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.

Letter to Shropshire CCG about permanent closure of Midwifery Led Units in Shropshire

On 7th December, we wrote to Shropshire Clinical Commissioning Group to express our strong concern over the recent decision to permanently close three Freestanding Midwifery Led Units in Oswestry, Bridgnorth and Ludlow.

After the units were shut on a temporary basis last summer, we wrote to the CEO of Shrewsbury and Telford NHS Trust reminding him that the closure of the units ran contrary to national policy, most recently confirmed by “Better Births” to offer women the full range of choices in terms of place of birth and to increase the number of births taking place in midwifery-led settings in line with women’s wishes. We also advised them that choice of place of birth falls within the right to respect for private and family life conferred by Article 8 of the European Convention of Human Rights/Human Rights Act 1998.

In his response dated 4th August 2017, Trust CEO Simon Wright claimed that the temporary closures were caused by short and long term staff sickness. It is therefore very disappointing to hear that the CCG have come to a decision to permanently close the units.

You can read our most recent letter, dated 7th December 2017 here.

Recruiting for New Legal Professional Trustee

Birthrights are recruiting for a new trustee from the legal profession. The role offers an exciting opportunity for a lawyer to get involved in our cutting edge work on women’s reproductive rights and bring further legal experience to our board providing invaluable advice and support for the work that Birthrights does.

Download the role description here for more information. Closing date for applications is 29 November 2017.

#Metoo shows we need trauma-informed maternity care

The outpouring of posts from survivors of sexual violence, assault and abuse as part of the grassroots #MeToo campaign underlines what many of us working in maternity care believe strongly. A significant number of women accessing important services in pregnancy and birth will have experienced trauma in their lives. And sadly, many of these individuals will have been traumatised by sexual violence which may impact on how safe they feel within services which might be triggering of their trauma.

Last week Birthrights was honoured to hold a seminar as part of the Sheila Kitzinger Programme, hosted by Green Templeton College Oxford. You can read more about it in our soon-to-be emailed newsletter. We met to consider how to make truly informed, lawful consent a reality in maternity care in the light of the landmark judgment in the Montgomery v Lanarkshire case. During the day it was clear to all that respectful maternity care, care that protects human dignity and autonomy, is of fundamental import to the physical and emotional wellbeing of women and their families. Moreover the group felt that an individual should not need to disclose previous trauma in order to access care that is sensitive to their needs. As part of our follow-up report we’ll be suggesting that a trauma-informed approach to maternity care, that ensures all services are sensitive to the needs of those who may contend with trauma in their lives, is essential.

Ahead of this report we are grateful to two anonymous survivors of sexual abuse for sharing their personal experiences and perspectives on maternity care with us and with those policy makers charged with the important work of transforming our maternity services. You can find their letters below.

Increasing continuity of carer, ensuring all birth place choices (including homebirth and maternal request caesarean) remain viable options and insisting that our midwives and doctors are given the time and skills within an appropriate organisational culture to be enabled to practice rights respecting care must remain a focus in the Maternity Transformation Programme.

We hope you will help us share their message and add your own below.

Trigger warning: please note that these letters discuss sexual abuse and birth trauma and some readers may find them triggering.

A letter from an anonymous survivor of sexual abuse for the attention of Birth Policy Makers

Another letter from an anonymous survivor of childhood sexual abuse for the attention of Birth Policy Makers

IMUK’s Judicial Review of NMC Decision: A Guest Blog

On 18th and 19th October, members of IMUK (the membership organisation for independent midwives in the UK) will bring to court their judicial review of the Nursing and Midwifery Council’s decision that their indemnity cover is inadequate.

In January Birthrights wrote to the NMC to express concern about the decision stating that their actions “appear designed to cause maximum disruption and damage to independent midwives and the women they care for,” adding that, “we do not believe that these are the actions of a responsible regulator.”

Ahead of their court date, IMUK Chair Jacqui Tomkins has shared her thoughts and hopes in this guest blog. 

I became an independent midwife almost 20 years ago. It has been an overwhelming joy to be able to determine my own volume of work and to work with women and families that I can take the time to listen to and get to know very well. This has also been hugely beneficial for my family who know that I will be at most of the big family events we want to share but if I do have to miss the occasional celebration they are to be found helping me pack the car inan excited state as I get ready to help another family welcome in their newest family member. 

I work with a collective of like-minded midwives who provide me with a wealth of knowledge and skills that are fast becoming lost to us as a profession and ultimately to women. We have a supportive network that holds us and lifts us when it’s needed and allows us all to thrive in a supportive and emotionally intelligent environment. It’s not all unicorns and rainbows but it is a safe space to work within and its the way forward for a lot of midwives who need to feel they can provide the care they have been trained to give with the time needed in order to give it. 

This way of working is so important to me, my colleagues and the women we work with as we all value the relationship that is at the centre of this very important life event. The women I have helped look after in the past and the present are shocked to understand that this right to choose for them, but also for midwives, is at risk of being lost forever. So many women have been telling me that they feel they have nowhere left to turn as for various reasons they feel they cannot use the local maternity providers. As Chair of IMUK I have also been hearing about how some of those women have made the difficult decision to birth alone during this enforced period of redundancy for self employed midwives. This is the most terrible consequence of the decision made around insurance supposedly and in the name of public protection as these woman had not set out to do this. 

As an organisation we are ready to move forward and resume our plans to help with the training of student midwives and help the government to deliver the vision of “Better Births” by supporting pilot NHS groups and continuing to work closely with NHS England. 

Overwhelming throughout the struggle for independent midwifery to survive, my concern has been both for the midwifery profession generally but also the thousands of women per year who seek out our care. This woman centred model gives women a skilled and safe option for their care, with a guaranteed assertion that they will know who is coming to support them on the day and that they trust that person implicitly to be able to turn up and of course will respect and protect their carefully thought out choices. 

The importance of clinical autonomy is fast being eroded within employed models and self employed midwives understand that this is the thing we must protect and enshrine within our profession at all costs. That is not to say we do not work collaboratively with other health professionals, we are very skilled at communicating our clients needs and best interests so will be making appropriate referrals and accompanying women when they need to make alternative care plans for their pregnancies and births. 
 

Midwives are fast becoming a scarce commodity so it makes no sense to remove the right to be self employed from the profession. We need help and support to be able to continue to practice and for there to be an understanding that these issues highlighted in court this week are not about safety but about finances. Finances that have been confirmed by two independent actuarial firms to be perfectly adequate for our scope of practice.

Four years ago when this board of IMUK decided not to accept the future in front of us, we had only midwifery experience between us.  Since then, the team and our members have been joined by supporters and experts from all walks of life, almost all of them having previously benefitted from independent midwifery in some way.  We have become very knowledgable about insurance, both its benefits and its restrictions, we have experienced the political arena, press and legal worlds all of which have given us surprising new life skills but most of all I’m proud of how far we’ve come as a small group of health professionals with a big problem and my hope is that next week we will find out that it has been enough.

How should Health Care Professionals handle a maternal request for caesarean?

Its been unusually noisy in the maternity world over the summer, as media reports have reignited discussion about what a safe” birth looks like. At Birthrights we believe that the need to listen to women is the mast that all those who care about the safety of women and babies during birth, can cling to when the seas of discussion get rough. 

Many women want to avoid unnecessary interventions in childbirth and, on the 15th August, Birthrights CEO Rebecca Schiller wrote about the vital role midwifery care plays in ensuring women who don’t need and want intervention have the best chance of avoiding it safely

We have also been working hard to support a smaller but important group of women who feel a planned caesarean section is the right choice for them. We created our recent maternal request for caesarean campaign to ensure that these women’s voices were heard and to discover the barriers to their requests being granted

In this blog post, our Trustee, midwife Simon Mehigan, shares his experience of working with women who want a caesarean for no medical reason, and why the approach of a number of Trusts to shut off this option from the outset, is counter-productive.

“A few years I was employed as a consultant midwife at a large teaching hospital in the Northwest of England. One of my responsibilities was to see all the women requesting a caesarean section in the absence of what was considered to be a medical reason.

Over the course of three years I saw over 500 women. I saw the majority of these women just once with a follow up either by email or by phone. Some I saw twice and for a small proportion I took over all of their care, as it was apparent that continuity would have a significant impact on their decision-making. Here’s what I learnt:

Saying no initially to a womens request for an elective caesarean section creates an antagonistic starting point for discussion and doesnt reduce the overall caesarean rate.

I very quickly discovered that by telling women very early on in my conversation with them that “if a caesarean section is ultimately what you want I will help arrange that for you”, that they relaxed, were prepared to listen to what I had to say and were receptive to discussing alternatives.

In fact having met me and discussed their options, 85% of women opted to aim for a vaginal birth of their own accord and over 70% of those women ended up having a vaginal birth.

A couple of women actually informed me after our consultation that because I had said I would support them in their request for a caesarean section that they no longer wanted one. Being told “no” by consultants had made them more determined to have a caesarean section because they were not prepared to let someone else make decisions about their birth.

A de-brief of their last birth often alters a womens view.

A number of women didn’t understand what happened to them last time. Going through it with them, explaining why things might have happened often helped women in realising that things could be different in this new pregnancy and birth.

After 28 weeks it is more difficult to alter the view that caesarean section is the right choice

Many Trusts schedule these conversations for the last few weeks in pregnancy and yet what I experienced was a direct correlation between the gestation at which I met women for the first time and whether they would be open to explore options that might ultimately feel better to them than a caesarean section. The later I saw them the less likely they were to consider any other options.

The plans of care I developed in conjunction with the women often focused on having an uncomplicated birth with a low threshold for a caesarean section.

The majority of women I saw had had a previous traumatic birth experience. Common themes were a lack of control, lack of communication from staff and a negative experience of induction. Therefore the plans we made together often stated no induction of labour, no rotational forceps, minimal examinations and diverting to a caesarean rather than trying other interventions if the birth wasn’t completely straightforward

Once a decision had been made a line had to be drawn.

Women found it very stressful having to revisit their decision every time they met a health professional.

A caesarean is the right choice for some women.

I have over the years met many women that have felt a caesarean section was the right choice for them. They could all explain rationally why they wanted to birth their babies in that way.

By listening to them, talking to them as an equal and ensuring they felt in control of the process they not only developed confidence in their bodies but more importantly in their caregivers and the organisation irrespective of whether their final decision was to opt for a caesarean section.

In over 20 years as a midwife I have yet to meet a woman that has made irrational decisions or choices. They have always been the right choice for that women based on her individual circumstances.”

Simon Mehigan