Update on NMC/IMUK situation

Over the last few days we have been fielding enquiries from people either directly affected or concerned by the NMC’s decision about IMUK’s indemnity insurance, asking what they can do.

While we await the response to our letter to the NMC, the maternity community are really pulling together to support midwives and women affected.

The RCM yesterday put out a statement suggesting that honorary NHS contracts could be a solution for some independent midwives. Simon Mehigan, Birthrights Trustee and Deputy Director of Midwifery at Chelsea and Westminster NHS Foundation Trust, is meeting with a number of Independent Midwives to discuss how honorary contracts may be used to support local women.

“We will do anything we can to mitigate the impact on women who have chosen to hire Independent Midwives and now find themselves in a very uncertain and stressful position. I am in the process of offering honorary contracts to the Independent Midwives we work with and I will be sharing the details of these contracts with other London Heads of Midwifery. If anyone else would like further details I urge you to get in touch.”

If you have hired an Independent Midwife, you should speak to your midwife/IMUK about the options open to you. They will be able to update you on their own discussions with local Trusts. You could also consider speaking to a Supervisor of Midwives at your local NHS Trust about what NHS care can be offered.

Anyone concerned about the NMC’s decision can:

– Write to Jackie Smith, CEO and Chief Registrar at NMC using Birthrights letter as a template

– Write to your MP and to Jeremy Hunt, Secretary of State for Health

– Sign this petition

A view from India: Human Rights in Childbirth

Today is Human Rights Day 2016. Every year on the 10 December we commemorate the day on which, in 1948, the United Nations General Assembly adopted the Universal Declaration of Human Rights. So on this day, when we think about how we can stand up for human rights both here in the UK, and all over the world, we are sharing a guest blog post from Lina Duncan, a midwife (@MumbaiMidwife), who has written about her experience of childbirth in India…

Trigger warning – this piece discusses a stillbirth

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I have lived and worked in urban India for nine years and during that time I have found that midwives are missing from the system. I have witnessed how hospital policies, mixed with religious or family tradition, harm women and their babies.

I have heard and read hundreds of stories about women in India who have been pressured into potentially unnecessary interventions with inaccurate, fear-mongering information. This breaks women. It damages them before they even begin to birth and care for their babies. Most women do not speak of these things because they are told that a healthy mother and baby is all that matters.

I have seen and heard of many tragic situations of pregnancy loss or stillbirth where the mother was not told the truth. In each case, the mother was told her baby was in the NICU. She was lied to and denied the right to meet her baby, to make memories, to grieve, to hold her baby. Mothers are too often then silenced in their grief.

I do not believe that a healthy mother and a healthy baby are all that matters. I believe that the truth also matters. Facts, and language, are vital, so that women have all the information they need to make informed decisions. This is especially the case when a care provider has to give difficult, or potentially devastating news.

Truth + Kindness + Compassion = (usually) Satisfaction and Comfort

Half-truths + Lies + Fear = Broken Trust, Fear and Trauma

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I have a friend. She looks a little wild, maybe that’s why I liked her from the start. She often has a vacant look in her eyes. Frequently, she adjusts her clothes and shows me bruises from her alcoholic husband.

She doesn’t know her birthday, nor her age. She looked about 22 when I first knew her, pregnant with her first son who was born in a temporary shelter where she was living on a disused railway platform.

Fast forward a couple of years. I have not seen her for months. Her chaotic life is mostly about daily survival. She feeds her drunk husband first, of course. Then, her son, and then, her pregnant self. She has not had any antenatal check-ups. I persuade her to go with me to the government hospital, with son in tow because she is afraid to leave him with his father.

I show her what to do and entertain her lovely unruly son who is filthy. Everyone stares at me, and her, and it’s awkward and tedious. It takes about seven hours to get completely registered. She is prescribed vitamins, calcium, protein powder. I get her a few of the important ones and open them so they can’t be sold for liquor.

I don’t see her again for months and I worry.

One day she rocks up and calls my name. She is 39 weeks pregnant. She has had no antenatal care for 30 weeks. She does not want to go back to hospital but her husband thinks it’s a good idea. I go with her. The son stays at ‘home’.

The hospital wants to see a sonogram. The machine is broken. We have to pay 400 rupees (£4) for a private one. She has 10 rupees only. I pay. It takes forever.

I’m ‘not allowed’ in with her. Then the curtains are drawn back and I’m invited in. I know it’s not good news. ‘No heartbeat and only part of the brain,’ says the sonographer, to me. My heart sinks. I ask him to tell my friend as my Hindi is not good enough. He tells her and she smiles and says, ‘let’s go get lunch’. She has not understood.

We get food and find her husband, who is drunk, and her 3-year-old son, who has bloody knees and chin from playing alone in a building site. She is angry. I call my consultant doctor friend who works in a government teaching hospital. He invites us to go there immediately.

Another sonogram. Heavily pregnant woman with confirmed anencephalic baby. Drunk husband. Three-year-old doing somersaults all around the hospital wearing his father’s t-shirt and nothing else. We are a laughing stock and I am requested to stay and admit my friend for induction and then remove the husband and son.

She is disturbed that her son is alone with dad and they are not ‘allowing’ her out of hospital. The hospital requests that she fasts and start induction at 5am the following morning. I ask several times, politely, if I may accompany her but it is not allowed. Baby is breech and still alive. I have had lots of conversations with her about what to expect. It hasn’t sunk in. She either doesn’t understand or doesn’t want to.

That night, I tell her I will come and I will be outside the ward until she gives birth and they let me see her. I tell my friend that when she feels alone, she can know I am just on the other side of the wall. This breaks my heart. I am a midwife.

She has to go into the labour ward alone.

A colleague and I sit on the floor outside the labour room for 19 hours. Being a doula through a wall is very hard, especially knowing what she is about to face. No one should have to labour and birth without a companion.

Around 1am we are called into a little room to look at her little girl who has been born dead. I ask to take a picture for my friend. They assure me that she will be shown her baby but don’t let me in to be with her. I take pictures on my phone. They are lovely doctors but I am so angry.

At 4am they let me in to see her and ask me to buy her tea and food. It had been about 30 hours since she has eaten.

It is easy to find her, sitting up in bed with a big grin, announcing she is starving and asking where her food is. I ask her if she has seen her baby and she says, ‘not yet’. I ask her if she wants to see my photos and she says yes. I tell her that her baby was not born alive, that she was a girl, that her heart had stopped beating before she was born. I tell her the truth. She doesn’t ‘hear’ it. She smiles, asks me to come back in the morning and goes into a deep sleep.

In the early hours of the morning my phone rings. Sobs, deep sobs and demands. ‘Come now’, she says. ‘They have killed my baby,’ she says. My friend is distraught in a room full of mothers with their babies.

The day she is discharged I go to bring her home. She’s a darling and so feisty. She laughs and jokes until we walk arm in arm out of the ward. Then her body begins to shake. She says, ‘I came here to have a baby and I’m leaving with empty arms’. I have tears running down my face as well and passers-by gave us kind looks.

My colleagues and I make many visits over the following days and weeks. The family like to see the picture on my phone.

My friend has since had another baby. Her husband sold her when she was only 2 weeks old. This is one woman, one story and she represents many that live in a silent story of abuse and disrespect.

Many of us are longing for the Human Rights in Childbirth conference to be held in Mumbai, February 2017. We hope to hear many women’s stories, hear from researchers, and talk about how a midwifery model of care can be introduced in India. Do follow the conference, and join in the conversation. #breakthesilence

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A day in the life of a human rights centred midwife

Today started as many of my days do with me going straight into a meeting, no time to grab a drink or check my emails. The meeting was discussing how we improve services for women accessing early pregnancy and gynaecology. By redesigning our estate we can improve the journey for these women. How does that relate to their human rights? Well, ensuring women are cared for in an area that’s private and appropriately staffed with skilled nurses and medical staff means women that are suffering a miscarriage or early complications in pregnancy are appropriately cared for and supported. Midwives working in a hospital setting often don’t have any dealings with women below 20 weeks so its important that I make sure that the way in which these women are cared for compliments the midwifery care they receive and promotes the ethos of women centred care. If the care we give is based on the needs and wishes of individual women then we are will be meeting their human rights.

Walking round the maternity unit I meet one of our new consultant midwives who talks to me about a women she has been caring for. This woman is very keen to have a vaginal birth but is being discouraged by some of the medical staff who have concerns about her risks. Midwives and obstetricians have an obligation to talk to woman about any risk factors they may have. Unfortunately every doctor this woman has met has felt the need to reiterate this woman’s risks factors. As she clearly states “ I know the risks, I’ve been told them, I’ve researched them, I just want the best chance to have a good birth experience”. The skill to being a woman centred midwife or doctor is to speak to women on an equal footing. To remove the power dynamic that is so often present in the relationship between health professionals and those they care for is one of the fundamental steps in building a trusting relationship. Trust is, I feel, one of the building blocks of a human rights based relationship with those we care for.

I meet a young woman who has recently given birth to her 1st child but is still here 6 days later. The baby has been under the care of the neonatologists. This intelligent woman has become a mother and has experienced first hand how the “just in case” approach and “doctor knows best” has led her to stay in hospital all this time. She’s a health professional and the work part of her has made her question the doctors, she doesn’t feel the treatment and the investigations her baby has had were necessary, but now she’s a mum and the very rational, logical, evidence based approach she uses every day at work has becoming clouded by the emotions that come with being a mother combined with all the changes taking place in her body following birth. We talk through how she feels, she comments on how the care she received was great until the baby was born and then it all “got out of control”. She has been told she can go home today so we agree that she will write to me, detailing her experiences as a mum and as a health professional. I can then use that to help me challenge some of the policies, procedures and behaviours that exist in the organisation that don’t support a culture of respecting the human rights of mothers and baby’s.

My afternoon is spent trying to support the managers in staffing the unit safely, rewriting a job advert for midwives focussing on attracting candidates that believe in women centred care and the role the midwife plays in facilitating choice and helping women and their families to have a positive birth experience. I then respond to a complaint from a woman who feels she wasn’t listened to when she was in pain, didn’t have her wishes respected or her beliefs.

All of the above makes my day sound pretty depressing but actually its full of positive stuff. I see midwives and doctors supporting women, being kind, communicating well and appropriately. I see staff members supporting each other with guidance and tips on how to manage particular situations and I see many, many happy faces of women, their partners and their families who have recently met the latest arrival to their family.

I haven’t laid a hand on a pregnant woman’s abdomen, or caught a baby as its mother pushes it out or helped a new dad figure out how to put a nappy on his new child. That doesn’t make me any less of midwife nor does it mean I’ve not been able to act in a way that promotes the human rights of childbearing women.

What makes a “human rights centred midwife’?

Kindness, compassion, consideration, respect, honesty and a fundamental belief in a woman’s right to choice.

You know what’s interesting? You could take out “human rights centred” because these are all the qualities that make a great midwife and having spent 22 years working in maternity services the overwhelming majority of midwives I have met have all those qualities. Unfortunately sometimes the services they work in, the culture of the organisation in which they are employed doesn’t support them in demonstrating all these qualities. Fear of litigation, of not following guidelines or off being labelled a “maverick” midwife by supporting choices women make that might not be the norm make some midwives act towards women in a way that they don’t fell comfortable with. This makes some midwives move on, some leave the profession all together and some give in, become part of the culture.

My words of wisdom…..

Be brave, be strong…….be a midwife…..

Simon Mehigan is Deputy Director of Midwifery at Chelsea and Westminster Hospitals NHS Foundation Trust, and a Trustee of Birthrights. This blog post was first published as part of the Growing Families Conference blog series.

Birthrights intervenes in Supreme Court case

On the 2nd November, Helen Mountfield QC will be intervening, on behalf of Birthrights and a coalition of charities, in an important appeal, R (A and B) v Secretary of State for Health to be heard at the Supreme Court challenging the Secretary of State’s decision to bar women who travel from Northern Ireland to England from NHS-funded abortion care.

The case, was originally brought in 2014 by a young woman, A, and her mother, B. At the time of her abortion, A was a 15 year old girl resident in Northern Ireland, who travelled to Manchester in 2012 with her mother to end her pregnancy, at a cost of £900. While their case was originally unsuccessful at the High Court and the Court of Appeal, A and B have been granted permission to appeal to the Supreme Court.

Birthrights is part of a coalition which also comprises Alliance for Choice, the British Pregnancy Advisory Service (bpas), FPA, and the Abortion Support Network. They are represented at the Supreme Court by two barristers; Helen Mountfield QC, from Matrix chambers, and Jude Bunting, at Doughty Street Chambers; and the leading firm of solicitors, Leigh Day & Co.

Speaking in advance of the appeal, Rebecca Schiller, CEO of Birthrights, said:

“It is shocking that the human rights rights of Northern Irish women are still being contravened to such a degree in 2016. It is unacceptable that women must choose between keeping an unwanted pregnancy, risk prosecution by purchasing illegal abortion pills or spend significant sums to travel to England. We hope that the outcome of this appeal will be the beginning of Northern Irish women’s human rights being upheld; both at home and in England.”

You can read our written intervention here.

Birthrights can provide press spokespeople – please see our Press page for more details.

 

Starting a #newchapter

It’s a busy week for human rights in childbirth activists….

Firstly, its #newchapter book club week when nearly 80 book clubs will be meeting to discuss Why Human Rights in Childbirth Matter! We are absolutely delighted that so many people are showing their support for Birthrights in this way. #Newchapter book clubs are not only raising the profile of human rights in childbirth they are also raising funds to help us continue our work. So we want to say a big thank you to all our book clubbers, both here in the UK and across the globe!

Don’t forget to share your photos and posts using the hashtag #newchapter!

At the same time, our Chair, Elizabeth Prochaska, and our CEO Rebecca Schiller, are on their way to Strasbourg for the Human Rights in Childbirth Summit.  The chosen topics for the summit are informed consent and midwifery/out of hospital birth. Elizabeth and Rebecca will be reporting on the situation in the UK and hearing about the experience of other countries. More on the Summit to follow…

To coincide with our #newchapter campaign, the Human Rights in Childbirth Summit, and a generally busy autumn for human rights in childbirth, look out for our new series of guest blogs, starting with a look at childbirth in India…

birthrights-ukThanks to James Crawford for supplying our #newchapter book club graphics.

“Safety” must include a maternity system that supports respectful care

In a statement responding to the Health Secretary’s announcement today of a package of measures aimed at improving safety in maternity care, Birthrights CEO Rebecca Schiller said:

Birthrights welcomes innovation and investment in maternity care. We are particularly pleased to see the Health Secretary’s commitment to the Better Birth report’s recommendation that a ‘rapid redress and resolution’ compensation system is introduced. We frequently see the negative impact of a culture of fear on healthcare practitioners, and the women they care for, and believe that this new model has the potential to improve transparency and practice in maternity care as well as the lives of people whose babies are damaged during birth.
 
Investment in maternity care is desperately needed but we are concerned that a narrow focus on ‘safety’, at the expense of a maternity system that enables midwives and doctors to provide respectful, personalised care, will not deliver the high-quality, safe service we need for all women in England. We urge those taking this initiative forwards to ensure that the vision of the National Maternity Review, which recognises that safe care is only possible in a system that wraps around the individual women, remains a key driver for positive change.

Human dignity after the EU referendum

In the volatile political, economic and social climate of post-referendum UK many of us are anxious and uncertain about the future. As a charity Birthrights did not take a position on the referendum and it would be wrong for us to do so now.

What is clear to me today is that we are presented with a range of opportunities at a challenging time. For some these are opportunities for division, discrimination, violence, extremism and hate. As an organisation founded on respect for basic human dignity, we deplore those who have exploited these opportunities and the acts of xenophobia, racism and violence we have seen over recent days. The murder of women’s rights champion Jo Cox MP is a tragic testament to the consequences of allowing these divisions to widen.

But this isn’t all that lies within reach. Whatever our beliefs (and however the consequences of last week’s vote unfold) there is now a chance to reinforce and promote another set of values: respect, dignity, equality, justice and fairness. The values of the human rights movement.

The need for an understanding of our human rights framework has never been greater. As we cast about for an anchor in this storm we can hold on to the legal protection of our rights as individuals and the specific provisions for vulnerable groups. These protections exists in UK law (particularly in the Human Rights Act 1998) at a European level (through the European Convention on Human Rights which is not directly threatened by our leaving the EU, contingent as it is on our membership of the Council of Europe) and at an international level.

The values that underpin the human rights movement and the legal scaffolding that gives them teeth are vital now more than ever. Yesterday the United Nations expressed “serious concern” about the impact of UK’s pre-existing austerity policies on the most marginalised and disadvantaged. As we face the prospect of further economic disruption and begin to imagine how this could affect vulnerable groups, it is important to know we are not in a vacuum. Our government has key human rights obligations and it must fulfil them.

With this in mind Birthrights will continue to defend the human rights of all childbearing women, with a particular focus on those vulnerable groups who need us most. Whatever the impact of the referendum on the NHS, on midwives, doctors or on the vulnerable migrant women whose risk of maternal death or stillbirth is so high, we will continue to advise women and families, champion their rights, inspire and train their caregivers and use the power of the law to protect them.

Pregnancy and childbirth are an intensely vulnerable time for an individual. The way they are treated during birth affects them at a time in their lives when their identities as mothers are being forged and when they are developing their relationship with the next generation. The long-term physical health of women and babies is at stake in the care they are given and women’s fundamental rights to human dignity and autonomy can be profoundly affected by their experience of maternity care.

Human dignity matters in the post-referendum UK. It should be the principle we live by and the basis of the world we aspire to live in. The safety, equality, respect and dignity of each woman during pregnancy and birth will always be a strong foundation for that aspiration.

Rebecca Schiller, CEO, Birthrights

Birthrights needs your support today.

Birthrights Submission to Health Committee’s Maternity Inquiry

Yesterday the parliamentary Health Committee met as part of a short inquiry into maternity services following the publication of the National Maternity Review report ‘Better Births’. Birthrights submitted written evidence to the Committee, which is now publicly available on the Health Committee’s website.

In summary, Birthrights agrees with the National Maternity Review report’s vision that safe maternity care is personalised care and welcomes its recommendations. In our August 2015 letter to the Review team we set out that safe maternity care is contingent on respectful care and that a rights-based approach offers the best means of improving maternity services in the UK. We echo the insistence throughout the report that healthcare professionals should offer genuine choice and unbiased information and that service infrastructure should be wrapped around women and their needs.

We believe that the human rights legal framework and the values it promotes are vital tools in seeing this vision come to life. Many of the report’s recommendations are supported by rights women should already enjoy. These rights arise from human rights law and existing policy and could provide a strong platform from which to drive implementation forwards.

Respect for human rights is fundamental to all healthcare. It is particularly critical in maternity care, given the transformative nature of childbirth and the moral and legal imperative to respect theautonomy and dignity of women. Moreover, quality maternity care improves experiences for the woman and her family, and affects a baby’s start in life and subsequent life chances. Every mother and baby should have equal access to quality care.

Birthrights believes that the Better Births recommendations could enable professional carers to provide respectful, woman-centred, personalised care which, we argue, will contribute towards optimal physical and psychological outcomes and secure family relationships. We urge the Health Select Committee to draw on the positive power of the human rights principles and framework in making these recommendations a reality.

Read our submission in full here.

Policing Pregnancy

Thanks to all of you who joined us for a packed day at the Royal College of Physicians on 13th April. The event was attended by over 100 midwives, advocates, academics, policy makers, journalists, and others concerned about the expansion of risk thinking and its effects for the autonomy and choice-making ability of women.

The Policing Pregnancy conference was collaboration between British Pregnancy Advisory Service (BPAS), Birthrights and the Centre for Parenting Culture Studies and was a chance to look at the impact of risk culture across the spectrum of pregnancy and birth decisions.

Impact on Women

Speaking in advance of the conference Birthrights chief executive Rebecca Schiller said:

 “We need to stop viewing pregnant women as hostile environments. The experience of childbirth can impact on women for a lifetime: setting them up positively for motherhood or leaving a traumatic legacy. Women’s fundamental human rights are at stake at this vulnerable time. All too often they are coerced in to making decisions they later regret. Given access to unbiased information, evidence and support, women can interpret and choose risks for themselves and their babies. For some the lowest risk on paper may not be the best option. There is no choice to be made between a woman and foetus. A woman and the baby she grows are best served by allowing her to make her own decisions with appropriate supportive care and evidence based information.”

You can hear Farah Diaz-Tello (of National Advocates for Pregnant Women’s), keynote lecture here along with slides from all the day’s presentations.

A human rights approach

Read articles based on the themes of the conference in The Conversation, the Daily Mail, and spiked. Additional press coverage is available here.

The Right to Choice in Maternity Services: Our Submission to The National Maternity Review

Birthrights was asked to provide information and guidance to the National Maternity Review on the legal framework that supports women’s right to choice in maternity care.

You can read our submission below which details that women do have the right to make choices in maternity care based on a number of different sources, but that the legal framework could be strengthened and clarified.

We hope that the National Maternity Review team will use this information to further clarify, strengthen and integrate women’s right to choice in childbirth as they publish their recommendations.

Maternity Review Right to Choice: Birthrights Submission .