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.

Maternity Care Failing Some Disabled Women

Research published today (15/09/16) by Bournemouth University and commissioned by Birthrights highlights how maternity care may not be meeting the needs of some pregnant disabled women.

A survey of women with physical or sensory impairment or long term health conditions highlighted how  – despite most women rating the support they received from maternity health carers positively – only 19% of women thought that reasonable adjustments or accommodations had been made for them. Some found birth rooms, postnatal wards and their maternity notes and scans “completely inaccessible”,  while a quarter of women reported that they felt they were treated less favourably because of their disability. Most strikingly, more than half (56%) felt that health care providers did not have appropriate attitudes to disability.

Just over half of the participants expressed dissatisfaction with one or more care providers, particularly their awareness of the impact of disability and their perception that their choices in pregnancy and birth were being reduced or overruled. One participant with a physical impairment and a long-term health condition stated, “No one understood my disability. No one knew how to help or who to send me to for support.” Another added, “I didn’t have any control or any choice. Everything was decided for me.” And one woman said, “They did not listen to me. I advised them on the unique way my body works. They did not listen to my advocates.”

Speaking in advance of the publication of her book Why Human Rights in Childbirth Matter and the Birthrights #newchapter campaign linked to the launch, Rebecca Schiller, chief executive of Birthrights said, “this interim report suggests that there are significant human rights issues at stake for disabled pregnant women in the UK and Ireland. More than a quarter of women we surveyed felt that their rights were either poorly or very poorly respected. This is unacceptable and we will be working hard to address this over the coming years.

After Birthrights’ dignity in childbirth survey (2013) we became concerned that the needs of disabled women in the system were not being met. Though it’s heartening to see how overall most women were satisfied with their care and hear some positive stories of excellent practice there is clearly progress to be made. The women surveyed asked overwhelmingly to be listened to. It is crucial to listen to and trust women to ensure the system is genuinely meeting their requirements and that they are at the heart of decisions about their maternity care. The Equality Act 2010 places a duty on the public sector to provide services that meet the diverse needs of those who use them yet participants indicated worrying lack of attention to accessibility of maternity services and facilities for women with a range of disabilities.

The survey is indicative of a wider problem around women’s rights in childbirth that can impact on all women and often most forcefully on the most vulnerable . This month Birthrights is launching a campaign for a #newchapter in pregnancy and childbirth to ensure safe, quality, respectful care is available to all women. Pregnancy and childbirth are a vulnerable time and the physical and emotional impact on women and their babies of a negative journey through pregnancy and childbirth can be severe.”

Professor Vanora Hundley of Bournemouth University added, “while this is a small survey the findings echo the recommendations of the National Maternity Review published earlier this year, which highlighted the importance of personalised, woman-centred care with continuity of carer. It is clear that these are important considerations for all women, but particularly for those women who have a disability.”

Read the full interim report here. We expected the full report to be released in January 2017 when the qualitative research is completed. 

Help Us Start A New Chapter for Childbirth

RS Book cover

On 15th September Rebecca Schiller’s book Why Human Rights in Childbirth Matter will be published by Pinter and Martin. The book advocates for the human rights of all childbearing women here in the UK and around the globe, telling their stories and exploring the cultural and political forces surrounding birth in 2016. Insisting that women matter in the birth room, Rebecca shows how neglecting birth rights can have serious implications for women’s broader freedoms at home and abroad.

We need your help to seize this chance to start a new chapter for human rights in childbirth. Help Birthrights protect childbearing women by hosting a fundraising book club to put these issues firmly in the spotlight. We’re asking you to invite your friends and colleagues round to discuss Rebecca’s book and to make a small donation to support our work. We are suggesting you do this in the week commencing the 17th October and to join in the conversation using the #newchapter hashtag on social media.You can help us spread the word about what Birthrights does and why it matters.

As Birthrights starts a new chapter in its growth, we need to grow our income too. The funds you raise will help us continue to provide expert legal advice, give midwives and doctors the tools they need to provide respectful care, influence maternity policy and campaign for change for all women.

Register your interest in being a #newchapter book club host here.

You can find some information about hosting a #newchapter book club here, and also some questions to get discussion started.

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.

Last chance to stand up for Supervisors of Midwives

SoM image

Tomorrow (17th June) this unassuming consultation on amendments to modernise midwifery regulation comes to an end:

Remarkably the key role that Supervisors of Midwives play in advocating for women doesn’t even get a mention in the consultation document. As an organisation we refer women to SoMs on a daily basis – they are crucial defenders of women’s human rights. Today we need to defend these defenders. That is why we have today submitted the response below to 3 key questions in the consultation. If you haven’t already – please join us in submitting a response…

Q1. Do you agree that this additional tier of regulation for midwives should be removed? 

No. At Birthrights, we believe that safe maternity care is contingent on respectful care and that a human rights-based approach offers the best means of improving maternity services in the UK.

In the current regulatory system in the UK, Supervisors of Midwives (known as SoMs) play a dual role: they are responsible for making sure that midwives under their charge abide by professional standards and they are responsible for supporting and facilitating women’s decisions about their pregnancy and birth. SoMs provide a critical protection for women’s rights in maternity care. They enable women who may have been refused access to specific services to obtain the care they want and need; they negotiate with obstetricians and other members of the maternity team to support women’s choices; they are at the heart of planning safe and respectful care for more complex births. Birthrights calls on the help of SoMs for the women we advise on a daily basis. Remarkably, this aspect of SoM’s role does not appear in the consultation document. Birthrights is deeply concerned about the consequences of removing the role of SoMs without giving any proper thought to how to maintain this critical function.

We recognise that improvements must be made to the current regulatory system. Morecambe Bay showed what can happen if the statutory supervision system is not well understood, supported and implemented. A weak supervisory system can be subverted to protect midwives rather than to advocate for women. However, we believe that the response to the tragic failures at Morecambe Bay and elsewhere must put respect for women at its heart. Safety can only be achieved by full recognition of women’s right to dignity and respect in maternity care. This entails much more than compliance with protocols or improved documentation; it means genuinely personalised care given by staff who listen to women and respect their individual needs. This requires ongoing access for women to an “expert” who understands the care setting and can help women to navigate it. The role of SoM, protected by statute, provides a healthy level of challenge to Trusts to ensure they remain focused on women’s needs, and fulfil their obligations under the NMC Code and human rights law.

With the RCM, and others, we are concerned that putting supervision on a non-statutory basis will leave supervision at the mercy of employers to fund and implement. These changes move supervision from a must have to a nice to have. In the current financial climate of the NHS, that does not bode well. Indeed it could create many of the problems with supervision that were reported in Morecambe Bay where supervision was not prioritised, and where SoMs put their loyalty to their employer, and colleagues, above their loyalty to the Local Supervising Authority. Supervisors may be forced to tow the line of their employer or leave themselves exposed for standing up for women. Regulatory systems that fail to protect women also fail to protect midwives: Birthrights is aware of cases in other countries where midwives have faced criminal prosecution because they have supported women’s decisions to give birth in ways that are not supported by mainstream health providers. There is a real risk that eroding the distinctive system of regulation for midwives will leave women and midwives in a highly vulnerable position.

The proposal in the consultation document that supervision continues merely “as a vehicle for professional support and development” entirely fails to appreciate the distinctive role of SoMs in the provision of safe and respectful care for women. In their focus on the regulatory intricacies of supervision, the Department of Health and the NMC have overlooked this crucial aspect of safe care. They do so at the risk of endangering women and babies and degrading the quality of maternity services.

Birthrights calls for guaranteed access for women to SoMs who are explicitly charged with promoting respectful care and upholding the NMC Code.

Q2.Do you agree that the current requirement in the NMC’s legislation for a statutory Midwifery Committee should be removed? 

Birthrights does not agree that the statutory Midwifery Committee should be removed.

Midwifery is a distinct profession from nursing. It is not based on a curative model of care, but on a social model, which has significant implications for the way it is both practised and regulated. Midwifery puts the needs of women and their families at its heart; its does not treat a specific complaint but supports a woman in her transition to motherhood. The NMC must ensure that the unique characteristics of midwifery are respected and protected and maintaining the Midwifery Committee is the means of achieving this.

Furthermore, modern regulation should understand and meet the needs of the community that it regulates. It is contrary to best regulatory practice to create super-regulators that are distant from the professionals they serve. The abolition of the midwifery committee will lead to the loss of midwifery standards and ethics in regulation; and the assumption of nursing standards will be detrimental to the distinctive practice of midwifery.

Q13:Do you think that any of the proposals would help achieve any of the following aims: 

  • eliminating discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010? 
  • advancing equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it? 
  • fostering good relations between persons who share a relevant protected characteristic and persons who do not share it?

No. Birthrights is concerned that the elimination of statutory protection for the role of Supervisor of Midwives will have a detrimental impact on pregnant women. Currently, pregnant women have access to a SoM who supports and facilitates their healthcare decisions. This role reflects the unique position of pregnant women in healthcare services; for the majority, they are not receiving treatment for a condition, but seeking support for a normal life process which requires support and respect for their decisions. If pregnant women are no longer able to access SoMs, they will undoubtedly receive less support, the quality of their care will diminish and their safety will be compromised.

These proposals should be changed so that the role SoMs play in supporting women is given proper recognition. This may be by maintaining statutory supervision or by placing an enforceable obligation on Trusts to ensure that women are given guaranteed access for women to SoMs who are explicitly charged with promoting respectful care and upholding the NMC Code.

 

 

Maternity experience of women with physical disabilities

Birthrights are excited to be taking part in a joint research project with Bournemouth University looking at disabled women’s experiences in maternity care. The survey below is open now (deadline extended from 3rd June). If you are a mum with a physical disability, please fill in the survey. Otherwise please share the link. The more women we can reach the better!

Disability survey

This is an area that we want to work more on and are planning some qualitative research with Bournemouth University in the future. The survey results will be shared widely. We will also be using them to inform our training and resources.

With thanks to the Matrix Causes Fund for part-funding this project.

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.

Birthrights Responds to the National Maternity Review Report

Speaking in advance of the release of the NHS England National Maternity Review report’s release today, Birthrights Director Rebecca Schiller said, “the National Maternity Review report has a powerful message for all interested in improving maternity care. Birthrights agrees with the Review team’s vision that safe maternity care is personalised care and welcomes the recommendation that women should be in control of their care through the introduction of personal maternity care budgets.  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 are therefore delighted to see that innovations to support women’s autonomy have been included in the plans. We echo the insistence throughout the report that genuine choice and unbiased information should be supported by healthcare professionals and service infrastructure.

It is now crucial that these ideas become a reality. 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 demand that changes are made. The report’s ambition that all women are offered choice of place of birth by 2020 is a reality women should already expect, based on long-standing Department of Health policy which stipulates that women should be able to choose where to give birth. It is time for action to match rhetoric.”

Elizabeth Prochaska, Chair of Birthrights and human rights barrister adds, “As Birthrights set out to the Review team in our ‘Right to Choice in Maternity Care’ submission, legal protections on existing rights to choice could be strengthened and clarified by the simple step of amending the NHS Constitution and the 2012 Regulations so that maternity services are included in the right to choose a provider in the same way that choice is guaranteed to recipients of other health services. This would give women the confidence that they were entitled to receive choice and oblige providers and commissioners to accept their responsibilities for providing it.

Birthrights welcomes the Review’s recommendation that the Department of Health establishes an insurance scheme to provide redress to parents whose babies have suffered harm during birth. Families would obtain financial support without having to prove that a professional was at fault during the birth, sparing them years of litigation and emotional trauma, and the NHS would be freed from the devastating consequences of a litigation culture which has spread fear and defensive practice.

The Review has provided a once in a lifetime opportunity to get maternity care right. We hope that the government seizes the chance.”