THE MAGA ZINE OF THE ROYAL COLLEGE OF MIDWIVES
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MSWS, STUDENTS AND S O C I A L M E D I A : T H E B E L FA S T BRANCH IS ON A MISSION
T H E F I R S T M I D W I F E- L E D P E R I N ATA L M E N TA L H E A LT H PRESCRIBING CLINIC
R C M CO N F E R E N C E A N D AWA R D S S P EC I A L : C E L E B R AT I N G M I D W I F E R Y
Together we can
NOVEMBER 2021
F R O M P A Y T O S TA F F I N G , F R O M F L E X I B L E WO R K I N G TO W E L L B E I N G, T H E R C M IS FIGHTING FOR ITS MEMBERS
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Editor Rebecca Davies-Nash Director of communications and engagement Jo Tanner Director for professional midwifery Mary Ross-Davie Executive director of external relations Jon Skewes Editorial contributors Janice Warman, Juliette Astrop
Editorial board Kate Ashforth, Mary Caddell, Kate Evans, Sarah Fox, Alexandra Hawkins-Drew, Jayne Marshall, Sophie McAllister, Ruth Sanders, Angie Velinor, Louise Webster
Publishers Redactive Publishing Ltd 78 Chamber Street London E1 8BL 020 7880 6200 Director Jason Grant
Advertising midwives@redactive.co.uk 020 7880 6231
Design Senior designer Seija Tikkis McPhail Picture researcher Claire Echavarry
Production Production manager Aysha Miah-Edwards aysha.miah@redactive.co.uk
Membership 0300 303 0444
Magazine subscription rates (For non-members only, per annum) UK £130 European Union £175 Rest of the world £185
Magazine subscription queries Curwood CMS Ltd +44 (0)1580 883844 subs@redactive.co.uk Printed by Precision Colour Printing. Mailed by MAFMK. All members and associates of the RCM receive the magazine free. The views expressed do not necessarily represent those of the editor or of The Royal College of Midwives. All content is reviewed by midwives. Full article references are available on request from magazine@midwives.co.uk Midwives ISSN 1479-2915
Recycle your magazine’s plastic wrap – check your local LDPE facilities to find out how.
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Newly elected RCM president Rebeccah Davies outlines her grassroots approach
Welcome I
t’s a delightful shock to be elected RCM president and an absolute privilege. The fact that members voted for me suggests they wanted someone in the role with recent and relevant insight into their world. And I really do: I’ve only recently retired as a labour ward coordinator and I still have a full-time job as staff-side chair, RCM steward and branch chair. I’m approaching maternity transformation from a place of knowledge and empathy. I see this as a vital part both of my working life and in this role as an ambassador for the RCM. I’ve always felt it was important to be a link between senior management and staff on the ground, setting up staff-side forums and raising concerns in a constructive way. Trusts – and I imagine boards too – used to work in silos, so it’s about understanding the limitations of that, starting conversations and working better together. As an RCM activist, I understand the importance of giving people a voice, bringing issues into the open and protecting people’s rights – the membership will recognise this as being fundamentally what the RCM stands for, and I’m proud to be part of that. My priorities as president are to improve working life and promote flexible working.
It’s been a particularly tough 16 months for maternity services battling with COVID-19. Midwives and MSWs have quietly stepped up with dignity and shown amazing resilience and commitment, often spending periods away from their own families, so the RCM’s Caring for You campaign has never been more important. Empowering and encouraging MSWs to see their own potential for promotion and career development is also vital. Some MSWs are happy as Band 2, and that’s fine; but some aren’t, and should be developed – it’s about working to the strengths of MSWs, no matter what stage they are at in their careers. I’m so proud of the first MSWs at my trust doing an apprenticeship in Bristol, which the trust is supporting and funding. Finally, supporting student midwives and NQMs to become a strong and resilient workforce is a key goal, especially after the disruption of COVID-19. The same goes for advancing Race Matters to challenge inequity of care for mothers and babies as well as the working lives of maternity professionals. It’s important to stand up for your values and to make appropriate challenges where it’s needed. Both the RCM and I am all for that: it’s what the RCM is there for.
Midwives and MSWs have shown amazing resilience
NOVEMBER 2021
Editorial
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The official magazine of The Royal College of Midwives 10-18 Union Street London SE1 1SZ 0300 303 0444
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Date of preparation: October 2021
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VOLUME 24 / NOVEMBER 2021
37 Compendium of winning entries
50
In our special showcase, we highlight the winners and runners-up at this year’s awards ceremony, with comments from RCM chief executive Gill Walton
NOVEMBER 2021
External submission 30 Don’t forget to tell SCID What you need to know about newborn screening for severe combined immunodeficiency
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47 Hearts and minds
News 6
The first midwife-led perinatal mental health prescribing clinic – is this the way forward?
In brief Your professional midwifery news – from the UK and around the world
Talking point 50 Pills in the post
56 The fellowship The role of research midwife and the career opportunities it can provide
The provision of abortion services has transformed in the face of COVID-19, but will the greater access to care continue?
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RCM Awards
10 RCM Conference 2021 Some of the highlights of this year’s virtual conference
The longer read
Voice of...
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32 A student midwife Supporting and caring for migrant women and refugees
14 Together we can
COVER ILLUSTRATION: MICHAŁ BEDNARSKI
Midwifery is at crisis point – learn how the RCM is tackling staff burn-out and PTSD
22 Rebirth of the Belfast branch How the branch reinvented itself during the pandemic
Employment advice 26 Flexible working How to ensure your application is successful
Voice of a mother 58 Behind the mask
34 Relationship building Catering for the needs of women with learning disabilities
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Working as a midwife through the pandemic – and then becoming pregnant
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News
READ The Royal Society for the Prevention of Accidents’ advice on safely using baby slings: bit.ly/ ROSPABabySlings
one to watch SUPPORT To mark 140 years since it was founded, the RCM is asking each branch to raise £140 to support midwives and MSWs facing financial hardship. Visit bit.ly/ RCMfundraiser for more information
YO U R P R O F E S S I O N A L MIDWIFERY NEWS
RCM presses Prime Minister on pay The RCM has written to UK Prime Minister Boris Johnson highlighting its dissatisfaction with the recent 3% pay award its members in England received. It has suggested the government should instead recognise that midwives and maternity support workers (MSWs) deserve a pay rise that reflects their expertise and dedication to the NHS. A recent RCM member survey found 92% of respondents said being a midwife or MSW is not valued by the government and 95% told the RCM they were unhappy with the pay award. The RCM
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is highlighting these issues ahead of the upcoming Comprehensive Spending Review and say NHS funding must include a fully funded staff pay rise. Jon Skewes, RCM’s executive director for external relations and an NHS Unions chief negotiator, said: “In the RCM survey, 86% of respondents told us a fair pay increase might encourage those who are considering leaving the profession to stay. We will continue to fight for our members so they receive a decent pay rise next year and one that starts to make up for years of pay restraint.”
READ Nurturing Maternity Staff, by Dr Jan Smith published by Pinter & Martin SEE The first Windrush and Commonwealth NHS Nurses and Midwives Statue, honouring the contribution of those from an African and Caribbean background, at the Whittington Hospital, north London.
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The largest-ever survey of women suffering severe pregnancy sickness, hyperemesis gravidarum (HG), has found that more than half of women (52.1%) considered termination and nearly 5% ended a pregnancy as a result of the condition. Of the more than 5,000 women responding to the survey, which was published in October in the journal Obstetric Medicine, 25.5% said they had considered suicide, with nearly 7% regularly feeling suicidal. Dr Caitlin Dean of Pregnancy Sickness Support said: “This study demonstrates the scale of the problem with HG care in the UK… We need greater awareness of the available treatments and more compassion in the way care is provided” Clare Murphy, chief executive of the British Pregnancy Advisory Service, said: “No woman should have to end a wanted pregnancy because she has been unable to access the care she needs. This is an important study that must raise awareness of the devastating consequences of severe pregnancy sickness. We must move away from the mantra that ‘nothing is safe in pregnancy’ because not treating pregnant women is also harmful. Safe, effective medications are available and women must be offered them.” The study was a collaboration between the BBC, Pregnancy Sickness Support and researchers at Kings College London. Read it at: bit.ly/HGstudy
Unplanned pregnancies
Lockdown babies: numbers up There were nearly twice as many unplanned pregnancies during the first lockdown compared with before the pandemic, a study led by University College London Hospital and published in BMJ Sexual and Reproductive Health has found. The study found that women reporting difficulties in accessing contraception rose from 0.6% pre-lockdown to 6.5% post-lockdown. This led to a near doubling in unplanned pregnancies,
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from 1.3% pre-lockdown to 2.1% post-lockdown. The authors say the percentage of unplanned pregnancies may be an underestimate. The cost of unplanned pregnancies in England, including those ending in births or abortions, was estimated as £193m in 2010. There were 210,860 abortions reported in England and Wales in 2020; the highest since records began.
NOVEMBER 2021
Hyperemesis gravidarum
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Pregnancy sickness
PREDICTING PREMATURE BIRTH – NEW RESEARCH Mothers at risk of premature birth could be identified far sooner than current tests allow by looking for specific bacteria and chemicals in their cervicovaginal fluid, according to a new study by Tommy’s researchers at King’s College London published in the Journal of Clinical Investigation. The Tommy’s team looked at data from four UK hospitals. Researchers analysed cervicovaginal samples taken 10-15 weeks into the pregnancy and again at 16-23 weeks, then grouped women by their typical communities of bacteria and biochemicals. They checked this against cervical length measurements – the current standard NHS assessment for premature birth risk – and followed up to see who gave birth early. A specific bacterium was found to limit the risk of premature birth, which could lead to preventative therapies. A combination of metabolites and bacteria were linked to birth at or before 34 weeks, and these links showed in the first and second trimester – meaning those at risk could be identified much earlier and benefit from treatments that are not possible in late pregnancy. Visit www.tommys.org
See page 50 for more on abortion services.
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PUBLIC HEALTH BUDGET CUTS REVERSED Hampshire County Council has reversed public health budget cuts after pressure from One Voice, a partnership of leading women’s health organisations that includes the RCM, Institute of Health Visitors, the Royal College of Obstetricians and Gynaecologists, Sands and the National Childbirth Trust. Gill Walton, the RCM’s chief executive said: “What was due to happen in Hampshire is happening elsewhere across the UK. We absolutely recognise the strain that local authority budgets are under, but slashing spending for some of the most vulnerable is a false economy… consider the risks that leaves behind, particularly when it comes to supporting perinatal mental health and taking vital points of face-to-face contact away from women, particularly those who are at their most vulnerable.”
Perinatal mortality
RISE IN ABUSE Half of all medics have seen NHS colleagues being abused or assaulted, according to findings published by the British Medical Association. Treatment delays and changes to the NHS during the Covid-19 pandemic were cited as causes of increase in abusive behaviour. NHS England said: “The NHS will not tolerate abuse or violence directed at staff and despite the despicable actions of a minority, the overwhelming support from the public during the pandemic has meant a great deal to staff, who are proud to have helped millions of patients over the last year.”
Covid-19
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MBRAACE report In response to the MBRRACE-UK Perinatal Mortality Surveillance Report for 2019, Sarah McMullen, director of impact and engagement at the National Childbirth Trust, said it: “demonstrates the deeply concerning impact of poverty on families, with babies born to women living in the most deprived areas of the UK twice as likely to be stillborn and at higher risk of neonatal death compared with those born in more affluent areas. It is also completely unacceptable that, regardless of socioeconomic status, rates of stillbirths and neonatal deaths remain higher for babies born to Black, Black British, Asian and British Asian mothers than for White babies.” The Twins Trust also noted that stillbirth in twins has increased – from 6.07 twin stillbirths per 1,000 births in 2018 to 6.68 in 2019 – and there was a rise in neonatal deaths for multiples. Shauna Leven, chief executive of Twins Trust, said: “It is critical that maternity units adhere to National Institute for Health and Care Excellence multiple birth guidance and our T-MEP quality improvement project can help them do this – and save lives.” Read the report at bit.ly/MBRRACEmortality
Get the jab One in six of the patients most critically ill with Covid-19 being treated by the NHS are unvaccinated pregnant women, according to NHS England. Twenty of the 118 patients with Covid-19 who received extra corporeal membrane oxygenation between July and September were mothers-tobe. Of these, 19 had not been vaccinated and the other had only had a single dose. NHS England released the statistics as part of a renewed effort to persuade pregnant women to get fully vaccinated amid new evidence from doctors in Israel that Covid-19 can cause serious problems for mothers-to-be and their babies in the later stages of pregnancy.
MIDIRS Digest 1 Has the pandemic reaffirmed what women want from maternity services? Sarah E Milnes 2 Pregnancy in prison – a literature review. Part 2: fragmented care, Caroline Snowe, Magdalena Ohaja 3 Determinants of maternal mortality in the Rohingya refugee camps of Bangladesh, Mylene Appere 4 Postpartum mental illness during the COVID-19 pandemic: a population-based, repeated crosssectional study, Simone N Vigod, Hilary K Brown, Anjie Huang et al 5 The influence of self-compassion upon midwives and nurses: a systematic review of the literature, Mary Steen, Mitra Javanmard, Rachael Vernon The above papers are published in MIDIRS Digest. Access them at www.midirs.org Some Evidence Based Midwifery papers are reprinted in MIDIRS Digest. Visit bit.ly/ EBMJournal
IMAGES: ISTOCK / SHUTTERSTOCK
NOVEMBER 2021
News
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Vulnerable communities
What’s on?
Caring for migrant women
3 NOV National Stress Awareness Day: bit.ly/StressAwareEvents
New guidance from the RCM, with support from Public Health England, outlines the duty of care health staff have towards vulnerable migrant women and how to support them. “The role of midwives and their colleagues is to give these women the care and support they need and are entitled to. Any issues around immigration status and whether or not they should pay for their care are not the responsibility of midwives or MSWs,” said the guide’s author, Clare Livingstone, professional policy advisor at the RCM. “Migrant women have a right to NHS maternity services, just like any other woman in this country. Many have come from areas of conflict and may have had little or no antenatal care. They may be traumatised and have little or no support in this country. Our duty is to care for them.” Maternity Action has also published a report on the charging of migrant women for NHS maternity services. Ros Bragg, director of Maternity Action said: “Charging migrant women for maternity care increases stress and anxiety for a group who are already at increased risk of destitution and homelessness. Many women avoid maternity as they are fearful of incurring debts they cannot pay.”
11 NOV INMO/RCM conference
Download the guidance at: bit.ly/RCMmigrant Read the Maternity Action report at: bit.ly/MAmigrant
5 DEC International Volunteers Day
15 NOV MSW Week: see RCM website for webinars, podcasts and more 25 NOV-10 DEC 16 Days of Activism against gender-based violence
NOVEMBER 2021
22 NOV Start of Carbon Monoxide Awareness Week 30 NOV St Andrew’s Day
Safer care
CQC report calls for improvement The latest Care Quality Commission (CQC) report, Safety, Equity and Engagement in Maternity Services, has called for maternity service improvements to be prioritised to ensure safer care for all mothers and babies. Dr Mary Ross-Davie, the RCM’s director for professional midwifery, said the report was especially welcome as it includes the voices and experiences of women and their families. “While the report recognises that many maternity services across the UK are providing good care, the RCM is concerned that much more work needs to be done to bolster leadership and improve culture and multidisciplinary working. The RCM remains committed to providing personalised care to women and their families, which undoubtedly improves safety and promotes a positive birth experience. However, we also need to
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be realistic and ensure there are enough midwives to implement this safely. Right now, across the UK most services are understaffed, with some shifts barely at 50% capacity. That is why the RCM has called on the government to ensure we have enough midwives.” Angela McConville, chief executive of the National Childbirth Trust, agrees: “The CQC report rightly draws attention to the need for improved
inter-professional team working in maternity care, as called for in Better Births. An emphasis on listening to women’s concerns and cultural competence is a must. However, these ambitions will not be achieved until maternity services are adequately staffed and calls for a fully supported workforce must be heeded.” She added: “In addition, research has repeatedly shown that the postnatal period is the most dangerous for both mother and baby, yet this period is often overlooked. Postnatal care needs radical reform, with clear leadership and accountability to ensure safety for mothers and babies.”
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Read a perinatal mental health midwife’s story on page 47. The RCM has been supporting its members and maternity services to improve safety and culture with its Solution Series. Download part four at: bit.ly/RCMSolutionsPart4
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Day 1 ‘Together we can build a stronger profession’
NOVEMBER 2021
5-6 October 2021 This year’s virtual conference brought a message of solidarity and hope: that we are in this together, and by supporting each other, we will succeed. Here’s a brief overview of some of the sessions
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The conference welcome session saw RCM president Rebeccah Davies and RCM chief executive Gill Walton reflecting on the past year and discussing the challenges that lie ahead. Gill talked honestly and openly about how fragile everyone is following COVID-19 and the continuing pressures on the service. She also had a message of hope: that you should feel proud of your achievements so far and acknowledge that things will get better – and that the RCM is fighting for it to get better by “rolling up our sleeves and wading in”.
‘Together we can restore ourselves’ On Stream B, Keelie Barrett and Dr Thomas Kitchen discussed what support is available for maternity professionals who are feeling overwhelmed, and the importance of kindness and respect in the workplace, including self-kindness. Thomas talked about how important ideas of restoration and regeneration have been brought into the spotlight, and how we create workplace behaviours of role-modelling, trust, civility and joy. A key message is to ask someone how they are – and then ask again, because they will automatically answer that they are fine, when they are not at all.
‘Together we can care for each other’ In this session, Helen Rogers, RCM director for Wales, Professor Pauline Slade and Professor Helen Spiby picked up on some of the topics discussed in the previous session. They discussed the effects of trauma, post-traumatic stress disorder and the importance of self care, and that it’s okay not to be okay and
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NOVEMBER 2021
How are you? word cloud from the ‘Together we can restore ourselves’ session
to ask for help. Both Helen Spiby and Pauline discussed in detail the Poppy initiative, featured on page 14, which offers support for maternity workers experiencing the effects of trauma.
‘Together we can improve maternity safety and outcomes’ This session tackled safety failures in troubled services and looked at the framework put in place to make improvements in safety and quality ‘business as usual’. Val Wilson, director of midwifery at Cwm Taf Morgannwg University Health Board, gave
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Together we can improve maternity safety an insight into the work of the improvement team and sustainable service-led changes. Sascha WellsMunro, deputy chief midwifery officer for England, discussed the Maternity Safety Support Programme and the work of the improvement team. “Frontline staff have the solutions to the issues they face and can describe what change needs to happen.” It was an honest and hard-hitting look at what’s wrong with maternity service organisation, stressing the importance of involving frontline staff in quality improvement in a sustainable way: “They know what good looks like”.
For more, see the RCM Solution Series: bit.ly/SolutionsHumanFactors and bit.ly/SolutionsLeadership
‘Together we can support midwives to support women’
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Consultant Midwives Katie Christie from University Hospitals Sussex, Shona Hamilton from the Northern Health and Social Care Trust, Shelly Higgins from the Powys Teaching Health Board and Maureen McSherry from NHS Lanarkshire discussed the different countries’ approaches to birthing outside guidelines, respecting women’s choices and trying to support those during the pandemic while meeting the challenges of COVID-19.
‘Together we can forge the future’ Jo Williams, Helen Kaye, Ella Simpson and Renée Bull of the RCM Student Midwife Forum shone in this session. The NMC’s Andrea Sutcliffe demystified the role and practices of
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Your RCM
NOVEMBER 2021
her organisation, answering questions such as ‘How can the culture of blame be eradicated?’ The panel outlined expected behaviours as well as the support available to students to help them feel confident entering the workplace.
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Stories are just data with a soul
See the NMC Caring with Confidence animations at: bit.ly/RCMCwithC And watch: bit.ly/NMCStudentMidwives
SMF session chat Question to the SMF: If you could design a future midwife career framework, what would this include and why? Jo’s answer: “more supernumerary time to get acquainted with the wards, protected learning time for students and qualified midwives alike, protected time for reflection and psychological support. Also, specific roles within trusts to support students with structured scheduled clinical training. A clear pathway for career development which doesn’t involve giving up clinical responsibilities - maybe more AMPs?”
‘Together we can turn the tide’ The first of the conference’s sessions focusing on racism and inequity in health care – mistrust of healthcare is a huge part of the ethnic minority experience. Suzanne Tyler’s description of Dr Gloria Rowland as a force of nature feels inadequate; her passion is palpable. Her report Turning the Tide identifies areas where culture and the current systems clash. Her no-nonsense message was to challenge yourself and challenge the inequalities in the system. There are plenty of projects to support this change, including a mentorship programme. Ann Remmers spoke honestly about “seeing and not seeing” – because of feeling ng powerless to make change or not knowing where to start. She spoke of the importancee of drawing strength from stories – “stories are just data with a soul” – and said that while acknowledging ing unconscious bias is uncomfortable, e, acknowledging cultural differencee can be enlightening. Watch the RCM webinar: bit.ly/RCMblackhistory
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Day 2 ‘Together we can make race matter’ The second day kicked off with a continuation of the Race Matters issues, with a fascinating discussion between Suzanne Tyler and writer, broadcaster and film-maker Afua Hirsch, while ‘Together we can improve outcomes’ also highlighted the disparity of outcomes in mortality and morbidity in childbirth for black and brown women, the MBRRACE report data and what can be done to improve care. Also taking part were Agnes Agyepong, head of engagement for Best Beginnings, Rosemary Idiaghe, consultant midwife with Barking Havering and Redbridge NHS Trust, and Jenny Kurinczuk, professor of perinatal epidemiology and director of the National Perinatal Epidemiology Unit at the University of Oxford.
‘Together we can have a conversation about birth’ RCM’s director for professional midwifery Mary Ross-Davie and Dr Juliet Rayment, Re:Birth research fellow, discussed the RCM’s Re:Birth project and how divisive language can be for maternity professionals and the women in their care. On a similar theme, the session ‘Together decision-making and consent can support intrapartum
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This was a heart-rending session on
Re:Birth word cloud from the session ‘Together we can have a conversation about birth’
‘Together we can support each other’ The conference closed with a review of its highlights, with Dr Benedicta
Agbagwara-Osuji, deputy director of midwifery and gynaecology at West Hertfordshire Hospitals NHS Trust, Keelie Barrett, RCM board member and maternity support worker at East Lancashire Hospitals NHS Trust, RCM president Rebeccah Davies, Jon Skewes, executive director for external relations and RCM chief executive Gill Walton. Takeaways included the acknowledgement that the workforce is at crisis point and a reminder that the RCM has got members’ backs, the importance of white allyship in addressing racial inequality in health care and the workplace, and the vital role of leadership in making systemic change. There was an agreement that the RCM’s focus in the year ahead should be on safety and culture change as well as the wellbeing of staff. Jon highlighted cause for optimism in the political arguments for investment in maternity and the growing, powerful voice of RCM’s members.
NOVEMBER 2021
‘Together we can support the most vulnerable’
how to support those for whom the pregnancy journey is not a time of joy but a trigger for mental health issues or past or current abuse, or a time of anxiety where social deprivation is brought into sharp relief. The SWAN team in Belfast told the session how they led with kindness and saved lives.
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care’ looked at the importance of communication and stressed the need to know what’s important to women and birthing people in order to know what information needs to be shared with them so they can make a choice. The iDecide framework offers a way to offer safe, personalised and above all, highquality care.
MISSED A SESSION? All the sessions are available to watch at bit.ly/RCMconf2021
RCM ANNUAL REPORT RCM’s 2020-2021 Annual accounts are available to view at www.rcm.org.uk
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The longer read
Together we can NOVEMBER 2021
With the profession haemorrhaging staff and many experiencing burn-out and PTSD, midwifery has reached a crisis point. Janice Warman discovers what the RCM is doing about it
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NOVEMBER 2021
A
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recent RCM survey of midwives and MSWs found that, shockingly, 57% are considering leaving the profession, and half of those have already handed in their notice. That’s in addition to the acknowledged shortage of 3,500 midwives pre-COVID-19. It’s a perfect storm caused by understaffing, safety issues, burn-out and post-traumatic stress disorder (PTSD) caused by workplace abuse. The RCM has made a commitment to combat the problems faced by its members. Alongside its political campaigns for a decent pay deal, investment in services and to attract more midwives through a reinstatement of the student bursary, it is fighting for flexible working, better conditions and a positive working environment for all. Lesley Wood, the RCM’s health and safety advisor, runs the Caring for You (C4Y) programme. It has come a long way since the C4Y Charter, which was signed in 2016 and challenged employers to create positive working environments – and commit to working through heads and directors of midwifery with the whole of the RCM branch as a team, not just the health and safety reps. It’s also a programme that is currently being reviewed, refreshed and relaunched in response to current needs. “We are developing work tools and resources to help members and workplace reps to challenge more of these situations when they do arise in the workplace,” says Lesley. “The emphasis will be on reminding the employers of their duty and reminding the members of their legal rights – because our members, both midwives and maternity support workers, just accept [poor working conditions] as part of the job or just carry on, and it isn’t acceptable. “It’s always been a busy service. It’s always been unpredictable. You could perhaps manage one shift or a couple of shifts where it’s been like that; but now,
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it’s every shift. It isn’t sustainable. That’s why staff are leaving; they are burned out. Members who are eligible for retirement at 55 are retiring fully, where previously they may have retired and returned to the service part time.” The RCM is developing and improving the resources available. It has increased training for health and safety, ensuring reps have the latest information and the right skills and resources to challenge behaviour in the workplace. “Each maternity workplace will have an RCM branch that can have workplace representatives, one of which will be a health and safety representative. So they’re the ones that are giving midwives the tools to challenge the situation,” Lesley says.
Staff were experiencing these feelings pre-pandemic “There has been a trend of changing shift patterns in order to save money. We saw the introduction of 12.5-hour shifts and fewer of the shorter shifts, so there was no overlap, which is obviously a financial saving. But it can create a situation where staff are tired and burned out, without having the relief and resources of other staff to share the workload.”
Workers’ rights The RCM has many routes to influence policy-makers and effect change. “We’ve got a local role as a trade union, and a national role where we need to influence decision-makers to understand the pressures that lie under shortages,” explains Alice Sorby, the RCM’s employment relations advisor.
“We have a commitment from the government for more midwives; it admits that there is a shortage. We have to keep the pressure on the government. But then there’s also other pressures that we need to keep on: to ensure that staff have their breaks and are able to work flexibly, in order to retain staff. Because, like a leaky boat, there is no point filling it with more midwives if you’ve got midwives leaving. “We need to work with managers and heads of midwifery to look at what can be done practically in the workplace about our members’ workload, about our members’ access to water, to meal breaks, and to five minutes’ sitting down when you’re on a 12-hour shift.” These are basic needs, and so it is a sign of the times that reps are having to get involved to ensure staff get these necessities. Meanwhile, the RCM’s high-profile pay campaign is continuing, as is its push for making flexible working patterns a practical reality. “Pay isn’t the reason people work for the NHS; however, pay is an absolutely key way to show that you value people,” Alice says. “Our members deserve to be paid fairly; they have suffered through years of pay restraints. Fair pay can go some way towards retaining staff. “For midwives and MSWs, their idea of flexible work is probably to reduce their hours and to fix their shifts. You don’t know which day you’re going to be working, so that can make it really difficult if you’ve got caring responsibilities. Often, our members would just like to be able to fix their shifts and have more autonomy over working patterns. It is really important to give people that sort of work-life balance,” she says.
Workplace hazards Pauline Slade, a consultant clinical psychologist and professor of clinical psychology at the University of Liverpool, has led work on two
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ILLUSTRATIONS: MICHAŁ BEDNARSKI
NOVEMBER 2021
The longer read
28/10/2021 16:03
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NOVEMBER 2021
important projects tackling trauma for midwives and obstetricians: the Programme for the Prevention of PostTraumatic Stress Disorder in Midwifery (Poppy), and the Impact of Traumatic Perinatal experiences in Gynaecologists and Obstetricians (Indigo). “The work from Poppy and Indigo all pre-dates COVID-19,” she explains. “This is a situation that has existed in an unacknowledged way within the maternity workforce prior to the pandemic. I’ve no doubt the pandemic has exacerbated this, and I’m sure the staffing issues will only exacerbate this further. Exposure to potentially traumatic events was a workplace hazard and continues to be one within the maternity workforce. “If we think about the programme of work, which has extended now over about 10 years, the first came about because I was involved in setting up a birth trauma clinic for women, and as a result of that, several midwives came to see me informally. It was very clear that they were suffering from PTSD in relation to events they were exposed to at work. And because of that, we then set up a study with a PhD student, Kayleigh Sheen, in liaison with the RCM. The work was co-supervised by my long-term midwifery collaborator, Professor Helen Spiby from the University of Nottingham. “I think we were horrified by the findings in our survey. We set up the study around 2012, and the full results were published around 2015. Within this, we had qualitative interviews about the impact that PTSD was having on midwives’ lives, both personally and professionally. Some of the impacts were heartrending to hear, and these were midwives still in post. We weren’t actually tapping into those who’d already left. “What was very clear was that the systems of support were not adequate to impact effectively on these sorts of difficulties; often, the responses were
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Pay is a key way to show that you value people
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NOVEMBER 2021
The longer read
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seen very much as a weakness rather than a normal human reaction to very difficult events. Often people’s distress was hidden; people suffered in silence, I suppose. But this affected their work – we found in our study that PTSD symptoms were associated with depersonalisation of care. That’s where one separates oneself off from the person that one’s caring for, to protect oneself. What we know is that, in childbirth, women desperately need really sensitive care that I know midwives also want to be able to give. “On the basis of this work, as well as what midwives were saying about what they wanted, and what we know theoretically about what can help to prevent PTSD after people have been exposed to traumatic events, we put together in the Poppy programme. “The first element is universal prevention. That’s providing a workshop for all maternity staff, where it helps people to understand the nature of trauma responses, why and when trauma exposure translates into PTSD, and what you can do to try to prevent that translation, because the most typical response to trauma exposure is actually natural resolution, not PTSD. Most people exposed to quite traumatic events resolve this naturally, but what can get in the way of this is how we naturally try to cope with our early responses after a traumatic event. The Poppy programme has built-in support through confidential access to trained peers. If necessary, it also
A finding from a prepandemic feasibility and acceptability study of a sample of midwives attending mandatory training showed an estimated 14% of midwives would show clinically significant PTSD, Pauline says. “So, you’re probably talking about one in six midwives showing the full complement of PTSD. There are similar rates in obstetricians, and that relates to information from the Indigo project, which we ran with the Royal College of Obstetricians and Gynaecologists,” she adds.
Beyond the trauma
We were horrified by the findings in our survey on PTSD has rapid and confidential access to trauma-focused intervention. The final part is that trust guidance is revised to ensure that it incorporates care for staff after potentially traumatic events. The idea is to create a different work culture, so that exposure to trauma and the responses that occur are recognised work hazards that employers take account of and maximise the wellbeing of their staff.”
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The Poppy and Indigo work helped support the midwives, obstetricians and gynaecologists that took part in the programme, but what about those who did not? Dr Jan Smith, a psychologist, researcher and author of Nurturing Maternity Staff: How to tackle trauma, stress and burnout to create a positive working culture in the NHS, is perhaps in the best position to know. “For about 15 years now, I have been supporting families who have been impacted by trauma, and staff who have been affected by burn-out, moral injury, trauma, or are going through proceedings,” she says. “I also have a research post at Sheffield Hallam University, and a lot of my day-today work is supporting health care professionals or families in some way or another. I think it’s important to highlight that [the new findings on stress and trauma] are not something that’s new; maternity staff were
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Make sure the person complaining is heard. It might help to repeat their complaint back to them to show that you understand and are taking their complaint seriously. If their concern is legitimate, this may help to calm them down • If someone is shouting or being confrontational, then stay calm. If you do the same, they will only become more agitated. However, if you stay calm it will help calm them too and help you to retain control of the interaction • Keep yourself safe. If the abuse continues, then you have a right to remove yourself from the situation. This is also to safeguard your own mental health and wellbeing. Call for support from security services • Remember this is not personal – you’ve done nothing wrong. The other person may be going through their own struggles and taking these out on you because they feel they can. This doesn’t make it right, but it does make it easier to process. Allow yourself to feel proud of how you handled the situation and know that if you have a similar experience in the future, you will know how to handle that too.
experiencing a lot of these feelings pre-pandemic. What the pandemic has done is to compound them – or, for a lot of people, it’s changed their outlook and led them to re-evaluate what they want in life.” Jan believes that there are some solutions. “One way is to empower midwives to enable them to recognise and manage their own mental health and wellbeing, but it also requires a top-down approach. Those people in management positions within maternity need to lead and change
Workplace abuse The pandemic brought with it workplace abuse – whether that was the visiting and appointment restrictions for pregnant women and their partners, or, after the lifting of many COVID-19 safety measures across the UK, the resentment at still being required to wear masks in hospitals (bit.ly/NHSAbuseSurvey).
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Valerie Wise, national domestic abuse lead at the charity Victim Support, says her service is there to help. “The first thing I would advise is that you look at your workplace policies and procedures, because abuse is not acceptable, whether it’s from a colleague or from a patient,” she says. “There’s no bottom line: it’s not acceptable in any situation. “I would say to the person: ‘do you want to report it to the police?’ Victim Support can give you help with reporting it to the police. You might want to discuss these things with your line manager and with your trade union. We would be giving you emotional and practical support on a case-by-case basis. You can contact us anonymously via a live chat or by phone. Or if you need ongoing in-person support, we cover 75% of England and Wales, so there will likely be a local service near you,” Valerie adds. Valerie highlights the fact that abuse is a criminal matter and that it is not acceptable as “just part of the working day”. Your employer and the RCM won’t accept it, and neither should you. There’s no doubt that midwifery in the UK is facing a crisis. But just as the word ‘midwife’ is derived from the old English for ‘with’ and ‘woman’, we’re with you. Together we can.
NOVEMBER 2021
• The number one thing to do is to listen.
the culture. It’s not just about patient safety, because you can’t have that or even conversations about patient safety without talking about the mental health and wellbeing of staff – they go hand in hand. “Also, within teams, management should create a space where it’s about learning and psychological safety, and move away from a ‘blame and shame’ culture. I have heard repeatedly over the years about bullying within maternity. That is something that needs to be outed, and not only do we need to be able to address why it’s there, but also support midwives on how they manage that. This then goes a step further. I don’t think we do enough to train student midwives about how to work in an emotionally challenging environment, or to help them with how they manage mental health – or also, how to cope with power dynamics. How do they manage when they are being asked to do something by someone more senior to them – if they don’t feel that that’s the right thing to do, what are their rights? “We need to prepare midwives who are newly qualified, giving them the support that they need within teams and shifting them to a space of psychological safety – and leaders should be at the forefront of modelling the behaviours that they expect from the staff. The standards that midwives work to wouldn’t be acceptable in a lot of other industries. There’s a much bigger conversation to be had around how to create compassionate workplaces. How do you embed diversity, inclusion and equality at every level?”
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TIPS ON DE-ESCALATING SITUATIONS
MORE INFO Visit the Caring for You hub for resources and support at www.rcm. org.uk/caring-for-you-hub-home/ RCM podcasts – Current realities facing maternity services: bit.ly/PodcastCurrentRealities Together we can: bit.ly/ TogetherWeCanPodcast The RCM’s Caring for You Campaign: bit.ly/C4YPodcast Contact Victim Support at www.victimsupport.org.uk Supportline: 08 08 16 89 111 Live 24h chat service: bit.ly/VictimSupportLivechat
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congratulations to our 2021
Partnership Working Award Dr Sally Pezaro
Slimming World’s Caring for You During a Global Pandemic
Coventry University
WaterWipes® Maternity Support Worker of the Year Award
Cardiff RCM Branch
Candice Noonan
JOHNSON’S® Excellence in Midwifery Education, Learning & Research Award
Oxford University Hospitals NHS Foundation Trust
Excellence in Maternity Care During a Global Pandemic Anne Richley and Claire Dale Northampton General Hospital NHS Trust
Thompsons Members’ Champion Award
Cardiff and Vale University Health Board
Susanne Thomas and Patrice McKenna Belfast Health and Social Care Trust, Royal Jubilee Maternity Hospital
Excellence in Bereavement Care Award Sian Ness and Beth Towsey Mid and South Essex NHS Trust
Zoe Meneilly Belfast Health and Social Care Trust
RCM Alliance partners:
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Sponsors:
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Pregnacare Student Midwife of the Year Award
WaterWipes® Team of the Year Award
Beatrice Bennett
Lisa Darrah and Sinead McFarlane
University of Nottingham
Belfast Health and Social Care Trust
Innovation in Maternity Care Amanda Mansfield and Susan Watkins The London Ambulance Service NHS Trust
RCM Race Matters Award Fatima Ghaouch and Samukeliso Sibanda Northampton General Hospital NHS Trust
NMC Excellence in Perinatal Mental Health Award
Midwives’ Midwife of the Year Award - Northern Ireland Susanne Thomas Belfast Health and Social Care Trust
Midwives’ Midwife of the Year Award - England Tania Pearce East Surrey Hospital
Midwives’ Midwife of the Year Award - Scotland Frances Arrowsmith NHS Highland
Fiona Laird and Mellissa Jhagroo North Middlesex Hospital
Midwives’ Midwife of the Year Award - Wales Sarah Hookes
RCM Leadership Award Grace Thomas
NHS Wales Shared Services Partnership
Cardiff University
Midwifery Service of the Year Manchester University Hospital NHS Foundation Trust
@MidwivesRCM | #rcmawards | rcmawards.com
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The longer read
Rebirth of the Belfast branch NOVEMBER 2021
R RCM’s Belfast branch went from being a ‘wet lettuce’ to an active, growing community making a difference to the day-today lives of its members – and all of it done during a pandemic
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he RCM Belfast branch is thriving and busy with multiple events throughout the year, from Bake-Off competitions and virtual study days to celebrations for MSW Week. Its committee and reps are highly visible – not least because they regularly dish out morale-boosting goodies and tokens of appreciation – and the branch has a strong and engaged following on social media. It is gaining new members too, including a big influx of MSWs and student midwives, with the Midwifery Society at Queen’s University about to cement the relationship with a formal affiliation with the branch. But at the start of 2020, when current chair Zoe Meneilly and a brand-new
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committee took over, it all looked very different. What had previously been a busy and active branch had stalled as committee members and reps had moved on to senior positions outside the trust, explains Zoe: “Through no fault of their own, they weren’t able to be as present and active as they had been, and the branch lost momentum – it was a bit of a wet lettuce for a while. “But at the AGM a miracle happened - we filled our quota of offices with a new chair, a new secretary, a new treasurer and two additional workplace reps, at that stage going from Band 5 right up to Band 7, all in different departments and different roles – a great thing to enable us to connect with staff everywhere at every level.” The new team, which inherited a sizeable chunk of money, decided to relaunch the branch. “Then COVID-19 came along and we had to rethink what we wanted to do with the resources we had,” adds Zoe. “It was such a stressful time, especially at the start – everyone was terrified and didn’t know how it would hit maternity or how to deal with it.” “We felt it was even more important we reactivated the branch to let staff know we were there and to do what we could to
help them,” adds Lisa Darrah, branch secretary. “So, we set about spending the money on a Caring for You campaign.”
Caring for You Whether it was an Easter egg hunt, pancake day hampers, or Hallowe’en pumpkin carving, every holiday and event was marked with treats and plenty of RCM Belfast branch branded goodies, all helping to raise visibility. “Whatever it was, we hijacked it and put ‘RCM Belfast branch’ on the front of it!” says Zoe. Virtual quizzes were laid on “to create that social connection that COVID-19 had taken away” and the team launched their hugely successful ‘mugging’ initiative, where branded mugs filled with goodies are given out to worthy recipients nominated by a colleague. “It’s a way of saying ‘you’re making a difference’ and that someone sees what you’re doing and appreciates it,” says Zoe. “The person nominating remains anonymous so it’s completely altruistic, but we print out and laminate what they’ve said and give it along with the mug. The response has been phenomenal. So many people tell us ‘this has made my week’, or ‘I was having a tough day, I really needed this’.” Every one of the trust’s 300-plus RCM members received a small
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Whatever it was, we hijacked it and put ‘RCM Belfast branch’ on the front of it
NOVEMBER 2021
Christmas gift from the Belfast branch. The team also put together comfort stations for staff bathrooms stocked with everything from sanitary products to nail files. During the recent heatwave, which made for “horrendous working conditions”, they delivered baskets packed with mini fans, cooling wipes and facial mists. “The key thing is to be responsive,” explains Zoe. “You don’t always have to do a lot of planning – just show members you have an eye and an ear on the ground and you’ll do whatever you can to make life a little bit better for them.” “It all helps create that unity and team solidarity that is so important, especially through Covid”, adds Lisa. At the same time, the new team was building a social media presence
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from scratch, creating a Facebook page to share branch activity and a Twitter account to connect with a wider audience too. Starting from zero they now have around 400 followers across the two platforms, and thousands of comments and interaction. “I think what has worked is the good news stories,” says Zoe. “Publicising the Caring for You campaign, sharing photos from the muggings – which always bring a flurry of new nominations – and celebrating members’ successes, including if they are outside work. That’s when you get comments in the hundreds, with people saying ‘well done’ and ‘well deserved’. It helps create community and that feelgood factor too.
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The longer read
“We’ll always post about the RCM HQ events and campaigns too, but keep a balance between what’s going on at a national level and the things we’re doing locally.”
NOVEMBER 2021
Spotlight on MSWs
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Recognising that Belfast was the only branch in Northern Ireland to have no MSW members was the impetus for its next mission. “Again, that was a visibility issue – our MSWs didn’t know that there was anything for them in the RCM,” says Zoe “When MSW Week came up, we thought ‘this is our chance to fix that’.” The team arranged for banners and posters announcing MSW Week, then on one day during the week delivered 200 cupcakes across every department and handed out branded ‘thank you’ pens to every support worker in the building that day. Adds Zoe: “A lot were quite surprised, but it meant that we were able to start conversations and explain to them that they don’t have to be dedicated MSWs to join the RCM – any support worker working in maternity from Band 2 upwards is welcome. All of them were already members of other unions, so we needed to show them what the RCM could do for them. It was also about recognising the massive contribution our support worker colleagues make and letting them know they’re valued.” That was a turning point: the branch has now signed up 16 MSW members and has brought Kirsty Breen on board as an MSW advocate to be the voice of support workers in the branch. Kirsty says: “Other MSWs might not feel like they can approach a senior midwife, but they can come and speak to me and I can take it to
Zoe or Lisa or the reps. I know I can go to them with anything.” Kirsty, who quit her previous union to join the RCM, adds: “I don’t think the union I was with totally understood what our role involves, but the RCM knows what’s expected of you and values what you do. “Since Zoe and Lisa and the others have taken over, they’ve given us more information about what’s available for you as an MSW and got us involved in meetings and study days – things that improve your skills. They are all for enhancing support workers’ roles.” Plenty of treats have helped raise both staff morale and the profile of the branch, but as Lisa puts it: “We’re not just about the buns! It’s about support, education, encouragement and being there in the difficult times too.”
“You could see that they were once as new and anxious as the most junior people are now.” From this came the idea for a workshop on interview preparation, says Zoe: “We realised there was a big gap there for people to go for those senior roles, and for thirdyear student midwives preparing for what might be their first professional interview too. Again, it was a big success – we were approached by the Midwifery Society at Queen’s University to ask if we would help them run similar events.”
Student midwives Engaging with student midwives has been another key thread in the Belfast branch approach, explains Zoe: “We reached out to the midwifery society and let them know about our social media accounts and soon we had student midwife members joining. We started doing studentonly giveaways online with diaries, pens and memory jars to help them keep track of how many births they’d assisted at. And we’ve had lots of student members engage with our events too.” The branch got involved with the society’s annual student of the year and mentor of the year awards, giving them a trophy to be presented each year. They created a campaign for the launch of the Future Midwife Standards and make sure that all newcomers to the service, including student midwives on placements, hear about RCM Belfast branch as part of their induction. So strong is the connection that the student midwifery society is now in the process of setting up a formal affiliation with the branch. While it has undoubtedly been a lot of work done on their own time, both
The RCM knows what’s expected of you and values what you do
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So as 2021 rolled in, their next move was to bring back some more formal RCM member events. The biggest this year so far was a virtual study day for International Day of the Midwife, focusing on supporting midwives to be ambitious and illuminating career pathways. Says Zoe: “We contacted every single manager and specialist midwife and asked them to give a talk about their career to that point, how they got there, and what they would recommend to people wanting to follow the same path. We also asked them to send us photos of them as a student or newly qualified midwife.” It was a huge success, with 60 people dipping in and out throughout the day, and it also “made people in very senior roles relatable” adds Zoe.
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NOVEMBER 2021
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Lisa and Zoe agree the effort and energy they and the rest of the team have poured into revitalising the branch has been worthwhile. “The rewards are new members and engagement like we’ve never had before,” says Zoe. “Members feel that somebody is listening, somebody is caring, somebody is responding – it’s a huge boost for morale.” Lisa agrees: “They now know the RCM exists, they know the Belfast branch exists, they know all the committee members and the reps – we are so much more visible now and working so much harder for them, and they can see that. “This is such an amazing profession to be part of, with so many opportunities to make a difference to women and to society as well. But we need mutual support and togetherness to be able to do that – and being a part of the RCM gives you that. “Creating a sense of belonging and pride in our service and in being midwives and MSWs was also something we wanted to do for our members, and I think we have achieved that too.”
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Employment advice
Flexible working
NOVEMBER 2021
Employment relations advisor Alice Sorby discusses the new rules on flexible working
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Q: I’ve requested flexible working so that I can care for my mother; it’s difficult to get professional care for her because my shift rota varies each week. But my request has been refused. What can I do? I don’t want to have to leave midwifery This is a huge concern – in an RCM survey, 36% of members who said they had requested to work flexibly had had that request refused. Our evidence suggests this is becoming increasingly difficult due to poor staffing levels. But this is a catch-22: if requests are denied because there aren’t enough staff, and that causes more midwives and MSWs to leave the profession, then staffing is only going to get worse. With this in mind, the RCM and Maternity Action have produced a guide to the new flexible working rules. All NHS employees in England and Wales now have the right
to request flexible working from day one of employment and can submit more than one request in any 12-month period, regardless of the reason for submitting their requests. Discussions are under way on flexible working in Northern Ireland and these changes in Scotland will be introduced in line with the ‘Once for Scotland’ Workforce Policies Programme. However, the right to ask for flexible working doesn’t mean you have the right to get it. So here’s some advice on how you can increase your chances. First, you should try to put yourself in your employer’s
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shoes: work out what concerns they might have and then address them as best you can. You probably know your job better than anyone else, so think about how the new working pattern could function. The more you can demonstrate to your employer that your request is workable, and the more solutions you can provide to any objections they may have, the more likely it is that your request will be granted – or that its refusal isn’t justified. Remember the process is a negotiation. To maximise your chances, it’s a good idea to present your employer with two or three different workable scenarios. It will be more difficult for them to justify refusing a number of options than it is to justify refusing a single scenario. Also bear in mind that you are asking your employer to be flexible, so it is a good idea if you can do the same and be prepared to make compromises yourself. This makes it much more likely
Try to put yourself in your employer’s shoes: work out what concerns they might have
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that you can come to a workable solution together.
Employer responsibilities NHS employers are also being encouraged to consider the benefits of granting flexible working requests, particularly if it means the service can keep that member of staff in the maternity unit. A 2021 RCM member survey found that 67% of midwives and MSWs who had left or were considering leaving the NHS could be encouraged to return if there were greater opportunities to work flexibly. Your employer should have a policy that sets out a fair and consistent approach to all applications and
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how they are assessed – it may be helpful to refer to this policy in your application. The NHS Terms and Conditions Handbook also states that all employers must have a carer policy to address the needs of those with responsibilities for children or dependants. This policy should emphasise the benefits of flexible working arrangements. Therefore, your employer has a duty to properly consider your request and would only be justified in refusing flexible work if there were good business reasons – such as costing too much, having a negative effect on the organisation’s ability to meet demand, or they are
NOVEMBER 2021
Under the flexible work legislation, you can appeal and challenge an employer’s refusal if they did not consider the application in a reasonable manner, the decision was rejected on the basis of incorrect facts, or they refused the request without a legal business reason, such as having no part-time vacancies or the job is too senior; more examples can be found in the RCM guidance. However, you cannot challenge a decision because you disagree with the business reasons the employer gave. For NHS staff, the NHS Terms and Conditions Handbook makes it clear that employers should work in partnership with trade unions to agree an appeals procedure that applies to all staff, and that employees have the right to be accompanied by a trade union representative at an appeal hearing. The appeal should consider whether the agreed local policy has been properly followed and whether all appropriate options have been fully considered.
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APPEALS
unable to reorganise the work among existing staff or recruit additional staff – and if there was no alternative solution. Your employer must explain why that reason for refusing your request applies in your circumstances. Employers are expected to take account of technological advances, such as whether you can work from home, and they would be expected to consider any compromises you suggest. If your initial request is turned down, you should look at the reasons your employer has given. It is helpful to consider these to see how you may overcome them when making your next request. However, if your employer is not considering your requests in a reasonable manner, then you have the right to appeal (see ‘Appeals’). The new Agenda for Change handbook (England and Wales) provides requirements for: “centralised oversight of processes to ensure greater consistency of access to flexible working, including an escalation stage for circumstances where a line manager is not initially able to agree a request”. This is in addition to the appeals process. By considering the issues and suggesting solutions, you should be able to find a workable solution with your employer. And at any stage you can ask your local RCM rep to get involved in discussions or meetings about your request. Good luck!
MORE INFO For more information and help with flexible working, download the RCM’s: bit.ly/FlexibleWorkingGuidance NHS Terms and Conditions Handbook: bit.ly/NHSTCHandbook Visit Maternity Action at maternityaction.org.uk
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5-6 October 2021
on demand The RCM Annual Conference took place across 5-6 October in the virtual world for a second year. Key thought leaders within midwifery came together with members of the RCM to discuss this year’s overarching theme “Together, we can”.
If you weren’t able to join the sessions live or would like to re-visit any of the content, it is available to watch on demand via the RCM website: www.rcm.org.uk
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What to expect Presentation and welcome from Gill Walton, Chief Executive and Secretary & Rebeccah Davies, President
A fantastic opportunity to join together with colleagues and friends and discuss the topics that have affected midwifery in the last 12 months and a look to the future and innovation Sessions across the two-day event include; • Together we can make race matter • Together we can build a stronger profession • Together we can research to make pregnancy safer • Together we can support vulnerable women
Thank you to our sponsors Headline sponsor:
Session sponsors:
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External submission
NOVEMBER 2021
What you need to know about the new evaluation of newborn screening for severe combined immunodeficiency (SCID) programme
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F
rom September 2021, the NHS newborn blood spot (NBS) screening programme began an evaluation of screening for severe combined immunodeficiency (SCID) in six centres in England. SCID is a group of rare, inherited conditions that impair development of the immune system. Without early recognition and treatment, babies with SCID generally die before they reach one year of age. All babies up to a year old are currently offered NBS screening for nine other conditions: • congenital hypothyroidism • cystic fibrosis • glutaric aciduria type 1 • homocystinuria • isovaleric aciduria • maple syrup urine disease • medium-chain acyl-CoA dehydrogenase deficiency • phenylketonuria • sickle cell disease. A blood spot sample is collected from a baby’s heel onto a specially designed card when the baby is five days old. The sample is then sent to a regional laboratory for testing. Community midwives, neonatal nurses or maternity care assistants usually take the sample. The sample can also be taken by a health visitor if a baby moves to
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England under a year of age. The SCID evaluation will take place in two-thirds of the country over a two-year period. In the areas taking part, screening for SCID will be offered as part of the existing NBS screening programme, using the same blood spot sample.
What is SCID?
Screening in practice The evaluation will help to determine whether screening for SCID works in practice, as part of the existing NBS screening programme. Following the twoyear evaluation, screening for SCID will continue while the evidence is reviewed. The UK National Screening Committee will decide whether to recommend screening for the condition as part of the national programme. The areas taking part are those covered by the screening laboratories in: • London (Great Ormond Street Hospital and Guy’s and St Thomas’ Hospital)
IMAGE: MAURO FERMARIELLO / SCIENCE PHOTO LIBRARY
Don’t forget to tell SCID
outcomes can be achieved if this is done early enough. Gene therapy is also an option for some types of SCID, but this is still a very new type of treatment that is undergoing clinical trials.
SCID is very rare disease that affects the immune system, leading to reduced and malfunctioning numbers of T and B lymphocytes. These are specialised white blood cells made in the bone marrow and thymus gland that help to fight infection. This means illnesses that are not serious for most babies can be life-threatening for babies with SCID. About one in 40,000 babies in England is born with SCID, equating to roughly 14 babies a year. SCID is more common in some black and ethnic populations and consanguineous families. About one-third of cases are diagnosed because of a family history, but the delay in identifying the remainder means that these babies are exposed to infections for longer before receiving treatment. This delay can make these babies very sick and increases mortality, morbidity and reduces the success of treatment. The main treatment for SCID is a bone marrow transplant to repair the body’s defences against infection. Good
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About one in 40,000 babies in England is born with SCID, equating to roughly 14 a year
and health visiting services will not need to collect any new data.
BCG vaccination in England From September 2021, the BCG vaccine will only be offered to eligible babies from four weeks of age where a baby has a ‘SCID not suspected’ or ‘SCID screening not offered’ result. This change is necessary because the BCG is a live vaccine and can make the treatment for SCID more complicated. Changes to the BCG vaccine service targeted at specific groups will also improve the uptake of the BCG vaccine within these groups. For health visitors and midwives, if you are in an area that will be taking part in the evaluation, you will need to: • Contact families that move into your area as soon as possible to confirm that they have a valid NBS result if they have a baby under one year of age. If so, no further action is needed • If the baby does not have a valid NBS result, give parents information on all conditions, including SCID, to help them make an informed choice • Clearly mark whether parents decline the test for SCID on the blood spot card. Parents can still choose screening for the other conditions if they decline the SCID test • It’s important to note any family history of SCID or use of immunosuppressant drugs in pregnancy on the blood spot card • There is no need to take a different sample – just take four good-quality blood spots and complete the card accurately • Remember to record if the sample is a repeat.
NOVEMBER 2021
affecting the immune system • ‘SCID screening not offered’ – the baby had NBS screening in a non-screening area, so they were not screened for SCID. Babies with a ‘SCID suspected’ result will be referred immediately to regional immunology services for diagnostic testing to confirm if the baby has SCID or another condition that affects the immune system. Laboratories and child health information services are making changes to their systems to collect data on the evaluation, but maternity
31 RCM.ORG.UK/MIDWIVES
• Manchester • Birmingham • Newcastle • Sheffield. In these areas, families will be offered screening for SCID for their baby. If screening is accepted, the blood spot sample will be taken in the usual way and tested for SCID as well as the other conditions. Babies will have one of three results: • ‘SCID not suspected’ – indicating the baby is very unlikely to have SCID • ‘SCID suspected’ – indicating the baby may have SCID or a similar condition
MORE INFO Resources for families and professionals: bit.ly/SCIDResources E-learning SCID resource: bit.ly/SCIDLearning PHE updates: bit.ly/PHEUpdates
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28/10/2021 16:11
Voice of
Kristina Goh
NOVEMBER 2021
A student midwife
RCM.ORG.UK/MIDWIVES
T
he promotion of inclusivity in health is vital in midwifery to support women who experience barriers to healthcare, including sex workers, vulnerable migrants and those experiencing homelessness. Around 200,000 people were experiencing homelessness in the UK in 2020. Working with a specialist midwife for migrant women has underlined the need for multidisciplinary input for those who not only already face prejudice but also have additional needs such as housing issues, substance misuse and mental health conditions. I spent my placement in Barry House, an accommodation centre for asylum seekers and refugees in South London. The centre has shared rooms and bathroom facilities, plus a large open canteen. The midwife is based in a clinic room, where women attend
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Many have been separated from their loved ones antenatal appointments while staying in the accommodation. One of the most memorable aspects of this placement was caring for a woman in her booking appointment. Lorisa* was booking late, at 31 weeks, and had received no scans or antenatal care as she had fled from human trafficking across Europe. She spoke no English and the appointment was facilitated with a face-to-face interpreter. One of the issues highlighted to me was how easy it is to assume someone can buy products many of us take for granted, such as heartburn medication
or pregnancy vitamins. This rewired my thinking as I realised that the things most of us can purchase without a second thought are not an option for Lorisa, who relies on the resources available at the accommodation as she has no income. Many of the women in Barry House arrive in the UK either without family or have been separated from their loved ones across borders. Women without family networks are usually signposted to mother and baby groups for social support. However, for women such as Lorisa, who do not speak English, this can further separate them from society as the language barrier means they struggle to form relationships with other mothers. To prevent this, mothers at Barry House attend sessions at the Happy Baby Community, where group sessions are translated into different languages and mothers living at the
IMAGE: GETTY. *NAME AND SPECIFIC DETAILS CHANGED TO PROTECT CLIENT PRIVACY
Kristina Goh was on a placement with a specialist midwife supporting migrant women and refugees
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accommodation can socialise with those from similar backgrounds.
MORE INFO Read the RCM’s guidance on Duty to Refer under the Homelessness Reduction Act at bit.ly/RCMDutyRefer RCM i-learn Understanding asylum seekers and refugees: bit.ly/RCMAsylumRefugees Maternity Action has advice and training for those supporting vulnerable migrant women, including advice on the issue of migrant charging: bit.ly/MigrantWomensRights
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GUIDE TO CARING FOR MIGRANT WOMEN In recent years, Europe has experienced an unprecedented influx of refugees, asylum seekers and other migrants. A new wave of migration has followed recent events in Afghanistan. With support from Public Health England and input from specialist midwives, the RCM has co-produced guidance for midwifery and maternity staff on caring for migrant women and detailing the vital role midwives play in providing immediate and responsive care for this vulnerable group. Some migrant women will be at high risk, having escaped conflict in their home country while leaving family members – including children – behind and having faced dangerous journeys to the UK. They may now live in the UK with no social support network. Women can be at risk due to precarious and sometimes dangerous circumstances, which include homelessness, destitution and violence. Some will lack basic resources, be dependent on others for survival and be unfamiliar with and afraid of the consequences of engaging with maternity services. In recognition of the fact that every migrant woman is different, the guide is designed to serve as a practical resource, setting out principles of good care and featuring examples of best practice and signposting for further support. While midwives in some areas already provide tailored support to diverse populations, others may find this useful for up-to-date reference. Access the guide at: bit.ly/RCMmigrant
33 RCM.ORG.UK/MIDWIVES
Understandably, many women like Lorisa suffer from poor mental health because of the traumatic experiences they have suffered. They are also afraid that their abusers will find them after their escape. Midwives have to respond appropriately to each woman’s psychological needs, referring to perinatal mental health specialists for further assessment and support. The need for safeguarding and wider professional involvement is key to ensuring the best perinatal outcome. This placement kick-started my interest in inclusion health and how we can support those experiencing homelessness and excluded from healthcare. I found being part of a team that creates a safe atmosphere for women incredibly valuable, and from this I aim to promote student engagement in inclusion health. I am currently student lead for the London Network of Nurses and Midwives, and we recently held an event for students about career pathways in inclusion health. Building a wider student network would be ideal to allow students interested in inclusion health to work together and strive towards best practice to reduce health inequity. Homelessness is not just rough sleeping – it includes those who are sofa surfing or in refuges, bed and breakfast hostels and temporary accommodation. It is so important to tailor care towards such vulnerable women, listening to their needs and doing what we can as healthcare professionals to support them physically, socially and psychologically.
NOVEMBER 2021
Perinatal mental health
28/10/2021 16:12
The longer read
Relationship building NOVEMBER 2021
The award-winning Vulnerable in Pregnancy service in Fife is offering wrap-around care for women with learning disabilities alongside other vulnerabilities
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34
A
learning disability is defined as a “significant reduced ability to understand new or complex information and to learn new skills, with a reduced ability to cope independently”. Midwives may see women with learning disabilities as part of their practice, and there is an obvious focus on how best to impart medical information to support a happy and safe pregnancy and birth. But that is only part of the picture. Rebecca Saunders, senior child protection midwife, and Charlene Lawson, family liaison team leader, are part of an award-winning Vulnerable in Pregnancy (VIP) service in Fife. The pair are keen to stress the difference between learning difficulties and learning disabilities, and it goes beyond ensuring the literature that’s handed out is understandable for those with neurological differences. “It may seem odd that child protection specialisms are needed, but when a woman with learning disabilities presents in pregnancy, she may be subject to multiple disadvantages,” says Rebecca. “There may be an unsupportive family environment, in an situation with alcoholism or drug use, exploitative friends or family, and an inability for the women themselves to make good risk assessments. They
may not have awareness of what’s appropriate and what’s not, or what’s safe and what’s not.” Charlene agrees: “There are multiple issues caused and compounded by disability. We have to ask: ‘what’s the social environment like? Is there good support from friends and family? Are they keeping them safe?’ If they don’t have a good support network, then that
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has ramifications for both the woman in our care and her baby.” The NHS Fife VIP service, which is based at Victoria Hospital, gets involved once the community midwife booking has been made. It cares for women in pregnancy where there are identified vulnerabilities – which, among others, include learning disabilities. The team forms a support service to assess and care for the woman and her baby and work alongside the local authority to offer additional help and support. The specialist team can continue caring for women for up to four weeks after birth should the mother want and need it. Primarily, the service is there to work in the best interests of the mother and baby and ensure their safety.
Intervention and support The service involves continuous risk assessment and an intensive level of work, something that is not always welcome. “Some women can be resistant to services because of their family
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IMAGE: ISTOCK
VIEW FROM THE TOP: MARY ROSS-DAVIE
Mary Ross-Davie, the RCM’s director for professional midwifery, says: “Women with a learning disability may have great support around them to help successfully parent their new baby. But some don’t, leaving them vulnerable to exploitation and putting their baby at risk. “Even with a good support network, women with a learning disability need frequent, consistent support throughout their pregnancy to understand how they can best look after themselves and highlight the signs they need to look out for and seek help for – such as reduced fetal movements or bleeding. They also need to have time to prepare for the birth and becoming a parent. Sometimes this
support will come from different professionals working together, including midwives, social workers, family support workers and learning disability teams. It is vital that all of them communicate well and share key information. “By working together in this way, multiprofessional teams can provide the right tailored support. This may include assessments and observations in the early days of parenting to identify whether the woman is able to take on the role of parent safely, such as repeated demonstrations of handson parenting skills in the woman’s home. “Unfortunately, this might not be enough, and assessments may identify that the woman is not able to provide the
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right environment for the baby. In this case, the woman will need support to help her come to terms with relinquishing her baby. These are difficult cases for midwives – they need the right training. “Teams like Fife’s VIP enable midwives to develop the particular knowledge, confidence and skills that they otherwise may not have time to develop in a more general community midwifery role. These specialist teams also support relationship building, not only between midwives and the women in their care but also between midwives and other services. This multi-agency cooperation and collaboration is vital to ensure these families get the best possible support.”
woman’s additional needs. “But more than that,” says Rebecca, “unlike any of the other support services, midwives give them a chance to hear their baby’s heartbeat. Because of learning disabilities, a women can struggle to see where they fit into the world. Hearing the heartbeat can be both wonderful and overwhelming – and they get to share that with the midwife.” It leads to a level of trust that can be missing from other services they encounter. “It helps us to communicate honestly with the women in our care too,” notes Charlene, “In some cases, the safest outcome is for the woman to not be the primary caregiver for her baby and for the baby to be placed in the care of the local authority. In those cases, it’s important that the woman understands that this is the best thing for her baby.” Both Rebecca and Charlene note that the reactions to their support can vary from one extreme to another. “Some women treasure the relationship and really appreciate the care, and others never want to be seen again. It can be such rewarding and yet such hard work, but we know that the service is vital and that it’s making a difference for women with learning disabilities who are experiencing multiple vulnerabilities in pregnancy,” says Charlene. Little wonder then that the VIP Team Initiative won the Midwife Award at the Scottish Health Awards in 2020 (see bit.ly/ScotHealthAwards) and were Scotland’s Champions finalists for the Caring Champion Award 2021 (see bit.ly/ScotChampions).
NOVEMBER 2021
Some women treasure the relationship and really appreciate the care
If there’s mistrust or hostility from the outset, then how does the service overcome that? “Through building a good relationship with the midwife,” says Rebecca. It’s an important point: going to see a woman at her home rather than expecting her to come to appointments breaks down barriers and shows a willingness to work with the
35 RCM.ORG.UK/MIDWIVES
history. If there have been interventions from social services in the past, then any offer of support may be viewed with mistrust or hostility,” notes Charlene. “Even if that isn’t the case, it can be stressful for the woman if they aren’t used to that level of scrutiny and the number of meetings,” says Rebecca. “We try to lessen the impact of this and be as flexible as possible. For example, we visit women in their homes to carry out clinical care and, in fact, continued to do so throughout lockdown because virtual meetings didn’t work well for this group – they didn’t seem to want or like being on camera.”
MORE INFO For more on the VIP service, visit bit.ly/FifeVIPservice
28/10/2021 16:14
Nominate yourself or a colleague to win WaterWipes Pure Foundation Fund WaterWipes, the world’s purest baby wipes, has launched this years’ Pure Foundation Fund, a bursary scheme that recognises the ‘beyond incredible’ achievements of healthcare professionals working in maternity, neonatal and postnatal care in the UK.
3 ‘beyond incredible’ winners will receive £2,500 each for their department, unit or practice.
About the Pure Foundation Fund Every day, maternity professionals, neonatal staff, community nurses and health visitors achieve ‘beyond incredible’ things. WaterWipes is dedicated to continuing to support the amazing care they provide for expectant or new parents and their babies.
How to enter Have you gone above and beyond or been inspired by a colleague who has? Nominate yourself or a colleague for the Pure Foundation Fund, by completing an entry form available at hcp-pure-foundation-fund. waterwipes.com or by scanning the barcode below.
Nominations must be for healthcare professionals working in neonatal or maternity care or health visiting in the UK. The entry must specify how the individual was ‘beyond incredible’ either in the care they provided or what they achieved professionally. If known, the entry should also outline what the bursary fund could be used for.
‘Beyond incredible’ winners A panel of WaterWipes representatives and representatives from Bliss will review the nominations and select 3 winners, each of whom will win £2,500. Nominations open on 4th October and the deadline for entries is 22nd November. Discover last year’s incredible winners by visiting waterwipes.com/uk/en/health-care
For further information on the Fund, or questions regarding the application process, please visit waterwipes.com/uk/en/health-care or contact: purefoundationfunduk@WaterWipes.com
MIDNOV21.036.indd 2
25/10/2021 10:57
It feels like an achievement just to have been able to gather in person, to celebrate the incredible work of midwives and MSWs, students, newly qualified midwives, HoMs, DoMs and the whole spectrum of maternity. I want to congratulate you all for not only surviving, but for thriving – to have lived and worked through the worst public health crisis in living memory and
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still strived for excellence; still supported your colleagues and the women in your care and still found ways to innovate. Isn’t it a testament to the solidarity of the profession that during the first year of the pandemic colleagues and peers still found time to nominate others for awards? For this reason, we should celebrate the RCM awards this year with gusto. I asked everyone at ceremony venue The Brewery, London to applaud and cheer extra loudly, to make ourselves heard outside the building, to applaud everyone in the service not just those there in person. We all recognise the fragility of the service, and that’s even before
the pressures wrought on us by COVID-19. We understand the crisis that we are facing better than anyone, and we are the ones who are making it work, making it better, together. I’m so proud of the profession and its resilience and I’m humbled by the amazing work detailed in the following pages. I asked everyone at the awards not only to celebrate the nominees and winners, but to borrow and steal their good ideas to make their own services better - and I’m urging you to do the same. Borrow and steal ideas, innovate and collaborate, support and care – together, we’ve got this.
37 RCM.ORG.UK/MIDWIVES
WELCOME
NOVEMBER 2021
Compendium of
Gill Walton Chief executive
29/10/2021 09:24
THANK YOU TO OUR SPONSORS Over the past 27 years, the mission of Emma’s Diary has been to make sure that every mum-to-be and new parent has the information and tools they need and the support to make those important decisions .
Johnson & Johnson, the maker of JOHNSON’S®, is proud to work with the RCM, supporting midwives in their work to care for mothers and babies. JOHNSON’S® partnership with the RCM is highly valued and we are pleased to be able to sponsor these awards, celebrating the hard work and dedication of midwives.
NOVEMBER 2021
Slimming World recognises the importance of healthy lifestyles and weight management to the health of expectant mums and their children. Established in 1969, we’ve been supporting women and families to adopt healthier lifestyles for 50 years and hold 19,000 weekly groups – temporarily being run virtually - across the UK and Ireland. We are delighted to be sponsoring the Caring for You Award.
RCM.ORG.UK/MIDWIVES
Vitabiotics Pregnacare is the UK’s No.1 pregnancy supplement brand, providing expert nutritional care 38 throughout pregnancy and breast-feeding. The range includes Pregnacare Conception, for women trying for a baby, Pregnacare Original, Gummies, Liquid, Plus and Max for throughout pregnancy and Pregnacare Breastfeeding and New Mum. As a proud RCM Alliance Partner, we are delighted to sponsor the Student Midwife Award.
As the professional regulator of nurses and midwives in the UK, and nursing associates in England, we work to ensure these professionals have the knowledge and skills to deliver consistent, quality care that keeps people safe. There are more than 700,000 professionals on our register.
Thompsons Solicitors has supported thousands of RCM members and their families by providing free legal advice when they have suffered injury or injustice. We are proud that throughout our history, we have only ever acted on behalf of the injured or mistreated – never for employers and never for insurance companies.
WaterWipes® are the world’s purest baby wipes, made with jjust 99.9% water and a drop of fruit extract. WaterWipes® have been specifically developed to be as mild and pure as cotton wool and water, while offering the convenience of a wipe. They are also accredited by Allergy UK & the Skin Health Alliance. WaterWipes® provide safe cleansing for the most delicate newborn skin and can be used on babies from birth.
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29/10/2021 09:24
JOHNSON’S® Excellence in Midwifery Education, Learning & Research Award
Partnership Working Award WINNER Dr Sally Pezaro
WINNER
Coventry University
Susanne Thomas and Patrice McKenna
educational tools to
Belfast Health and
Syndrome and hypermobility
Social Care Trust,
spectrum disorders
for co-creating
support those birthing with hypermobile Ehlers-Danlos
Royal Jubilee Maternity Hospital SMARRT Pack (Supporting Midwives,
What was particularly praiseworthy about this entry was the way
Newly Appointed, Returning to Practice,
it addressed a genuine problem by engaging with a wide range of
Rotating Departments and Training)
clinicians, as well as women affected by Ehlers Danlos syndrome, and a growing number of organisations that represent maternity
The Midwifery Practice Education Team (MPET) recognised the need
professionals and women both in the UK and internationally. This
for a more robust, structured and individually tailored approach to the
initiative has also ensured the voice of midwifery has been prominent
welcome and induction of newly qualified midwives (NQMs) and newly
throughout, including securing the first midwife representation on the
employed midwives within the Trust.
International Consortium on the Ehlers Danlos Syndromes.
Dr Pezaro and her colleagues have succeeded in securing multiple
Training). It was initially developed to support NQMs, but quickly
funding sources and in developing numerous tools, publications
evolved to include midwives returning to practice following a career
and awareness-raising events. This has generated considerable
break or leave of absence, and to assist with the rotation of midwives
impetus and ensures the project is sustainable and capable of
between departments.
being scaled up.
This was a really good and well-planned project, with clear justification, benefits, purpose, and cycle of evaluation and updating. It is clearly beneficial to all midwives and promotes safety, quality, confidence, competence and revalidation.
RUNNERS-UP Hora Soltani and Frankie Fair
RUNNERS-UP
Sheffield Hallam University Partnership with migrant mothers to improve safe perinatal care – making a sustainable impact
Juliet Wood and Laura Iannuzzi
Suzy Hall and Lynn Bayes
Bournemouth University Zoom the Midwife Global Café
Lewisham and Greenwich NHS Trust Partnership working with doulas
Jane Rooney and Lorna Gerrish
Isabelle Bourton and Nina Khazaezadeh
Edge Hill University Skills @ Home pilot for perineal suturing
Guy's and St Thomas’ NHS Foundation Trust Caseload midwifery – a radically holistic approach
Sarah Fairbairn and Mary Bell
Milena Wezgowiec and Harriet Hickey
Northumbria University Online Transition of NIPE education in response to the pandemic
Medway NHS Foundation Trust Specialist midwife-led preterm clinic
37-45 Awards Compendium_November 2021_Midwives.indd 39
NOVEMBER 2021
From the initial conversation that sparked this initiative,
newly Appointed, Returning to practice, Rotating departments and
39 RCM.ORG.UK/MIDWIVES
The MPET developed the SMARRT Pack (Supporting Midwives,
29/10/2021 09:24
NMC Excellence in Perinatal Mental Health Award
Innovation in Maternity Care WINNERS Amanda Mansfield and Susan Watkins
WINNERS Fiona Laird and Mellissa Jhagroo
The London Ambulance
North Middlesex Hospital
Promoting safe conversations when
Case holding women with perinatal
maternity emergencies occur
Service NHS Trust
mental health collaboratively This is a critical project that could have a huge impact in saving the This is a continuity team, providing enhanced perinatal mental health
lives of women and babies. It is clearly a strong collaboration between
care to a multicultural population with a high proportion of social and
two different professions, and it has generated and added to the body
medical complexities. There was very good reach of service users
of knowledge for midwifery as it has developed a tool that improves
through well-developed and established social media channels,
outcomes for women, babies and families. The project has already
including engaging service users and their partners and families to
been scaled up across a wide area and can be implemented UK-wide
co-produce services.
at minimal financial cost. The candidates presented with great passion
Multi-disciplinary clinics had been developed to include
and enthusiasm, and demonstrated collaborative working at its best.
safeguarding and provide a one-stop shop for women with complexities, with the attendance of a continuity midwife. There were
RUNNERS-UP
NOVEMBER 2021
excellent clinical outcomes, including type of birth and personalised
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40
care plans, as well as women’s experience of care. There was good support of wider midwifery teams, with established training provision and clinical supervision. This was a multi-talented group of midwives, offering a wide range of complementary therapies such as massage, art therapy and belly mapping.
Sarah Gregson and Shazia Nazir Maidstone and Tunbridge Wells NHS Trust Birth planning Infographics to support informed choice
Sophie Kelleway and Sarah Green North West London Maternity Transformation Programme Supportive signposting in maternity
RUNNERS-UP
Lisa Darrah and Sinead McFarlane
Kate Allon
Belfast Health and Social Care Trust SWAN Team - Social Wellbeing Antenatal Care
Darent Valley Hospital Mental health midwife non-medical prescribing clinic
Ilaria Harrison and Alaine Holland University Hospital Coventry and Warwickshire Complex Continuity Team for perinatal mental health and vulnerabilities
Zara March
WaterWipes® Maternity Support Worker of the Year Award
Royal United Hospitals NHS Foundation Trust
Katie Potton NHS Fife Delivering excellence in perinatal mental health
Annmarie Thomas Swansea Bay Health Board Becoming a perinatal mental health specialist midwife
WINNER Candice Noonan Oxford University Hospitals NHS Foundation Trust
Candice’s personal story was very relevant and influenced her role. She met all the award criteria, demonstrating passion for the role and its development, and introducing innovations in the role, including a new process for memory making and developing multi-faith packs. She used feedback from users to improve the service and developed stickers to improve processes. She employed a flexible approach to supporting families when needed and was clearly well respected and valued in the service by both staff and families.
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29/10/2021 09:24
Excellence in Bereavement Care Award Award WINNERS Sian Ness and Beth Towsey
Slimming World’s Caring for You During a Global Pandemic
WINNER
Mid and South Essex
Cardiff RCM branch
NHS Trust
Cardiff and Vale University
The Lullaby Team
Health Board Caring for you – supporting staff through engagement,
The RCM thought these were clear winners. Their passion and
positivity and kindness
commitment to improving service provision for bereaved women really shone through. The panel was impressed by how, in a very short
Cardiff’s RCM branch met all the award criteria. They gave a
space of time, they have turned this service around.
fantastic presentation, showcasing their prolific work and innovative
The pair have worked not only with staff but also women and their
actions. The branch works collaboratively to deliver many fine
families to hear their views and make them part of the process. They
examples of regular engagement support to members. MSWs are
have engaged with and worked in collaboration with the charitable
embraced and included.
sector to implement major service improvement.
The branch reacted quickly to what members wanted and needed at the beginning of the pandemic. This rejuvenated branch has gone
RUNNERS-UP
on to do great things, including providing live training via Facebook
Judith Cutter and Jessica Holmes
on the pandemic. International Day of the Midwife and MSW weeks
Swansea Bay University Health Board The Gift – a beautiful birth and a beautiful death
Daryl Mallis and Myra Kinnaird Scottish Health Professionals Bereavement Network (pregnancy & neonatal loss) Bereavement networking: benefiting staff and families
There were raffles and fundraising for the benefit of members; a new ‘random acts of kindness’ scheme continues to boost morale, and other events such as St David’s Day and Christmas are celebrated.
RUNNERS-UP Jacqueline Owusu-Ansah Imperial College Healthcare Trust
Pamela Galloway NHS Fife Improving staff resilience She showed clear evidence of multi-disciplinary working, provides support and training to other MSWs and has participated in teaching with student midwives. She has developed herself with further training and is now able to support women with consent to post-mortem.
NOVEMBER 2021
Victoria Owens and Hannah Gardener
were celebrated with innovative ideas.
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Cardiff and Vale University Health Board The Teardrop and Rainbow Baby Bereavement Service
and creating support posters and social media to show RCM guidance
Jillian Ireland and Lisa Relton University Hospitals Dorset NHS Foundation Trust Showing care by building relationships and strengthening links
RUNNERS-UP Vanessa Savage Royal Berkshire NHS Foundation Trust
Veronica Williams Guy's and St Thomas' NHS Foundation Trust
37-45 Awards Compendium_November 2021_Midwives.indd 41
29/10/2021 09:25
RCM Race Matters Award
Thompsons Members’ Champion Award
WINNERS Fatima Ghaouch and Samukeliso Sibanda
WINNER Zoe Meneilley
Northampton
Belfast Health and
General Hospital
Social Care Trust
NHS Trust Midwives for Change:
This is an example of good
our journey around the race
teamwork, and of how the hard work of two new officers can turn a branch
These two midwives from different backgrounds have used and built
around and bring members together. The team has successfully
on their own life experiences to give voice to the voiceless among
raised the profile of the RCM and engaged well with members.
colleagues and women. Maintaining their passion and commitment despite staffing challenges, they are also making changes to the way
RUNNERS-UP
care is delivered. They were able to show evidence for the impact they have made – for example, homebirth rates went up and stillbirth rates went down in
Cardiff Branch committee Cardiff and Vale University Health Board
local BAME communities. They have introduced reverse monitoring, with directors coming
Haywards Heath and Brighton Branch University Hospitals Sussex NHS Trust
NOVEMBER 2021
into clinical areas to experience the working lives of black midwives.
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They have used the Black Lives Matter campaign to open challenging
Imperial Branch
conversations with colleagues and are demonstrating how small
Imperial College Healthcare NHS Trust
things really matter. They have achieved a great deal in eight months to put race awareness, inclusion and respect firmly on the agenda.
Sally Morgan
They embody the principle that if midwives’ voices are heard, so
Tameside Hospital
too are women’s voices. They have shown that change is possible and have overcome resistance to improve services and working environments for BAME midwives.
RUNNERS-UP Benash Nazmeen Bolton NHS Foundation Trust
Patricia Mugwangi Dartford and Gravesham NHS Trust Maternity Equality Diversity Inclusion – MEDI
Sara Sardarizadeh and Chelone Lee-Wo St George's Hospital 'About me' Posters
Excellence in Maternity Care During a Global Pandemic WINNERS Anne Richley and Claire Dale Northampton General Hospital NHS Trust The Incredible Journey
Anne and Claire demonstrated great leadership, a fast reaction to the needs of women and midwives, and consultation with users of the service. They worked collaboratively with many others, including maternity management and the executive team at the trust, from whom they had excellent support. They showed creativity, sustainability and flexibility in their approach. They knew how to use their powers and vulnerabilities to obtain what they needed. They also demonstrated communication skills, a down-to-earth approach, tenacity and reflection on what they have achieved. This project’s transferability to the future has already been demonstrated, as they have now been asked to work with Afghan women in hotels in the community.
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29/10/2021 09:25
Pregnacare Student Midwife of the Year Award
RUNNERS-UP Jemma Hughes Cardiff University
Tracey James
WINNER
University of South Wales
Beatrice Bennett
Sheffield Hallam University
Emily Davis
University of Nottingham
Eilidh Cole University of the West of Scotland
Beatrice’s passion and enthusiasm for midwifery and the care of women was evident in the work in which she has been engaged. Central to her work has been the welfare of fellow students and colleagues and her desire to ensure that accessible and inclusive services are available to support them. As president of the university’s midwifery society, she has led
RCM Leadership Award
numerous successful events, fundraising initiatives, social activities and study days, while providing opportunities for socialising and
Her leadership has seen the midwifery society increase its
WINNER Grace Thomas
membership from 15 to 250 members, ensuring its financial stability.
Cardiff University
She has also committed to continuing to support the incoming
Compassionate leadership
committee as they take the society forward.
in midwifery education
Beatrice clearly articulated her capacity to work collaboratively in both local and global initiatives, the outputs of which further
Grace demonstrated all the
demonstrate her commitment and dedication to student welfare.
characteristics of a truly great leader. She was outstanding, and described and demonstrated exceptional leadership skills. Her presentation was inspirational, and the panel was hugely impressed with what she has achieved. She demonstrated great insight and compassionate leadership. She showed how her leadership and passion has given her courage,
RUNNERS-UP
demonstrated through exceptional political astuteness and awareness.
Kelly Parker and Didi Craze Brighton and Sussex University Hospitals Trust Communications and Media Midwife innovative & contemporary job role
RUNNERS-UP
Jane Coyne
Oxford University Hospital Foundation Trust
NOVEMBER 2021
contemporary issues.
43 RCM.ORG.UK/MIDWIVES
extra-curricular activities, enriching learning and raising awareness of
Heidi Ottosen Greater Manchester Health and Social Care Partnership Saving babies’ lives through the Greater Manchester Smokefree Pregnancy Programme
Frances Rivers and Jackie Latimer Kingston Hospital NHS Foundation Trust Supporting Homebirths During a Pandemic
Natalie Carter and Victoria Cochrane Chelsea and Westminster NHS Foundation Trust Chelsea and Westminster COVID-19 response - caring during crisis
Jane Coyne Greater Manchester Health and Social Care Partnership Saving babies’ lives through the Greater Manchester Smokefree Pregnancy Programme
Kayleigh Wdowczyk North Manchester General Hospital Leadership of a midwife ultrasound scan team and service – helping to save babies’ lives in Greater Manchester
United Lincolnshire Hospitals Trust Ongoing training provision through a pandemic
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29/10/2021 09:25
WaterWipes® Team of the Year Award
Midwives’ Midwife of the Year Award WINNERS
WINNERS
England: Tania Pearce
Lisa Darrah and Sinead McFarlane
East Surrey Hospital
Belfast Health and Social Care
Tania is an inspirational
Trust
midwife and leader who
SWAN Team -
demonstrates the qualities and
Social Wellbeing Antenatal Care
attributes of the Midwives’ Midwife of the Year Award. Tania's commitment to contributing to the wider profession while
This team is a fantastic example of a midwife identifying a problem and
maintaining local support and guidance to her team is admirable
building a multi-disciplinary solution. The passion and commitment
and, most importantly, recognised by those around her.
of these team members to providing high-quality, supportive and tailored care to the city’s most vulnerable women is exemplary. Their
‘problems’ has led to tangible improvements in access and outcomes
Northern Ireland: Susanne Thomas
for women that are at high risk of adverse outcomes.
Belfast Health and Social
philosophy of acknowledging women’s strengths rather than their
By engaging with their wider maternity colleagues, other health
Care Trust
NOVEMBER 2021
and social care services and charities, this team are reaching out
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44
and building capacity and capability beyond their own circle. They
Susanne has made
have had the courage to directly face the poorest of outcomes and
outstanding achievements
ensure the entire service learns from the tragedies of maternal
and shown a huge commitment to
deaths. This team is now influencing the development and roll-out of
midwives, MSWs and the wider maternity
other services for vulnerable women and for perinatal mental health
team. Susanne demonstrates the total embodiment of the attributes
services across Northern Ireland – they are champions of what great
required of the Midwives’ Midwife of the Year Award.
holistic midwifery can achieve.
RUNNERS-UP Jenny Carter and Vicky Robinson Guy's and St Thomas' NHS Foundation Trust and King's College London Preterm Surveillance Clinic
Deirdre Gill and Fiona Clarke Western Health and Social Services Trust OASIS
Scotland: Frances Arrowsmith NHS Highland
This midwife is without doubt the most amazing colleague and manager. She provides care that is of the highest standards and there is never anything that is too much trouble for her. As a colleague she exudes kindness and compassion. She is an inspiration in how a manager should support and lead a
Polly Kay and Nick Kametas King's College Hospital The Hypertension Clinic
Barbara Strawbridge and Paula Morrison Northern Health and Social Care Trust Continuity of midwifery care
team of midwives.
Wales: Sarah Hookes NHS Wales Shared Services Partnership
Sarah Hookes is clearly a motivational and well-respected leader, demonstrating her passion and drive in delivering high quality training. This is recognised by her colleagues, who feel inspired by her total commitment to improving the quality of training that midwives receive.
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29/10/2021 09:26
Midwifery Service of the Year Award
Its recent achievements include:
•
A smoking cessation service that has supported over 1,000 women
•
Personalised care to support and engage with women whose babies are in NICU
•
Successfully introduced AEQUIP across local maternity system
WINNER
•
Manchester University NHS Foundation Trust
Introduced a six-day-a-week, midwife-led, third trimester scanning service.
The team is committed to continuous improvement and seemingly every year they have a new development or initiative. This award
This year we are awarding a trust that in recent years has consistently
is given in recognition of sustained excellence, a culture of high
been high performing, innovative and a great place to work.
achievement and a focus on helping others.
Formed out of the merger of three large services, it is expertly led by a director of midwifery who has created a strong leadership structure and culture beneath her with heads of midwifery (HoMs) on each site. This trust has a justified reputation for supporting student midwives, and for keeping its students and supporting them through their early careers.
The new Honorary Fellows of the RCM exceptional individuals who have made an outstanding contribution
the service and created a culture where management, HR and the
to the profession.
RCM have developed policies and guidelines to support staff, mindful of individuality and inclusiveness. It was the first maternity service to
Terri Coates
sign the RCM’s Caring for You charter, and has introduced hydration
Through her involvement
stations, reliance workshops and a learning bus.
with the TV drama Call
This is a service that reaches out to support others. It leads by
the Midwife and other
example across Greater Manchester, supporting and informally
productions, Terri has raised
mentoring newly appointed HoMs, and during the pandemic it
midwifery’s profile nationally
supported neighbouring services that were closed.
and internationally.
Professor Ann Holmes Ann has made a huge contribution to midwifery in Scotland and the UK as chief
45 RCM.ORG.UK/MIDWIVES
This year, the RCM has awarded honorary fellowships to four
Matters to Me’ initiative has embedded staff wellbeing throughout
NOVEMBER 2021
For a number of years, it has actively involved staff at all levels in decision-making and developments within the service. Its ‘What
midwife for the Scottish Government and as lead of
RUNNERS-UP Noella Aers Maidstone and Tunbridge Wells NHS Trust
the ‘Best Start’ review.
Dr Kathryn Gutteridge A former president of
Sarah Blackwell University Hospitals of Leicester NHS Trust
Harriet Burke Maidstone and Tunbridge Wells NHS Trust
the RCM, Kathryn is an independent consultant midwife and a practising psychotherapist examining childbirth's emotional impact.
Lorraine Hawkins Milton Keynes University Hospital
Shona Hamilton Northern Health and Social Care Trust
Professor Marlene SInclair Marlene is head of the Maternal Fetal and Infant
Emma Mckay Hywel Dda University Health Board
Research Centre at Ulster University. She founded and
Sarah Smith
edits the RCM's Evidence
University of Derby and Burton Hospitals NHS Foundation Trust
Based Midwifery journal.
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29/10/2021 09:26
Recruitment For more information or to advertise your job vacancy please contact: midwivesjobs@redactive.co.uk
Midwives
NOVEMBER 2021
Midwifery – for you it’s so much more than a career…it’s a calling. And now the chance to do what you love, in a country we know you’ll love, is calling your name. Now is the time to breathe new life, energy and optimism into your career and quality of life, here with us in the Wellington region of New Zealand. So, take a breath, relax and ready yourself for the move of a lifetime. If there was one word to encapsulate what we have to offer you, it’s ‘options’. Whether it’s core midwifery, community midwifery, primary, secondary or tertiary care...you’ll find an opportunity here that’s sure to suit. It’s in large part to do with the choice of locations we have for midwives across the greater Wellington region. With Wellington Regional Hospital, Hutt Hospital in Lower Hutt, the Kenepuru Maternity Unit at Kenepuru Community Hospital, and the Paraparaumu Maternity Unit on the Kapiti Coast all potential bases for
you, finding your ideal fit will be a breeze. And regardless of where you end up, you can look forward to working with highly supportive, passionate colleagues, caring for diverse multicultural communities. As well as excellent scope to develop your career while enjoying our unique, patientfocused model of care, you will also have the chance to live the enviable quality of life New Zealand is famous for. The Wellington region is renowned as a true lifestyle hotspot thanks to stunning natural surrounds, modern amenities, less density and the space to just breathe easy. If you’re an experienced midwife who’s excited at what’s on offer with us, and ready to explore how you could make the move happen, talk to us today. To apply or find out more go to justbreathemidwives.co.nz
RCM.ORG.UK/MIDWIVES
46
The perfect place to find the latest midwifery vacancies Midwives Jobs is the official jobs board for the Royal College of Midwives
jobs.midwives.co.uk @midwivesjobs
MIDNOV21.046.indd 46
28/10/2021 14:32
External submission
T
Kate Allon is a specialist midwife running the first midwife-led perinatal mental health prescribing clinic, and believes she’s on to something
NOVEMBER 2021
Hearts and minds 47 RCM.ORG.UK/MIDWIVES
he perinatal period starts at the point of conception and ends on the child’s first birthday. During this time, mothers are under significantly more stress and are susceptible to developing mental health problems. Although some mothers may have pre-existing conditions, for many women becoming a mother acts as a catalyst. It has long been established that mothers are more at risk of developing mental health issues during the perinatal period than at any other time. The World Health Organization, in its 2020 Maternal Child Mental Health report, found that approximately 20% of mothers in developing countries experience clinical depression after giving birth, and that 13% of mothers worldwide that have recently given birth experience a mental health disorder. In the UK, the National Institute for Health and Care Excellence estimates that 12% of women will experience depression and 13% of women will experience anxiety at some point
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28/10/2021 16:15
External submission
during pregnancy. Approximately one in every 500 pregnancies will result in the mother having severe and enduring mental health issues. The fact that this number has not fallen over the past few decades is concerning, especially considering the progress that has otherwise been made in the field. It highlights that a new approach needs to be taken to better support women in their journey to motherhood. The role of a perinatal mental health midwife arose to address the nuances involved in providing effective and targeted care, but how this is done can vary greatly from trust to trust/board or maternity service.
NOVEMBER 2021
Improving efficiency In the past, women have been seen in obstetricled clinics, where waiting times just to arrange
and attend appointments can often be long, with appointments also usually running over the designated time by at least an hour. These appointments offer only a small chance of continuity of obstetrician and midwife, and make it difficult to establish the necessary relationship between health professionals and women because
One in 500 pregnancies will result in the mother having severe and enduring mental health issues
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28/10/2021 16:15
Clinic benefits A dedicated perinatal mental health clinic holds many more benefits – it offers shorter waiting times, quicker referral times and better continuity of care. At the clinic, I can offer holistic care for women and babies, and establish good relationships with them at each succeeding appointment. The arrangement makes it easier for these women to access mental health support.
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NOVEMBER 2021
Moreover, obstetricians and consultants have more time to deal with the patients with much more severe mental health issues such as schizophrenia and psychosis. It results in a much more appropriate allocation of time in terms of patients seeing the correct medical professionals while spending as little time waiting as possible. If this type of clinic could be replicated across the UK, it would result in new centres of care for women in the perinatal period. Improved continuity of care makes for shorter future appointments due to a better knowledge of a patient’s situation and care needs. The clinic increases access to mental health support. Trained and experienced specialist midwives like myself are able to assess the women in our care, establish an effective treatment plan and consult with them on medication – whether to introduce new medicines or change the type or dosage of their current prescription. This takes less time than it takes at present for a woman to have a consultation with a doctor or other medical professional, for these health workers to possibly consult with the woman’s GP, and then for the woman to collect her medication. A re-audit of the clinic a year since its opening showed a massive increase in patient satisfaction and accessibility of support when required. We are also now firmly established within the multidisciplinary team, taking referrals from GPs, community mental health teams, health visitors, social care and midwives. I hope that by breaking the norm for the role of midwife, l can act as a catalyst for others to do the same. Hopefully, this new clinic model will help lower the high suicide rates and morbidity suffered among new mothers with poor mental health. These are the heights we must strive to reach.
49 RCM.ORG.UK/MIDWIVES
of the intimate and sensitive nature of the details disclosed. Consultant obstetricians should not need to allocate time to women with low-risk mental health conditions as well as low obstetric risk as they could easily be managed by a specialist midwife. This is especially important considering that these consultations typically last much longer than the usual 15-minute window that is allocated for them. For example, from 1 January to 31 December 2019, 1,247 of 4,900 women booking their maternity care at Darent Valley Hospital in Kent reported an existing mental health condition. In April, an audit was conducted to establish what type of medical professional women needed to see based on the kind of support and information they needed. It was found that of 132 appointments in April, 11 women needed to see a consultant experienced in perinatal mental health and obstetrics, 67 needed to see an obstetrician with knowledge of perinatal mental health, and 41 could have been seen by a specialist midwife. If these 41 women had been seen by a specialist midwife only, not only would this relieve pressure across services, it would also provide 41 women with midwife-led care. This made me realise there was a role for specialist perinatal mental health midwives with training in prescribing. I undertook a prescribing course in which I learnt the dynamics and intricacies of pharmacokinetics and pharmacodynamics of various drugs. I then established a perinatal mental health midwife prescriber’s clinic – the first of its kind in the UK – made possible by fantastic support from my head of midwifery Michele Ahluwalia, manager Karen Woolway and consultant obstetrician Mark Waterstone, who mentored me in prescribing.
MORE INFO RCM Specialist Mental Health Midwifes – What they do and why they matter: bit.ly/RCMMentalHealth National Institute for Health and Care Excellence, Antenatal and postnatal mental health: www.nice.org.uk/ guidance/cg192
28/10/2021 16:15
Talking point
NOVEMBER 2021
Pills in the post RCM.ORG.UK/MIDWIVES
50
Many midwives work in abortion services and see this as an essential part of their role. COVID-19 measures revolutionised UK abortion services, but will this greater access to care continue, asks Juliette Astrop Early Medical Abortion (EMA) services underwent a sea change in the UK with the advent of the first COVID-19 lockdown. From the end of March 2020, women have been permitted to take both abortion pills in their own homes instead of only the second pill. And instead of attending an in-person appointment, they can be prescribed both medications to terminate pregnancy under 10 weeks’ gestation following a phone or video consultation. Both these measures, which were brought in on a temporary basis in the light of the pandemic, have revolutionised access to abortions – and reignited the debate around them, prompting fears of perceived risks around clinical safety, safeguarding and the provision of psychological and emotional support. While a question mark still hangs over the ongoing provision of this ‘pills in the post’ service, the evidence so far has been overwhelmingly positive. Research has shown it is safe, effective, cuts waiting times, improves access to care, and would be the preferred option for four
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in five women seeking a termination (Aiken et al, 2021). Meanwhile, in Northern Ireland there has been an even more profound shift. Following the decriminalisation of abortion there in October 2019, a new framework of regulations for lawful abortion services came into effect on 31 March 2020, introduced by the UK Government. Heath trusts have responded, operating interim services for early medical abortions up to the first 10 weeks of pregnancy. However, the commissioning of full services has stalled completely in the face of ongoing legal and political challenges.
While a question mark still hangs over ongoing provision, the evidence so far has been overwhelmingly positive
28/10/2021 16:16
Professor Dame Lesley Regan FORMER RCOG PRESIDENT AND CURRENT CHAIR OF ITS
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for women. They are not waiting to come into a clinic, nor do they need to arrange childcare or transport. “In relation to concerns about safeguarding, my colleagues on the front line in EMA services say they are actually able to do better safeguarding [with this arrangement] – in some ways, it might be easier to find things out via a virtual platform, when a woman is not accompanied by a potentially coercive person. “This has been a great step forward and definitely a silver lining to come out of COVID-19. The challenge is now to ensure it stays in practice. We have absolutely shown it works and shown it is safe, and I have a paper about to come out that shows it is cheaper too. My argument now would be to keep the funding the same and improve services to ensure women having an abortion get at least a year’s worth of reliable contraception – that conversation should be included in their consultation. “If this service were to be withdrawn, that decision would be purely political, not medical. Some may believe that keeping abortion difficult to access, more unpleasant to undergo and more dangerous will persuade women to continue their unwanted pregnancy. But you just have to look around the world to recognise this claim is invalid. Irrespective of your point of view, we know that abortion doesn’t go away in societies where access to it is restricted – instead, it goes underground and becomes unsafe.”
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“The argument around ‘pills by post’ is longstanding. After many years of campaigning, in August 2018 women were finally allowed to take misoprostol at home. It was a big step forward, but the real argument was around mifepristone – the first pill that stops a pregnancy. That was the one we wanted to get over the line, but there has been a lot of resistance. “When we went into lockdown, we persuaded the Health Secretary to take special measures to ensure mifepristone could be prescribed by post. That didn’t mean it was unregulated – it was about making sure women didn’t have to physically come into a clinic to take the medication in front of the doctor or healthcare practitioner. “The big change from a practical point of view was that, in the past, visiting a clinic meant many women also underwent an ultrasound dating scan. There were concerns about women getting their dates wrong or having more serious complications such as bleeding or undiagnosed ectopic pregnancies – but that hasn’t been the case. In fact, this has been one of the most successful experiments in medicine during the pandemic; not only are we reducing waiting times – and so reducing complications, as every week of gestation of pregnancy you wait to perform a termination, the greater the risk profile – but it is also much easier
NOVEMBER 2021
ABORTION TASK FORCE
28/10/2021 16:17
Talking point
Dr Suzanne Tyler
NOVEMBER 2021
EXECUTIVE DIRECTOR AT THE RCM
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“There have been some myths and anxiety around ‘pills in the post’, including two cases of maternal death being cited – but actually, both happened before the service was introduced. “One thing that wasn’t anticipated was that, as the number of medical abortions as opposed to surgical abortions increased dramatically, women were not going into a clinic before treatment as they had done historically. If they had any difficulties or excess bleeding, rather than returning to the abortion clinic, they were picked up in maternity triage. Midwives started to see things they wouldn’t normally have, so it felt to them like a big increase in complications even though that wasn’t the case. “There were also fears about more missed ectopic pregnancies – but again, when you look at the evidence, that hasn’t happened any more than it did before. A massive audit of more than 50,000 abortions before and after the service change (Aiken et al, 2021) should give everybody reassurance there is no question of an issue with safety. “But what that study also shows is that the time between a woman’s decision to end her pregnancy and receiving treatment was reduced and the number of early abortions increased; ‘pills in the post’ has improved access and timeliness, which can only be a good thing. “Another piece of the debate is around the safeguarding
of trafficked and vulnerable children. Social workers fear that if children forced into prostitution are no longer seen in person, pimps and handlers will be able to force them to have abortions using ‘pills in the post’. These professionals are proposing that ‘pills in the post’ shouldn’t be available to under18s. But abortion providers suggest that to deny this service to all under-18s for the sake of a tiny minority of very vulnerable girls is disproportionate, and these forced abortions would sadly probably happen regardless. That debate is still ongoing. “From an RCM perspective, we absolutely support the continuation of ‘pills in the post’. But if that is where things are going, those running maternity services will need to be well briefed and in contact with abortion providers in a way some haven’t been before. “There is also the potential knock-on effect of the fact that ‘pills in the post’ is much cheaper. If this service attracts less commissioning income from the NHS, the British Pregnancy Advisory Service (BPAS), Marie Stopes International and other providers may start having to think about the viability of their physical clinics. “While telephone counselling is all many women seeking a very early termination are looking for, we want to make sure women don’t lose access to the wrap-around support and care that abortion providers have traditionally provided so well.”
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28/10/2021 16:17
Hannah Thompson A MIDWIFE AND LECTURER, HANNAH WORKED UNTIL RECENTLY AT BPAS BUT IS STILL INVOLVED IN SUPPORTING PEOPLE WHO HAVE ABORTIONS AND RUNS TRAINING ON THE POLITICAL
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happened under the old system at the same rate. “In terms of easier access, not having to make travel arrangements or childcare arrangements and not having to tell people what you’re doing if you don’t want to, this service is a lot better for women. Some are in precarious situations at home; I used to speak with women quite regularly who told me ‘I can’t come in – what will I tell my partner?’ or ‘What will I tell my family?’ “It is also cutting waiting lists – and I know for a lot of women, the period between deciding they want an abortion and actually having it is one of the most difficult times in their life. There is something happening to their body that they don’t want, and the urgency to reach a resolution is so intense that it really affects people’s mental health. “We also know the lower the gestation, the safer abortion is. Not only that, but it’s less painful, with less blood loss, so it’s improving safety and women’s experiences as well. “The only reason not to continue with this would be to control and restrict women’s right to choose what they do with their bodies. According to safe medical practice, [continuing the programme] has to be a yes.”
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“I worked in the one of the largest abortion clinics in the country, doing everything from consultations for EMA to caring for women having medical or surgical abortions right up to the limit. Much of my role was preparing people for their treatment, making sure everything had been done to keep them safe from a medical point of view – but it also involved talking to them, seeing what their situation was, what I could do to help, offering contraception and family planning information, or just reassuring them it’s okay to cry. “While this job is also done by nurses, to my mind it’s definitely midwifery. This is part of people’s reproductive and fertility journey, and a big turning point in their life. It’s important to be able to support and reassure them that the decisions they are making are okay and that they’re safe. “I’ve seen ‘pills by post’ overwhelmingly well received by women. In cases where women aren’t satisfied by their experience, it’s usually around passing the pregnancy at home, which is nothing new – a stay in a clinic through the whole process was never really offered with early abortions – or around having complications, which
NOVEMBER 2021
AND ETHICAL ASPECTS OF ABORTION
28/10/2021 16:17
Talking point
Karen Murray
NOVEMBER 2021
RCM DIRECTOR FOR NORTHERN IRELAND
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“We now have a regulation that allows abortion up to 12 weeks on request, up to 24 weeks where there is a risk to the physical or mental health of the mother, and access to abortion care without gestational limit in order to save the life of the woman, prevent grave physical injury or in the case of serious fetal abnormality. But the problem is that the Northern Ireland Department of Health hasn’t commissioned a service – there is no commissioning, no commissioning plan and no funding for abortion services. “The minister has deemed this ‘crosscutting and controversial’, to use the language of Northern Ireland politics, and has advised it can’t progress unless it goes through the Executive. We are approaching the second anniversary of decriminalisation, and the lack of progress from the Department of Health is beyond disappointing. “The regulation came in March 2020 just as COVID-19 was kicking off. At that point, sexual and reproductive health services were being stepped down and colleagues in those services took the decision to establish abortion services because they recognised women couldn’t travel to England, Wales or Scotland to access an abortion, as they have been able to do since 2017. “Informing Choices Northern Ireland (ICNI) took on the role of referring women to the appropriate trust, where sexual and reproductive health staff would carry out a phone conversation. If that woman met the criteria, she would be invited into the clinic to take the first medication and then take the second at home. That’s how early medical abortion services have been run here since April 2020 – but there are no
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The lack of progress is beyond disappointing services for women over 10 weeks. “For women later in pregnancy, abortions are being offered in maternity services where there is serious fetal abnormality or a serious risk to the mother – but again, that isn’t commissioned, so has no additional funding or resources. “As things begin to return to normal, sexual and reproductive health services now have less capacity and some trusts have had to temporarily suspend abortion services. The ICNI couldn’t maintain its role indefinitely without funding, and withdrew as of 1 October 2021; for now, BPAS has stepped in as
that central point of contact. “While there are now abortion services, the concern is that women are unclear of how to access them in the first instance – there is limited guidance on trust websites or the Department of Health website, for example. We also have pro-life groups masquerading online as abortion service providers in order to obstruct and delay women – at times until they pass beyond 10 weeks and then have to travel. Women are also buying abortion pills online, so we’re missing out on that opportunity to provide them with sexual health services, including contraception. “The RCM is calling for fully commissioned and funded services, with a clear framework for service delivery, clear pathways and clear professional guidance – including for those exercising the right to conscientious objection. We also support calls for safe access to services, addressing the significant issue of prolife protests around abortion providers,
28/10/2021 16:17
Hollie Lander MIDWIFE PRACTITIONER, BPAS RICHMOND/
MORE INFO Further reading: bit.ly/PillsPostCovid England and Wales: bit.ly/ Abortions2020 The English and Welsh governments’ consultation, which ran from November 2020 to February 2021: bit.ly/ HomePillsConsultation
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know that 80% of women said that telemedicine was their preferred method of treatment, and 97% report being satisfied or very satisfied with their experience. Last year, a record 88% of terminations were at less than 10 weeks – and 26% at less than six weeks. Waiting lists are down and women are receiving treatment more quickly. “In terms of clinical outcomes, an analysis of over 50,000 EMAs found that there was no difference in treatment success, serious adverse events, or the incidence of ectopic pregnancy when comparing in-clinic EMAs to telemedicine (Aiken et al, 2021). There is no clinical argument for going back to the way things were – and there are so many benefits for women. “It doesn’t suit everyone, but ‘pills in the post’ 100% needs to stay. This is a service women want and need – to go back to a time when they could only begin their treatment in a clinic on a day set by us would be heart-breaking. “I am passionate about this work, but I feel we are a hidden branch of midwifery. It is about being with women and, just as in traditional midwifery, we build relationships with women at a vulnerable and stressful time. I feel privileged to work in a much-needed service ensuring women are cared for in the safest and most compassionate way.”
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and want to see the provision of telemedicine to bring Northern Ireland into line with the rest of the UK. “This is very much about women, but also about RCM members – who, like the rest of society here, reflect the full range of views on abortion. So guidance around the right to conscientious objection is also important. “It is complex and things do get mired in both the courts and our political system here. But we have made progress, not least in terms of societal views – even just being able to have open conversations about abortion shows how far we’ve come.”
“Before COVID-19, a woman seeking an early medical abortion would come into clinic for an initial consultation and scan. Now we screen for any clinical indicators – any discrepancies in the menstrual history, or signs of an ectopic pregnancy – and only some women below 10 weeks will need to be seen before treatment. Any woman over 10 weeks will still need to be assessed in clinic with a scan. “I think as midwives in BPAS we were sceptical initially, because it’s such a different way of working. But we’ve seen ‘pills in the post’ constantly evolving; women’s safety is always the priority, and if the evidence or women’s feedback identifies something that needs to change, that’s what we do. “On the safeguarding side, that’s also been evolving. When we speak to someone under 18, it has to be via video rather than a phone call, and we ask them to pan around the room to show if they’re with anyone. If they’re suitable for ‘pills in the post’, we also need to speak to the designated adult who will be with them during treatment, and follow up three weeks later to see if they need any further support. And if for any reason something doesn’t seem right or we have a safeguarding concern, we can always see that person in clinic. “We are 18 months in and still gathering evidence, but we
NOVEMBER 2021
RICHMOND TELEMEDICAL HUB
28/10/2021 16:18
External submission
The fellowship NOVEMBER 2021
Trainee consultant midwife Laura Bridle demystifies the role of research midwife and encourages others to take this opportunity
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ealth Education England (HEE) launched its first national Population Health Fellowship for NHS clinical staff in England in February 2020. I was one of the 21 clinical staff – and the only midwife – selected to join the scheme. It was a brilliant experience, and I encourage other midwives to take advantage of this opportunity. Population health management is an approach that aims to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population. The 2010 Marmot Review into health inequalities in England highlighted that, for women – particularly those in deprived communities – life expectancy has fallen and the number of years spent in poor health is increasing. This is linked to poor socioeconomic status. As midwives, we can play a key role in health promotion and advocacy by working with our integrated care systems (ICS). I have been placed in Lewisham, which is within the South East London ICS. The ICS supports a community of more than two million people over six boroughs and five trusts. Part of the fellowship includes contact days with HEE and the other 20 fellows from all over England. Our first contact day was in person, but because of the pandemic every other has been via a
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screen. Despite the pause in the fellowship to return to clinical duties during the pandemic’s first wave, I have really enjoyed and benefited from the experience.
The research The 2021/22 NHS priorities and operational planning guidance encourages services to use real-time data to improve outcomes through population health management. Anecdotally, I know that any breakdown in communication between primary and secondary care can delay treatment or prevent key information from being shared. In Lewisham, we are using software from Cerner to create a database drawing together information from primary, secondary and mental health services. The Cerner software uses a platform called ‘HealtheIntent®’ to integrate whole health systems, making population health management possible. I have been using the software and working with colleagues to ensure that staff in primary care networks (PCN) understand how to use it. My public health supervisor and colleague allowed me to join a work stream that was looking at gestational diabetes mellitus (GDM) in pregnancy. It has been very educational for me; as a perinatal mental health midwife, I
have had some experience of how women are now being supported antenatally, but I was not aware of the increased risk of developing type 2 diabetes. NICE states that nearly 50% of women diagnosed with GDM develop type 2 diabetes within five years of the birth. In longterm studies, nearly 70% of women with GDM developed type 2 after 10 years. Women should be screened at three months postnatally and again every year for type 2 diabetes. Early diagnosis of diabetes and timely intervention reduce long-term complications. When accessing the data platform, I could see that in one practice alone, 40% of women with GDM had developed type 2 diabetes between 2017 and 2020. Of this cohort, 63% of women did not have an initial screening at three months and 99% did not have an annual screening. Although it was depressing to discover this, it showed the impact real-time data management
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IMAGE: SCIENCE PHOTO LIBRARY
Joining the dots One outcome from this work has been the ability to work with GPs and PCNs to see where breakdowns in communication could be happening. This led to further work with the diabetes midwifery teams at two local trusts to improve communication. The diagnosis for GDM is now on the first page of the discharge paperwork and there’s been a sharing of services that women could access freely, such as Weight Watchers and the National Diabetes Prevention Programme (NDPP). By using the data platform, women can be contacted more
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This fellowship has been really beneficial to my career as a midwife
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can have on recognising who needs to be offered further screening and where to target interventions to help prevent the development of type 2 diabetes.
easily as GPs and PCNs can see who needs to be screened. It also promotes a conversation about why some have not attended a screening, allowing for service improvement. After speaking to women myself, I received feedback that the diagnosis brings with it limitations of what to cook. With almost 80% of women birthing in London not being born in the UK, there was a need for more culturally sensitive recipes to be made available. Working with women, dieticians, specialist midwives and recipes found online, such as the Diabetes UK website, I have created an electronic resource for women. This includes 25 recipes, additional services that women can access – such as community-run cooking classes and the NDPP – and tips for eating well. This was trialled within Lewisham and then south-east London; a recipe book will soon be available nationally. Despite the obvious setback of missing out on face-to-face connections, this fellowship has been really beneficial to my career as a midwife. And, now the fellowship has ended, I am on a foundation programme to work as a consultant midwife in public health, and I encourage more midwives to do the same. If population health is not your passion, there are many alternative fellowships, such as the Darzi Fellowship or Future Leaders fellowships. As Nelson Mandela said, “Education is the most powerful weapon which you can use to the change the world.” So why not consider it? MORE INFO Find out more about the HEE Population Health Fellowship and read Laura’s project summary at bit.ly/HEEPopHealth Health equity in England: the Marmot review 10 years on See bit.ly/MarmotReview10 Gestational diabetes and the incidence of type 2 diabetes: a systematic review bit.ly/GDMType2
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Voice of a mother
Behind the mask
NOVEMBER 2021
Working as a midwife through the pandemic meant that Paige was often the sole supporter of women when COVID-19 meant their loved ones couldn’t be there. And then she found that she was pregnant
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orking as a midwife through a pandemic gave me a new perspective on my job. Suddenly, I was not just a midwife – I was the partner holding a clammy hand during induction or the early stages of labour, or the lifeline to a terrified woman, trying to share a smile behind a mask and steamed-up goggles. I don’t think I ever really understood what a huge privilege this was or its importance to women – until I found out that I was pregnant. I booked myself a private scan, and after a short and awkward exchange I was told that the result was inconclusive and to contact the Early Pregnancy Assessment Unit at the hospital. We were devastated. With the mutterings of miscarriage from the early pregnancy nurses, I was in unknown territory. Suddenly, I was in a clinic, scared and desperately searching for the reassuring look behind the mask. I had scan after scan, alone, weeks apart. As I sat with the nurse for the final time, I heard the words: “I’m so sorry for your loss”. I was left alone for a little while to call and break the news to my partner over the phone. I was supported that day by the kindest of nurses, who gave me cup
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after cup of tea and two hours of care. The next few days were a blur. I chose to have a surgical management (alone), saw the nurse (alone) and attended the hospital for surgery (alone), with just a wave from the entrance from Midwife Paige and my husband. Just like all husband Dave, an ICU my other appointments, doctor, are expecting I was greeted by a baby in November the smiling eyes of unfamiliar faces. After a year of being The heartache of losing a baby during the sole supporter of women in my a pandemic can feel like the loneliest daily work, I was on the other side and place in the world. I’m grateful for the realised the importance of the role: the early pregnancy nurses, who were at the sympathetic look, the squeeze of the end of the phone for me when I needed shoulder, the “are you okay?”; the porter’s them and treated me like a friend after friendly banter easing my nerves, and regular visits. They see miscarriages the look of disappointment and sadness multiple times a day, but made me feel on the registrar’s face as I cried. like I was the only person going through it and have given me so much support. I have a new appreciation for what others are going through. Midwife means “with women”, and that’s never resonated with me more. I never thought I’d be working on the front line as well as receiving care during a global pandemic, but I’ve learnt how important that kindness really is.
Losing a baby can feel like the loneliest place in the world
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