been rolled out in Rotherham across respiratory medicine, and plans are in place to use the criteria in a modified way on the Stroke Unit and obstetrics and gynaecology in order to undertake retrospective audits.
• Case Managers report numerous examples where experience told them that a patient needed moving to a less acute environment but InterQual provided the evidence-based assessment to confirm this.

Long term objectives (from HSJ seminar)

• Using Interqual data to identify the number and type of patients who are not meeting or requiring acute level of care to inform future commissioning.

• To commission the most appropriate service model location and resource structure to deliver this.

• Changing the culture of the organisation and clinical practices.

• Identifying bottlenecks (eg bed blocking or delivery room blocking)

• Ensuring medical intervention at appropriate times, levels, and places.

• Short term pain for long term – redesigning care system so that they are efficient in the long term so that care is provided when and where it needed says Gary Lane.

Right Care, Right Place, Right Time

For Mums that means: One mother one midwife, at home, for the birth

Wednesday, 20 January 2010

Harsh reality and gritten teeth

This week the snow finally cleared.  The ice on the windows became condensation.  I could get dressed without the heater being on for 40 minutes first!  The coldest winter for thirty years and we move into the coldest house in Bradford!

But snow gives a beautiful dressing to everything, ice stops people coming to see you; huddled around the fire you don't venture into the rest of the house to see what needs doing.  This week the snow cleared and out of my office window I can now see the builders rubble, the plaster, the discarded cardboard boxes.  The over-grown lilac has lost its sparkling dressing and looks leggy and messy.  Without the Victorian Christmas look the porch looks less Dickens and more tatty tenement.  What will people think as they come to the door I fret? - They won't want to come to a birth resource centre looking like this?

And though the hall has beautiful pannelling it needs touching up and a polish, and as fast as I clear it up another lot of stuff is dumped by the front door on its journey up, down, in or out of the house.  The living room needs half a dozen boxes removed and just needs tidying up - and one of those Belgium-sized sofas removed.  Could anyone come here and believe this was a place to learn about birth and be nurtured in it?

And the therapy room - the fridge as the family call it - because that is what it is.  A gaping doorway into a once lovely Edwardian glass and wood extension makes this the coldest room in the house.  And so it has become the repositiory of all boxes and items without a home and not essential for immediate use.  And it feels empty and sad and in need of a coat of paint.  Could this be a therapy room where women are nurtured and loved, and where healing is offered? Could you see it and believe it?

I believe it, I know it . . .but will others see it and believe it too?  People who I need to come to the groups, facilitate the groups, provide the therapies, provide the funding?  Can they see it?  Could they come to a place with a scruffy garden with daffodils peeping through as scouts for the beautiful garden we will make  - could you?  Could you come and sit and learn in a big room that is beautiful but not finished - like when you wear a suit and then sturdy boots for the weather? Or your pretty dress has the stripes of a sickly baby?  Could people feel  comfortable with cosy but not yet posh? Could you?

And could a therapist see a beautiful but cold drab room and believe that this in 4 weeks could look pretty good and feel wonderful and 12 months be perfect?  Could they?  Could you?

This week I have faltered because the snow has cleared and the harsh reality on a dull wet day is that there is alot to do.  The house IS tatty and you can't replace all the windows of a Victorian Edifice for under £10 thousand pounds and we spent that on getting the roof weather proof and the cellar damp proof.  And my wild roses won't flower until June and we won't be cutting the trees until later in spring.

And my kind and honest friends - are they being really honest when they share my enthusiasm and say how lovely the house is and capture my vision and say everything will be OK? And that all it needs here is a coat of paint and there a sort out?

Sometimes realising a vision means holding on to your vision with gritten teeth, believing when the reality tells a different story, and just working task by task.  Sometimes only your friends can see the progress.  Sometimes you need a holiday.

Thursday, 7 January 2010

I am a believer.

"If I count how many steps it would take to climb this mountain I would go no further: I would sit down and cry. But I have decided to be a believer."

I have not blogged for a good while. And I am sorry for that but let me tell you something of why. We had this dream, this plan. It started off as a plan to put work and home together, to simplify our lives so we did not spend 2 hours and 20 miles a day in a car taking children to school and us to work. We wanted a more sustainable lifestyle. But then we looked around some houses homes, premises – all kinds of things, all over the north of England and Wales. Mind you, there seemed to be a theme, as our favourites tended to be old doctors surgeries.

And so another dream began to emerge. “What a lovely big room” we thought. “It could work for classes, courses, training etc. And look at this room! This would be so fab as a therapy room.” Basically, we realised that we might be able to have an office, a pool storage and a Birth Resource Centre. That phrase was given us by a doula moving down from Edinbugh who had worked with Nadine Edward’s set up. She gave me the concept I was looking for: A resource to parents, midwives practitioners for maternity birth and beyond. A place to be informed, nurtured and massaged as well. A network hub for birth.

That was the dream. Now the reality. A large family a small income, a small but expanding business, a credit crunch. After 18 months of arguing with banks (No, the Royal Bank of Scotland does not lend to small businesses any more) and vendors (What? You want to knock another £10 thousand off for the tree in the cellar?”), we finally purchased 89 Bradford Road, known to the children as 89 Zoo Lane ( Do you remember ’64 Zoo Lane' on TV?) and to David as Gormanghast.

Our new home is a gargantuan Victorian edifice with no central heating system. After the TV programme ‘Victorian Farm’, we’re going for the spin off: ‘Victorian House’ complete with real TB. Spread over four floors there is ample opportunity to lose children, ladders, staircases and whole rooms. Visitors and workman have been known to appear in doorways looking puzzled and nonplussed asking “Where have the stairs gone?” “I thought they were around here somewhere”. And so our enchanted house casts its spell.

We got the keys to the focus of our dreams on 30th November. On 1st December the builders moved in to remove the tree from the basement wall, put the stairs back where they need to be for health and safety reasons as well as reaching the fourth floor, and to make other basic repairs – such as restoring the roof and chimney etc.

It was an exciting week when we moved in – and yes it took a week to move the Weston tribe with their goods and chattels plus expanding business into one set of premises – (and yes we do now have a tradesman’s entrance!). Unfortunately as we moved in, the central heating boiler moved out into the skip and we had the white Christmas we would never have contemplated otherwise. Ah the twists and turns of fate! Our children have now learnt that getting ready for bed means putting your pyjamas on top of your day clothes. And no one is allowed out with less than five layers of clothes. Tom says he prefers ‘windy Walney’ (our holiday home) with outside loo because it is warmer there. And it is.

The Scott of the Antarctic Memorial Society are holding their annual re-enactment at 89 Zoo Lane to which all who have the appropriate clothing are invited. Bring a penguin. Placement students from the British Antarctic Survey are also welcome. (None of this is true but its sounds good! - ed)

And so here I sit with large jumper retrieved from case of clothes from my student days and woolley hat (I may look silly but I feel warm!) writing my blog. IN four weeks time I want the embryo Birth Reosurce Centre to be ready for birth – I suspect, like every mother, I will have to learn the art of contented waiting. In the mean time there are boxes to empty, furniture to arrange, walls to paint, workmen to find and organise. And at the same time, meals to cook ( where is that pan it can’t be in a box), washing to do, children to take (or not) to school, customers to deal with, bills to pay.

If I count how many steps it would take to climb this mountain I would go no further: I would sit down and cry. But I have decided to be a believer. So instead I count the steps I have made and look back at how far I have travelled. With the courage this gives me I can turn my face forward.

I know that in three years time we will hardly believe the distance we have covered. I am a believer.