MIDWIVES - rcm.org.uk · Opinion Practice rcm.org.uk/midwives 3 CONTENTSMIDWIVES VOLUME 21 | Autumn 2018 7 Editorial The RCM’s Julie Richards on shaping strategy by listening to

MIDW

IVES / AUTU

MN

2018

AUTUMN 2018

MIDWIVES

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UK/JOB/18-11727

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MID.Iss3.2018.002.indd 2 07/08/2018 10:03

Opinion

Practice

3rcm.org.uk/midwives

MIDWIVES

CONTENTSVOLUME 21 | Autumn 2018

7

EditorialThe RCM’s Julie Richards on shaping strategy by listening to members

News

31EBM

The contents of the latest issue

32ResearchTwo authors summarise their work

34Inspirational

researchPapers that have made an impact

36How to...Keep your

career on track

21One-to-oneTV presenter Kate Quilton

on breastfeeding

8 News

The impact of revalidation; stillbirth

national guidance

9, 11, 13 Country news

The latest from the RCM’s country directors

16 Your RCM newsFGM campaign wins

award; NHS pay results; Pride parade

27Voice of a mother

Siobhán Ridley pens a letter to her student midwife

28RCM branch voice

Powys branch trials Facebook Live

branch meetings

12 Th e big story

New guidelines for critically ill women

19On employment

Alice Sorby on unpicking your pay deal

17 On politics

Pushing for a fair Brexit deal for EU staff

18Your student news

Apprenticeships; Mentor Appreciation Day;

fundraising on a cliff edge

25Your thoughts

Ruby Handley-Stonesays NIPE skills

breed confi dence

14 Global news

Stories fromaround the world

26Student voice

Louise Webster on never giving up on your dreams

29Voice of an NQM

Anna Merrick describes her time on postnatal ward

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Features

4 rcm.org.uk/midwives

MIDWIVESVOLUME 21 | Autumn 2018

51MSWs

Defi ning new career paths and improving status

46Th e Big ConversationWhat were the key themes

that emerged from the listening exercise?

53i-learn

New courses, including VTE prevention, available

54ASAP

Community ‘skills and drills’ training in Powys

60MTP

An Early Adopter site in London is pioneering new ways of working

64UK-US midwifery

How a special relationship was forged a century ago

66RCM fellows

Six new high-achievers are appointed this year

68SCT screening

A project to increase uptake among fathers

57Diary

Courses, training, events

82Competitions

Win somegreat giveaways

72FNAIT

The science behind low platelet count in newborns

75Global volunteering

The benefi ts of twinning projects in developing countries

78MTP

Playing catch-up to harnessnew digital technology

Cover story

40CommunicationWords are powerful:

how midwives use the language of

labour to a mother can aff ect her entire

birth experience 48Infant feeding

The new RCM position statement empowers all

mothers in making a choice

50Refl ection

Breedagh Hughes looks back on 21 years at the

RCM in Northern Ireland

58RCM board

Four members explain what they bring to the table

lc

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MID.Iss3.2018.005.indd 2 06/08/2018 16:54

MATERNITY SUPPORT WORKER

www.rcm.org.uk/mswweek

COMING TO YOUR WORKPLACE THIS NOVEMBERHOW ARE YOU CELEBRATING MSW WEEK?

#MSWWeek2018

The RCM: Supporting Support Workers

12th -18th NOVEMBER

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7rcm.org.uk/midwives 7

JULI

E RI

CHAR

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Chai

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oard

It has been an exciting 12 months since being appointed as chair of your RCM board by supporting a number of new board members, welcoming Gill Walton as new CEO and strengthening the board engagement with the executive team. Th e elected board has a vital role to play in holding the CEO and executive team to account, and thinking about the long-term sustainability of the RCM. In simple terms, this means protecting members’ money and their interests and infl uencing the RCM as an organisation that is in the best shape it can be to lead for midwifery. Over the CEO’s fi rst year in post, as a board we have been very supportive of her approach in regards to taking time and creating opportunities for listening, engaging and understanding.

Members are at the heart of decision-making for the profession and for the organisation. It’s very important that our RCM vision and priorities have been informed by hearing from them. Th e RCM’s Big Conversation has been a golden opportunity for members to put forward what they think makes the RCM strong, and what needs to be done to promote, support and inform good quality maternity services. It has beena real chance for members to be very much part of the RCM – OUR RCM.

Th e Big Conversation themes were used as part of the strategy development

held in July where we considered all the information and feedback from the campaign, using it to create a fi ve-year strategic plan for OUR RCM. Th e current plan consisted of six strategic goals, and their underpinning priorities. Th e strategy day reframed these into four easy-to-understand goals which were sketched up as visual picture by Scarlet Designs who were the facilitators for the development day. Th e fi nalised strategy will be launched by Gill at the October RCM conference with your board members on hand to discuss the content of the fi ve-year plan. Th e plan is ambitious and vibrant to make sure the RCM is in the best shape it can be for the next fi ve years. Th e new strategy is intentionally very visual, very clear and understandable, and we hope will be very much owned by you, the members. It will be the board’s responsibility to then monitor and oversee to ensure the refreshed ambitions come to fruition.

Looking forward, the board would like each member to know what the strategic vision of OUR RCM is, and what progress we are making toward achieving those objectives. Also, from a woman’s point of view, the board would like them to be able to see the very clear diff erence that the strategy is making to the quality of services for them and their families.

OUR RCM,fi ve years aheadWhat does the future look like for OUR RCM? Th e Big Conversation has shaped the strategy.

The offi cial magazine of The Royal College of Midwives15 Mansfi eld StreetLondon W1G 9NH0300 303 0444

EditorialEditor Emma GodfreyDeputy editor Aviva AttiasAssistant editor Hollie [email protected] sub-editor James HundlebyContent assistant Nicole BainsProfessional editor Professor Mary SteenPhD MCGI PGDipHE PGCRM BHSc CIMI RM RGN

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Printed by Precision Colour Printing.Mailed by Priority, Salisbury.

All members and associates of the RCM receive the magazine free.

The views expressed do not necessarilyrepresent those of the editor or of The Royal College of Midwives.

All content is reviewed by midwives.

Full article references can be found in the ‘Midwives magazine feature articles’ section of the RCM website.

Midwives ISSN 1479-2915

Recycle your magazine’s plastic wrap – check your local LDPE facilities to fi nd out how.

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THELATEST NEWS


Your professional midwifery news

Public Health England has published guidance for screening providers and commissioners of the newborn and infant physical examination (NIPE).

The guidance highlights actions that need to be taken by screening providers and commissioners, and examples of best practice initiatives from across the country.

These initiatives include demonstrations of the use

A new report reveals how the number of stillbirths fell by a fi fth at maternity units where national guidance has been adopted.

Th e guidance, known as the Saving babies lives care bundle, has been implemented by 19 maternity units and so far has helped save more than 160 babies’ lives, according to an independent evaluation.

Th e clinical improvements in the guidance include reducing smoking in pregnancy, better monitoring of babies’ growth and movement in pregnancy, as well as better monitoring in labour.

Th e Saving babies lives care bundle is part of ambitious plans by NHS England to make maternity care safer and more personal.

Th e best practice guidance is now being introduced across the country and NHS England says it has the potential, if these fi ndings were replicated, to prevent an estimated 600 stillbirths.

NHS England’s national clinical director for maternity and women’s health Matthew Jolly said: ‘Th ese fi ndings show signifi cant progress in the reduction of stillbirth rates. Th is is thanks to the dedicated maternity staff who have developed and implemented the clinical measures we recommend as national best practice.

‘We know more can be done to avoid the tragedy of stillbirth and as we develop the 10-year plan for the NHS, we want to build on the progress we’ve made to make maternity services in England among the safest in the world.’

Th e new secretary of state for health and social care Matt Hancock said: ‘Th is improvement is welcome and testament to the incredible NHS maternity staff who do everything they can to improve care; saving many babies’ lives as a result.

‘We still have more to do but these results demonstrate really positive progress towards our ambition to halve the rates of stillbirth, neonatal death and maternal death by 2025.’

Th e Saving babies’ lives project impact and results evaluation (SPiRE) was commissioned by NHS England and delivered by the Tommy’s Centre for Stillbirth Research within the Faculty of Biology, Medicine and Health Sciences at the University of Manchester.

Th e study was adopted into the National Institute for Health Research (NIHR) Clinical Research Network (CRN) portfolio.

SAVING BABIES’ LIVES

National guidancecould prevent stillbirths

REFLECTIVE PRACTICE

NMC reports positive impact of revalidationAn independent evaluation of the NMC’s revalidation programme has found that it is having a positive impact on the attitudes and behaviours of midwives and nurses.

Evidence suggests that the NMC programme is encouraging midwives and nurses to analyse the care they give by refl ection on practice and seeking feedback from colleagues, patients and service users.

Refl ective practice was singled out as a likely driving force behind changing attitudes and behaviours among midwives and nurses.

Revalidation was introduced in April 2016 and is independently evaluated by Ipsos MORI.

Staff who have undergone revalidation feel positive about the process, and there is evidence of a growing understanding of the NMC code, and a positive attitude towards its important role in practice.

Figures from the NMC’s second revalidation annual report show that 204,218 midwives and nurses revalidated in the past year, with 406,917 revalidating

SCREENING

NEW NIPE QUALITY IMPROVEMENT GUIDANCE RELEASED

RCMi-learnRevalidation: all you need to know

NewsMidwives / Autumn 2018

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Country news


RCM DIRECTOR, MARY ROSS-DAVIE

SCOTLAND

PAY: As I write, midwives and MSW members of the RCM in Scotland have accepted the negotiated proposals for those on the Agenda for Change staff pay. The announcement follows a consultation with members where a large majority (95%) of respondents voted to accept the proposals for staff in the NHS in Scotland. The deal means that the value of the top pay point of Bands 1 to 8C will increase by 9% cumulatively over three years from 2018-19 to 2020-21. We think the deal is a good start and will go some way to address the real terms pay drop we have experienced over the last few years.

NETWORKS: The Scotland network for early career midwives, the First Five Years Forum, has now met twice and the members are working hard on developing new guidance on successfully supporting NQMs.

We have asked for midwives to apply to join our new Perinatal Mental Health Forum and this will meet for the fi rst time in September. And the Scottish Midwifery Unit Network, which we support, will also be meeting in September.

CELEBRATIONS: We have enjoyed celebrating some signifi cant dates over the last few months – starting with International Day of the Midwife events all over Scotland.

The RCM Scotland team spent the day with a good few of you at the MaMa conference in Glasgow and we were delighted that RCM patron HRH The

Princess Royal visited University Hospital Wishaw to offi cially open their new alongside midwifery unit.

It was also great to see the RCM tapestry panel, which has toured the whole of Scotland as part of celebrations to mark the centenary of the Midwives Scotland Act in 2015, and to see the panel joining the Great Tapestry of Scotland on a permanent basis.

In July we celebrated the 70th birthday of the NHS with the maternity team in Glasgow and then with representatives from all over Scotland at a reception in Edinburgh, along with the Duke of Cambridge and the fi rst minister Nicola Sturgeon.

AWARDS: Time is running out to put yourself or your team forward for both the RCM awards or the Scottish Health awards. There are lots of categories and we hope to see great success for Scotland again.

of the NIPE Screening Management and Reporting Tool (NIPE SMART) at junior doctor induction sessions; and designated ultra sonographers entering data directly onto NIPE SMART after hip ultrasound (instead of sending notifi cation by email or letter to the maternity service).

Another initiative was to appoint a hip screening champion responsible for following up all screen positive hip outcomes and providing accurate data.

The guidance also reveals ways to improve consistency in managing gaps in the NIPE screening pathway and make sure the response is proportionate.

Trusts use NIPE to monitor and manage their cohort of newborn babies and identify any gaps in their local newborn screening pathway.Read the guidance at bit.ly/NIPE_guidanceIM

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since the programme began in 2016. Th is amounts to around two-thirds of the UK’s midwives and nurses.

The NMC estimates that 690,000 midwives and nurses on the register will have gone through the process by 2019.

Emma Broadbent, NMC director of registration and revalidation, said: ‘Nurses and midwives deliver world-class care to millions of people across the UK each year. Whether in hospitals, care homes or the community, revalidation is helping them to improve the care that they deliver.

‘Th ey’re refl ecting more on their practice, analysing what they can improve and using what they learn to develop as professionals.

‘We’ll take on board the recommendations of this evaluation as we continue to support all those going through the process.’Read the reports at bit.ly/revalidation_reports

REVALIDATION

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NEWSIN BRIEF

Stop smoking guidanceNHS trusts and midwifery teams can request Public Health England’s new smoking in pregnancy information pack via the link below. The password is ‘stopsmoking’. A blog on the pack can be read on the RCM website.bit.ly/PHE_smoking_pack

BREASTFEEDING SUPPORT

Extra funding for breastfeedingin ScotlandTh e Scottish Government has pledged to help support mothers in Scotland to breastfeed for longer through a £2m investment programme.

Th e funding is in addition to the £2.3m the Scottish Government provides annually to NHS health boards and partners to implement a range of breastfeeding support activities and interventions to prevent or manage common issues, which can aff ect how long mothers breastfeed.

Th e investment aims to address the government’s commitment to reduce the drop-off in breastfeeding rates at six to eight weeks after birth by 10% by 2025.

RCM director for Scotland Mary Ross-Davie said: ‘We hope that health boards in Scotland will now be able to use this money to provide high-quality consistent postnatal support for all women.’

Midwives / Autumn 2018News

NIHR INITIATIVE

NEW SCHEME TO CREATE RESEARCH CHAMPIONSMidwives and nurses have the opportunity to become research champions and drive improvements in future care through a new £3m training scheme.

A total of 70 senior midwives and nurses will be chosen to take part in the senior midwife and nurse research leader programme and will champion the importance of research activity in clinical practice.

Th e project will be backed by funding from the National Institute for Health Research (NIHR) to allow participants two days a week to develop an innovation, further implementation of science activities and inform research

FINANCIAL ASSISTANCE

IMT RESEARCH AWARDS OPEN SOONApplications for the Iolanthe Midwifery Trust (IMT) awards for midwives, return-to-practice midwives and students open in November.

Th e IMT funds a variety of projects focusing on research, training, self-development and maternity service improvements. Find out more at bit.ly/IMT_awards

TRAVEL BURSARIES

FELLOWS WANTEDMidwives are invited to expand their professional and personal horizons and travel abroad for up to two months by applying for a Churchill fellowship.

Th e deadline for applications is 18 September. See more and apply at bit.ly/Churchill_fellowship

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Country news


RCM DIRECTOR, HELEN ROGERS

WALESIDM: A great number of events were held across Wales to celebrate International Day of the Midwife; in particular I was delighted to attend Cardiff and Vale University Health Board’s (CVUHB’s) launch of Wales’ fi rst specialist FGM pilot clinic.

The specialist service known as the Women’s Wellbeing Clinic will be open to all those aff ected by FGM or who are at potential risk of it. Specialist FGM midwife Emily Brace leads the midwife-led service working in close collaboration with the consultant obstetric team, designated child health consultant paediatricians and third-sector agency support. The clinic is staff ed by females and held every Wednesday at Cardiff Royal Infi rmary’s Health Access Practice.

The clinic received funding from the Iolanthe Midwifery Trust through the Jean Davies award, which funds individuals or teams working specifi cally to reduce or to investigate inequalities in maternal health.

CVUHB’s executive director Ruth Walker said: ‘It’s important to us that every woman who needs medical help or advice has the opportunity to be heard and receive the treatment and support they need. The health board is very pleased to be leading the way for Wales in off ering the Women’s Wellbeing Clinic in Cardiff .’

HONOURS: The Queen’s birthday honours announced in June were very well deserved. Congratulations go to Billie Hunter who is RCM professor of midwifery and director of

the WHO Collaborating Centre for Midwifery Development at Cardiff University. Billie was awarded a CBE for her work in education.

CONGRATULATIONS:We extend our congratulations to Emily Brace on her successful appointment to consultant midwife in Cwm Taf University Health Board in July.

Emily Brace, Helen Rogersand Ruth Walker

WHO CONFERENCE: We are delighted to congratulate Cardiff and Vale midwife Alys Gower who had her abstract ‘Why junior midwives should actively seek opportunities to be involved in the activities of the global maternity community’ accepted to present at the 12th Biennial Conference of the Global Network of WHO Collaborating Centres for Nursing and Midwifery in July in Cairns, Australia. RCM Wales were thrilled to be able to support Alys in representing the Cardiff University WHO Collaborating Centre and Wales.

ACTIVIST TRAINING:Well done to all at the Powys branch for presenting ‘How to run a virtual branch meeting’ at the summer Activist Training Day held in Leeds in July. The presentation was based on top tips on running a Facebook Live virtual branch meeting. Read more on this on page 28.

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Research fellowshipsWellbeing of Women has announced it is accepting applications for its entry-level research scholarships, research training fellowships and new post-doctoral research fellowships. bit.ly/WoW_scholarships

Pregnancy planning Public Health England has recently published a professional resource on healthy pregnancy planning and reproductive choices, with a section on interpregnancy planning and advice.bit.ly/PHE_pregnancy_planning

priorities within their organisations.Th e selected participants will champion research

collaborations and the interdisciplinary sharing of research knowledge and skills throughout their profession.

Director of nursing, learning and organisational development of the NIHR clinical research network Dr Susan Hamer said: ‘Th e NIHR is hugely appreciative of the vital role of midwives and nurses in the clinical research system.

‘Th e 70 senior midwives and nurses chosen for this new initiative will be tasked with driving changes to actively develop a dynamic evidence-based culture within the NHS’s largest workforce.’

Th e NIHR hopes that by building research capacity there will be an increase in the uptake of training and research led by midwives and nurses, which should see improvements in the quality of care, outcomes and cost-eff ectiveness within the NHS.

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storyTHE BIG

12

A renewed focus on the vital roles of team-working, core skills and an early warning system are the key features of new guidelines for the care of pregnant women who become unwell.

Care of the critically ill woman in childbirth: enhanced maternal care replaces the 2011 standards, Providing equity of critical and maternity care for the critically ill pregnant or recently pregnant woman.

Published in August, the new document is the culmination of several years’ work led by the Obstetric Anaesthetists’ Association (OAA) and is published jointly by the OAA, the Royal College of Anaesthetists, the RCOG, the RCM, the Intensive Care Society and the Faculty of Intensive Care Medicine.

It summarises the latest evidence-based recommendations on the care of pregnant or recently pregnant women who require treatment in acute hospital maternity and critical care specialist services.

Th e impetus for the new guidelines has come in part because practitioners had found the 2011 version unwieldy and diffi cult to work with. ‘Th e idea was to

produce a much more streamlined document,’ says Carmel Lloyd, RCM head of education and learning. ‘It is much clearer in its intention and draws attention to the key factors rather than providing a lot of dense information that people fi nd diffi cult to work their way through.’

Fragmented careTh e new guidelines concentrate more on up-to-date practice and, in a key feature, link the strength of the recommendations to the quality of the evidence. Th e document also gives real-world examples of the experiences of women who became seriously ill during childbirth. ‘Th e striking thing about these stories is how fragmented their care can become when it moves out of the maternity setting into critical-care settings,’ says Carmel. ‘In this way, the new guidelines encourage more joined-up thinking, and highlight the important moments when everybody has to work together in the interests of women and their babies.’

While the document aims to promote more focused care, it also introduces new content,

New evidence-based guidelines and a joined-up approach will improve the

care of pregnant women who require treatment from acute and critical

care services.

STREAMLINING CRITICAL CARE


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COMMEMORATING 100 YEARS: Centenary celebrations have continued with cathedral services in Belfast and Derry and a lovely drinks reception in the Guildhall. We’re still collecting stories from midwives and mothers for the book that will be published to commemorate 100 years of midwifery legislation in Ireland, so keep sending your stories to [email protected]

We’ll be continuing the festivities with the joint RCM/INMO conference in Dublin on 18 October and a galaball in Belfast City Hall on 30 November.

INCREASE IN TRAINING PLACES: We’ve now had confi rmation from the Department of Health that the number of midwifery training places in Northern Ireland (NI) is to be increased by 40% this year – up from 65 to 90. While this is very welcome, the increase must be sustained year on year if we are to replace our ageing midwifery workforce.

PAY: Health service trade unions in NI have begun pay discussions with the Department of Health, although

in the absence of a government it seems that any pay rise for this year will be capped at 1% in line with the direction set by the last Assembly. We will keep you updated if there is any progress.

ABORTION: The South of Ireland has voted to repeal the 8th Amendment to the Irish Constitution, which gives the unborn child a right to life equal to that of its mother. This has generated further discussion on the issue of abortion in NI.

The fi nding of the Expert Working Group convened by the last Assembly recommended a change in the law in NI in cases of fatal fetal abnormality, and there was a clear fi nding by the UK Supreme Court that the law on abortion here does not meet the standards of the European Convention on Human Rights. This means we can expect further legal challenges, such as that being proposed in Westminster seeking the decriminalisation of abortion, so that it is regulated like any other healthcare procedure.

FAREWELL: This will be my last update before I retire, and I’d like to pay tribute to all of the wonderful midwives and colleagues that it has been my great privilege to work with in 21 years with the RCM.

A special word of heartfelt thanks goes to Mary Caddell and Anne Marie O’Neill, without whom I would have achieved very little, and a warm welcome to Karen Murray who will succeed me in September.

Read more on Breedagh’s time at the RCM on page 50.

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KEY RECOMMENDATIONS Enhanced maternity care and working in teams: women in childbirth should get the same care as other critical patients, which means staff need to know the early warning signs and how to step up care. These core skills, called enhanced maternal care (EMC), mean any practitioner can care for women whose health worsens either during or after childbirth but who doesn’t need to go to a critical care unit. EMC also requires maternity and critical care teams to work side by side.

Education and training: everybody working in maternity care – including midwives, obstetricians, anaesthetists and nurses – should be properly trained to care for critically ill women. Existing teaching and training is normally enough, but some curriculum changes may be needed. To provide this, critical care and maternity services need to work together locally and regionally.

An early warning system: all acute care services should have a system in place for women who are pregnant or within 42 days of birth. The guidelines set out the vital components of an early warning system, with the hope that these become the norm for obstetric units nationwide.

Where care is delivered: most critically ill women can be cared for safely on the maternity unit. In some cases, the critical care outreach team will be able to assist. If a woman needs to go to a critical care unit after childbirth, her baby should normally be kept with her.

Care in the general critical care unit: a named lead should liaise between critical care and maternity services. The teams should also have shared care principles. The maternity team needs to review women in general critical care units at least once every 24 hours. All units should base their follow-up services on NICE guidelines.

Country news

RCM DIRECTOR, BREEDAGH HUGHES

NORTHERNIRELAND

such as the core skills that midwives, and other health professionals, are expected to have when working with women who become critically ill during or after pregnancy. In particular, it sets out the knowledge that any practitioner needs in order to provide enhanced maternal care, which is the treatment given to women who fall very sick for a short period but who are not so severely ill that they require critical care.

Finally, it throws a spotlight on the importance of an early warning system. Pregnant women’s health can deteriorate rapidly, so promptly picking up on the indicators can make all the diff erence – the sooner a multidisciplinary team acts, the sooner critically ill women can get better.

‘We welcome these new guidelines,’ says Carmel. ‘Midwives have been waiting for this information for some time. It’s one of those areas where guidance enables people to provide more consistent care. And when everybody is working together, that tends to mean you get better outcomes.’

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14

News

GLOBAL NEWS

Midwives / Autumn 2018

GLOBAL

WHO MIDWIFERY UPDATEHere are the latest happenings in midwifery at the WHO. ● Special consultations on midwifery education were held in Geneva in March and in Oxford in July with many participants, including the RCM, to develop global policy guidance for countries and implementing partners on strengthening midwifery education (pictured below). ● WHO has also conducted a worldwide survey of midwifery educators and is undertaking a policy review of global midwifery education. ● The organisation has launched a global taskforce on midwifery and nursing and is also leading a programme to strengthen inter-professional quality midwifery education, helping to achieve the sustainable development goals through universal health coverage by 2030. ● In July, WHO collaboration centres for midwifery and nursing from across the world met in Cairns, Australia, and held a special day to focus on midwifery.● For the fi rst time, the World Health Assembly in 2019 will focus on midwifery.

GHANA AND TOGO

New workshop packageUK midwives are leading a workshop package for healthcare providers working in low- and middle-income countries to address the health needs of mothers and babies during and after pregnancy.

The midwives within the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine are working on the new competency-based workshop package, which covers what is needed to meet the physical, mental and social aspects of maternal and newborn health.

It also supports healthcare providers regarding how they can provide respectful maternity care and screen for and manage domestic violence and depression during and after pregnancy.

The programme has started in Ghana and Togo with further activities planned in Nigeria, Tanzania and Chad.

UK

Focus on girls The needs of adolescent girls in humanitarian settings was the focus of an UNFPA, WHO and Children’s Investment Fund Foundation conference in London in July.

While children and pregnant women are prioritised in humanitarian settings as vulnerable groups, adolescent girls fi t into neither group and are often missed from humanitarian programming as they have unique needs and vulnerabilities.

The conference highlighted that these girls are often a target for exploitation, sexual gender-based violence, child marriage and have unmet education and sexual reproductive health needs.

By not including the girls in humanitarian programming as a specifi c group, opportunities are missed to protect and empower them.

Midwives were said to be ideally placed within humanitarian settings to provide adolescent girls with sexual reproductive health services, psychological fi rst aid and to signpost girls to education, wider health services and peer-based support groups.

NIGERIA

Female health workers’ projectA project to increase female health worker numbers in northern Nigeria has been coordinated by Health Partners International.

As many women give birth unattended due to cultural taboos about being cared for by male health workers, the Women4Health project, which the RCM has contributed to via twinning UK midwifery lecturers with Nigerian counterparts, aims to address female workers’ numbers.

In June, Oxford Brookes midwifery lecturer Kirsten Baker was in Abuja, where tutors and principals from the schools of midwifery and nursing attended a workshop focusing on how to deliver a curriculum that addresses the humanitarian need of the population.

Senior members of the Nursing and Midwifery Council of Nigeria were also present to endorse the work and resulting materials, which, it is hoped, will be used more widely.

around the world...

rcm.org.uk/midwives

KENYA

Teaching studyMidwifery tutors in Kenya have been receiving training in emergency obstetric care to improve the knowledge and skills of their students.

The Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine has been working in partnership with the Ministry of Health in Kenya and experienced clinician volunteers to deliver the training, which has formed part of a non-randomised controlled trial.

As part of the study, the eff ectiveness of the training for the fi nal-year midwifery students was measured using a combination of skills tests, multiple-choice knowledge tests and a self-effi cacy-style confi dence questionnaire.

The training has been shown to be benefi cial in other settings, and it’s hoped that the study will demonstrate its value as a sustainable, capacity-building programme to support midwifery training.Access the study at bit.ly/trial_Kenya

Kirsten (centre) with workshop participants

Project lead Hannah McCauley (centre, front row) with workshop participants

014_MID_NEWS_Global_news.indd 14 21/08/2018 14:15

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MID.Iss3.2018.015.indd 2 16/08/2018 09:45


Midwives / Autumn 2018News

YOURRCMNEWSWhat’s going on at the RCM?

Here’s the latest updates...

NHS PAY RESULTSFollowing two separate consultations, which closed in June and August, RCM members have voted to accept the negotiated proposals for NHS Agenda for Change staff pay in both England and Scotland.

A large majority (85.7%) of respondents voted to accept the negotiated set of proposals for England, and some 95% voted to accept the proposals for Scotland.

While Wales has also been off ered a new deal, which the RCM is consulting members on, in Northern Ireland the RCM continues to press the case for pay parity.

RCM CEO Gill Walton said of the England result: ‘I’m pleased that members have accepted this off er. It means that midwives, MSWs and other NHS staff can start to recoup the losses of the last eight years. It also means an increase to starting salaries for new midwives who will, for the fi rst time, be burdened with student debt.’For details on the English deal, see bit.ly/NHS_pay_results; for Scotland, see bit.ly/Scotland_pay_results; and for Wales, see bit.ly/Wales_pay

FGM CAMPAIGN WINS AWARDTh e FGM animations created by the RCM won a TUC Communication Award 2018 for best digital membership communication.

Th e judges said that the entries showcasing positive stories of union successes and infl uence were deemed the most interesting and eye-catching, but the moving animation on FGM from the RCM was their favourite.

Th ey said: ‘Th ese powerful animations are deeply moving. A great eff ort by a union to positively aff ect the society around them by mobilising their members. Survivors’ voices are at the centre of this impressive resource.’

Th e series of short animated fi lms were developed by the RCM in collaboration with the RCOG, the RCGP, survivors of FGM, NGOs and local community partners.

Th e RCM and its partners worked closely with FGM survivors to ensure the authenticity of the stories being told via the animations remained true to the realities of surviving FGM.Watch the animations at bit.ly/FGM_animations

RCM annual report 2017Th e RCM board and the RCM trust board are pleased to present the RCM annual report 2017, including the directors’ report and consolidated accounts for the year ended 31 December 2017. Read the reports in full at rcm.org.uk/rcm-annual-report-2017

Stay up to date Stay updated with the latest news, articles, analysis and information. Call 0300 303 0444, email [email protected] or update your details via the My RCM portal.

NEW POSITION STATEMENTS Th e RCM has published new position statements on infant feeding and baby boxes.

Th e statement on infant feeding confi rms that ‘the decision of whether or not to breastfeed is a woman’s choice and must be respected’.

Th e RCM recommends that balanced and relevant information be given to parents choosing to formula feed their babies, whether exclusively or partially, to enable them to do so safely and with support to encourage good bonding. Read more on this statement on page 48.

Th e statement on baby boxes supports the universal provision of these boxes across the UK.

Th e RCM believes that providing baby boxes where the baby has their own sleep space is likely to reduce the risks associated with unsafe co-sleeping. However, it acknowledges that there is limited evidence around baby boxes reducing deaths from SIDS.

At present the boxes are given to all new babies in Scotland, while in England some NHS trusts have introduced pilot schemes or full baby box schemes over the last two years. Wales and Northern Ireland do not have any baby box schemes.Read the statements at bit.ly/RCM_infant_feeding and bit.ly/RCM_baby_boxes

016-017 rcm news.indd 16 21/08/2018 11:07

On politics

RCM PUBLIC AFFAIRS ADVISOR

STUART BONAR


WE ARE NOW GETTING TO CRUNCHtime for the Brexit negotiations. There is no longer any time for the prime minister to answer questions about it with empty phrases like, ‘Brexit means Brexit’ and the government wants a ‘red, white and blue Brexit’.

One of the areas where clarity is needed is on the rights of people from one of the 27 other EU member states (EU27 nationals) who are living and working here in the UK to continue to do so after the UK has left.

This group includes many midwives working in the NHS. Indeed, there are 1700 EU27 nationals registered with the NMC to practise as midwives in the UK. Looking at the latest numbers, some hospitals have dozens of EU27 midwives, one has almost 100. These midwives – as well as EU27 MSWs too – make a big contribution to maternity services, in total providing care for tens of thousands of women each year.

Thankfully, this is one area where the government has brought forward clear plans and the RCM is keen to share them.

The government plans to introduce a new system of ‘settled status’. Starting with the limited trials in August and running until mid-2021, there will be essentially a three-year window during which EU27 nationals can apply to have their status confi rmed.

If, at the time they apply, individuals have lived in the UK for fi ve years or more, they will be given ‘settled status’, which will mean that they are free to continue to live in the UK, as now, for the rest of their lives. If at the time of application they are living in the UK but have done so for less than fi ve years, they will get ‘pre-settled status’ and have permission to live here for a further fi ve years, allowing them to clock up the time needed to obtain full settled status.

The process sounds like it should be pretty straightforward, with offi cials instructed to be helpful to applicants. The cost will be £65 for most people, with some reductions, for example for children.

There is obviously too much detail to put in this article, and if you are an EU27 national you will no doubt have lots of questions. The best place to go for more information is the government’s website, where there are more details. Visit bit.ly/EU_guidance

Ever since the EU referendum took place in 2016, the RCM has been pushing for a fair deal for midwives and MSWs who have come to the UK from the EU. We value your contribution, and the simple fact that you have made your lives here and have had no say in this process whatsoever. The UK has chosen this course, and it should treat those aff ected by it with generosity.

Status confi rmed?

FOND FAREWELLS After 24 years at the RCM, Louise Silverton CBE has stepped down from her post as director for midwifery.

A treasured member of RCM staff , Louise has played a pivotal role in improving midwifery care and promoting evidence-based practice.

Th e organisation would like to thank Louise for her unfaltering dedication and long service, and we look forward to continuing to work with Louise in the future.

Th e RCM also says thank you and a fond farewell to Northern Ireland director Breedagh Hughes, who retired in August after 21 years.

Breedagh has been a driving force for change in both Northern Ireland and the UK and made a real impact on maternity services during her long and successful career at the RCM. Read more on page 50.

Breedagh will be truly missed as a colleague by the RCM staff across the UK.

RCM TAKES PART IN PRIDEAlong with hundreds of other organisations and groups, RCM staff took part in the annual Pride parade in London in July to celebrate diversity and the LGBT+ community.

RCM employment relations advisor Alice Sorby said: ‘Midwives marched alongside other trade unions braving the heat to proudly represent the RCM. Th e crowds cheered us as we walked by wearing our t-shirts and waving our fl ags. It was a fantastic atmosphere and we are already looking forward to next year.’

Th e RCM has been pushing for a fair deal for midwives

and MSWs who have come to

the UK

016-017 rcm news.indd 17 20/08/2018 18:17



RAISING MONEY 4LOUISSOCIETY CLIMBS THREE PEAKSMembers of the City University of London Midwifery Society climbed

the Yorkshire three peaks to raise money for their nominated charity of the year 4Louis.

Phoebe Stannard, Elly Bamber and Ruth Rogers gathered a group of midwives and student midwives to attempt the climb: a 24.5-mile circular walk in North Yorkshire including 1585m of vertical ascent.

Th e team spent much of the day walking in a giant cloud, but managed to complete the challenge in just over 12 hours and raised £5295 for 4Louis.

Th e charity was chosen after a number of students, who were involved in the care of bereaved women during their training, were grateful to 4Louis for providing memory boxes to help the families.

PREGNANCY AND BEYONDWELLBEING EVENTTh e University of Greenwich Midwifery Society hosted its fi rst pregnancy and beyond wellbeing event in June.

Th e free event ran workshops such as pregnancy pilates, a talk for dads-to-be and a myth-busting pelvic fl oor session. Th ere was also an exhibition of informative stalls for women by local businesses and organisations, including NHS trusts and sling libraries.

Th e day was a success with women describing feeling well cared for and professionals feeding back that it was a good chance to network.

2

1

3

Mentor Appreciation DaySUCCESSFUL COLLABORATIONCoventry University Midwifery Society and George Eliot Maternity Unit collaborated to arrange a Mentor Appreciation Day in June.

All students were able to nominate mentors who had gone above and beyond, and they received certifi cates and ‘thank you’ cards.

It was a great opportunity for both students midwives and mentors to drink tea, eat cake and celebrate great working relationships.

APPRENTICESHIPSCOMING SOON IN ENGLAND?NHS trusts and higher education institutions are

taking the fi rst steps towards creating midwifery degree apprenticeships in England.

Th e government created a new national apprentice system in 2016, which has seen every sector of the economy create apprenticeships to widen access and address the skills shortage.

Coming together as a ‘trailblazer’, with the RCM as a sector partner, midwifery leaders from across England have created a fi rst draft Midwifery apprenticeship standard – based on the 2009 NMC standards – with the hope of the fi rst midwifery degree apprentices beginning in 2019. Read more on this, the consultation period and what happens next at bit.ly/RCM_blog_apprenticeships

Th e RCM is working alongside trailblazer members to support the process and will keep members updated. See bit.ly/midwifery_apprenticeships

4

YOURSTUDENT NEWSWhat’s new in the student world?

Your chance to tell us where you’ve been and what you’ve been up to...

018-019_MID_NEWS_Student.indd 18 20/08/2018 17:43


On employment

EMPLOYMENT RELATIONS ADVISOR

ALICE SORBY

NHS PAY IN ENGLAND HAS BEEN back in the media again over the past few weeks, so I want to use my column to look at the agreement again and hopefully clarify a few things for you.

The information that the RCM has provided on the agreement, which combines both pay award and reform of Agenda for Change, was accurate throughout the consultation and has been since.

We know that the deal is complex and aff ects midwives and MSWs in diff erent ways depending on where you sat in the pay structure as of 31 March 2018 (the agreement is from 1 April 2018 to 31 March 2021). There are a couple of charts showing diff erent aspects of the restructure process, with one showing the pay journey for individual members and one showing the reform of the structure (which is a static tool for use by payroll). Understandably this has led to some confusion, the information on both the documents is the same but presented in diff erent ways.

To make it easier to understand exactly what the changes mean for you a pay calculator was developed for members to use during the consultation period, this was held on a joint union site so that everyone was accessing the same information. You can still access that calculator, there is also now a full

pay journey tool at nhsemployers.org/paytool and I encourage you to use this if you still have questions about the changes. There are also some frequently asked questions jointly held on the NHS Employers website.

I will now try and explain, in a nutshell, where we are on the implementation of the agreement. If you are at the top of your pay band, your increase comes

from the pay award. In your July pay, you should have received a 3% increase; in your August pay, you should receive back pay in full from 1 April 2018 including unsocial hours.

If you are below the top and above the bottom point of a band (the bottom point of each pay band has now been removed), you should have received around a

1.5% increase in your July pay and in August back pay on that amount. The rest of your increase will come on your next incremental date. So the increase is phased in for you, but in general if you are in this group your increase over the three years as a percentage exceeds those at the top of the pay band.

The agreement means we have started to recoup the losses of the last eight years – it doesn’t make up for all the years of pay restraint, but it is the best deal in the public sector and marks the beginning of us once again being able to negotiate for fair pay on behalf of members.�

5Understanding your pay

PrideMARCHING IN EDINBURGHRCM Scotland and Edinburgh Napier Midwifery Society joined thousands of people in the streets of Edinburgh for Edinburgh Pride in June.

Th e torrential rain didn’t dampen their spirits and they proudly marched along fl ying the RCM fl ags for all to see.

A big thank you goes to the midwifery society and their friends and family for coming along on the day.

STUDENT WINS AWARDQUALITY OF CARE HIGHLIGHTEDSecond-year student midwife Kayleigh Graham has won the University of South Wales’ student midwife of the year award.

Kayleigh was nominated by one of the fathers she cared for on a labour ward clinical placement. Th e family had been through a very stressful experience and Kayleigh was pleased that she was able to provide care that they remembered.

She said: ‘I am extremely passionate about the care I provide and winning the award has proven that all the eff ort and time I put into placement and the course is worth it. I am so lucky to learn from the amazing midwives that I have worked with and am grateful for their support through the course.’

6

The agreement means we

have started to recoup the losses of the last

eight years

018-019_MID_NEWS_Student.indd 19 20/08/2018 17:43

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MID.Iss3.2018.020.indd 2 15/08/2018 11:37

OPINIONTh oughts, views and your comments

rcm.org.uk/midwives 21

READ ONYour thoughtsStudent voice

Voice of a motherRCM branch voice

Voice of an NQM

‘We don’t see breastfeeding in public, we don’t see it in the media’

When Dispatches documentary Breastfeeding uncovered, presented by journalist Kate Quilton, aired on Channel 4 it generated a hail of press coverage and debate. We caught up with the new mum to talk about the programme, what moved her to take on this emotive subject, and her own

breastfeeding journey.

Kate Quilton is best known for fronting the series Food unwrapped and Superfoods, delving into the

truth behind the foods we eat – but her latest project tackles nutrition of a diff erent kind.

In the Dispatches documentary Breastfeeding uncovered, Kate set out to investigate why the UK has some of the worst breastfeeding rates

ONE-TO-ONE

in the world, taking a look at issues such as cuts to support services, formula marketing, public attitudes, and the stigma around breastfeeding in public.

She also shares her own struggle with breastfeeding, speaking candidly about painful nipples and exhaustion in the weeks following the birth of her son in May.

Th e programme garnered a huge reaction in the press and on social media, and Kate was inundated with personal messages, including from mums who watched it ‘in tears because they’d just felt nobody out there shared their pain or understood it’.

‘I have been pretty overwhelmed at the reaction,’ she says. ‘I have received so many messages from mums saying “thank you so much for sharing the stories and shining a light on the fact that this isn’t easy – we thought we were the only ones”.

‘What I have realised is that there is an army of breastfeeding mums out there trying to do their best,

021-023_MID_OPINION_121.indd 21 21/08/2018 11:10

rcm.org.uk/midwives

OpinionONE-TO-ONE

22

really trying to stick at breastfeeding, but behind closed doors, are struggling and feeling very alone.’

Shocking statistics However, it wasn’t her own struggles with breastfeeding that inspired Kate to take on the subject. Th e idea came a couple of months before her son was born when she visited the NHS breastmilk bank at Bristol while fi lming for the series Live well for longer.

‘We started talking about breastfeeding rates and I found out that shocking statistic that at six months less than 1% of babies are exclusively breastfed,’ she explains.

‘I was talking to the midwives and doctors about what the issues are – the lack of support, and the fact that it’s cultural, that breastfeeding is quite absent. We don’t see people breastfeeding much in public, we don’t see it in the media – I couldn’t name a fi lm I’ve seen with a woman breastfeeding in it, and I’ve never seen it on TV.

‘I went to speak to the boss of Channel 4 to say people need to see this – even if I just happen to be breastfeeding while fi lming another documentary, it’s an important message.’

Channel 4 then suggested making a documentary in time for World Breastfeeding Week, says Kate, which would mean fi lming just weeks after she gave birth, but she and her husband, actor James Lance, both decided it was ‘too important’ an issue not to take it on.

‘I started meeting mums around the country struggling to breastfeed, and

ALL

ABO

UT K

ATE

Egg loverKate never leaves the house

without a boiled egg: ‘They’re the perfect snack on the road.’

Keen musicianKate plays the fl ute and saxophone. Now she

is a mum and at home more of the time, she is determined to start playing with a band again.

KATE'S CAREER Kate Quilton is a 34-year-old journalist and TV presenter. Since 2012, she has been the host of Food unwrapped, and has fronted Superfoods: the real story, since 2015. She also presents Live well for longer. When studying at Bristol University, she carried out a food experiment, eating just kebabs for a week. She recorded the results and the story was picked up by a national paper. She worked for ITV and the BBC as a student before becoming a broadcast journalist in Somerset. From 2010 to 2014, Kate was Channel 4’s youngest ever commissioning editor. She won a BAFTA for digital creativity and the Digital Emmy award in 2014, before moving to focus on presenting.

Sleep-deprivedNow caring for a three-

month-old, Kate’s favourite way to relax is sleeping.

Midwives / Autumn 2018Opinion

there were some really shocking stories. What was common across the board was that women felt really alone; they felt like their experience wasn’t something other women were going through. It was clear that we just need to start talking about this more.’

But the programme does not play into the polarising breast versus bottle debate, the lens through which breastfeeding is so often presented in the media, says Kate.

‘Our aim in making this documentary was not to alienate any mums feeding their babies out there at all. We really wanted to make it for the 80% of mums who want to breastfeed and who encounter issues for whatever reason. It’s not

an easy time of life and we wanted to support mums and share their stories – we wanted to shine a light on it.’

She adds: ‘Now I’m in touch with this brilliant band of fantastic women really trying to make change in this space. We will just keep pushing this forward.’

Stigma of breastfeedingA key focus in the documentary is how our society views breastfeeding, and the stigmatisation of mums who do so in public.

Kate herself has encountered reactions ranging from ‘warm smiles’ from ‘mums who have been there’ to tutting, whispers, raised eyebrows and even ‘low-level harassment’.

021-023_MID_OPINION_121.indd 22 21/08/2018 11:10

rcm.org.uk/midwives 23

She recalls being approached by two women while breastfeeding her son on a bench at a local park who told her outright that they thought she shouldn’t be there.

‘Th ey actually told me they’d just said the same thing to a woman breastfeeding in the pound shop up the road,’ says Kate. ‘I think they were going around east London walking up to breastfeeding women and telling them: “Go home. We did it behind closed doors and so should you.”

‘It’s a very vulnerable time in your life. You’re extremely sleep-deprived like never before, you don’t quite feel yourself, you’re riddled with anxieties, not just about breastfeeding, but about everything. In the fi rst two months I felt more vulnerable than I have ever felt in my life.

‘You’re trying to go out into the world and regain some of your independence, do a few normal things. At that time, to be met with this low-level harassment is absolutely terrible – shocking.

‘Making this fi lm and hearing all these women’s stories, you start

to question how baby-friendly are we as a society? We could be a lot more baby-friendly that’s for sure,’ she adds.

Culture changeSo, what can we do to create a more baby- and breastfeeding-friendly culture?

‘I think every single breastfeeding mum can help with this,’ says Kate. ‘When I started my breastfeeding journey, when I went to a restaurant I was looking for the quietest table in the corner. After making this documentary, I think visibility is a big issue – now I go into a restaurant and pick whatever table I want, I pick my favourite table – not a table in the shadows because I may need to breastfeed.

‘Mums have to do whatever they are comfortable with – but the more that get out there and breastfeed, the better it’s going to be for the next generation of breastfeeding mums.

‘We need to see more breastfeeding in the media, more in television shows, in movies – it doesn’t have to be central to the story – it can be that it just so happens that a mum is there breastfeeding her baby.

‘Th ere needs to be better representation in government – at the moment, breastfeeding doesn’t

land in anyone’s remit. Alison Th ewliss MP is really pushing for there to be a representative – someone to take care of it.

‘And rules which don’t allow women to breastfeed in certain parts of the Houses of Parliament absolutely need to change – that is not an example for the rest of the country to follow.

More help for women‘We need to improve support. I feel I have had a gold standard of breastfeeding support which has helped me. I know budgets are under a lot of pressure – but it would be brilliant if more could be done for all women.’

And as for her personal breastfeeding journey, despite the ‘ups and downs’ of the fi rst eight weeks, Kate is still exclusively breastfeeding her son, something she would love to do ‘for as long as possible’.

‘It’s a journey,’ she adds. ‘You don’t know what’s around the corner; all I know is right now it’s going great – he’s happy and I’m happy.’

‘Mums have to do whatever they

are comfortable with – but the more that get out there and

breastfeed, the better it’s going

to be for the next generation of breastfeeding

mums’

BREASTFEEDING IN THE UK

Breastfeeding initiation was 81% in 2010. The prevalence of breastfeeding fell to 69% at one week and 55% at six weeks. At six months, only 34% of babies were still being breastfed at all. Only 1% of babies were exclusively breastfed at six months, as recommended by the WHO. According to a survey by Swansea University, exclusively given to the Dispatches programme, 67% of those polled thought there was no diff erence between breastmilk and formula.

(NHS Digital, 2012)

021-023_MID_OPINION_121.indd 23 21/08/2018 11:10

We’re expectingOur new standard for gentleDue February 2019

UK/JOB/18-11729

JOHNSON’s® is a partner in the RCM Alliance Programme. To learn more visit johnsonsbaby.co.uk

Visit the Johnson’s® stand at the

MID.Iss3.2018.024.indd 2 07/08/2018 10:04

25

Your thoughts

rcm.org.uk/midwives

Ruby Handley-Stone refl ects on her role as a newborn infant and physical examination practitioner.

The thought of qualifying as a midwife sparked excitement and uncertainty. But I also had to prepare for the added responsibility of working as a newborn infant and physical examination (NIPE) practitioner, screening for congenital abnormalities

in the newborn during the examination undertaken within 72 hours after birth (PHE, 2017).

I studied at Birmingham City University, one of the few UK universities off ering both theory and practice competency components of NIPE training as part of the midwifery programme (Yearly et al, 2017).

As a student training to screen for conditions relating to the heart, hips, eyes and testes, I detected some of the more common abnormalities such as cryptorchidism, the failure of one or both testes to descend into the scrotum, present in 4.5% of newborn males (Khatwa and Menon, 2000), but not less common conditions, such as genetic and chromosomal defects, so I still felt I lacked experience.

It took four further months after qualifying to encounter conditions such as congenital cataracts, occurring in up to two or three per 10,000 births (Lomax, 2015). I was surprised, however, at how confi dent I felt in safely detecting, referring and then communicating with parents in these situations, and felt increasingly confi dent in my NIPE skills.

On the delivery suite, I was able to facilitate earlier discharges for women by performing the examination myself as the only NIPE practitioner available. Similarly, on the postnatal ward, when midwives were inundated with paperwork and the new mothers are eager to return home, I was able to off er the examination instead of waiting for an available paediatrician. I couldn’t help thinking that the lack of qualifi ed NIPE practitioners was a recurring barrier against women gaining their independence through early discharges.

Being able to perform the examination brings increased autonomy, empowerment and an improved service. Despite this, there remains a shortage of NIPE-trained midwives – currently only 13.7% of UK midwives (Council of Deans of Health, 2017) – which could be due to a lack of emphasis on the value of this role by hospitals and education facilities.

NQMs often feel emotionally vulnerable, but I believe that being provided with these additional skills instils greater confi dence, and enables a smoother transitional period and a quicker sense of belonging within the multidisciplinary team.

I feel strongly that it should be a requirement of the NMC that all higher education institutions off er the NIPE course pre-registration, followed by a preceptorship programme off ering more protected time for development as part of rotation. Undergoing training alongside paediatricians may help to better prepare NQMs, building a closer relationship between the paediatrician and the examining midwife, and off ering the opportunity to share skills and expertise.

Undergraduates may not fully grasp the need for this additional qualifi cation, but there is no better feeling than knowing you are well prepared for the start of a long and rewarding career.

Ruby Handley-Stone is an NQM at University Hospitals Birmingham NHS Foundation Trust

THE NIPE EXAM INCLUDESEyes: position, symmetry, size and colour, and presence of red refl exHeart: observation, palpation and auscultationHips: the Ortolani and Barlow manoeuvres to screen for dislocated or dislocatable hipsTestes: palpation of scrotal sac and/or inguinal canal to determine location.(PHE, 2018)

BE BETTER PREPARED WITH NIPE

RCMi-learnExaminationof the newborn

025_MID_OPINION_Your thoughts.indd 25 20/08/2018 17:44


STUDENT VOICE

I had just fi nished my last ever night shift on delivery suite as a student midwife and a few of my peers from my cohort had posted on social media that they had passed their fi nal exam, so I thought I’d check my result before heading to bed. It was then that I felt that my world had

come crashing down around me – I had failed a section of my exam. I had that big bold F staring at me. I called my tutor and sobbed, I called one of my best friends and sobbed. I called my mum and sobbed. What was I going to do?

After a few days coming to terms with the reality of failing my fi nal exam, I spoke with my tutor and agreed to meet up the following week. I knew I could retake my exam at the end of the term, but I wanted to go and see her and talk through the paper to fi nd

out exactly where I had gone wrong. Before our meeting, I posted a video on social

media for the #maternityleader initiative. It was a diffi cult video for me to make – putting out there my vulnerability, my feeling of failure – but now I see that it helped me to realise that I wasn’t the only one. I had a lot of messages of support and encouragement from other students and midwives, some of which were from the inspirational midwives I had met throughout my journey as a student. Th ey expressed how they too had failed parts of their modules, exams and dissertations, and these were amazing women I looked up to. Th is gave me a huge boost of confi dence.

After seeing my tutor I started to feel more positive about my resit, and knew where I had gone wrong previously. It was hard going back to university for our fi nal week – seeing the girls in my cohort fi nd out their PIN numbers and complete their NMC paperwork, not knowing if I would be doing the same in a few weeks.

Th en the day came – exam time. All I needed to do is pass. After a weekend of waiting I had an email to say that I had passed my resit! I cried again, but I had done it – I was going to be a newly qualifi ed midwife. My paperwork went off to the NMC the following day and by the end of February this year I received confi rmation that my PIN number was registered and I was able to start work, which I did so a week later.

What I realised over this time is that you should never give up on your dreams. I was discouraged from pursuing them years ago and thought that by failing my exam I had fallen at the last hurdle, but I hadn’t. Th ere is always a second chance. If midwifery is the career that you really want then go for it, never let anyone dull your sparkle or tell you otherwise.

Louise Webster is RCM SMF chair and an NQM at Walsall Healthcare NHS Trust

TOP TIPS FOR RESITTING EXAMS

Speak to people – peers, friends, family, tutors – don’t keep it all bottled up inside because it will eat away at you. You need a support network around you. Even contact a member of the SMF (see bit.ly/RCM_SMF or via Twitter @louise_ann_RM)

Revise! By speaking to your tutor you’ll know what you need to revise. Take regular breaks to make sure what you’re revising sinks in, and if something is confusing, seek advice for clarifi cation.

Believe in yourselfLouise Webster thought she’d fallen at the last hurdle in becoming a midwife, but with grit and determination she reached her goal.

Midwives / Autumn 2018Opinion

026_MID_OPINION_Student_Voice.indd 26 20/08/2018 17:44


VOICEof a mother

I found my fi rst midwife appointments intimidating. Our community midwives were lovely, but when you see a diff erent one every single time, it’s hard to feel... a connection. I needed a connection.

Th en there was you dear student midwife. You arrived at one of our appointments and looked at me with bright

enthusiastic eyes. You really LOOKED at me. You greeted me like we were meeting in the pub. Two women, not pregnant lady and keeper of the information. You looked at my husband, you smiled at him and chatted to him. You asked us if we’d be one of your case studies. ‘Of course!’ we said.

You gave us your number so we could update you. Th at made me feel like I would be in your thoughts. Over the course of months, you made us feel like we were the only people in the whole world having a baby and we were so special. I felt held.

Th en fi nally our birthing day arrived. ‘I so hope she’s there,’ I whispered between contractions in the car to the maternity unit. And there you were. With your bright eyes, and your beaming smile and your softness and your friendliness and we were just friends in a pub. And it was lovely. You were mine. My midwife. My familiar face. My continuous carer throughout. You were walking our journey with us and you would be there to the end. I was excited to share our moment with you.

You and your colleague were more than I could ever have hoped for. You heard all our wishes and you sat with us, watching respectfully, patiently, lovingly. I felt held. I went into myself and I connected with my body, because you made me feel safe to do so. Because I trusted you, and believed you trusted me, I allowed myself to trust my birthing process

and just work my labour. Sometimes I opened my eyes and looked into the room and made eye contact with you, and I heard your colleague whispering words of gentle awe and I felt held. WE felt held.

In our fi rst moments as parents, you told me how amazing I had been, how strong I was and I felt incredible. Just before you said goodbye, you gave our son his fi rst ‘skin-side’ gift. I couldn’t fi nd the words to tell you what you’d meant

to us. I couldn’t fi nd any words, they all seemed so... pithy.You may not remember us, but I will never forget you. We talk

about you sometimes, my son and I. ‘Mummy, this is my special bunny from the lady at my birth’, ‘yes babe, it’s from the lady who taught me the power of woman just “being” with woman.’

Th ank you for being the midwife you are, I hope you have some idea of how much it meant and what a gift you are.

Love, Siobhán

Siobhán Ridley is a pregnancy and birth coach in Norfolk and blogs on her website yourtinyhuman.com

You may not remember me, but I will never forget you.Dear student midwife...

You heard all our wishes and you sat with us, watching respectfully,

patiently, lovingly. I felt held

ed

e

in your thoughts. Over the course of

anSoeyrowicoofW

ashohoinsasoI cto

to us. I couldn’t find any words, they

027_MID_OPINION_Mother_Voice.indd 27 20/08/2018 17:45


RCM BRAN

CH VO

ICE

OpinionMidwives / Autumn 2018

In an age when we rely heavily on computers and technology, and where social media is taking the lead for lines of communication, we, as branch offi cials, decided to get creative with how we promoted our meetings and gained the interest of our members. For an RCM branch with little

activity over previous years, we really wanted to make an eff ort to become more active.

Th e health board employs 39 midwives, as well as our management team, and there are others within the health board that are RCM members too. So, with more than 40 members belonging to the branch and Powys being a vast county spanning over 2000 square miles, attendance due to travelling to meetings and juggling workloads was a massive task.

After hearing about the virtual meetings being held in England, we decided to give it a go ourselves. Our RCM branch AGM was held earlier in the year and we thought it was the perfect opportunity to trial it. Th e RCM Worthing branch was kind enough to share their experiences with the following top tips: ● When you’re live, there’s about a 30-second delay

between your recording and what your viewers see. So if you ask for responses, there will be that delay to consider.

● When holding a more formal meeting like an AGM, have whatever device you’re using to go live with

(for example, phone/tablet/laptop) set up in front of you at the end of the table, and make sure you have a phone near you ‘watching’ the live feed, so that you can see comments clearer.

● Only use Facebook Live with your closed RCM group. ● Always make it as a Facebook event. Th ey will

know when to tune in. Share your agenda and put all your big voting parts nearer the beginning so you capture the most people, as you’re viewers will jump in and out.

● You can publish the live feed to your group after the meeting. When this is posted, make a comment that it was recorded earlier and is not live now, because you could have people watch it later thinking it’s live and try commenting. We had fi ve members in attendance at our

meeting and three more viewed the live stream on Facebook making our overall attendance eight. Th is was an achievement in itself. However, since then our post has had over 20 views with RCM members commenting as well.

I think it’s safe to say that our fi rst attempt at a live stream of our workplace representative meetings was an experience with hiccups and lessons learnt along the way. But isn’t that what we strive for – refl ective learning? Th ere will be more live streams to come and we are planning to use the guidance that the RCM has recently produced. And there are so many ways that we as a branch can use social media to engage with our members, so watch this space.

Alice Hammond is RCM Powys branch secretary

Virtual realityRCM Powys branch share their experience of engaging with members through Facebook Live meetings to overcome the challenge of geographical distance and the diffi culty keeping in touch traditionally.

AGM, with

But isng? Th ere w

are planning to urecently produced. Andwe as a branch can use socour members, so watch this s

Alice Hammond is RCM Powys branch

Left: midwives at our IDM tea party held for retired midwife Jan Cross. Below: a scholarship event with Dr Marie Lewis, who came to talk about her Florence Nightingale travel scholarship to New Zealand

028_MID_OPINION_RCM_branch.indd 28 20/08/2018 17:45


VOICE O

F AN N

QM

Opinion

The postnatal ward is always full – of noise, people and emotions. It is a close and warm environment of blue curtains and fl uorescent lights. Th e air is thick with the tiny bodies of new babies and tired, elated parents. Buzzers and

telephones ring, a network of staff weave in and out of rooms, trolleys and machines rumble along the corridor.

Women, still freshly stunned from birth, pass in and out of the hands of many. In a snapshot of sentences, from person to person, they tell us a part of their stories – the journey that has brought them, and so many others before them, to this moment of crying baby, shattered body. You can almost see their minds whirling, ticking over what has happened to them. Subtle body language, passing comments, watery eyes, diffi cult speech. From behind the curtain, as the ward whizzes around them, women tumble over their changed identities.

I am caring for a woman I have met before. She is exhausted and depleted – readmitted with postnatal complications after a diffi cult birth. ‘I didn’t know about this part,’ she says. She is overwhelmed by the physical changes to her body and the fatigue of becoming a parent. Her face is a tangle of confl ict. She is overjoyed and relieved; her sixth pregnancy but fi rst child, a long road of IVF and miscarriages, a wide eyed little boy in the cot. She is beaten and doubting, caught in a confusing place between expectation and reality.

Her words echo those that have been said by others, so many times before. I tell her that I

Being enoughRefl ecting on her rotationto the postnatal ward,Anna Merrick fi nds a common ground with new mothers and their stories.

understand what she is saying. ‘I can see that you do,’ she replies. I am surprised when we both have quick, quiet tears in our eyes.

Walking home, after another both challenging and rewarding day, I think more about why her words impacted me so much. Having known the woman already, our rapport was established and this likely infl uenced my emotional investment in her care; seeing her distressed was upsetting. But beyond this, I realised that we shared an unlikely common ground. Unsure, drained, inexperienced. Proud, excited, growing.

Th roughout the shift, we both frequently doubted our abilities and questioned our worth. We asked for help, got things double-checked. We sought approval and wanted to learn. We were sensitive. We were resilient. We kept going and found support because we wanted to be better mothers, better midwives. We both remembered how far we had come to get to this point. As women whirled through their experiences behind the blue curtains, I was simultaneously whirling through mine at the desk. Th e wobbly identities of new mothers are those of new midwives too – intense, overwhelming, changing.

Earlier in the day, the woman said to me: ‘Wow, it’s so busy, you guys really do an amazing job.’ At the end of the shift, I tell her that she is doing really well and to keep going, but that it is okay to need some help. We understand each other, from our diff erent perspectives. She is trying her best. I am trying my best. She is enough. I am enough.

Anna Merrick is an NQM working in London


029_MID_OPINION_NQM.indd 29 21/08/2018 14:13

Could you be an RCM Fellow?

Becoming an RCM Fellow will give you the opportunity to:

• Lead on future developments and initiatives in midwifery.• Contribute to the national and international development of midwifery.• Influence national policy and contribute to strategic groups.• Become an ambassador for midwives and the RCM.• Become recognised and appreciated within your organisation.• Demonstrate role modelling for peers and colleagues.

Applications open from 1st November 2018 – 7th January 2019

For further information and to apply for fellowship, please visit www.rcm.org.uk/rcm-fellowship

At the RCM, we value individuals who give exceptional care and have made a valuable contribution to midwifery. The RCM Fellowship scheme recognises members and midwives who lead and deliver excellence in practice, education or research.

MID.Iss3.2018.030.indd 2 10/08/2018 16:24


THELATESTRESEARCHEvidence Based Midwifery is the

RCM’s quarterly journal featuring in-depth research.

Here is the summary of contents from the June 2018 issue of EBM.

1 Intrauterine prenatal surgery: an alternative to abortion

Marlene Sinclair

When fetal abnormality is discovered, parents rely on midwives, who have a duty to keep abreast of technological advances in fetal surgery and present the available evidence to those who may be deeply opposed to abortion.

2 Breastfeeding knowledge and attitude scale: Arabic version

Reem Hatamleh, Sawsan Abuhammad and Heba Rababah

Robust and transparent frameworks are needed to ensure acceptability and practicability when borrowing instruments for use in diff erent cultures and countries. A systematic and comprehensive literature review was undertaken to answer the question: ‘Is the Arabic version of knowledge and attitude towards breastfeeding equivalent to the English version?’ The 2005 WHO guidelines in English were transplanted and adapted for use in Jordan.

3 Coping, help and coherence: a non-dichotomous theory for childbirth

Susanne Darra

Building on the work of Aaron Antonovsky's theory of a Sense of Coherence and nurse-midwife Ernestine Wiedenbach's Need for Help theory, the author describes an explanatory framework through which to understand birth. Combining these two theories avoids the drawbacks of a dichotomous structure and integrates the perspectives of both the woman and her midwife, refl ecting the high value placed by both on coping and self-reliance.

4 An exploration of the methodology used in a study to examine the

eff ectiveness of education and training in providing nutritional advice to pregnant women: systematic review protocol Shwikar Othman, Rasika Jayasekara, Mary Steen and Julie Fleet

The authors undertook a systematic review to examine the signifi cant role of nutritional knowledge and education in infl uencing dietary and eating behaviours of pregnant women and the impact on maternal health outcomes.

5 Online educational resources for health professionals caring for

pregnant women with heart disease: a scoping literature review using Arksey and O’Malley’s methodological frameworkMary Gillespie, Marlene Sinclair, Janine Stockdale, Brendan Bunting and Joan Condell

Heart disease is the leading cause of maternal death in the UK, with just over two deaths per 100,000 maternities reported. This study aims to identify the nature, content and accessibility of educational resources available to health professionals.

6 Men looking into a ‘woman’s world’: the views of urban men involved in

antenatal services at a public hospital in Ghana Veronica A Agyare, Florence Naab and Ivy F Osei

In the patriarchal society of Ghana, where men participate little or not at all in maternal care, this study explores the views of urban men taking part in routine antenatal care and the key role of men in improving maternal health.�

→ To access these papers, visit bit.ly/RCM_EBM

031_MID_PRACTICE_EBM.indd 31 20/08/2018 17:46


RESEARCHWhat’s happening in the world of midwifery research? Two lead authors summarise their work.

PAPER ONE

RESEARCH

The Ehlers-Danlos Syndromes (EDS) are a group of 13 genetic conditions that aff ect the connective tissues throughout

the body. Th e prevalence of EDS may be far greater than previously thought (0.75% to 2%) and remains largely undiagnosed. Th ose with a diagnosis of EDS report a lack of understanding among healthcare professionals.

Hypermobile EDS (hEDS) and the related Hypermobility Spectrum Disorders (formerly Joint Hypermobility Syndrome) is the most common subtype of EDS and is associated with a number of childbearing complications. Consequently, the aim of this research was to draw upon the existing international evidence, and present evidence-based care considerations for newborns and childbearing women with hEDS.

Women with hEDS can experience higher rates of infertility. Due to this, the genetic nature of EDS and for the provision of existing medical management plans, it is prudent to suggest appropriate preconception medical review. Pregnant women with hEDS are more likely to experience premature labour, increased joint elasticity and dislocations, pain, varicose veins and increased rates of depression and anxiety. As such, this may prompt early referrals to physiotherapy, obstetric, mental health

and GP services. Appropriate maternal positioning should also be led by the mother throughout. Furthermore, up to 78% of women with hEDS also experience Postural Tachycardia Syndrome (PoTS) or orthostatic intolerance, the symptoms of which may be exacerbated by the cardiovascular changes seen in pregnancy.

Th e literature retrieved demonstrated how those with hEDS are at higher risk of a variety of complications in childbearing when compared to the general population. As such, the management of hEDS in childbearing women can be complex. Some of the evidence retrieved suggested that the use of non-tension, non-dissolvable, deep double sutures for perineal repair, left in for at least 14 days, early anaesthetic reviews, a multidisciplinary approach and individualised care plans may improve the quality and safety of care received. Newborns with hEDS can also be given extra joint support to avoid unnecessary dislocations.

While it is beyond the scope of a midwife’s role to diagnose hEDS in childbearing women, the authors suggest that midwives could play a key

Pezaro S, Pearce G, Reinhold E. (2018) Hypermobile Ehlers-Danlos Syndrome during pregnancy, birth and beyond. British Journal of Midwifery 26(4): 217-23.

Supporting pregnant women and newborns with Ehlers-Danlos Syndromes

MOREREADING

032_033_MID_PRACTICE_Research.indd 32 20/08/2018 17:46

role in raising awareness and making useful referrals where appropriate. In light of a lack of evidence in this area, the authors also suggest further work to develop robust guidelines for all health professionals caring for this unique subgroup of women. Th is work forms part of the EDS Clinical Toolkit developed in partnership between the RCGP and Th e Ehlers-Danlos Support UK, a project led by co-author Emma Reinhold.

Sally Pezaro is a midwife, researcher and lecturer at Coventry University

MOREREADING

Has your research

been published recently? Would you like your summary to appear on these pages? Contact [email protected]

PAPER TWO

Birthing options in Australia are more numerous in densely populated coastal regions but less available in rural and

remote areas, often necessitating some women to move to city regions as their birth due date draws near. In Australia, rural and remote maternity units are regularly shut down and obstetric intervention continues to rise. Th is prompted us to investigate whether women are increasingly likely to birth before arrival into a maternity unit and whether some of these births may actually be freebirths.

Th ere are anecdotal accounts that freebirth is increasing in Australia, however there is no offi cial collection of data. We proposed that the freebirth rate could be estimated through examining data on babies born before arrival (BBA) and seeing whether these events occurred more often in geographic areas where home birth was also more prevalent.

Using population-based linked data

we looked at all births in New South Wales (NSW) between the years 2000-11. Th e Perinatal Data Collection in NSW records births which occur before arrival, which were not intended home births. Th is surveillance system also records maternal postcode, which always asks for a socioeconomic profi le of women to be established and geographical settings to be examined.

During the time period, there were 1,097,653 births and a BBA rate of 4.6 per 1000 births. Th e BBA rate changed from 4.2 to 4.8 per 1000 births over time (p=0.06). Babies BBA were more likely to be premature (12.5% compared with 7.3%), of lower birthweight (209.8g mean diff erence) and be admitted to a special care nursery or NICU (20.6% compared with 15.6%). Th e perinatal mortality rate was signifi cantly higher in the BBA cohort (34.6 compared with 9.3 per 1000 births). Women in the BBA cohort were more likely to be in the lowest socioeconomic decile, multiparous, have higher rates of smoking (30.5% compared with 13.8%) and were more likely to suff er a postpartum haemorrhage requiring transfusion than the non-BBA cohort (1.5% compared with 0.7%). Th e most common occurring complications for neonates were suspected infection (6.9%), hypothermia (6.9%), respiratory distress (5.4%), congenital abnormality (4.0%) and neonatal withdrawal symptoms (2.4%). BBA occurred more in areas where the distance to a maternity unit is more than two hours’ drive and in coastal regions where there is also a high rate of home birth.

Th ree forces appeared to be at play in the occurrence of a BBA event: geographical distance, maternal socioeconomic factors and a correlation between home birth and BBA, which we propose is a proxy measurement of freebirth. Women need to be provided with options of care that meet their needs regardless of geography or socioeconomic status.

Charlene Thornton is associate professor of midwifery at Flinders University, Australia

What causes women in New South Wales to birth

before arrival, and why?

Thornton CE, Dahlen HG. (2018) Born before arrival in NSW, Australia (2000–2011): a linked population data study of incidence, location, associated factors and maternal and neonatal outcomes. BMJ Open 8(3): e019328.

PracticeMidwives / Autumn 2018


032_033_MID_PRACTICE_Research.indd 33 20/08/2018 17:46


PracticeMidwives / Autumn 2018

Th e RCM’s CEO explains the research that infl uenced her and why.

I completed my midwifery training in 1987 with hardly any mention of research! Th e fi rst research that inspired me was Sleep et al (1984) that certainly infl uenced the reduction in episiotomy in the unit I worked in. Th is research also inspired me to start a degree. Th e focus during that course was on quantitative research and in particular randomised controlled trials – the only research we were told that evidence-based practice could be built on.

Th en in 1991 I heard Ruth Davis present her ethnographic study of student midwives’ experience of their training (Davis and Aitkinson, 1991). Her presentation and explanation of ethnography was inspiring and led me to think much more widely about how qualitative methodologies could infl uence evidence-based practice, our understanding of the world in which we worked and what we

could do to keep improving maternity care by asking ‘why?’.

However, it did much more than that, it also led me to explore for myself the hierarchies and cultures in maternity services and I realised there was much to do to understand and seek to change negative cultures. It also had an impact on my use of qualitative methodologies as I studied further.

Action research became my methodology of choice and fi nally inspiring my interest in quality improvement (QI) techniques. My last Ql project was the development and use of a shared decision-making tool for choice of place of birth. It is true to say that now as RCM CEO I am still promoting healthy cultures, mutual respect and support for everyone in the maternity team and QI still grabs my attention as a methodology to create empowered change.

Influential researchTHE RESEARCH THAT INSPIRED ME: GILL WALTON

Sleep J, Grant A, Garcia J, Elbourne D, Spencer J, Chalmers I. (1984) West Berkshire perineal management trial. British Medical Journal (clinical research edition) 289(6445): 587-90.

Davis RM, Atkinson P. (1991) Students of midwifery: ‘doing the obs’ and other coping strategies. Midwifery 7(3): 113-21.

MOREREADING

RCMi-learnResearch evidence and its impact

Have you been inspired by a piece of research? Would you like to share it? Maybe you have just completed a PhD and would like to have a summary of your thesis published in Midwives?If so, contact [email protected]

34_MID_PRACTICE_Research.indd 34 21/08/2018 11:10

You want your new mums to be

des993

MID.Iss3.2018.035.indd 2 06/08/2018 16:56


Th e latest practical guide...

PRACTICE

36

Keep your career on track

HOW TO...

The RCM career framework encourages a more refl ective attitude to your work and helps map out future directions.Michelle Lyne explains how you can fulfi l your ambitions.

T housands of students across the UK at the time of writing are anxiously awaiting results that could help

launch them on their future career trajectories. I still recall my own anxieties at that time and wonder if I would have done anything diff erently if I were to plan my career today.

Working in the NHS has always been challenging, but today it s eems even more so. Resources are severely stretched, with staff often feeling undervalued and unable to give women the high-quality care they need and that midwives want to provide. Many newly qualifi ed practitioners feel dissatisfi ed with the level of care they can give, and are unhappy with the workload, culture and working conditions, and the lack of ongoing support, training and development. All of which can result in midwives leaving the profession – often as early as two years after qualifying.

If we are to retain our maternity workforce, we need to consider how we address these issues through leadership, positive role-modelling and motivating midwives to remain in the profession. We are also experiencing increasing diffi culty recruiting into senior roles, with a lack of succession planning and development to facilitate career progression.

I have had a long and varied career as a midwife but I believe that,

other than deciding very early in my training to be a nurse that I wanted to be a midwife, my career was left to chance: I just seemed to be in the right place as opportunities arose.

The next generationFor the purposes of this article, let us subscribe to the stereotyping of generational cohort typologies: along with a quarter of the current NHS workforce (Jones et al, 2015), I am a baby boomer. We typically entered the NHS workforce with the intention of gaining a job for life, so just went with whatever the journey presented, providing it off ered job security – even at the expense of our families. Th ose following us, generations X and Y, view life and careers diff erently. Th ey

are more likely to be determined to achieve a more family-orientated career; while being ambitious, they often have more than one career. Th ey prefer to know what their journey has to off er. Research with newly qualifi ed midwives and nurses has shown the needs and expectations of these staff members (see NQM job satisfaction, right).

Our members have told us that they have rarely if ever had any career guidance. If we are to challenge the decision to leave, the profession needs to follow through on the initial investment in training staff by consolidating and building on their skills, motivating them and giving them reasons to stay in the NHS.

036-037_MID_OPINION_How_to.indd 36 20/08/2018 17:47

37rcm.org.uk/midwives 37


their specifi c job title because the career framework is currently an illustration of a sample of destinations beyond entry to the maternity workforce. Th e examples included provide you with an explanation of what the post entails, the knowledge, skills and expertise required for that position and options for progression should you be considering ‘What next?’

It features inspiring real-life case studies that describe career journeys and off er refl ections on the challenging and rewarding aspects of their role. We have also included videos of people talking about their roles.

Future destinationsTo support your ongoing development, signposts to resources such as within i-learn and the new RCM leadership programme can help you develop your practical, management, leadership and research skills in readiness for embarking on your next career move.

As the career framework develops, it will include more existing and new roles within the NHS as well as in professional organisations, trade unions, charities and government bodies.

Th e RCM career framework will be situated within i-learn and will be launched later this year.

Michelle Lyne is RCM professional education advisor

A new career frameworkYou can fi nd many career frameworks that have been developed for health professionals, but these are predominantly driven by the nursing agenda. For the RCM, it was important to determine what a career in maternity services could look like. We must develop our highly skilled workforce into one that has the scope to provide world-class maternity care beyond 2020. Th e RCM career framework will:● Provide a clear profession-

specifi c career structure ● Contribute to improving

outcomes for women, their babies and families

● Enhance lifelong learning ● Build capacity and leadership

within the profession. Th e framework identifi es key roles

and the core competencies required to undertake that role. Th ese are followed by the added professional competencies needed to progress your career.

Career paths can provide direction in two ways. Th ey can be defi ned, linear paths: these are paths trodden by ‘most people’ following that route into a particular job. It has a logical sequence but limited opportunity for alternative routes of entry. Alternatively, people choose their own pathway by seeking out the experiences they need in order to progress. Within the maternity workforce, very few careers are linear; there is often frequent movement between the four pillars of clinical practice, management, education and research (see fi gure below), and many choose careers that straddle two or more.

Identifying the education, training, knowledge and expertise we expect of the maternity workforce will be a valuable resource for members, employers, educators, health and education commissioners.

Th e fi rst version of the career framework focuses on roles within the NHS and universities. Not everybody will be able to see

NQM JOB SATISFACTION● A clear, structured career pathway● To feel support personally and professionally

from leaders and teams● To be part of a team● Feedback, guidance and development ● Flexible ways of working to achieve a good

work/life balance ● Support to deliver the quality of care● To be engaged in meaningful work that

makes a diff erence.(Jones et al, 2015)

Practice

EDUCATION

MANAGEMENT RESEARCH

CLINICAL PRACTICE

LEADERSHIP

036-037_MID_OPINION_How_to.indd 37 20/08/2018 17:47

• Presentations from the RCM chief executive and RCM president

• An opportunity to debate the big issues affecting contemporary midwifery care

• A lively, formula-free exhibition featuring over 60 companies, organisations and stakeholders

• The opportunity to earn 16 hours towards your 20 hours required for revalidation

• Sessions on topics including, multidisciplinary teamworking; perinatal mental health; challenging inequality, sexism and discrimination; leadership at every level; stillbirth and systems design and patient safety

• A larger conference at our central venue in Manchester - making it easy for all four UK countries and more RCM members to attend

ALL THIS AND MORE AT THE FREE* TO ATTEND RCM ANNUAL CONFERENCE IN MANCHESTER ON 4-5 OCTOBER.

*For RCM members

We’re excited to announce that many of you will be joining us at Manchester Central on 4-5 October. If you’re yet to book, act fast as fi nal places remain!

The conference will feature a bustling schedule of inspirational speakers, all exploring and debating the big issues affecting contemporary midwifery care.

Additionally, there will be a lively, formula-free exhibition featuring over 60 companies, organisations and stakeholders. This conference is your perfect chance to earn 16 hours towards your 20 CPD hours for revalidation.

RCM Alliance partners:

rcmconference.org.uk | @MidwivesRCM | #rcmconf18

EXPECT

FINAL PLACES REMAINsecure your place now at: rcmconference.org.uk

MID.Iss3.2018.038-039.indd 2 17/08/2018 17:45

*If you have booked a place and can no longer attend please let the team know.

Gill Waltonchief executive, RCM

Susan Bookbindermanaging director, Zamala Ltd

RCM CHIEF EXECUTIVE GILL WALTON IN CONVERSATION WITH SUSAN BOOKBINDER

PUTTING POLICY INTO PRACTICE

Deb Jacksonhead of midwifery

and associate director of nursing family and therapies, Aneurin Bevan

University Health Board

Justine Craighead of midwifery,

NHS Tayside

Clemmie Hooper midwife, mother, author

GROWING A BABY BY A MOTHER OF DAUGHTERS

Lauren O’Neillstudent midwife

THE WILDERNESS: SUCCEEDING IN YOUR SECOND YEAR

PERINATAL MENTAL HEALTH: FROM THE PERSONAL TO THE BIG PICTURE

Samantha Collingematernity bereavement

service manager University Hospitals Coventry and Warwickshire NHS Trust

David Monteithfounder, Grace in Action

PERINATAL MENTAL HEALTH: FROM THE PERSONAL TO THE BIG PICTURE

Jane Fishermother

Teresa Nixondirector of assurance,

Regulation and Quality Improvement Authority (RQIA)

CHALLENGING INEQUALITY, SEXISM AND DISCRIMINATION

Leyla Hussein psychotherapist, activist and founder of the

Dahlia Project and co-founder of Daughters of Eve

Helen Pankhurstactivist and author

Advisor CARE International

Alice Hoodhead of equality

and strategy, TUC

THE TOP, THE MIDDLE AND THE BOTTOM: LEADERSHIP AT EVERY LEVEL

Rosie Jenksmidwifery student at

University of West London and member of the RCM Student Midwife Forum

Karyn McCluskeychief executive offi cer,

Community Justice Scotland

Dame Tina Lavender professor of midwifery and director of the

Centre for Global Women’s Health at the University of Manchester

SYSTEMS DESIGN AND PATIENT SAFETY – LEARNING FROM OUR MISTAKES

Dr Suzette Woodwardnational cinical director,

Sign up to Safety

E TOP THE MIDDLE AND THE BOTTOM: SYSTEMS D

PROGRAMME HIGHLIGHTSPPPRROGRSPEAKERS AND

MID.Iss3.2018.038-039.indd 3 17/08/2018 17:45


CommunicationMidwives / Autumn 2018

Midwives listens to the language of pregnancy and birth, and

asks how it aff ects a woman’s experience during labour

– and beyond.

Mid i li t t th l

040-045_MID_cover feature.indd 40 20/08/2018 17:47


GOOD COMMUNICATIONis fundamental to midwifery. It is ‘the vehicle by which all else is learnt and relationships are built’ (Kirkham, 1993), and it incorporates everything from active listening and touch, to body language and tone of voice. But

fundamentally it is about words.Words refl ect and infl uence our attitudes and

behaviours in ways we are not always conscious of; they convey layers of meaning, and subtly – or not so subtly – defi ne the power balance in conversations and relationships (Carboon, 1999).

Good words, bad words?A recent article in the British Medical Journal lists examples of poor language choices in birth communication – language that provokes anxiety, is over-dramatic, violent, discouraging or patronising – and off ers alternatives (Mobbs et al, 2018).

Terms such as ‘fetal distress’, ‘rupture the membranes’ or ‘big baby’ should, the authors suggest, make way for ‘changes in the baby’s heart rate pattern’, ‘release the waters’ and ‘healthy baby’. ‘Poor obstetric history’ or ‘high risk’ is better described as ‘medically complex’, and ‘failure to progress’ as ‘slow labour’ (see further examples on page 43).

As well as avoiding ‘exclusive or codifi ed language’ such as abbreviations and acronyms, the article also recommends dropping words and phrases that don’t respect a woman’s autonomy as an adult, an individual and as a decision-maker, such as ‘my lady’ or ‘good girl’, or ‘you must have/need/require’.

The language of powerTh e authors acknowledge that eyes may roll at the thought of ‘political correctness gone mad’ but argue IL

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that these suggestions are fi rmly rooted in woman-centred care, refl ecting that ‘the role of birth attendant is no longer “owner” of the situation but “facilitator” of the health services’. It is ‘the duty of caregivers to use language that will help empower all women,’ they add (Mobbs et al, 2018).

But while it is relatively straightforward to change the literature and even alter practice, achieving a shift in deeply ingrained language and the thinking it refl ects is diffi cult.

Words and phrases linger on, with the language of ‘managing’, ‘allowing’, ‘conducting’, ‘delivering’ and ‘risk’ still refl ecting ‘who has the power in any given situation’ (Leap and Hunter, 2016).

Choosing your words carefullyDebating the most appropriate words has long been a part of midwifery discourse – much of it centred around calling out words and phrases that undermine a woman’s autonomy, heighten fear and anxiety, or foster self-doubt.

For example, using the word ‘patient’ to describe a woman during her pregnancy, with its connotations of passivity and compliance (Silverton, 2017), has now made way for ‘woman’ or ‘mother’ – although some still prefer ‘lady’ (Munson, 2016).

Words refl ect and infl uence

our attitudes and behaviours in ways we are not always

concious of

↘


rcm.org.uk/midwives42

Similarly, the word ‘deliver’, which shifts power to the carers around a woman (Hunter, 2006), is now replaced more frequently with the more woman-centred ‘birth’.

Th e language of maternity care continues to be questioned. For example, is asking a woman in labour about pain relief at regular intervals ‘sabotage language’ and an ‘obvious undermining of her confi dence’ for example? (Leap and Hunter, 2016).

Should the word ‘contraction’ be reframed as ‘surge’, ‘wave’, ‘rush’ or ‘expansion’, as some hypnobirthing practitioners already suggest?

And has the language of high risk/low risk in maternity care had its day? Research suggests that labelling a woman ‘high risk’ may negatively aff ect her psychosocial state (Stahl and Hundley, 2003) and result in higher levels of anxiety (Lee et al, 2012). ‘Complex care’ or ‘complex needs’ are terms fi ltering into maternity speak instead, but even here some have argued it is a case of replacing one unhelpful and vague catch-all with another (Davies, 2012).

Clearly, language choices in maternity care are far from clear-cut. Even the internationally recognised term ‘normal birth’ is fraught, as is the alternative ‘natural birth’, leaving women ‘questioning the binaries of normal/abnormal, natural/unnatural’ (Leap and Hunter, 2016) and risking marginalising those who need medical interventions (Lyerly, 2012). Currently, a raft of alternatives including ‘physiological birth’, ‘straightforward labour and birth’ and ‘optimal birth’ all remain on the table (Leap and Hunter, 2016).

The power of words Louise Silverton, former RCM director for midwifery, believes poor communication, whether inappropriate language or the use of opaque medical terms, can have a real, negative impact.

‘Women can get very frightened, and we know that fear impedes physiology – when that happens, labour doesn’t progress, and that leads to more interventions.’

‘Delivery’ describing any type of birth is one of several phrases she’d like to see consigned to history.

‘Th e postman delivers, Amazon delivers – women give birth. Even if they are assisted to give birth, it’s a CS birth, a forceps birth – delivery takes away the

→

woman’s agency,’ she says. ‘So, when you’re carrying out an examination of

a woman, don’t say “you’re only two centimetres” – say “Your cervix is two centimetres open. You’ve got started – that’s really good.”’

Th e use of positive, supportive language is a key feature of midwifery care. Leap (2010) used the phrase ‘midwifery muttering’ to describe the quiet repeated use of words of encouragement throughout the labour which have a ‘steadying eff ect’ and create a ‘sense of calm’ (Leap and Hunter, 2016).

But remaining positive doesn’t mean being closed to concerns, adds Louise. ‘If you are leaving the room for any reason, be quite clear about where you are going and how long you’ll be.

‘Be careful to involve the woman in any conversation, or explain that you are just going to brief your colleague and go into the corner of the room. You should not be saying anything that you haven’t shared in layman’s terms with the woman and her partner.’

A lasting impactIt is not only during labour, but throughout a woman’s pregnancy journey that midwives must choose their words carefully, rooting out the negative connotations in so many everyday turns of phrase, says Louise.

‘Rather than saying “I think I’d like to give birth at home”, say “I’m planning a home birth” – be positive.

‘And my absolute bête noire – “going to try to breastfeed” – just sows the seeds that you are not going

‘Th e postman delivers, Amazon delivers – women give birth. Even if

they are assisted to give birth... delivery

takes away the woman’s agency’

↘



Midwives / Autumn 2018Communication

Mind your language Good practice in birth communication

Mobbs et al, 2018

Respectingwomen as

autonomous adults

SWAP: My womanFOR: Use her name or say ‘the

woman I am caring for’

SWAP: Good girl (during labour)FOR: You’re doing really well

Replacing exclusive or codifi ed language with plain language

SWAP: SROMFOR: Your waters have broken

SWAP: PPHFOR: Extra bleeding

after childbirth

Respectingwomen as individuals

SWAP: The primigravida in room 12FOR: Use her name or say: The woman in room 12

SWAP: I’ll go and consent herFOR: I’ll go and ask if she’s happy with that

and ask her to sign a consent form/discuss informed consent

Respecting awoman’s autonomy as a decision-maker

SWAP: You must have/need/require a CS FOR: I would recommend/suggest/advise

CS because… (give benefi ts, risks and alternative for any recommendation)

SWAP: Patient refusedFOR: She declined

Avoiding phrasesthat are anxiety-provoking,

over-dramatic or violent

SWAP: Fetal distress FOR: Changes in baby’s heart rate pattern

SWAP: Trial of forcepsFOR: Let’s see if we can help the

baby out using forceps

Avoid discouraging or insensitive language

SWAP: Failed induction FOR: Unsuccessful induction

SWAP: Poor maternal eff ortFOR: Not fi nding it easy


CommunicationMidwives / Autumn 2018


to succeed before you’ve even started,’ she adds.Clearly, the impact of communication at this

time extends well beyond a woman’s pregnancy and birth experience: poor support and communication during labour and birth is associated with a higher rate of postnatal mental health problems, including postnatal depression and post-traumatic stress disorder (RCM, 2012).

Lynn Jackson-Taylor, hypnobirthing practitioner and co-founder of a perinatal mental health website, believes that communication and language during this time has a profound eff ect on a woman’s fundamental self-belief.

She says: ‘If a midwife can help a woman have that “I am capable” attitude, that’s positive in the early days with her baby, it’s positive for her self-belief in motherhood and in womanhood.

‘But if you’re telling a woman for example that “if your baby doesn’t come in the next 20 minutes we are going to have to intervene”, that comes across as a major ultimatum – a threat.

‘It’s perfectly possible you can turn it around and help a woman rediscover “I am capable” – a lot of that is done simply through the way you say things.’

So what can midwives do?While there is a dearth of evidence on interventions to inform effective communication between maternity care staff and healthy women (Chang et al, 2018), some maternity units are taking steps to improve communication. University Hospitals of Morecambe Bay NHS Foundation Trust has developed a staff training programme that draws on families’ real experiences to illustrate the impact of words (see box above).

Mel Elliston, chair of the local Bay-Wide Maternity Voices Partnership and a practising doula, co-designed and developed the project, conducting 16 fi lmed conversations with women that now form the basis of a staff training day.

She says: ‘Everything that’s said, and more importantly the way it’s said, can have a deep and lasting impact on women, and care providers have

it in their power to make a positive diff erence by the way they speak to women and the vocabulary they use.’

For Mel, the key is an individualised approach. She suggests that care providers can ask a woman how they would like something described, or how much information they need, or tune in to the language she favours.

But even more important than the vocabulary is the intent and the feeling behind it.

‘If a midwife can somehow impart her confi dence to the woman that she can do it – show a sense of belief in her – she can help a woman feel her own strength, trust in her body and empower herself.

‘It’s not just the vocabulary,’ adds Mel. ‘It’s the belief in the person; you can’t just say the right words – you need to believe them.’

THE ‘OUR COMMUNICATION MATTERS IN MATERNITY AT MORECAMBE BAY’ PROJECTSally Sagar, senior engagement and development matron at University Hospitals of Morecambe Bay NHS Foundation Trust, says: ‘As doctors and midwives we can use terminology that might be everyday to us, but can actually be quite shocking to women.

‘One woman I went out to see had had a number of miscarriages. To her, they were all her children – she had named them, they were part of her family – but with a subsequent pregnancy a doctor had insisted they weren’t babies, they were miscarriages. That really upset her.

‘Another woman I saw said she came out of her room holding her baby and walked down the corridor. A midwife popped her head out and said: “Babies don’t bounce, you know.”

‘When I spoke to the midwife, what she’d meant was “just be careful you don’t trip and fall,” but the woman was feeling vulnerable at the time and felt like she was doing something wrong in how she cared for the baby.

‘We are just asking people to be mindful of the terminology they use, to consider how women can be impacted by the language, and make sure they absolutely understand what you mean.’

The communication workshops began in November, and every member of staff who comes into contact with a woman on her maternity journey will attend.

Sally says: ‘We have seen our complaints reduce since November and women are showing greater satisfaction in our surveys. Women who have given birth with us before are reporting that care has improved.’

→



A mother’s storyLou Holroyd, a mum-of-three from Morecambe, is one of the women to share her story as part of the ‘Our communication matters in maternity at Morecambe Bay’ project.

She was left traumatised by an experience with a locum registrar who stitched her vaginal tear following the birth of her fi rst child, without proper anaesthesia. She told him she was in terrible pain, but he replied: ‘Well you’re the one with a baby boy over there, not me,’ and continued.

A supportive midwife and hypnobirthing techniques helped her rebuild her confi dence prior to the birth of her second child. But after labouring at home, her experience in hospital was devastating, despite the fact she gave birth just 15 minutes after arriving.

‘Th e midwife was really very cold and abrupt – she was very commanding and demanding. She told me to get on the bed, she kept saying: ‘I need to examine you. I need to examine you.’ I had a lot of anxiety after such a bad experience being stitched up the fi rst time. I don’t think she realised how far along I was. I was in too much pain to be examined, I didn’t want to be examined.

‘I was scared so I clamped my knees closed – I ended up giving birth fl at on my back with my legs still closed.

‘She demanded I opened my legs because the baby’s head was out, but by that point I was non-responsive to her – she had no warmth in her tone - I shut down. It was only when my husband said: ‘Lou you really need to open your legs, the baby’s head is out and your squashing it,’ that I responded.

‘I had no relationship with her. I had no trust that she would be careful. I felt like I would have

‘She praised me for the smallest things – that meant a lot at that time. I felt more

empowered – more in control, more confi dent – a lot

less vulnerable’

the same experience I had before when that locum registrar stitched me up. I would never have wished to give birth like that.’

With the birth of her third child in 2016, her experience was completely diff erent.

‘Th e midwife was just so kind. She let me take things in my own stride – she was patient. She made suggestions – but they were just suggestions, not demands or commands. She listened to the things I wanted, like low lighting for example, and I was really keen for a waterbirth and I wanted to have my hypnobirthing CD on. She listened to me and made things happen as best she could.

‘And she praised me – she praised me for the smallest things – that meant a lot at that time. I felt more empowered – more in control, more confi dent – a lot less vulnerable than I had with my second birth.

‘I don’t really remember the words, but I remember the tone of voice, the warmth, the

positivity. During my fi rst and third births the midwives looking after me were so kind,

so calm and relaxed – their warmth came through. I felt like I genuinely mattered, my baby genuinely mattered.

‘But when I look back on the bad experiences, I don’t just remember the tone, the negativity, I remember the words – they played in my head over and over

again. It’s hard to escape, even years later. It’s not something I think about a lot

now – but I’ll remember those words, those experiences, for a long time to come.’

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WEHEARYOURCM CEO Gill Walton and director of services to members Suzanne Tyler off er big thanks to all the midwives who took part in The Big Conversation and talk about the future for OUR RCM.

DURING MARCH, APRILand May this year, RCM members everywhere were engaged in Th e Big Conversation. We

met you at workplace meetings and branch events, and you spoke to us through our online survey, through Facebook and Twitter. Th e aim was to listen to and learn from you – our members, the people who make OUR RCM the powerful and respected force that it is – as well as about

what’s going well and what needs to improve to strengthen our collective voice, our networks and our passion for midwifery care.

You confi rmed what we have been saying loud and clear: it’s tough in maternity services but, despite that, good things are happening. Th ere are promises for more staff and better pay; however, these are yet to be felt in the working experience of midwives and MSWs. We heard that access to training and development is limited, and that undermining behaviours and bullying remain far too prevalent. We heard that leaders and managers are struggling too. In relation to OUR RCM, we heard that we don’t always communicate as clearly with you as we could, and we are not always as visible as you want us to be at local level.

You said you wanted us to do more to promote positive images of midwives and MSWs, to champion the role of the midwife where it is under attack, to fi ght for respect, strong leadership and a true culture of learning, and to do more to share good practice and innovation to strive for improvement. You said we needed to shout more about what is wrong in maternity, and at the same time do more to show a positive image and celebrate the work you do.

Passionate commitmentYou told us that our three key overarching priorities of safety, partnership and leadership are the right ones. Th at we can only ensure safe, high-quality care where midwives and MSWs are able to give their best through supportive, compassionate leadership and partnership based on trust and respect, not hierarchies.

We are taking note of all this: we will work harder to foster good relationships with the RCOG and others at local as well as national level; we will hold the government to account to deliver on its promises around pay and staffi ng; and we will have a major campaign next year to raise the profi le of leadership at all levels.

We heard that many of you remain passionate, committed and positive about the work you do and the care you give. We heard that you feel privileged to be involved in the care of women and their families, and that some teams work well and pull together with mutual respect and support. Joint meetings among the multidisciplinary team, excellent role models and fl attened hierarchies do exist and do make a diff erence. We will do more to search these out and publicise them to showcase what you are doing in a world dominated by bad news stories.

Midwives / Autumn 2018Th e Big Conversation


046-047_MID_big convo.indd 46 20/08/2018 17:49

‘Have an education team to support new

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We heard that the RCM awards are the way to highlight and celebrate best practice, that our i-learn and i-folio resources are giving you access to CPD, and that making conference free to attend has widened your ability to participate. We will continue to review and refresh our membership off er to ensure we give you value for money.

Th e Big Conversation outputs have helped your elected board determine overall strategy for the next fi ve years:● Listen to and learn from members

so that we can eff ectively lead and infl uence

● Deliver products and services that off er value for money and meet the individual and collective needs of all our members

● Actively grow and build networks, alliances and partnerships.At conference, we will deliver

a fuller report and outline how we intend to act on the messages you have given us. But this cannot be the end of Th e Big Conversation. Th e RCM is committed to conversations with all our members over the months and years to come. Only together can we ensure OUR RCM is an organisation we can all be proud to be part of.

KEY THEMESEMERGING FROM THE BIG CONVERSATION● Pay and working conditions● Staffi ng levels● Education and training● Leadership and management● Culture● Communication● Improving maternity practices● Increasing RCM visibility.

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FEEDBACK Suggestions for improvement What needs to change

046-047_MID_big convo.indd 47 20/08/2018 17:49

Respecting reality

48

IMAG

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Many mums continue to struggle with breastfeeding. Clare Livingstone explains how the new RCM position statement empowers all mothers making decisions on infant feeding.

BREASTFEEDING IN ACCORDANCE WITH recommended guidelines brings clear health benefi ts to both mother and baby. Wonderful work is taking place in maternity units throughout the UK, where dedicated and

highly skilled staff support women along their journey to successfully breastfeed their babies.

However, at the RCM we were unable to ignore negative reports from some women who have felt under pressure to breastfeed when this was not their choice, or judged when they opted to give their baby formula

rcm.org.uk/midwives

Infant feedingMidwives / Autumn 2018

048-049_MID_infant feeding.indd 48 20/08/2018 17:50


with, personally and professionally, but we are required to respect and support them nonetheless.

Gill says: ‘We recognise that some women cannot or do not wish to breastfeed, and rely on formula milk. Th ey must be given all the advice and support they need on safe preparation of bottles and responsive feeding to develop a close and loving bond with their baby.’

We know this cannot happen without proper resourcing, and our position statement explicitly calls for suffi cient investment to be made in maternity units, staff and postnatal care to ensure this is the supportive, respectful service received by every woman. Th e RCM is maintaining its current position of not accepting advertising from infant food manufacturers or allowing them to exhibit at RCM events.

While our position statement has been overwhelmingly well received by members, professional bodies – including the Royal College of Paediatrics and Child Health, the Institute of Health Visiting and the RCN – and other stakeholder organisations such as the NCT, we are aware of the concerns and confusion, especially around some of the media coverage. Sensationalised tabloid headlines created much heat, but little light, around the message and we can only learn from this.

Infant feeding, like many other issues connected to women’s health, generates strong feelings and sometimes disagreement, but the RCM stands by the content of this position statement, confi dent that nailing our colours to the mast in this way was the right thing to do.

Clare Livingstone is RCM professional policy advisor

We were unable to ignore negative reports from some women who have felt under pressure

to breastfeed

POSITION STATEMENT KEY POINTS● Exclusive breastfeeding for the fi rst six months is the most appropriate

method of infant feeding● If, after being given appropriate information, advice and support on

breastfeeding, a woman chooses not to do so, her choice must be respected● Parents who formula-feed infants should be provided with the information to

do so safely and be given support to encourage bonding● More investment in maternity units and postnatal care to enable each woman

to make informed choices about feeding her baby● Breastfeeding mothers should feel supported and respected by the

wider society● Access the full position statement at bit.ly/RCM_infant_feeding

milk. We are aware of cases where some mothers have not been adequately educated on the preparation and feeding of formula milk, and even been denied supplies of formula milk while in hospital. Th is is in breach of UK guidance, such as the NHS constitution in England, which guarantees patients’ rights ‘to receive suitable and nutritious food and hydration to sustain good health and wellbeing’ (NHS, 2015).

Th us, in June, the RCM launched a new, refreshed position statement on infant feeding.

A mother’s choiceWe felt that there were new aspects to the infant-feeding debate worthy of inclusion that would be relevant in practice. Midwives and MSWs are supporting women’s choices and decisions every day with evidence-based information and advice, and our position statement needed to refl ect the reality and context of their work.

RCM chief executive Gill Walton says: ‘Evidence clearly shows that breastfeeding in line with WHO guidance brings optimum benefi ts for the health of both mother and baby. However, the reality is that often some women for a variety of reasons struggle to start or sustain breastfeeding.’

We are all aware that today’s mothers and their families often have signifi cant challenges to overcome. Many are trying to cope with fi nancial diffi culties, workplace insecurity, physical and mental health needs, and societal pressures, which can all impact on their decision-making.

Our role is to empower, inform and enable that decision-making. As registered midwives, we have a duty of care to treat people with ‘kindness, respect and compassion’ (NMC, 2015). Sometimes this will fi nd us caring for women who make decisions we may not agree

048-049_MID_infant feeding.indd 49 21/08/2018 11:11


Refl ectionMidwives / Autumn 2018

the health service in NI, however by 2010 all RCM branches in NI were co-terminus with the new health and social care trusts. In 2007 the NIA was reconstituted and NI fi nally acquired a local supervising authority midwifery offi cer.

MSWs and industrial actionMSWs were introduced in 2009 and the fi rst FMU opened in Downpatrick in 2010, followed by the FMU in Lagan Valley in 2011. Our long-awaited Maternity strategy was published in 2012 and the Mater Hospital FMU opened in 2013. RCM members in NI took industrial action for the fi rst time in our history in 2015and we fi nally got abortion guidance from the Department of Health in 2016 after 12 years of court proceedings. We affi liated to the Irish Congress of Trade Unions in 2017 and the NIA collapsed again a short time later.

Th roughout my time with the RCM in NI we’ve hosted visits from three RCM general secretaries, fi ve RCM presidents and HRH Th e Princess Royal. I’m leaving in the middle of a year of wonderful celebrations to commemorate the centenary of the Midwives (Ireland) Act, but I know that with Karen Murray as my successor, midwives, women and their families will be in safe hands in the years ahead.

After 21 years at theRCM in Northern Ireland, directorBreedagh Hughes is stepping down. She refl ects on her experiences and the changes that have evolved.

Lookingback

IWAS APPOINTED IN APRIL 1997, IN THE middle of clinical grading, just after the maternity unit in Newtownards had closed and just before Tony Blair’s New Labour was elected. Midwifery education in

Northern Ireland (NI) transferred into Queen’s University and our fi rst midwife-led pilot projects were under way.

In 1998, my colleague Mary Caddell joined Anne Marie O’Neill and myself in the NI team and we began our campaign for women’s choice in relation to pregnancy and place of birth. Th e new Northern Ireland Assembly (NIA) was elected in June and NI’s midwives lobbied for better pay.

In 1999, the maternity unit in Dungannon closed and the NIA was suspended, leaving us in a policy vacuum – some things clearly haven’t changed!

Campaigns and manifestosTh e Jubilee Maternity Hospital in Belfast merged with the Royal Maternity Hospital in early 2000, and as the alongside midwife-led unit opened in Craigavon, we began our campaign to have freestanding maternity units (FMUs) established in NI as part of a comprehensive regional strategy for maternity services.

Th e NIA fi nally got up and running in 2001 with Bairbre de Brun appointed as fi rst health minister, and the thorny issue of abortion was fi rst raised in the NIA. Ruth Clarke was appointed as the fi rst midwifery adviser in the Department of Health and in a spirit of optimism we published our fi rst RCM manifesto for NI. However the NIA collapsed again in 2002and remained suspended until May 2007.

In 2003 we saw the introduction of direct-entry midwifery training and as the CS rate shot up to 24%, we intensifi ed our campaign to introduce midwife-led care in an attempt to off er women an alternative to hospital-based obstetric-led care. Downpatrick maternity unit closed in 2003, however 2004 saw direct rule health minister Angela Smyth, give us the go-ahead to develop FMUs in NI as Agenda for Change was introduced across the UK. Th e maternity unit in Magherafelt closed in November 2006 as centralisation of maternity services continued.

Th e years 2005-07 brought the Review of public administration with a major review of

RCM NI on strike 2015

Princess Anne visits Lagan Valley

Joint RCM/INMO conference

050_MID_FEATURE.indd 50 20/08/2018 17:50

The new MSW:

defi nedroles,clearcareers


↘

A new programme todevelop a nationallydefi ned and standardisedMSW role in England is underway. Midwives fi nds out more about it.

BACK IN MARCH, THE THEN-secretary of state for health and social care Jeremy Hunt announced a range of measures designed to boost maternity services in England. Th e plan to train

more than 3000 more midwives over the next four years caught the headlines, but just as important was the proposal to set out a more defi ned role for MSWs and new training pathways for those who want to move into midwifery.

Th e measures are intended to support the ongoing drive to realise the vision of Better births, the 2016 national maternity review in England. Th is envisages more multiprofessional working and fewer barriers between midwives, obstetricians and other health professionals, to deliver more world-class, safe and personalised care for women and their babies.

MSWsMidwives / Autumn 2018

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051-052_MID_FEATURE_HEE.indd 51 20/08/2018 17:50


MSWs Midwives / Autumn 2018

→ MSWs are a vital part of the maternity workforce that will deliver Better births. Th ey play a key role in supporting midwives, maternity teams, mothers and their babies throughout pregnancy, labour and during the postnatal period. Th e problem is that, within the current workforce, the actual day-to-day roles and responsibilities of MSWs vary widely.

‘We have MSWs working all over England, doing diff erent things because there is no standardisation of the role,’ says Carmel Lloyd, RCM head of education and learning. ‘We have MSWs working at Bands 2, 3 and 4, but it is all very mixed. We want a clear demarcation between what an MSW working in each band knows and can do.’

A programme to rationalise, develop and professionalise the MSW role is now underway. Health Education England (HEE) is leading it, working closely with partners across the system, including the RCM, NHS England, NHS Improvement, the RCOG, Public Health England and MSWs themselves. Th e overall aim is to:● Develop a nationally defi ned and

standardised MSW role in England, including a national competency and career framework

● Look at the possibility of a voluntary register for MSWs

● Introduce new training routes into

HEE recently commissioned the University of the West of England to develop the MSW career and competence framework, which will involve close working with the HEE maternity programme team, MSW implementation group and stakeholders across the maternity system.

The team is holding four regional workshops in October and November to get input and feedback on their proposals.

The events will be open to anybody who works in the maternity system. The organisers particularly want to attract MSWs and midwives – the events will be a great opportunity for them to get involved in helping to inform and develop the fi nal products.

Full details of the events, along with booking information will be announced in the near future. The dates

below have been agreed in the meantime, and anybody who wants to register an early interest in attending can contact the team on [email protected]

London: 9 OctoberMidlands and East: 19 October (Birmingham)South: 1 November (Bristol)North: 7 November (Leeds or Sheffi eld)

MAKING SENSE OF APPRENTICESHIPSJeremy Hunt’s announcement kick-started the development of a midwifery apprenticeship to attract more people into the profession. Skills for Health, HEE, educational institutions and employers set up the ‘midwifery apprenticeship trailblazer’ to develop the standards.

While the trailblazer is still in the early stages, it will have to negotiate a few obstacles. The fi rst is the new NMC standards for midwifery education expected to be published in 2020, meaning that any apprenticeship standard developed now against the current standards will have to be revised in 2020. The second is that apprentices following the new framework won’t be able to apply for recognition of prior learning from courses that are not NMC-approved midwifery qualifi cations, making the new apprenticeship less fl exible than some others.

The possible structure of the apprenticeship is also causing confusion, says Carmel Lloyd: ‘Some people think you won’t need a degree at the end of an apprenticeship, and that you will have two types of midwife, one with a degree and one without. That isn’tthe case.

‘Whether you go via the normal university route or the apprenticeship route, you still have to have a degree qualifi cation to get onto the NMC register. A university degree to become a midwife takes three years, but via an apprenticeship it will take longer.’

For more information, visit bit.ly/apprenticeship_standard

midwifery through the development of apprenticeships.

Th e intention is that this programme will provide opportunities for MSWs to strengthen their roles within the maternity workforce and to develop their careers. New access routes will open for those who have their sights set on becoming a registered midwife.

‘Th e standardisation will help people on that career pathway,’ says Carmel. ‘Some MSWs take up that role because that’s what they want to do. Th ey like working alongside midwives and being part of the maternity team. Th ey are fulfi lled and have no aspirations to go on and do midwifery. But for others, being an MSW triggers their interest, and they feel they have something to off er in terms of being a midwife. Th ey have skills that would be transferable to midwifery training.’

Th e changes will also mean that employers can invest in developing their current MSWs, helping them not only to retain existing staff but also to attract people who can contribute to delivering the agendas for Better births and continuity of carer.

Sally Ashton-May, regional associate clinical lead at HEE, says the work on the new defi nitions and career paths is now well advanced: ‘We have regional

HAVE YOUR SAY

workshops coming up in the autumn to get input on the proposed framework, and it should all be ready to be launched in January.’

Whatever the fi nal detail of the framework might look like, it will help to improve the standing of MSWs no matter where they work. ‘It will defi nitely help the status of the MSWs,’ says Carmel. ‘Some of them have done a foundation degree but are working at Band 2, and some are Band 2s doing the work of a Band 4, so I think this will ensure they are banded correctly and paid properly for the work they are doing. From the MSW perspective, this is a move in the right direction.’

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051-052_MID_FEATURE_HEE.indd 52 20/08/2018 17:51

Th e latest modules and updates released by the RCM’s i-learn team.

What’s new?Professionaland practice

VTE prevention and midwifery practice Venous thromboembolism (VTE) and pulmonary embolism are one of the leading causes of maternal morbidity and mortality in the UK. Th e midwife has an important role in prevention, detection and education around VTE. Th is updated interactive course includes videos, resources and activities to enable midwives to identify and prevent VTE.

Women aff ected by forced marriageForced marriage is a global problem. Th is new course provides an understanding of the issue and its scale within the wider context of honour-based abuse and violence against women and girls in the UK. It uses case studies to help midwives and support workers understand and identify the diff erences between forced marriage and arranged marriage, the motivation for forced marriage and how it presents.

Th e module explains the safeguarding responsibilities of midwives and support workers; the practical steps to protect victims; potential victims and the unborn

FOR MORE INFORMATIONTo access these courses and lots more, go to ilearn.rcm.org.uk

child; referral pathways; identifi able signs and symptoms of forced marriage; and the important ‘One Chance’ rule.

It helps develop confi dence in handling victims in a clinical setting who may have experienced forced marriage and other serious crimes associated with it, such as rape or modern slavery.

10-minute updates Spreading the word – getting

your abstract accepted Sharing knowledge and expertise of practice, education and research provides an opportunity to learn from others and to bring about improvements in care for the benefi t of women, babies, maternity staff and the service. Th is new module provides hints and tips to get your abstract accepted at conferences, events or awards. It also includes advice on developing an oral presentation or poster and outlines some of the various opportunities to showcase your work.

Building resilient practitioners:2018 update Working in maternity services is challenging so midwives, students

and support workers need to fi nd ways to take care of themselves and their colleagues. Research into midwifery resilience suggests that it is possible to develop personal and professional strategies to enhance resilience and keep practice sustainable. Th is short course includes a research-based resilient repertoire with linked refl ective questions and has been updated with more resources to help identify positive mood changers that suit you and your lifestyle.

ActivistsGDPR for activists

Th is short i-learn module on the General Data Protection Regulation (GDPR) aims to support workplace reps and branch offi cers in understanding how these new regulations impact on the way they store and use data about RCM members. Th is course contains videos, interactive activities and examples to give a better understanding of what is meant by personal data and the importance of sensitive data; the rights of the individual; why these regulations are relevant to you; and what to do if a data breach occurs.

i-learnMidwives / Autumn 2018


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IMAG

E: IS

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Keeping it In rural mid Wales, midwives have developed realistic ‘skills and drills’ training for home-birth emergencies with no obstetric support. Shelly Jones and Dr Marie Lewis explain how.

POWYS TEACHING HEALTH Board has been running community ‘skills and drills’ training for midwives and paramedics

for 15 years. Since 2007, it has off ered the Appropriate Skills for Appropriate Places (ASAP) course to midwives and paramedics from across the UK.

Local backgroundMaternity services in Powys cover more than 200 square miles of rural mid-Wales and are wholly midwife-led. Th ere is no district

general hospital, so obstetric care is commissioned from consultant units outside the county. Women who choose to give birth in Powys can attend one of six freestanding birth centres or birth at home. Th e overall home-birth rate here ranges from 8% to 12%. Midwives work in the community, partnering with paramedics when necessary. Transfer times to an obstetric unit for consultant care range from half an hour to two hours, dependent on where in Powys a woman lives; it was therefore essential for the

county to develop a specifi c skills and drills training.

Existing training tends to focus on care within the hospital setting, where most births happen (Wickham et al, 2012). Midwives in the community may be working alone, and need to respond to an emergency situation. When training has been conducted within a ‘home-like’ environment, they have been rated positively, specifi cally in relation to aspects such as equipment and communication (Pauley and Dale, 2016). Such training encourages the

Midwives / Autumn 2018ASAP

054-056_mid_Powys.indd 54 20/08/2018 17:51


real

development of teamwork, and the application of practical skills in a ‘safe’ environment (Kirkham, 2018).

It was vital that the course, which has been accredited by the RCM, was robust and evidence-based. Th e accreditation process involved completing lesson plans, risk assessments, aide memoires and robust evaluations. Th e ASAP training programme has recently been awarded its second three-year accreditation.

Midwives in Powys only provide intrapartum care in freestanding

be developed to meet their specifi c needs because an obstetric skills and drills training model did not prepare them for a community-based situation. Midwifery supervisors developed a course that would meet the needs, concentrating on working in teams or in partnership with paramedics. Drills could be carried out by midwives in a setting appropriate for community care, while remaining realistic about the equipment accessible to community midwives. Th e setting for the training was as close to real life as possible – a remote Welsh farmhouse.

Rooted in real lifeASAP aimed to develop and deliver a realistic training programme to meet the needs of community midwives and encourage working partnerships with paramedics and health visitors (see Objectives of ASAP training, above).

OBJECTIVES OF ASAP TRAINING● Enable midwives to practise

key emergency skills● Encourage teamwork

and communication● Cover essential training topics.

midwife-led units or in a woman’s home, and their team often consists only of another midwife or a paramedic. So training needed to

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Th e two-day ‘Obstetric emergencies in the community’ course promotes the role of midwives in the community and their ability to provide up-to-date evidence-based care. It focuses on the promotion of normality, risk assessment and handling emergencies. Th e residential course off ers opportunities for team-building and personal refl ection, as well as updating knowledge. Th e venue allows for the set-up of real scenarios and enables midwives to practise skills in a home setting: emergencies take place in bathrooms, bedrooms, living rooms and on the stairs. Issues of transfer and support available to midwives in the community as well as risk assessment and key clinical skills are covered.

Approximately 15 delegates attend the two-day ASAP training; small numbers allow adequate time and feasibility for the practice scenarios. Midwives are required to bring with them the equipment they would normally carry in the community and use this throughout the training. Group discussion is used to evaluate and explore diff erent approaches to dealing with diffi cult situations.

Course evaluationBetween 2014 and 2017, 82 UK midwives attended the course. All attendees completed an evaluation form at the end of the course and scored each session on a Likert scale of one to fi ve (one being poor, fi ve excellent).

All attendees were asked to score how important they felt the training was to their practice. Th ey all scored four or fi ve, with an average score

of 4.9, demonstrating the value of the course to community midwives. Th ey were also asked to score how confi dent they felt in dealing with emergencies within the community both before and after the training. Before the training, attendees scored themselves between two and fi ve, an average confi dence score of 3.4. Following the training, scores recorded were four to fi ve, with an average confi dence score of 4.9.

Midwife feedbackAll attendees said they had thoroughly enjoyed both days and valued the opportunity to practise these skills in realistic settings. Words used by the attendees to describe the course included: ‘excellent’, ‘loved it’, ‘fantastic’, ‘enjoyable’ and ‘empowering’.

Attendees described important lessons, including the promotion of normality, how to have conversations with women about birth options, taking a step back and evaluating the situation, and using what is available and thinking through the natural physiological process.

Running an obstetric emergency course in the community for midwives is valuable in the current drive to promote midwife-led care. Th e evaluations indicate that attendees left the course feeling more confi dent, empowered and better prepared to off er women a choice for place of birth.

Shelly Jones is assistant HoM and Dr Marie Lewis is consultant midwife at Powys Teaching Health Board

MORE INFORMATIONNext course and how to book:14 and 15 November, Llandrindod Wells, Powys (two-day workshop, includes accommodation).Email Zara Abberley at [email protected] or call 01597 828755.

CONFIDENCE BOOST

Before ASAP 3.4

After ASAP 4.9

Confi dence levels on dealing with emergencies in the

community (marks out of fi ve), scored by midwives on ASAP course.

ASAPMidwives / Autumn 2018

→

RCMi-learnHome birth modules are available

054-056_mid_Powys.indd 56 20/08/2018 17:52


DIARYUpcoming courses, training and events relevant to midwifery.

LABOUR WARD LEADERS WORKSHOP: WORKING TOGETHER FOR SAFE CARE 6 DECEMBER

This one-day interactive workshop is designed to address some of the current challenges in maternity services around leadership on delivery suite. The workshop will support labour ward leaders to work collaboratively together to develop safe and cohesive teams delivering eff ective and safe care.Location: DublinE: [email protected]: rcm.org.uk/get-involved/events

Advertise with us

If you would like to advertise here, contact Toyah Power on

020 7324 2735 or email [email protected]

KG HYPNOBIRTHING TEACHER DIPLOMA22-24 SEPTEMBER – LONDON25-27 OCTOBER – YORK9-11 NOVEMBER – MANCHESTER24-26 NOVEMBER – LONDON19-21 JANUARY – BIRMINGHAM16-18 FEBRUARY – BRISTOL

Expert hypnobirthing trainers and midwives. Come to the specialists for your training. The UK course chosen by midwives and hospitals. Special rates for midwives.T: 01264 535002E: offi [email protected]: kghypnobirthing.com

COMMUNICATION SKILLS AND DELIVERING DIFFICULT NEWS22 SEPTEMBER, 8 DECEMBER

SUPPORTING PARENTS’ DECISIONS27 OCTOBER

ARC’s (Antenatal Results and Choices) professional training days are aimed at healthcare professionals who provide care throughout the antenatal screening process and its consequences. We off er study days and bespoke half-day sessions in-house. Quote ARC345 to get £10 off the study day. Location: LondonT: 020 7713 7356 E: [email protected]

RCM ANNUAL CONFERENCE 20184-5 OCTOBER

Informative, inspirational and motivating, the RCM annual conference and exhibition is an essential forum to share evidence, update knowledge and network with colleagues while hearing about best practice from across the UK. This conference has something for everyone, a ‘must attend’ for all those involved in maternity care.Location: Manchester CentralCost: FREE for RCM membersE: [email protected]: rcmconference.org.uk

RCM ANNUAL MIDWIFERY AWARDS 20195 MARCH – LONDON

The RCM annual awards have been recognising and celebrating outstanding achievements in midwifery across the UK since 2004. Each year, the awards promote the best new evidence-based practice and world-class standards, showcase ground-breaking initiatives and reward individual and team excellence. It’s free to enter. Submit your entries now! The deadline is 14 September. Location: The Brewery, LondonE: [email protected]: rcmawards.com

INTERACTIVE PERINEAL SUTURING WORKSHOP FOR MIDWIVES27 OCTOBER, 24 NOVEMBER, 8 DECEMBER

During the practical session, a range of realistic models will be used to practise handling surgical instruments, continuous non-lock technique, subcuticular technique, interrupted suturing technique, basic knot-tying techniques, episiotomy, and labia repair.Location: Hilton Garden Inn Hotel, HeathrowCost: £150; £130 for studentsT: 07957 412676E: [email protected]: perihealthlondon.com

LABOUR WARD COORDINATORS: A WORKSHOP FOR ASPIRING COORDINATORS7 DECEMBER

This one-day interactive workshop is designed for experienced midwives who are looking to step into the role of labour ward coordinator and for coordinators who are new in post (fewer than 18 months) and looking for some guidance and strategies to being more effi cient and eff ective in the role.Location: DublinCost: £40+VAT; non-members £60+VATE: [email protected]: rcm.org.uk/get-involved/events

DEVELOPING PERSONAL EFFECTIVENESS 1 NOVEMBER – STOKE-ON-TRENT

This event is targeted at Band 6 midwives who want to improve their overall impact and eff ectiveness within the profession by enhancing self-awareness and self-confi dence, improving personal communication skills, developing professional relationships and the ability to infl uence others. It will be helpful to those taking on new roles and responsibilities or those who want to make changes in the way they approach their working life. Cost: £40+VAT; non-members £60+VATE: [email protected]

AQUA-NATAL 2 – ADVANCED TEACHING SKILLS24 NOVEMBER

BACK AND ABDOMINAL CARE IN PREGNANCY AND BEYOND25 NOVEMBER

AQUA-NATAL 1 – INTRODUCTION TO TEACHING IN PREGNANCY2-3 MARCH 2019

Aquafusion’s aqua-natal courses for midwives are delivered with unrivalled expertise and are nationally recognised by the RCM for continuing professional development.Location: Leeds/BradfordT: 01943 879816W: aquafusion.co.uk

W: arc-uk.org

W: rcm.org.uk/get-involved/events

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Giuseppe LabriolaHoM, Lewisham and Greenwich NHS Trust

I’ve learnt a lot about the wider issues facing midwives and support staff around the UK during the year I’ve been on the RCM board. It has been great to get a strategic overview of what people are talking about nationally.

I’m really looking forward to working with the executive team, getting out there to talk to members, get feedback and really move the strategy on over the next fi ve years.

My passion is to ensure that the staff in my trust have a positive experience of work and women and their families have safe and positive experiences of our maternity services. I enjoy meeting with women to get their feedback and working with staff to make sure that our service is safe, high quality and they have a good experience too.

Th e negative side is that there are never enough hours in the day, it’s a huge job. But it’s me and I can’t think of anything else I would rather do.

My perfect weekend is really simple – a nice coff ee, catching up with emails and meeting friends. I also like cycling and taking my motorbike out.

THE RCMBOARD

2018Julie Richards (chair)

Natalie Linder (vice chair)Giuseppe Labriola

Kate EvansTracy Miller

Helene Marshall Michelle BeacockBirte Harlev-Lam

Pauline Twigg

Nine midwives have been re-elected to the RCM board in 2018. We speak to four of them about what being a member of the board means.

Thebenefi ts ofexperience

THE ROLE OF THE RCM BOARD

Ensuring the RCM is effi cient and eff ective, properly managed, supervised and accountable are just a few of the responsibilities of the RCM board. Ultimately, its members are responsible for the broad strategic direction and control of the RCM, setting a long-term vision, ensuring clarity of the College’s purpose and protecting its reputation and values.

In 2017 this meant ensuring the RCM campaigned with the Family Planning Association, British Pregnancy Advisory Service, Amnesty International and others to give women in Northern Ireland access to free abortion services, for example. Th e RCM board also set in motion work on a career framework for midwives and MSWs, and oversaw the recruitment of CEO and general secretary Gill Walton.

All members of the board are practising midwives who have been elected by members of the RCM. Th ey must have been full members of the RCM for at least three years and possess the core competencies required.

To apply for election to the board, complete the RCM’s self-nomination/eligibility declaration form, send your CV to the RCM, and prepare an election address for the RCM to distribute with voting papers. Th e assessment process for 2019will take place at the end of March, with the election scheduled to take place in April. For more information, visit rcm.org.uk/rcm-board

058-059_MID_FEATURE_board members.indd 58 20/08/2018 17:57


Kate EvansPublic health specialist midwife, Abertawe Bro Morgannwg University Health Board

During the year I have been an RCM board member I’ve learnt how diverse our responsibilities are and how they draw on our strengths and attributes. I also realise how hard the executive team works behind the scenes.

I’d like us to get the election process underway to welcome new board members in 2019 and launch our new strategy for the next fi ve years.

Th e most important lesson I’ve learnt is patience! Change doesn’t happen overnight and I’ve had to adapt to that.

I absolutely love midwifery and work with some amazing midwives and associated health professionals, and I love the fact that being a board member means I have the opportunity to make OUR RCM better for those midwives and MSWs.

But if I hadn’t gone into midwifery I might have become a car detailer – my main hobby is cars and I take part in concours competitions, which have made me very adept at car cleaning and detailing! My perfect weekend would involve a car show with our closest friends cleaning cars all weekend in preparedness for judging.

Julie RichardsHead of midwifery and sexual health, Powys Teaching Health Board

I joined the board in 2015 and it has been an amazing leadership opportunity. I have learnt so much about good governance, fi nancial management, supporting a new CEO to join the organisation and most recently as the new chair to the board. It has been great development learning from other board members and the RCM executive team in the skills and knowledge that each person has to off er.

Over the next year I’d like to see the recently developed RCM fi ve-year strategy to be very visual, clear and understandable, and very much owned by the members. I’d also like a range of members, including MSWs, to be interested in standing for election to the board in 2019.

Th e most important lesson I have learnt over the last year is to be brave and bold to have the courage to put myself forward. In fi ve years’ time I hope to be looking from afar at how well the board has delivered on the fi ve-year strategy.

My perfect weekend would be walking in beautiful Powys, followed by relaxing with friends and family over a home-cooked dinner.

Tracy MillerCommunity midwife in Stonehaven for NHS Grampian (currently on secondment for one yearas a caseworker with the RCM Scotland team)

I’d like the RCM board to raise its profi le and show midwives from all areas that this is something they can do to benefi t their personal development, career and communication skills.

I have been a board member for a year and I have learnt to listen to everyone’s views and ensure my view is also listened to and to challenge when my gut feels something is not quite right.

As a caseworker I’ve learnt that so many midwives are going above and beyond their roles to care for women but it’s not sustainable – they are burning out and we really need to fi ght their corner for more resources.

Having said that, the best thing about my job is meeting new people all the time and trying to support them as best I can.

If I hadn’t gone into midwifery I probably would have been a nurse, as that is what I was before doing midwifery. However, I’ve always liked the idea of being a beautician.

My perfect weekend is a long lie-in, a walk on the beach, then dinner and a gin and tonic.

RCM boardMidwives / Autumn 2018

058-059_MID_FEATURE_board members.indd 59 20/08/2018 17:58

TRANSFO FEVER


Amanda Rogers and Fiona Ghalustians describe their experiences of going ‘further, faster’ at an Early

Adopter site in London, implementing Better births as part of the Maternity Transformation Programme.

Midwives / Autumn 2018MTP

060-63 mid_mtp NW LONDON.indd 60 20/08/2018 18:00

RMATION


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THE NORTH WEST LONDON COLLABORATION of Clinical Comissioning Groups (CCGs) covers eight boroughs across inner and outer London – a large, diverse and densely populated area. Maternity services are

provided by six maternity units across four NHS trusts: ● Chelsea and Westminster Hospital ● Hillingdon Hospitals● Imperial College Healthcare● London North West University Healthcare.

Around 30,000 babies are born here each year, with an ever-increasing prevalence of socially and medically complex women requiring care during pregnancy, birth and beyond.

Creating new ways of workingFollowing the successful reconfi guration of our maternity services in 2015, which saw the emergence of true multidisciplinary partnership and collaboration, we applied to become one of seven Early Adopter sites across England to implement recommendations from Better births by testing and evaluating new ways of working in maternity care, and launched the project in January 2017.

We began by mapping the current care pathways for women in three categories: low-risk and uncomplicated care, shared obstetric care and socially complex care. We identifi ed teams

in the local area that were already providing exemplary continuity and postnatal care, while also highlighting areas on which to focus our mission for improvement. Th ese included improved consistency of information and testing new ways of working with women who require both low- and high-risk care.

Our next step was to learn what our staff and service users wanted, gauging how those on ‘the front line’ felt about providing continuity of care through new ways of working. We were particularly interested in learning about any perceived barriers to making these a reality. We engaged with women and their families, through existing Maternity Voices



Partnerships and events at local children’s centres. We also introduced a purpose-built engagement website, allowing women to provide us with feedback on their experiences of care, in line with the themes highlighted in Better births.

Th ree potential new ways of working began to emerge. In collaboration with the project team, each trust modelled the feasibility of the options and agreed what it could test and implement within the life of the project and beyond. Our project management team worked alongside senior midwives at each maternity unit to make our shared aspirations achievable by support with modelling, reconfi guration, engagement and recruitment. Th roughout this process, learning has been shared, successes and challenges explored, and momentum maintained through regular trust and sector-wide meetings.

Counting successesA group of professionals from across the sector has been busy collaborating on the development of a personalised postnatal care planning tool. Th is helped to form a booklet that was designed to be discussed with women during antenatal appointments to prepare them for the often under-explored leap into parenthood. Th is tool will now be included in our soon-to-launch north-west London mum-and-baby app, which will provide women with digital antenatal, birth and postnatal care plans that can be completed to suit their individual needs and wishes.

As the project has grown, new priorities and initiatives have evolved. Your pregnancy and After your baby’s

birth information booklets (pictured left) were developed by the project team, clinical experts and service users to improve the consistency of information that women and their families receive. Available in both paper and digital formats, and in diff erent languages, we aim to ensure all women receive the same high-quality and evidence-based information, regardless of where in north-west London they choose to give birth.

Arezou Rezvani, lead midwife for community, caseload and specialist midwives at Imperial College Healthcare NHS Trust, says: ‘Th e team has worked in collaboration with a variety of clinicians, consultants and midwives to ensure the standard of care and the services which are provided across north-west London are the same. Feedback from staff and mums is that the After your baby’s birth booklet has been really useful and informative.’

To date, we have launched four diff erent models of continuity of carer (see table above), operating in 14 diff erent ways

across north-west London, with at least nine more starting over the autumn and winter. As clinical outcomes improve, staff satisfaction has increased and real change has begun to feel sustainable, the vision to achieve more has grown at an exponential rate.

Model 2 is an emerging and ever-growing success with women and staff alike. Th is model is easy to implement, operates within current staffi ng establishments and has the potential to indirectly contribute to cost-saving and quality improvement measures.

→

MODEL 1: Caseloading

MODEL 2: Birth centre continuity

MODEL 3: Group practice in community

MODEL 4: Hybrid teams

Level of continuity provided

Continuity of carer across antenatal, intrapartum and postnatal care

Continuity of carer across antenatal, intrapartum and postnatal care

Continuity in antenatal and postnatal care

Continuity in antenatal and postnatal care with linked team for intrapartum care

Team size Teams of four to eight midwives

Teams of six to seven midwives

Teams of four to 10 midwives

Two teams of six midwives, one in the community, one on the labour ward

Structure of midwifery care

Named midwife for antenatal and postnatal care with buddy, team or wheel system approach to providing on-call intrapartum care

Named midwife for antenatal and postnatal care, team approach to intrapartum care

Named midwife for antenatal and postnatal care operating in buddies or trios

Named midwife for antenatal and postnatal care, linked team providing intrapartum care

Caseload size Caseload 1:30-40 depending on risk

Caseload 1:60 Caseload 1:100-150 Caseload 1:50-100 depending on risk



Our caseloading teams are thriving, and provisional data shows great promise: one team achieved a home-birth rate of 11% in its fi rst two months. Th ese teams have each been supported to build a rota and on-call system that works for them and is fl exible around midwives’ lives – a method undoubtedly key to their success.

Madoussou Dosso, a midwife at Chelsea and Westminster Hospital who recently began working in a team that provides one-to-one maternity care, says: ‘I’ve been working in this new team for almost four months. I enjoy working this way because you get to build relationships with the women you are caring for. Th e real highlight for me is watching these women grow and seeing how they progress with their baby. Being on call can be tiring, but it’s also exciting to know that I am going to be there when one of my women gives birth.’

Key lessons Never underestimate the amount of time it can take for the successful delivery of new ways of working. From concept to establishment, there are many hurdles to cross and both foreseeable and unpredictable challenges to overcome. Recruitment to certain models has been, and remains, a challenge, but as the fever for transformation grows, so does the curiosity of those who were initially sceptical about their ability to work in a new way.

We can’t deny that the current fi nancial and staffi ng climate has been a challenge, a picture that is widely mirrored elsewhere in the NHS. Key steps to tackling this include careful planning of activity and maintaining midwife-to-women ratios within current staffi ng establishment levels. Unsurprisingly, the transition has the potential to carry fi nancial burden; however, the longer-term indirect savings associated with improved clinical outcomes, experience and length of stay make a compelling case for commitment to change.

Mindful of the NHS’s charge as an Early Adopter site to ‘go further, faster’, the ambition to deliver continuity of maternity care to women will be achieved in three ways: continuation, collaboration and evaluation.

ContinuationTh e local maternity system (LMS) intends to deliver all recommendations set out in Better births by 2020-21 and to achieve sustainable continuity of carer for a signifi cant proportion of women choosing to have their baby in north-west London.

We have laid the groundwork to ensure that women and their families are able to receive consistent, personalised care according to their needs and

delivered by midwives and doctors that they know. Th is will become ‘business as usual’ when the Early Adopters team concludes its work at the end of this year.

CollaborationCollaborative working is enabling the LMS to deliver on a number of key projects. Maternity Voices Partnerships have been established at each trust, and are being successfully led by service users. Th ese groups are infl uential in the way we look to improve care and women’s experiences of our services.

Our new maternity app is currently being user tested and will launch this autumn. Th is app will contain all the information women and their families need to know about having a baby in north-west London and will replicate the information already available in the booklets. Th e app encourages women to create personalised care plans to support each step of their journey into parenthood.

We are striving to ensure that women are aware of the three choices they have in relation to which setting they give birth in (at home, in a midwife-led birth centre or on an obstetric labour ward), in all of our maternity units. Th is is while promoting conversations that are led by women when meeting with their care providers during pregnancy to discuss their birthing options.

EvaluationAn evaluation partner supports the collation of project outputs and the formation of a toolkit to guide the national agenda to implement Better births. Th e new models of care are subject to key performance indicators that will help to evaluate the improvements, with a large-scale comparative audit sample to track the impact of the changes we have made. Midwives working within the new models are gathering this evidence thus learning about service improvement fi rst hand.

Th e goal to have 20% of women booked onto a continuity-of-carer model by the end of March 2019 is challenging, but we are striving to achieve this by working closely with midwives and service users to design models of care that work for our diverse population. We expect that the fi nancial investment we have made in our continuity models will result in direct and indirect fi nancial savings and increase the positive experience of staff and the women in our care.

Amanda Rogers and Fiona Ghalustians are members of the midwifery project management team at the North West London Collaboration of CCGs


MORE INFORMATION For more about the MTP at the North West London Collaboration of CCGs, email [email protected]

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UK-US midwiferyMidwives / Autumn 2018

rainstorm, and fording the swollen Kentucky River.Th ey came because of their extraordinarily close bond

with Mary Breckinridge, founder of the Frontier Nursing Service (FNS), who wanted them to open the fi rst FSN hospital on Th ousandsticks Mountain in Hyden, Kentucky.

Th at bond was based on a shared passion to help the poorest mothers and children.

Born into an infl uential family from the southern US, Mary had trained as a nurse in New York and as a midwife at Woolwich in London – there was no midwifery training in the US. She was appalled that more American women had died in childbirth than American men killed in all wars (Breckinridge, 1927). Maternal mortality rates were twice those in the UK (Breckinridge,

WINS TON CHURCHILL FIRST SPOKE OF the ‘special relationship’ between the UK and US in 1946. But it is pre-dated by a deeper one forged by midwives and nurses.

On 26 June 1928, Scotland’s chief medical offi cer Sir Leslie Mackenzie, 66, and his wife Helen formally opened a new hospital.

But this was 4000 miles away in the Appalachian Mountains – an area so remote that there were no roads and travel was on horseback. Neither of the Mackenzies could ride, so a buckboard was brought in for the journey from the railroad. Th ey trundled 22 miles over rough tracks, teetering over precipices in a violent


A specialrelationship

Chris Holme looks at how the transatlantic bond in midwifery services was forged on the American frontier, and how maternal

mortality rates in the UK and US have diverged since.

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TODAY’S UK-US MATERNAL

MORTALITY GAP8.9 women for every 100,000 live births die from complications of

pregnancy or childbirth in the UK, compared with 25.1 women in the US.

ProPublica looks at the reasons at bit.ly/UK-US_mortality

ProPublica and National Public Radio launched an award-winning

investigation into US maternal care and preventable deaths, Lost mothers, at bit.ly/lost_mothers

1927), which was served by well-trained Queen’s Nurses.

She found a model for her scheme in the Highlands and Islands Medical Service (HIMS) that Sir Leslie helped establish in 1913.

Cultural crossoverTh e Mackenzies had served on various royal commissions to promote the health and welfare of poor children. Th ey were close friends of Elsie Inglis, the pioneer female doctor and tireless suff ragist who set up the Scottish Women’s Hospitals for Foreign Service to provide all-female-staff ed hospitals in World War One. But her real life’s work was with poor women and children just off the now-fashionable Royal Mile in Edinburgh.

Th e Mackenzies rolled out the red carpet for Breckinridge when she came to Scotland in 1924. Sir Leslie was medical member for the Scottish Board of Health – the equivalent of chief medical offi cer now – and his letter of introduction for Mary’s tour north opened many doors for her on a journey that changed her life. She was overwhelmed by the warmth and kindness of the welcome, and the professionalism of the midwives and nurses she met, particularly in the Hebrides.

‘Sometimes an experience is so deeply creative that you respond to it with everything that you have, not only in retrospect but at the time. When I went to Scotland in mid-August of 1924... I knew that weeks of enchantment lay ahead of me, but I could not know until it happened what it would be like to enter a strange country and feel at once that I had come home,’ she later wrote.

Breckinridge found little poverty in the islands except for children on Colonsay who lacked warm clothing. Back in Edinburgh, she bought them jumpers from Princes Street. She also took copious notes – 11,000 words of her meetings and experiences.

Th e Mackenzies helped again when Breckinridge needed a leader for an epidemiological survey in Kentucky. Th ey recommended Williamina Bertram Ireland, a former colleague who had also done fi eld work in the Hebrides, before heading to the US to work for the Committee on Maternal Health in New York.

Williamina had two further essential qualities: she could ride a horse and take a nickname. As recounted in a previous article (Midwives, Spring 2014), the FNS gave nicknames to each new member of staff , mostly recruited from the UK. She became ‘Ireland from Scotland’ and

Annie Mackinnon, from Skye, inevitably became ‘Mac’.

Th ere were other transatlantic links. Yale’s School of Nursing was directly modelled on Rebecca Strong’s training at Glasgow Royal Infi rmary. Elsie Inglis had plans for a new maternity hospital, based on one she had seen at Muskegon, Michigan, on holiday in 1913.

In Canada, the Newfoundland Cottage Hospital System was inspired by the HIMS, and Elsie Stephenson drew on her time at Toronto University to develop

graduate nursing at Edinburgh.What made the Kentucky relationship so special

were the deep personal links. Sir Leslie went into lyrical overdrive when writing about his visit in Th e Lancet: ‘It is a story full of adventure, sacrifi ce, passionate enthusiasm and splendid initiative... Th e invitation was a call of the Highlands to the Highlands. It is a symbol of kinship in feeling and outlook. It is the lightning spark that reveals the essential unity of our culture.’

A fi ne legacy?Helen Mackenzie went on a lecture tour on her return, encouraging adventurous nurses to join the FNS. Already Lady Mackenzie as Sir Leslie’s wife, she was – highly unusually for the time – made a dame in her own right for her contributions to child health.

Th ese links continue today, with UK cities adopting the US Family Nurse Partnership. Th e frontier spirit lives on in Kentucky: the Frontier Nursing University was established in 1939, and the title of Queen’s Nurse was reinstated, in England in 2007 and Scotland in 2017.

So is there a glowing legacy from this special relationship? Not quite. Parity between the US and Europe for maternal mortality had largely been achieved over seven decades. However, this trend has been reversed since 2000 in the US, which despite far higher health spending, records far higher maternal mortality rates than other developed countries (Unicef, 2017).

Th e reasons are complex: US midwifery still faces a struggle for identity as a profession, there are stark disparities between ethnic groups, and lack of continuity of care is linked to poorer outcomes (see panel above).

One thing’s for sure: 90 years on, both Breckinridge and the Mackenzies would be shouting about it. Very loudly.

Chris Holme is a former Reuters Foundation fellow in medical journalism


Midwives / Autumn 2018UK-US midwifery

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FELLOWSHIPS ARE awarded by the RCM to individuals who have provided exceptional

leadership and shown excellence in either practice, education or research. In 2018, six midwives have been appointed fellows.

Dr Laura AbbottTh is year has been a big one for Laura – she gained her doctorate in health research, alongside her day job and achieving a fellowship.

Her academic career – which began in 2009 following seven years as a nurse and nine years as a midwife – often focuses on complex social issues and perinatal mental health.

Laura has a particular interest in the experiences of pregnant women in prison. She works with charity Birth Companions and helped write the Birth charter for women in prisons in England and Wales.

Describing herself as resilient, Laura thrives on bouncing back quickly and overcoming challenges. Her research has demonstrated the huge scope to improve policy, care and outcomes for mother and child, particularly marginalised women. Outside

work, Laura spends time with her husband and three sons, enjoying the theatre and cinema.

Marion WilymanHaving moved to Scotland from a Caribbean maternity department, Marion was among the fi rst cohort of midwives in Edinburgh in 1983 to receive a qualifi cation that was recognised in both Europe and the Commonwealth.

Since then she has practised as a midwife internationally in Australia and the Netherlands, among other countries.

In 2012 Marion completed a master’s degree in women’s health, in which she studied midwives’ experience of home-birth transfers. Th is experience, and working for the last fi ve years as a community midwifery manager at BSUH, has helped her improve their home-birth service, which won the RCM EuroKing Award for Better Births in 2016. She’s also worked on the launch of the fi rst midwifery hub for antenatal and postnatal care in the South East. As an RCM fellow she hopes to infl uence policy-makers to set realistic targets.

Most proud of her ‘terrifi c

Dr Laura Abbott

Senior lecturer in midwifery, University of Hertfordshire

Dr Susan WayAssociate professor, midwifery,

Bournemouth University

Marion Wilyman

Senior community midwife, Brighton and Sussex University

Hospitals NHS Trust (BSUH)

ProfessorJayne E Marshall

Foundation professor of midwifery, NMC lead midwife for education, University of Leicester

Dr Annette Briley

Consultant midwife, clinical trials manager, King’s Health Partners

Denise TiranEducation director,

Expectancy

In its third year, the RCM fellowship has been awardedto six high-achieving midwives. We speak to them.

The newRCM fellows


066-067_MID_FEATURE_Fellows.indd 66 20/08/2018 18:01

FUTURE FELLOWS

HOW DO I APPLY?Members must demonstrate evidence of professional development, exceptional contribution to promoting the art and science of midwifery and the eff ectiveness of midwives for the benefi t of women and their families’ health, to apply for a fellowship.Evidence includes professional and personal development of the self and others within the sphere of midwifery practice, and a signifi cant contribution to professional excellence in midwifery through consistent professional excellence in midwifery care and practice, education, research and scholarship.

WHY APPLY● Lead on future

developments and initiatives in midwifery

● Take the opportunity to contribute to the national and international development of midwifery

● Become an ambassador for midwives and the RCM

● Be recognised and appreciated within your organisation

● Demonstrate role modelling for peers and colleagues.

MORE INFOApplications are open from 1 November 2018 until 7 January 2019. Visit rcm.org.uk/fellowship-application-process

children’, Marion credits her very supportive husband helping her every step of the way.

Dr Susan WayAfter training as a midwife, Susan practised mainly in the hospital. Realising how much she enjoyed teaching, she undertook a PGCEA in 1991 and combined working in clinical practice with teaching.

In 2002 she began working for the newly-formed NMC as a midwifery advisor and was instrumental in revising the pre-registration midwifery standards. She has also completed a doctorate and written a book, Core skills for caring and assessment under the midwifery practice guide, all while working full time and helping raise two children with her partner.

It’s important to prioritise, she says, and manage time eff ectively. Susan spends her spare time gardening and knitting.

She hopes being an RCM fellow will allow her to give something back by supporting others and raising the profi le of midwfery education.

Dr Annette BrileyA qualifi ed midwife working in hospital-based services since 1983, Annette learnt how to scan in 1992 and was involved in establishing and running the Fetal Assessment Unit at Maidstone Hospital. In 1996 she began a one-year research post at St Th omas’ Hospital in London and ever since has worked in research in many single- and multi-centre

clinical trials in the UK and around the world.

She acknowledges the challenges she has faced by stepping away from ‘traditional midwifery’ into research, and has dealt with them by nurturing relationships with other professionals to ensure the value of midwifery input into clinical trials is clear.

A gregarious, determined and passionate person, in her own words, Annette is a trustee of Maternity Worldwide and enjoys her spare time with her family and walking her cocker spaniel, Dotty.

Denise TiranA freelance midwifery lecturer teaching courses on complementary therapies for midwives and doulas for the last 15 years, Denise has trained in several complementary therapies, including aromatherapy, massage, refl exology, homeopathy and acupuncture.

She became a midwife in the 1970s, based in a school of midwifery that eventually became part of the University of Greenwich. Since then she has developed a BSc degree in complementary therapies at the university, which she ran for 14 years, and during which she set up a specialist complementary therapies antenatal teaching clinic and treated almost 6000 women with various discomforts in pregnancy, birth and postnatally.

A master’s degree in health research followed, and Denise published a number of books on midwifery complementary therapies. She has overcome

criticism of complementary therapies as non-academic with sheer hard work, determination, tenacity and belief.

A keen reader and traveller, Denise has ambitions to extend her teaching into Africa and the US.

Professor Jayne E MarshallJayne began teaching students as a newly qualifi ed midwife and undertook a PGCEA while working as a midwifery sister at St Th omas’ Hospital in London. Since then she’s worked in higher education and was awarded a University of Nottingham Lord Dearing award for outstanding contribution to the development of teaching and student learning.

First and foremost an educationalist, Jayne, who has a PhD, has published widely and edited a number of key midwifery texts, including Myles textbook for midwives and Myles professional studies for midwifery education and practice; concepts and challenges, which will be published in 2019.

Describing herself as ‘determined, persistent and a perfectionist who is always willing to nurture and support others in reaching their full potential’, Jayne hopes her experience will help the RCM infl uence and promote its education strategy at all levels of membership.

Away from work, Jayne is a keen driver and national observer for the Institute of Advanced Motorists.


Midwives / Autumn 2018RCM fellows

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Fathers under the microscope

Emma Proctor measures the impact of local trust practices on screening fathers as part of

the NHS antenatal sickle cell and thalassaemia screening programme.

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SICKLE CELL AND THALASSAEMIA (SCT) ARE recessively inherited conditions that aff ect the red blood cells and are collectively known as haemoglobinopathies (Public Health England (PHE), 2018). In England,

sickle cell disease aff ects 1000 pregnancies each year, predominantly those with west African, Caribbean, Middle Eastern and Indian ancestry (PHE, 2018). Sickle cell disease causes severe pain, anaemia, infection and chest problems (PHE, 2016).

Th alassaemia is a condition aff ecting the quantity of red blood cells in the body and those with beta thalassaemia major are usually transfusion-dependent for life, with additional complications associated with iron overload as a by-product of transfusion (PHE, 2016). Beta thalassaemia major aff ects approximately one in 27,000 pregnancies in England (PHE, 2018).

In England, the NHS off ers screening to pregnant women with a subsequent off er to the father to identify parents at risk of an aff ected child. Th is enables informed decision-making regarding the pregnancy (PHE, 2017a). PHE sets the national standards for screening (outlined in Figure 1), and its 2015-16 annual data report shows that average father uptake of baby screening across the country is approximately 60%, but rates appear to be falling in low-prevalence areas (PHE, 2017b).

Aim and methodTh e aim of the project was to understand how variation in local pathways and processes impacts on the uptake of father screening as part of the NHS antenatal SCT programme across England.

A mixed-methods study was undertaken in maternity units across England. A total of 61 SCT high-prevalence sites participated, including four large trusts with two hospital sites each. Th e PHE defi nition of a high-prevalence site is one with greater than 2% screen-positive rate for SCT carriers in the pregnant population (PHE, 2017c). Screening uptake data was collected between April 2015 and March 2016 to identify sites with high and low uptake of father screening. Data was coded numerically by geographical region to preserve anonymity.

Recorded telephone interviews were undertaken during July, August and September 2017. Th e interviews explored local practice in relation to the screening pathway, including pre-conceptual screening, the role and responsibility of the screening pathway, use of resources and level of training completed. In addition, the interview included a discussion of any improvements that had been made to local pathways to improve uptake, and any suggestions that the interviewee had for the future.

Ethical considerationsTh is study did not require health regulation authority approval because it involved NHS employees. Correspondence between the researcher and the participants of the study was through secure NHS mail or a trust email address, and no personal email accounts were used.

Trusts participating in the study were given a unique study code and were identifi ed by the unique number only during data analysis. Information was kept on a secure laptop accessible only by the researcher and was password protected. Participants were informed that the data supplied in this study would not be used to inform their local screening quality assurance service/commissioning teams. Th ere was no discussion of individual cases or clients, and discussion at interview remained generic to the pathway only. Where participants disclosed their place of work during interview, the name

SCT screeningMidwives / Autumn 2018

↘ Figure 1: Standards for the antenatal SCT screening pathway

Standard 3Samples arriving in labratory with completed family origin questionnaire

Standard 4Test turnaround time = three working days

Standard 5Identifi cation of at-risk couples and off er of prenatal diagnosis by 12+0

Standard 7PND results within fi ve working days

Standard 6Prenatal diagnosis performed by 12+6

Standard 2Identify carrier and aff ected women by 10+0

Standard 1All women accepting screening have result

8 10 12 12+6 BirthWeeks



was removed when the data was transcribed. Qualitative data was supplied by the HoM at each maternity service, and signed consent was sought prior to interview.

Results and interviewsTh e response rate was 45% (27 out of 60). Th e total number of women booking for maternity care in the sample was 189,650. Th e total number of screen-positive mothers in the sample was 5473 (2.89% of the booking population). Th e rate of screen-positive mothers varied across the country and within each region, the highest in London at 8% and the lowest at 0.79% in the Midlands. Th e total uptake of father screening in the sample was 75.3%. Figure 2 shows that there is variable uptake of father screening across England, ranging from 11.4% to 95.7%.

Four of the fi ve maternity providers with the lowest uptake of father screening accepted an invitation to interview. Five providers with the highest uptake

participated in the qualitative interviews. In total, nine screening coordinators or specialist sickle cell nurses were recruited. Th emes identifi ed from the high-uptake cohort are shown in Figure 3.

Low and high uptakesTwo sites with high uptake of father screening reported that they contact the woman by text message to off er screening to the father of the baby. Both reported that women are more responsive to text messages than telephone calls. Also, text messages can be benefi cial to women whose fi rst language is not English as they might not answer a phone call because of diffi culty holding a conversation.

One respondent said: ‘We do try and use the phone, but occasionally nowadays because of the high incidence of nuisance calls that women receive, they won’t answer our call... I think also if there is a language barrier... sometimes they won’t pick up their phone. And if they know it is a midwife then they would do... I think sometimes people maybe when English isn’t their fi rst language, though they can speak it, will sometimes answer a text message.’

Text messaging as a method of contacting the mother was not included within any pathways in trusts with low uptake in 2015-16.

Four out of fi ve sites with high uptake of screening initially contacted the pregnant woman by phone with an off er to attend a face-to-face appointment for the discussion of results and requirement for father screening.

‘We would normally ask her to come in with her partner. We would suggest off ering the partner some testing and we would off er a face-to-face appointment and discuss it with the partner,’ said an interviewee.

In contrast, two sites in the low-uptake group did not contact the mother by phone but sent letters. One provider who phoned the mother did not off er a face-to-face appointment, and the fourth provider phoned the mother and off ered an appointment but had little engagement, reportedly due to the expansive geographical area covered and proximity of some to the hospital.

‘It is hard trying to get them to agree to come all the way into the hospital. It’s normally two or three buses for some women and can be a bit diffi cult, so they are reluctant to come in and have a face-to-face meeting,’ said a respondent.

→

Area No of high-prevalence trusts/sites

No of trusts/sites supplying

quantitative data

No of trusts supplying

qualitative data

South 8 4 1

London 25 10 5

Midlands and East 17 8 3

North 11 5 0

Total 61 27 9

Table 1: Sites providing quantitative and qualitative data by region

Figure 2: Percentage uptake of father-of-the-baby screening for SCT, including those previously tested with documented results, by maternity provider in 2015-16

Sites in study by geographical region

100

80

60

40

20

0

Upta

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)

London

Midlands

London

Midlands

London

North

London

Midlands

London

South

Midlands

North

North

North

South

London

MidlandsNorth

Midlands

MidlandsSo

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London

London

London

London

South



All fi ve interviewees in the high-uptake category stated that testing of the baby’s father would be completed in the maternity department by the screening coordinator. A majority said that this reduces the chance of error – for example, wrong details entered on the blood label or samples becoming misplaced and therefore not tested. Two sites off er testing at the weekend with an MSW: ‘He comes to us, we personally do it. We fi nd we get less mistakes that way,’ said a respondent.

‘We have a little room that we can use, a quiet room, so often we will talk to them in there. And then we have a phlebotomy room... it is always with somebody who can actually answer their questions just in case.’

In the low-uptake category, two of the sites off ered father screening in the pathology department only, with a phlebotomist.

All fi ve respondents from the high-uptake category stated that fl exibility was the key to screening men, with some reporting that men have diffi culty in attending for testing during normal working hours: ‘Off ering them a specifi c clinic day doesn’t always work. You have to off er fl exibility, especially in order to get the man.’

In contrast, three of the four trusts in the low-

uptake category only off ered screening during working hours on Monday to Friday. Th e fourth site off ered screening three days a week during working hours.

Although midwives prefer to screen the fathers before the fi rst trimester scan between 11+2 and 14+1 weeks’ gestation, as a fi nal resort the screening midwife will endeavour to undertake father screening at the same time. Th ree sites with high uptake reported that they fi nd men are often in attendance at a scan appointment, sometimes even returning from abroad in order to attend.

Four out of fi ve interviewees in the high-uptake category attempted to contact women and fathers by multiple means including phone, letter, GP and community midwife.

One interviewee said: ‘Th e secret is to keep going with people. Even though it is well outside the time limit of getting people tested, I still want to get the man in – so I will keep going with him.’

In contrast, three out of four providers in the low-uptake category sent a second letter to the mother if there was no response to the fi rst. If the mother did not make contact, there was no follow-up.

ConclusionTh e study shows variation in local trust practices and identifi es several themes that correlate with uptake of father screening. SCT disproportionately aff ects ethnic minority groups; therefore, pathways should be tailored accordingly to ensure equity of access. Under the Health and Social Care Act 2012, commissioners and providers of NHS screening programmes are responsible for ensuring that they are implemented in such a way to reduce health inequalities and focus on ensuring equity of care for those with predefi ned ‘protected characteristics’ such as age, race, religion and sexual orientation (UK Government, 2012).

As the study sample represents nearly half of the high-prevalence trusts in England, the fi ndings of the study provide valuable insight into processes across the country. It is hoped that the fi ndings of this study are used to prompt providers to review current pathways and seek to strengthen processes where performance is low. Th is type of study could be replicated in other parts of the UK.

Emma Proctor is senior quality assurance advisor, Screening Quality Assurance Service at Public Health England

Figure 3: Common themes identifi ed from qualitative interviews with sites in high-uptake category

SCT screeningMidwives / Autumn 2018

Appreciation of thoughts and

feelings of fathers

Attempting contact by

multiple means

Text message contact

Flexible appointments and testing in

maternity setting

Telephone off er of appointment

Screening at the time of the fi rst trimester scan

Engaging with the wider

multidisciplinary team

Themes: high

uptakes


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When a mother’s antibodies attack a fetus’s blood platelets, it can have life-threatening consequences. Matthew Hopkins looks

at the science behind fetal/neonatalalloimmune thrombocytopenia.

FETAL/NEONATAL ALLOIMMUNE thrombocytopenia (FNAIT) is the most common cause of severe thrombocytopenia – a low blood platelet count

– in the fetus or newborn (Mella and Eddleman, 2015). It is a rare complication in pregnant women: incidence in a Caucasian population is estimated at one in 1000 to 5000 live births (Arnold et al, 2018). Intracranial haemorrhage (ICH) is the most serious complication of FNAIT,

occurring in 10% to 20% of cases, and can lead to severe morbidity or mortality (Peterson et al, 2013).

Platelets include blood group antigens that the mother can make antibodies for. Platelet-specifi c antigens inherited from the father but absent in the mother cause an immune response generating maternal antibodies (immunoglobulin G, or IgG) that bind to and destroy fetal/neonatal platelets. Th e most common cause

of severe thrombocytopenia in an otherwise healthy newborn is maternal alloantibodies to human platelet antigens (HPAs) (Burrows and Kelton, 1993).

HPAs are localised either to platelet glycoproteins GPIIb/IIIa, GPIa/IIa, GPIb/IX/V or to GPI-linked anchor membrane molecule CD109. Platelet glycoproteins are cell surface molecules essential for normal haemostatic processes, platelet adhesion and aggregation. Th ese

Battlein the

bloodstream

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alloantigens are expressed as bi-allelic alleles termed ‘a’ and ‘b’. For example, a person may be HPA-1a1a, -1a1b or -1b1b (see Figure 1).

A diagnosis of FNAIT is confi rmed serologically by detection of maternally derived alloantibodies in the antigen-negative mother. Th e child inherits the cognate alloantigen from the father, and the mother’s immune system identifi es the antigen as foreign before initiating an immune response (see Figure 2). Antibodies directed to HPA-1a and HPA-5b cause approximately 95% of serologically confi rmed cases of FNAIT in a Caucasian population. HPA-1a accounts for approximately 80% of these cases, and 15% are due to HPA-5b alloantibodies (Mueller-Eckhardt et al, 1989).

Clinical presentationNeonatal thrombocytopenia is rare; around 98% of full-term newborns have a normal platelet count, between 150 to 450 x 109/L (Chakravorty and Roberts, 2012). But thrombocytopenia develops in 22% to 35% of infants admitted to neonatal intensive care (Roberts and Murray, 2003).

FNAIT can occur in fi rst pregnancies, and identifying the

can often be discovered only by chance (Bertrand and Kaplan, 2014). After ruling out viral and bacterial infection, disseminated intravascular coagulation and conditions caused by placental insuffi ciency, FNAIT can be diagnosed.

Evidence suggests that ICH can cause cerebral impairment. As many as 75% of ICHs occur in the fetus, as opposed to the newborn (Mella and Eddleman, 2015), thus requiring the use of cranial ultrasound to investigate signs of the complication.

Other risk factors associated with severe thrombocytopenia are length of gestation (pre-term) and low birthweight.

Testing and treatment If FNAIT is suspected, samples should be sent without delay to the histocompatibility and immunogenetics (H&I) laboratory at NHS Blood and Transplant, Filton, which provides specialist tests for the detection and identifi cation of platelet-specifi c antibodies (Green, 2012).

Additionally, the parents and infant (if available) are HPA genotyped to identify any antigenic diff erences between the family members. Fetal HPA genotyping from amniotic fl uid can also confi rm whether the implicated alloantigen has been inherited from the father. Identifying the zygosity of the father can aid in predicting the risk of FNAIT (see Figure 1).

Sample requirements for laboratory investigations are 1 x 6mL clotted blood and 1 x 6mL blood containing EDTA (a preservative) from the mother, 1 x 6mL EDTA from the father and 1 x 1mL EDTA from the infant if available.

Platelet counts in newborns typically return to normal during

condition usually occurs after birth. Severity is variable, so detecting signs and symptoms can be diffi cult. Careful examination of the infant may discover petechial haemorrhages, purpura, ecchymosis and gastrointestinal or genitourinary bleeding. Platelet counts will typically show less than 50 x 109/L in severe FNAIT. However, the infant may be asymptomatic if the platelet count is greater than 50 x 109/L, and thrombocytopenia

Midwives / Autumn 2018FNAIT

Father

Children

HPA-1a1b

HPA-1a1b

HPA-1b1b

HPA-1b1b

HPA-1b1b

HPA-1a1b

Mother

Figure 1: In this example, the children may be either HPA-1a1b or HPA-1b1b, depending on whether the baby inherits HPA-1a or HPA-1b from the father. There is a 50% chance that a child will inherit HPA-1a and be at risk of FNAIT (NHS Blood and Transplant, 2014)

Figure 2: How platelet antibodies are made during pregnancy

AHPA-1a1b fetal platelets (the HPA-1a is inherited from the father and the HPA-1b from the mother)

BThe baby’s platelets enter the mother’s circulation

CMother makes HPA-1a antibodies

DHPA-1a antibodies cross placenta

MotherHPA-1b1b

E HPA-1a antibodies bind to baby’s platelets and cause thrombocytopenia

↘

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Midwives / Autumn 2018FNAIT

the fi rst two weeks of life with or without intervention because of the reduction in circulating maternal antibodies. However, if FNAIT is clinically suspected, with a platelet count below 30 x 109/L and evidence of bleeding, platelet support for the newborn should not be delayed while waiting for laboratory confi rmation.

Th e 2013 Guidelines for the blood transfusion services in the UK advises that neonatal platelet counts should be maintained above 30 x 109/L or 100 x 109/L if major haemorrhage is evident (JPAC, 2013). NHS Blood and Transplant provides specialist stock of ‘on-the-shelf’ neonatal platelet components that are phenotypically HPA-1a(-) -5b(-). Th ese products are held in strategically placed holding centres throughout England and are usually eff ective in 95% of FNAIT cases due to the prevalence of HPA-1a and HPA-5b antibodies (Mueller-Eckhardt et al, 1989).

If HPA-typed platelets are not available, or in emergencies, washed maternal platelets or random donor platelets with the addition of intravenous immunoglobulin G (IVIgG) (0.4 to 1.0g per kg per day) can be used. All platelet products should be from a single apheresis donor (one whose blood is separated into its components and the platelets isolated) and, in addition, must be

cytomegalovirus (CMV) negative, ABO Rh compatible and gamma irradiated in order to prevent graft vs host disease. Typically, a neonatal dose would be 10 to 20mL/kg (JPAC, 2013).

Management of subsequent pregnanciesTh ere are currently no UK guidelines for the most eff ective antenatal treatment of FNAIT; the following are recommendations based on evidence-based practice.

In subsequent pregnancies for women who are alloimmunised, FNAIT can often be more severe. Th ese pregnancies are closely monitored by the consultant obstetrician, neurologists and specialists at the fetal medicine unit in conjunction with haematologists and H&I consultants. Ultrasounds are carried out at 20 weeks’ gestation to identify signs of fetal abnormalities such as ICH or ventriculomegaly. Th e mother will also be screened regularly throughout her pregnancy for development of HPA antibodies.

If maternal HPA-specifi c antibodies have been identifi ed, an antibody card indicating that the mother will require antigen-compatible blood products will be issued by the H&I laboratory to mitigate the risk of the mother developing post-transfusion purpura. Fetal HPA genotyping from amniotic fl uid can be performed if there is paternal heterozygosity or if the father is unknown, but fetal sampling increases the risk of adverse events by up to 10% (Paidas et al, 1995).

Several diff erent treatment options are available, which range from conservative to interventionist. First-line antenatal treatment for mothers who are alloimmunised is IVIgG (1g per kg of body weight at weekly intervals) from 18 weeks’ gestation, usually in isolation or in

conjunction with corticosteroids. A planned CS should be considered, and HPA-1a(-) -5b(-) platelets should be on standby. If neonatal bleeding is severe, they can be transported as a ‘blue-light’ emergency.

Intrauterine transfusion of HPA-1a(-) -5b(-) platelet hyperconcentrates can be given while fetal blood sampling is performed. Th ese products only have a shelf life of 24 hours, and the laboratory requires at least one week’s notice in order to arrange a suitable blood donor to provide this product. But the high risk of fetal morbidity and mortality means this treatment option should only be considered if the fi rst-line treatment therapy fails (Lucas, 2009).

Matthew Hopkins is a clinical scientist working in histocompatibility and immunogenetics at NHS Blood and Transplant, Filton

Intracranial haemorrhage,

occurring in 10% to 20% of FNAIT

cases, can lead to severe morbidity

and mortality

→ A MOTHER’S STORYDaniela Clark of Surrey gave birth to Jessie at full-term by emergency CS. She says: ‘In the delivery suite, my husband and I noticed some purple bruises on Jessie’s cheek and shoulder. The midwife said that these were Mongolian birthmarks, which fade in time. But the marks spread all over Jessie’s body as the hours passed. Eventually, a senior midwife saw something was not right and called for an examination. Jessie was rushed to intensive care. We now know she was covered in petechiae and her platelet count was only 6 x 109/L. She was at risk of intracerebral haemorrhage and needed an immediate transfusion and a brain scan. Thankfully, the scan showed no damage, but Jessie’s platelet count continued to yo-yo until several transfusions and two weeks in hospital stabilised her condition.

‘For my next pregnancy, I started weekly IVIgG infusions, plus daily prednisone steroids from week 20, doubling the dose at week 32. The side eff ects were nasty, and knowing that your immune system is attacking your baby made me feel powerless and guilty. Lucas was born with a low platelet count of 64 x 109/L. But he left hospital after nine days and only needed one blood transfusion.’ (Adapted from Clark, 2018).

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Midwives / Autumn 2015NMC Code

The RCM has enabled more than 90 UK midwives to take part in twinning projects across the globe. Here four

volunteers explain why it’s been so benefi cial.

THE INTERNATIONAL CONFEDERATION OF MIDWIVES(ICM) promotes twinning partnerships between professional midwives’ associations for mutual strengthening (ICM, 2014). Since 2012, the RCM has led or participated in externally funded

midwifery twinning projects in fi ve low-resource countries and has facilitated 113 volunteer placements for 93 UK midwives. Twinning brings benefi ts to partner associations but is also reciprocal with benefi ts to volunteers, to the RCM and to the wider NHS. Participating midwife volunteers have reported personal and professional growth, deeper engagement with the RCM and greater political activism. Th is year sees the RCM undergoing a systematic review and refresh of its volunteer management systems. Here are testimonies from four UK midwives who have volunteered with the RCM’s current Bangladesh Twinning Project.

Isabelle Lemberger-CooperRCM steward, Epsom and St Helier University Hospitals NHS TrustI have worked as a research and clinical midwife for four years. In April I volunteered for one month with the RCM’s

twinning project in Bangladesh, working alongside the Bangladesh Midwifery Society (BMS), particularly with the society’s president and the offi ce manager, supporting their activities and also conducting an outreach visit to a Rohingya refugee camp in Cox’s Bazaar. As I travelled alone, the RCM arranged in-country accommodation, safeguarding and security with VSO. Th e RCM’s global team also visited

Who wantsto be a

volunteer?

Global volunteeringMidwives / Autumn 2018

A training session at Cox’s bazaar with Isabelle and Halima Akhter from BMS and

some of the midwives working in the camp

↘

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Bangladesh to provide support during my placement. Th e placement built my knowledge and skills, while

challenging my perceptions of midwifery. It reinforced for me how important it is to be a midwife, what an impact midwives can have in women’s lives, not just medically but emotionally too.

Th e midwives I met in the refugee camp support women fl eeing unspeakable atrocities, reminding us that humanitarian aid is more than food, water and shelter. Th ese valiant midwives are delivering life-saving healthcare to many thousands of women in extremely challenging circumstances. Among so much tragedy this off ers a safe haven for mothers to come and birth their babies in a supported and empowering way. Th is will have a profound impact on their lives and has the potential to shape them as mothers and change their stories.

All of us want to know our work will make a diff erence. In the end, it will be the BMS team who will have the biggest impact themselves; we can but help. I hope to go back to Bangladesh with the RCM later in the twinning project and would recommend other members to apply if other opportunities are advertised. I’m so grateful to the RCM for their support and giving me this opportunity and most importantly to the fantastic BMS who welcomed me with open arms and shared their wisdom and strength.

Elizabeth Bannon OBEPhD student, Queen’s University BelfastMy midwifery journey began in 1979 and throughout my career I have valued the advice of Dame Mary Uprichard that ‘those who dare to practise must never cease to learn’. I continued to study completing a diploma, a degree, supervision of midwifery course, a master’s and a part-time doctoral study on midwifery leadership and management development. Th is work evolved out of a desire to understand what needs to be done to support midwives to secure management and leadership roles as an integral step to ensuring that women receive safe and eff ective care.

In 2015, having retired as co-director for maternity and women’s service in Belfast, I volunteered to join the RCM’s MOMENTUM project in Uganda. Th en in May 2018 I joined an RCM team travelling to Bangladesh to work with a small team of NQMs to develop their leadership

→

Global volunteeringMidwives / Autumn 2018

Some of the midwives taking part in the leadership workshop



skills and to introduce the concept of coaching.I was struck by the similarities between NQMs in

Bangladesh and the UK who share the same enthusiasm, energy and commitment to women and a desire to make a diff erence. Th e opportunity to travel abroad and experience diverse cultures, to work in partnership with like-minded people while assisting local communities is a privilege. For me, the involvement is not only about having an impact on the midwives and the care women receive but it also re-enforces the importance of the role of midwives and the consequence for women, their safety and families when it is undervalued or misunderstood.

Aine AlamPhD student, Middlesex UniversityA midwife since 1982, I have also specialised in teaching child development, health and social care and work-based learning. My PhD research is a narrative study about how international midwifery teaching teams can move from lecture-led to work-based learning. It was inspired by my international work with the RCM but was undertaken independently in Pakistan.

In 2012, I applied for a placement in Nepal with the RCM’s Global Midwifery Twinning Project, but instead was placed in Uganda. Visiting Africa was not on my life plan but I am so glad I went; working with Ugandan midwives prepared me for subsequent international work and opened my eyes and enabled me to question the quality of care given in the UK and Ireland. I later volunteered again in Uganda with the RCM’s MOMENTUM project and was privileged to work with an inspiring group of UK midwives and twinned Ugandan midwives. Twinning becomes a catalyst for change, both for the project’s aims but also for each of us professionally and personally.

I then volunteered with the RCM’s Bangladesh Twinning Project in 2017 and I was moved by the sheer determination of the BMS. I was invited into the Dhaka Nursing College Midwifery Department to help with teaching student midwives and senior midwife teachers. My approach is to fi nd out what my hosts want of me and how we can work together. It’s important to respect indigenous ways of learning, for example in Bangladesh I quickly realised that it is a tactile, oral and auditory culture. Written documents were rarely read, but

sharing of stories in narrative form over snacks and tea was endless and collectively informative. Poems, songs, dress and dance brought stories of struggle and through those forms much knowledge and practice experience was shared. We role-played, danced and sang many important midwifery practices for safe and dignifi ed maternity care.

Michelle LyneRCM professional advisor, educationSingly qualifi ed midwives are a relatively new concept in Bangladesh with only two cohorts of midwives graduating in the preceding fi ve years. I was invited as one of two consultants to help increase the BMS’s capacity to understand their role as a professional association in developing midwifery and leadership within the profession; and to undertake some introductory leadership workshops with a small group of midwives who had qualifi ed in the previous two years.

Th e aim was to help those midwives understand what leadership is for their personal and professional development. To achieve this, in addition to participating in the workshops, we required them to identify a small area of practice where they could undertake an initiative that would develop themselves and the BMS. Additionally, we wanted to leave them with a legacy of a peer support network and a model of coaching provided by senior midwives within the BMS to help them develop themselves, their practice and professionalism.

Highlights of my time in Bangladesh included working with new and old colleagues – the personal and professional relationship we established helped to make the trip a very positive experience. I travelled with a super organised RCM colleague from the global team and a volunteer who had undertaken other twinning work with the RCM. Although I have been a midwife for 33 years, I was the novice in the mix. Another highlight was meeting and working with the NQMs, who quickly formed strong supportive relationships and their enthusiasm for what we had to share was prodigious.

While we didn’t undertake any clinical visits, BMS is located within a hospital site and conditions were clearly extremely poor. I’ve learnt how fortunate UK women and midwives are to have equality and professionalism and how lucky we are to have the RCM.


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For more on RCM global resources and i-learn modules, go to bit.ly/RCM_global


of the biggest challenges services face is the current lack of interoperability – the ability of the various systems to ‘talk to each other’ and share information.

To overcome this barrier, NHS Digital is working with the RCM and others to create a standard that will dictate how information has to be recorded.

Julia explains: ‘If I’m looking after a woman in the Midlands who’s travelled up from London, even though she’s booked in London, I can access the platform and pull up her information in my system. When providers are all talking the same language, a woman’s data can travel safely across the country.’

Th e new standard is being fi nalised, and the interoperability platform should be up and running in two years. ‘It will make a huge diff erence,’ says Julia.

Exploiting the dataAnother primary area of focus is around the Maternity Services Data Set (MSDS).

‘Our aim with MSDS version two is to ensure the data is used to benchmark and improve,’ says Julia. ‘NHS Digital is planning to support this launch with a maternity data viewer, which will make it easy to review and compare information.

‘Harnessingdigital technology’ is one of nine workstreams within the Maternity Transformation Programme (MTP), but it underpins much of the vision set out within the Better births maternity review.

Th e aim is to make it easier for health professionals to collect and share data with each other and their clients. Th ere are four main areas of focus: harnessing data gathered by maternity services to improve safety, enabling the systems in use across the country to ‘talk’ to one another, improving online information, and developing personal health records for women.

Each objective has its own array of challenges – but getting them right means better opportunities for learning, improved productivity, greater choice and personalisation for women, and ultimately safer care for women and babies.

InteroperabilityJulia Gudgeon, clinical adviser to the digital maternity programme at NHS Digital, says one


Delivering on digital

With many local maternity services in England still reliant on paper notes, the MTP’s digital workstream has much ground to make up. Midwives looks at the progress made and the latest on transformation in Scotland.

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‘If we really embrace digital technology, you would see a massive impact on clinical safety. Data might seem very dull, but it can save women’s lives.’

Calderdale and Huddersfi eld NHS Foundation Trust has already harnessed the power of its data, following the introduction of the maternity electronic patient record (EPR) three years ago, providing end-to-end notes for all care delivered from the point of booking until discharge.

Dr Anne-Marie Henshaw, associate director of nursing and HoM at the trust, says the new system has had ‘a direct impact on improving quality and safety across the service’.

‘Th e maternity dashboard allows us to compare our data with other local services as well as regionally and nationally, which has directly aff ected care delivered to our women and changes to practice for the better,’ she says.

Th e EPR has transformed how the team is able to access and use data, allowing them to identify patterns and trends with a few clicks rather than trawling through paper records.

‘Th e system allows us to investigate the data really thoroughly and put changes in place,’ says Anne-

Marie. ‘For example, data retrieved from the system allowed the trust to successfully submit a business case for an additional middle-grade obstetrician out of hours.’

ePHR and online informationOne of the biggest changes on the horizon is the electronic personal health record (ePHR) for maternity. More than just digital maternity notes, ePHR should create a digital space that enables women to take greater control of their health and care.

As well as including health records, appointments, prescriptions and test results, it could allow women to communicate with the professionals involved in their care, share information about their health, complete questionnaires and receive information relevant to their pregnancy.

‘Women were very clear in Better births that their records are theirs, and they want to own them,’ says Julia. ‘We are taking tiny steps towards this.’

BadgerNet, a new paperless maternity record system introduced at Epsom and St Helier University

MTPMidwives / Autumn 2018

↘

TRANSFORMATION IN SCOTLAND Mary Ross-Davie, RCM Scotland director, says real progress is being made towards the ambitions of the Best start maternity review.

Two new alongside midwifery units (AMUs), which were available at just six out of 18 consultant-led units in Scotland, will help address the need for greater choice in place of birth. Forth Valley’s AMU, which was due to open in August at the time of going to press, and Lanarkshire AMU, which opened in April, saw 100 births in its fi rst two months.

Lanarkshire also has a new caseloading team of six midwives. ‘They will record their experiences and feed back to colleagues on work/life balance and what that way of working feels like in reality,’ says Mary.

In addition, there is innovation to improve continuity for women in rural Argyll. Midwives there have been given honorary contracts across the border by NHS Greater Glasgow and Clyde to allow them, for the fi rst time, to travel with their women needing obstetric-led care to the Royal Alexandra Hospital in Paisley.

And to better provide for women in Sutherland, who currently face a two-hour drive to their nearest consultant-led unit in Inverness, a small community hospital in Golspie is set to become a community hub, where they can access a CTG and communicate with their consultant by Telehealth link.

‘It’s great to see us moving from talking about change to real improvements actually happening,’ says Mary. ‘I am so impressed with the enthusiasm and innovation that is being shown by so many midwives, their managers and other members of the maternity team.’

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BENEFITS OF ePHRsFor women● Visibility, control and understanding of health information● Increased ownership and improved outcomes for safety● Fewer barriers with healthcare professionals● Critical reminders around screening and immunisations.

For midwives● Reduced administrative burden● Enhanced relationship with women● Convenient, eff ective interaction● Safer, better care and increased value.

Hospitals NHS Trust, has already made headway providing this ‘digital space’.

Katie Hamilton, IT midwife leading on its implementation, says the system is linked with others in the hospital, meaning ‘everything is in one place so a midwife can securely review a woman’s records’.

Crucially, it also allows women to see their information through a smartphone app, including their maternity notes, upcoming appointments and useful resources.

‘Th e midwife can add the information and any advice she wants to give to a woman’s clinical notes. Th e woman would then get a text to say her app had been updated and could go in and see it,’ Katie explains.

‘It’s a massive culture change,’ she adds. ‘But it has been really positively received by midwives. Now there is an app for everything, so it’s not that revolutionary for the women. Th ey have been told they are pioneers on the system, and they have been really receptive and positive.’

Another ongoing task is improving online information. Julia says: ‘In Better births, women felt there was so much information out there that they didn’t know what was and what wasn’t safe.

‘NHS Choices is currently working with users to review how information is presented, and ensuring content refl ects the maternity care women can expect from their midwife.’

Digital maturity assessmentsWhile some services are already reaping the benefi ts of improved digital technology, others have a longer journey ahead. With such an array of provision and practices, NHS Digital is undertaking a comprehensive digital maturity assessment (DMA) of maternity services in England.

Every trust off ering maternity services has returned its digital maturity survey. Th is is the beginning of a benchmarking exercise across a range of measures, including digital strategy and leadership, staff training and sharing of digital records.

It will not only refl ect a clear picture of how far maternity services have to go, but also provide a route map to help them get there, says Julia.

‘We have a team of analysts ready to start crunching the data to create a picture of what digital looks like

in maternity services, which we will report to the Maternity Transformation Board.

‘Th en we are going to create bespoke reports for each local maternity system, to show where they are doing well and those areas where they need to improve. Th e report will give them a toolkit to improve the areas they’re struggling with.’

RCM practice and standards professional advisor Rachel Scanlan says that the RCM is looking at how it can support members through the transitions.

‘Th ere is a lot of change happening very quickly, particularly in the digital area, and we don’t want anyone to feel overwhelmed or left behind.’

She points out that of the 134 DMA surveys returned, 76% were completed by midwives.

Rachel concludes: ‘It can feel like a lot of work and another thing on the list, but I think this is an opportunity for midwives to shine, to take the bull by the horns and lead the way.’

→

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Midwives / Autumn 2018Recruitment

If you would like to advertise on this page, contact Kristiina Kruusma on 020 7880 7621 or email [email protected]


jobs.midwives.co.uk

The perfect place to find the latest

midwifery vacanciesMidwives Jobs is the

official jobs board for the Royal College of Midwives

ives.co.uk@midwivesjobs

States of Guernsey

Integrated Team Midwife Salary: £31,531 - £42,715 per annum

The States of Guernsey is recruiting midwives to work

within its integrated midwifery team.

Do you want to deliver midwifery care within a stunning

island that has excellent midwife to mother ratios, enabling

you to have time to care? If so this is the opportunity you

have been looking for and we would love to talk you.

This new team has been developed to improve continuity of

care and carer and improve choices for women. As a member

of this team, you will deliver midwifery care throughout the

course of the pregnancy, intra-partum and postnatal period,

both in the maternity unit and community setting. This

integration will maintain your all-round midwifery skills and

provide the satisfaction of working closely with women who

you have had time to build relationships with.

You will work in the hospital and community settings and be

part of the on-call rota. Current on-call commitment is 2 to 3

times per month, plus extras for home births. Our birth rate

is 600 per year, and our home birth rate is around 3%.

We off er a competitive salary, an annual bonus plus a full

relocation package.

To speak to a member of our senior midwifery team,

please contact Elaine Torrance or Annabel Nicholas

on 01481 725241 ext. 4842 or [email protected]

or [email protected].

To apply online or fi nd out more,

please visit www.gov.gg/midwiferyjobs

Registered MidwifePalmerston North is a family friendly city where you can enjoy the New Zealand countryside lifestyle without missing out on the advantages of a big city. Housing is more aff ordable in comparison to the larger metropolitan cities. With a diverse artistic community, Palmerston North is home to a multitude of cultural events, cafes, restaurants and sports activities. Its central place in the lower half of the North Island makes it easy to access the beautiful ski fi elds 2 hours drive north, Wellington 2 hours south, vineyards 2 hours east, wonderful hiking and biking areas 10 min east and the west coast beaches only a 30 minutes’ drive west.

MidCentral Health services a population of around 180,000 people across our district with key sites at Palmerston North Hospital and Horowhenua Health Centre. Palmerston North Hospital is a 350 bed facility. The Womens health unit has an eight bed delivery suite and a 20 bed ante/postnatal ward. There are approximately 2000 births per year in our region.

You will have the opportunity to work in a variety of settings including delivery suite, maternity ward (ante and postnatal), antenatal outpatients day unit and community midwifery team.

We are a progressive unit and have developed specialist roles such as Diabetes Midwife and Long Acting Reversible Contraceptive (LARC) training for midwives. Recent practice change initiatives include introducing a new Induction of Labour Regime which is contributing to a reduction in the caesarean section rate in our hospital and the TOGETHER project which has succeeded in dramatically reducing our term baby admissions to the neonatal unit. Our midwives work in partnership with women and their families/whanau, collaborating with the multi-disciplinary team to deliver eff ective care. Hours of work will be 24-40 hours working rostered, rotating shifts.

Informal enquiries would be welcomed by: [email protected] or [email protected]

For a position description and/or to apply online please check out our website:www.midcentraldhb.govt.nz

MID.Iss3.2018.081.indd 81 21/08/2018 15:40


Midwives / Summer 2015Crossword

Midwives / Autumn 2018Competitions

COMPETITIONSHere’s a chance to get your hands on some great giveaways with our free prize draws...

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WIN ONEOF THREE COPIES OF THE POSITIVE BREASTFEEDING BOOKTh is book by leading infant-feeding researcher Amy Brown is a refreshing evidence-based step-by-step guide for parents, set to demystify breastfeeding.

Amy believes that getting informed about how breastfeeding works and where to get support is a great way to have the best possible breastfeeding experience. ‘Too many negative stories and misconceptions bounce around making women doubt their bodies and ability to feed their baby, leading to many women stopping before they’re ready and feeling miserable as a result,’ Amy says.

Th e book challenges that dialogue and instead provides a guide for navigating breastfeeding with confi dence, empowering women to meet their breastfeeding goals.

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WIN ONE OF THREE COPIESOF NEW WALKNew walk is the debut novel by former practising midwife and Th e midwife diaries blogger Ellie Durant. Drawing on Ellie’s personal experience as a trainee midwife, New walk is a moving coming-of-age story, where midwifery, birth, love and a dysfunctional family combine to shape a young woman’s life.

Th e lead character Chloe is a student midwife in inner-city Leicester. She fi nds fulfi lment caring for women and families from wide-ranging backgrounds – but will her own personal challenges derail her ambitions?

Having recently lost her mother, and supporting her father through addiction, Chloe must make some diffi cult choices.

► To be in with a chance of winning, email your name, address, telephone and membership number, stating which giveaway you are entering, to [email protected]

► The closing date is 3 November. Only one entry per household will be accepted. Winners are drawn at random. The editor’s decision is fi nal.

HOW TO ENTER

Worth £9.99each

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If you’d like to get support to lose weight, join one of 18,000 Slimming World groups for free with this exclusive off er. At group you’ll share recipes, tips and ideas with like-minded slimmers, as well as learnhow to manage time pressures and overcome emotional and psychological challenges.Group off er: join your nearest Slimming World group before 14 October 2018 and enrol for free, saving £10, so you pay a weekly fee of £4.95.

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082_midwives comps.indd 82 20/08/2018 18:05

MID.Iss3.2018.083.indd 2 06/08/2018 16:55

Academically approved CPD and resources

FOR HEALTHCARE PROFESSIONALS ONLY

3-Step CPDOnce you’ve found the relevant

module for your personal

development, simply:

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THE LIFECYCLE FAMILY

• Antenatal anti-D

• Bacterial vaginosis

• Child car seats

• Colic

• C-section wound healing

• Group B Strep

• Helping infants sleep

• Nappy rash

• Prenatal testing for trisomy

• Tongue tie & breastfeeding

We’re delighted to announce the launch of our free, online learning channel for maternity and midwifery professionals, formally known as the Mum & Baby Academy. Current modules include:

For more information visit us at www.healthprofessionalacademy.co.uk

MID.Iss3.2018.084.indd 2 13/08/2018 14:59

Documents

MIDWIVES - rcm.org.uk · Opinion Practice rcm.org.uk/midwives 3 CONTENTSMIDWIVES VOLUME 21 | Autumn 2018 7 Editorial The RCM’s Julie Richards on shaping strategy by listening to