Six months on and still no response from OUH on maternal request caesarean policy…

Our Chair, Elizabeth Prochaska, has today written to Dame Fiona Caldicott, Chair of Oxford University Hospitals NHS Foundation Trust to urge her to hold her board to account over the lack of response to a letter sent in July, asking OUH to clarify important details surrounding its maternal request caesarean policy. It is somewhat surprising that an NHS Trust that is accountable to the public, should feel able to ignore a serious request for information, made on behalf of local women, and we look forward to receiving a substantive response by the 3rd January.

The full letter to Dame Caldicott can be found here.

Happy Human Rights Day 2018

As the UK’s only organisation protecting human rights in pregnancy & childbirth, Birthrights are very proud to be supporting #HumanRightsDay2018 & to join forces with 155 organisations asking the PM to safeguard our freedoms here in the UK #weareallhuman #humanrightsday2018 #humanrights

Full text of the letter, co-ordinated by the British Institute of Human Rights (BIHR):

Dear Prime Minister

Today, on Human Rights Day, we ask you to join us in celebrating universal human rights in the UK and commit to standing firm on our hard-won freedoms and protections.

Created 70 years ago, the Universal Declaration of Human Rights (UDHR) is a milestone in human history. Following the horrors of World War II, the world community came together to say never again and set down the protections every person has simply because we are all human.

Heralded as Magna Carta for all human kind, the UDHR has set a common standard of achievement for all peoples and all nations, inspiring law and action across the world.

Through the European Convention on Human Rights and our own Human Rights Act we have brought those rights home, making them real and meaningful for people everyday across the UK.

2019 marks another milestone in our history. As the UK prepares to exit the European Union, and uncertainty surrounds us, we ask you to ensure that our commitment to universal human rights at home remains strong and certain.  


advice@birthrights.org.uk

Birthrights now has a dedicated email address for advice enquiries:

advice@ birthrights.org.uk

If you have any queries about human rights relating to maternity care – please get in touch with us. Our free email advice line is not only for women and their families but also for healthcare professionals.

If you have any other enquiries about training, speaking engagements or anything else then do continue to contact us on info@birthrights.org.uk

Would you like to be a Birthrights Associate trainer?

Do you have human rights expertise?

Are you a healthcare professional who puts human rights centred care into practice?

Birthrights is looking for experienced trainers to join its Associate Trainer team as either a Legal trainer or a Healthcare Professional trainer. We will give you the training you need, ongoing support and pay you for the training sessions you do. You will need to be available at least twice a year to deliver training sessions and be willing and able to contribute to the development of our training programme. The full role description is here and the application form is here.

The deadline for applications is the 9th November and the next Associate training day will be held in London on the 7th December. If you would like more information please contact us on info@birthrights.org.uk.

‘Child of Mine’ documentary, showing parents coming to terms with the stillbirth of their babies

Tonight True Visions’s ‘Child of Mine’ documentary, showing parents coming to terms with the stillbirth of their babies, will be shown on Channel 4 at 10pm on Thursday 18th October 2018.

We absolutely understand the potential benefits of a sensitively made documentary on stillbirth and the importance of raising awareness of what bereaved parents go through. However we do have some concerns about how this documentary was made and in particular how consent was obtained, which we shared with the Cambridge University Hospitals NHS Trust, that includes The Rosie Maternity Hospital, following an enquiry from a member of the public in the area, and you can view this letter here. The response from the documentary makers can be seen here and we understand filming ended shortly afterwards.

If you were affected by the filming at the Rosie or UCL and have any concerns about how this was conducted, please do get in touch on info@birthrights.org.uk.

If you have been affected by stillbirth or miscarriage there are a number of national and local organisations you can contact for support including:

SANDS, the Stillbirth and neonatal death charity

The Miscarriage Association

Antenatal Results and Choices

Birthrights appoints new Chief Executive

We are thrilled to announce the appointment of our new Chief Executive, Amy Gibbs, who will join Birthrights at the end of November 2018.

Amy is a health and human rights campaigner and senior leader with over 12 years experience in national charities, local government and Parliament. Throughout her career she has led teams and organisations to secure legal, policy and practice change for vulnerable adults and children denied their rights by services and society. Amy was a Director of child rights organisations Unicef UK and The Children’s Society, and earlier spent 5 years leading policy and campaigns on social rights and healthcare at mental health charity Mind.

Amy served for 8 years as an elected Councillor for the London Borough of Tower Hamlets, including two years as Cabinet Member for Health & Adults Services and Chair of the Health & Wellbeing Board, which oversaw integrated services including maternity care transformation. She has held various non-Executive positions including Vice-Chair of East End Citizens Advice Bureau and Governor of East London Mental Health Foundation Trust. Amy has an MSc in European Public Policy and MA in English Literature and German. When not working for Birthrights, she is kept on her toes by her lively toddler!

Amy says “I’m delighted and honoured to join Birthrights as Chief Executive. Protecting women’s rights and dignity in childbirth is an issue very close to my heart and I look forward to working with the staff team, trustees, partners and funders to deliver this ambition for even more women.

Birthrights welcomes new Legal Officer

Birthrights is delighted to welcome Reilly Willis, our new Legal Officer to the staff team. Reilly, who starts with Birthrights this week, is an experienced international human rights lawyer specialising in women’s rights and gender equality. You can find out more about Reilly here.

Reilly will be responding to our advice line enquiries, ensuring our resources are up to date and accessible, and will be leading any legal interventions undertaken by Birthrights, and we are very excited to have her on board!

What does a good maternal request caesarean policy look like?

One of the primary objectives of our campaign on maternal request caesarean is to highlight examples of best practice and celebrate the Trusts taking a woman-centred approach. One of the guidelines that really stood out to us was that of Birmingham Women’s Hospital (BWH).

BWH’s guideline on maternal request caesarean explicitly recognises that the evidence base around this decision is of very low quality. It uses language that recognises the woman as the lead decision maker such as, “If a woman has decided on CS” and, “at every appointment re-confirm (not challenge) decision”.

It came as no surprise to learn that BWH co-produced the guideline with service users who had faced this decision and had direct experience of the process. We spoke to Sara Kenyon, Professor of Evidence Based Maternity Care at the University of Birmingham, and the lead researcher on the project to revise the maternal request caesarean, about her experience of leading this project.

How did the idea to co-produce the maternal request guideline working with service user representatives come about?

It came from the clinicians who wanted to improve the care they offered.

How did you go about co-designing a new guideline?

We used a recognised process called ‘experienced based co-design’, which was developed by the King’s Fund. It uses the experiences of women (in this case) and clinical staff to re-design services taking account of the views of all those involved.

We talked to both of these groups separately and then shared our findings to check with both groups we had heard their concerns correctly. A workshop was then held with both groups to discuss findings and agree key areas for service improvement. A final workshop agreed changes to the pathway.

What were the main concerns raised by women and healthcare professionals?

Interestingly, similar key issues for service improvement were identified by both women and clinical staff. These were women having to discuss the request a number of times, delay in the decision for caesarean, women feeling judged, and that information for women needed improving.

You describe the co-design process as challenging and rewarding – tell us more…?

It was rewarding to see how keen everyone was to get involved to improve care.

It was challenging to keep the momentum going and finding time to get everyone together- clinicians and new mothers have competing priorities.

Was there anything that surprised you as you went through the co-design process?

The willingness of all those involved to engage in the project and the fact that both groups identified the same key areas for service improvement.

You talk about tension between the midwifery model of care and the medical model of care over this particular decision; can you tell us a bit more about that?

In this context, an added challenge was the professional tensions between the midwifery model of care and the medical model. Midwives are trained in a ‘culture of normality’ in which normal birth is promoted and valued and a women choosing an elective caesarean birth can feel like a failure to midwives although many would also feel that their role is to support a woman in whatever decision she makes.

The current Maternity Transformation Programme, with its focus on increasing choice and personalisation, may act as a tool to promote change.

Do you think the results would differ if carried out by other Trusts in other areas?

I would have thought that the same concerns would be raised by women and healthcare professionals depending on the current pathway. Having the support of a research team that understands maternity care was really helpful but in principle this sort of process could be carried out by any Trust working with service users.   

Some Trust policies are a result of local commissioning pressures and it would be important that commissioners were involved in the co-design process too.

What advice would you have for other Trusts looking to review their maternal request caesarean policy?

It does take time and commitment so it would be important to get buy in to the project, make a clear plan and keep going to the end.  But the resulting policy will be worth it.

What advice would you have for other Trusts looking to use co-design to revise any maternity guideline or policy?

It is the best way and Better Births, the national maternity review which is now being implemented, says that “Local Maternity Systems should be responsible for… ensuring that they co-design services with service users and local communities”.

The mechanism for doing this is through Maternity Voices Partnerships. You can find more information here. Co-design ensures the views of all parties are considered and included and enhances understanding of the issues involved.

Read more about this project here.

Maternal request caesarean research highlights postcode lottery

Birthrights has published research today concerning the treatment of women who request a caesarean section. Results of a nationwide Freedom of Information Act request show that the majority of Trusts in the UK make the process of requesting a caesarean lengthy, difficult or inconsistent adding anxiety and distress to women at a vulnerable time. And lawyers acting for the charity are concerned that at least one Trust may be acting unlawfully.

Official NICE guidelines states: ‘For women requesting a caesarean section, if after discussion and offer of support… a vaginal birth is still not an acceptable option (Trusts should) offer a planned cesarean section.’ But pregnant women in some regions who ask about the procedure are simply told to go elsewhere. Statistics show that 15% of Trusts have policies or processes that explicitly do not support maternal request caesarean, while 47% of Trusts have policies or processes that are problematic or inconsistent. Only 26% of Trusts offer caesareans in line with NICE best-practice guidance.

Commenting on these results, Chief Executive of Birthrights, Rebecca Schiller said: “Maternal request caesareans are the the number one reason women contact the Birthrights advice service. The women we support have endured previously traumatic births, mental ill-health, childhood sexual abuse or have carefully examined the evidence available and made informed decisions that planned caesareans will give them and their baby the best chance of an emotionally and physically healthy start. It is clear that women requesting caesareans meet judgement, barriers and disrespect more often than they find compassion and support. We are concerned that this lack of respect for patient dignity could have profound negative consequences for the emotional and physical safety of women.”

On 27th July 2018 lawyers acting for Birthrights wrote to Oxford University Hospitals NHS Trust and Oxfordshire Clinical Commissioning Group asking for further information about the policy in place at the John Radcliffe hospital not to offer maternal request caesareans.

Programmes Director Maria Booker explains, “Many women have contacted us about disrespectful treatment at the John Radcliffe hospital. We first wrote to the Trust and CCG in May 2017. Trusts are bound by human rights duties to offer individualised care. Any statement or policy from a Trust that caesarean would only be granted on medical grounds may be incompatible with Trusts’ obligations to have an open, supportive, two-way discussion that explores all reasonable options. If such a policy is then applied in a blanket way then it could be incompatible with human rights law. We have made the Trust and CCG aware that we hope to resolve this issue without litigation and we encourage Oxford University Hospitals NHS Trust and its commissioners to begin to work with us constructively to change their policy. Otherwise we will look to explore all options, including judicial review, to ensure that women living in Oxford get the respectful care they deserve and that the law obliges their caregivers to provide.”

Click here to find out more about our campaign and to see our interactive map.

Recruiting for Chief Executive Officer

Birthrights is looking for a leader to join us as our new CEO. You will lead develop a dynamic and influential young charity which is changing the conversation in maternity care and putting human rights and respectful care high on the agenda for women, healthcare professionals and policy makers.

Birthrights champions women’s rights to dignity, autonomy, humane treatment and non-discrimination. We believe that human rights principles have the power to transform maternity care in the UK and to ensure that women’s needs are met and the most vulnerable women are equally enabled to access safe, high-quality, respectful maternity services.

We reach thousands of women and health care professionals through our advice and training. Our influencing work embeds a human-rights approach in NHS Trusts and central government maternity policies. Our research and publications highlight the challenges faced by women from vulnerable backgrounds and our strategic legal interventions give pregnant women a voice in the courts.

Our successful candidate will be a dynamic and experienced leader with a strong understanding and commitment to human rights in maternity care. You will have a track record in growing organisations, developing and implementing strategies and building income streams. You will empower and inspire staff and create partnerships with a diverse range of stakeholders to influence policy. You will understand charity governance and work effectively with the Board to ensure strong financial and organisational management.

We believe strongly in flexible working. We operate an employee-led working schedule and a flexible holiday policy. Our staff work from home with regular meetings in London and the south-east. The Board is open to increasing the CEO’s working hours if funding permits.

If you believe you have the commitment, skills and experience to lead Birthrights at an exciting time in its development we would welcome your application.

For further information, please download the appointment brief: Birthrights CEO appointment brief