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

Leadership news

Birthrights CEO Rebecca Schiller will be stepping down from her current role at the end of September 2018 and will be re-joining the Board of Trustees to continue her work for the organisation. Birthrights will start the recruitment process for a new CEO on 6th August and will be looking to recruit a dynamic and experienced leader with a strong understanding and commitment to human rights in maternity care. A full appointment brief and application details are now available here: Birthrights CEO appointment pack.
Rebecca Schiller comments:

 

It has been a huge privilege to lead Birthrights over the past three years – delivering work to ensure that all women matter in childbirth. Thanks to the support of our staff, Board, volunteers, donors, fundraisers and the many midwives and doctors we work  with we have achieved more over the past five years than our Chair and Founder Elizabeth Prochaska and I believed possible when we set up our kitchen table organisation. 

I am proud that we now have a team of five part-time staff and will enjoy the support of the Esmee Fairbairn and Baring Foundations over the coming years. With their commitment we have been able to develop plans to focus on the human rights challenges faced by women facing severe and multiple disadvantage, disabled women and those with mental capacity issues over the next three years. We will continue to provide free advice and resources to those who need it, deliver more training to midwives and doctors and ensure local and national maternity policy is lawful and rights-based – always insisting that the diversity of women’s voices, experiences and needs guides our work.

I will be leaving my post as CEO at the end of September 2018 to focus on my writing, speaking and consulting work. It has been a difficult decision but I believe it’s now time to hand over the day-to-day running of Birthrights to energetic and experienced new leadership who will bring the skills needed to continue to develop our work, deepen our impact and ensure we build a robust and sustainable organisation to support women and those who care for them for years to come.

I will continue to work very closely with the staff team, our funders and volunteers in my new role on the Birthrights Board of Trustees. I look forward to continuing to be a Birthrights spokesperson and contributing to our work in a number of different ways. This is an exciting new chapter for Birthrights and we look forward to sharing it with our dedicated friends and supporters.”

Recruiting new Legal Officer

Birthrights is the UK’s only organisation dedicated to improving women’s experience of pregnancy and childbirth by promoting respect for human rights.

The Legal Officer is a new and critical role at Birthrights to manage our advisory and legal work, including running the advice service, overseeing strategic litigation and providing legal policy input with core stakeholders.

This is a part-time home based role, with a pro-rata salary of £15,000. To find out more and how to apply please download the Job Description.

Closing date for applications is 5pm on Wednesday 27th June 2018.

New research: Disabled women need to be heard and respected as experts about their bodies

Research published today and commissioned by Birthrights shows that disabled women are generally not receiving the individualised care and support they that they need to make choices about their maternity care.

Today’s publication includes and builds on the survey research published in 2016 which found that more than a quarter of disabled women asked felt that their rights were poorly or very poorly respected.  A quarter felt they were treated less favourably because of their disability, and more than half (56%) felt that health care providers did not have appropriate attitudes to disability. Some found birth rooms, postnatal wards, or their notes and scans “completely inaccessible”.

The new report published today presents data from in-depth interviews with disabled women.  It highlights the need to treat disabled women – as all women – as individuals with their own specific needs.  It emphasises the need to recognise that disabled women are experts in their own conditions and what they mean for their bodies and choices in childbirth.  Participants described distressing scenarios of having to prove that their choices were suitable, undermining their dignity. In one very concerning case, one participant described not being given all the information she needed to make an informed decision about her care during labour, and being denied the choices she would have made as a result.  Respecting women’s dignity means respecting and trusting women’s individual needs and knowledge.

Participants also described having to explain themselves repeatedly to each new care provider; at times feeling as if the focus was on their impairment rather than their needs as a person: “You’re not a pregnant woman you’re just a body. Because if I was a person to them, if I was a pregnant woman they would have read my file”. Women who had experienced continuity of carer spoke very positively of their experiences and of experiencing more dignified care.

All women had some poor experiences of postnatal care.  In some cases participants did not see the point in raising issues when continuity of care was lacking and midwives were short of time; something the researchers suggest “must raise questions of safety of practice”.

Participants had mixed experiences of antenatal and parenting support: some women were provided tailored support early on but others felt that they were expected to take the lead in asking for what they wanted or found that activities or information were not offered in an accessible way.

Throughout the study, women felt that they had to be empowered, enabled, informed and supported to advocate for their rights.  They emphasised the need to be listened to and treated as individuals.  Not doing this has a long term impact: women who were not listened to and whose rights were not respected lost confidence and felt undermined long after the birth.

Birthrights’ Chair, Elizabeth Prochaska commented: “It is fundamentally important that disabled women – like all women – receive dignified maternity care that respects their human rights. The research published today highlights that much more work is needed by maternity services in order to provide high quality individualised care to all disabled women.  This must include ensuring that all women are given all the information they require to make decisions about their care, in a way that respects their own knowledge about their bodies.”

Professor Vanora Hundley said: “The National Maternity Review, Better Births, highlighted the importance of personalised maternity care that focuses on the needs of the woman and her family. Good communication is a key to achieving woman centred care, and our findings suggest that this remains a particular challenge for women who have a disability.”

Dr Bethan Collins added: “The findings highlight the importance of communication: service providers need to both respect women’s knowledge of their own bodies while also providing the expert support to enable women to make informed decisions about their care.

“Continuity of carer was so important to many of the women, but does not seem to be common practice. As a researcher and as a disabled parent myself, I empathise with the experiences of women in our study. There is a job to do to raise awareness of disability and enable women to have a dignified experience.”

The research suggests that maternity services need to adapt to provide high quality individualised care to all disabled women. This includes improving both attitudes and knowledge of disability and disabled women among maternity professionals, ensuring all disabled women receive continuity of carer, allowing additional time for disabled women to discuss their needs, preferences and choices, auditing access and ensuring that reasonable adjustments as required under the Equality Act 2010 are made available.

The research was conducted by Jenny Hall, Jillian Ireland and Professor Vanora Hundley at Bournemouth University and Dr Bethan Collins, Senior Lecturer in Occupational Therapy at the University of Liverpool.

With thanks to the Matrix Causes Fund for supporting this work.

Home birth – what are a Trust’s responsibilities towards midwives and women?

What are the responsibilities of midwives to care for women who have requested a home birth? And how can Trusts best support these responsibilities?

Midwives owe the women they care for a legal ‘duty of care’. They are obliged by the NMC Code to ‘put the interests of people using midwifery services first’ and to ‘make their care and safety [their] main concern’. Under human rights law, all Trusts and their employees are obliged to respect women’s decisions in childbirth and cannot compel a woman to receive care in a hospital.

If a woman has stated her preference for a home birth and informs the NHS Trust or home birth team that she is in labour, the woman can expect the midwife to attend her at home. Trusts that prevent midwives from attending a home birth for a woman under their care present their midwives with a difficult dilemma – to defy their employer and put the woman first, or obey their employer and neglect their duty of care. If a midwife does not attend a woman, and the woman or her baby die, there is a real risk that the Trust could have breached the right to life (Article 2 of the European Convention on Human Rights).

In recent weeks, a small number of Trust home birth policies have been brought to our attention, which have suggested that a home birth will only be offered if women agree to any interventions or examinations midwives propose, and in some cases that midwives should leave the labouring woman should their “offer” of an examination or intervention be declined. Legally speaking, women at home have as much right to decline an intervention or examination as in any other birth setting. And making a home birth conditional on this “agreement”, or threatening to leave constitutes bullying and it is very likely to be an unlawful interference in a woman’s right to make decisions in childbirth. If she were to consent to an intervention as a consequence of a threat to withdraw support for her home birth or abandon her care, her consent may not be valid, and the midwife could be liable for criminal assault/battery.

Some Trusts will argue that these policies are designed to protect their midwives from being put in a difficult position and a particular concern has been raised about situations where midwives are asked to wait outside the room while a woman is in labour. It is important to distinguish between a couple who asks for some time alone in labour, and asking a midwife to remain outside of the room for the duration of labour and birth and only be on hand in an emergency. If a woman makes the latter request, it may indicate a lack of trust for the midwife, which will not be assisted by a blanket policy prohibiting the midwife from providing care in those circumstances. Relationship building and individualised care planning are much more likely to lead to safe and positive outcomes.

Midwives are also under a duty not to exceed their scope of practice and their experience. Trusts should be open with women about any concerns they have about their staffs’ expertise to attend more complicated births, whether at home or in hospital. This conversation needs to be managed with sensitivity and while risks must be carefully explained and contextualised, the woman must not be threatened or pressured to accept any particular course of treatment.

Whilst dealing with a home birth that doesn’t go to plan can be stressful for the midwives involved, it is women who ultimately bear responsibility for their own informed decisions. Midwives who give women the best available evidence about a recommended course of action and any reasonable alternatives, document their explanation and discussion and then support a women’s informed decision to decline are upholding professional standards and their human rights obligations, and have nothing to fear from lawyers or regulators.

Finally, as NHS resources become more stretched, home birth services are too often cut back by Trusts. While Trusts may rely on staffing shortages for failing to send midwives to a home birth they should only do so if there is a genuine and unforeseen staffing shortage. If they are withdrawing the service on a regular basis, they can be expected to make alternative arrangements. In a recent case, the NHS Ombudsman accepted that an NHS Trust that refused to make contingency plans after it suspended its home birth services was acting unreasonably.

Trusts’ home birth policies should be based on respect for women’s informed decisions. Any policy that makes care conditional on acceptance of interventions, or threatens suspension of the service due to staffing shortages, does not respect women’s right to make informed decision, fails to put their interests first and risks their safety.

Our email advice service (info@birthrights.org.uk) is available to any woman who feels she is not receiving respectful maternity care and any healthcare professional who is concerned that they are being prevented from delivering respectful maternity care.

 

Shropshire Midwifery Led Units re-open their doors

New Year’s Day saw the re-opening of the three Midwifery Led Units in Bridgnorth, Oswestry and Ludlow, which is great news for local women expecting a baby in 2018. A consultation expected to propose their permanent closure and replacement with community hubs is due to be published shortly. The response from Shropshire CCG to our letter of the 7th December can be found here.