Our constantly evolving MatExp story has since been published in NHS #100daysofchange . If you are in any doubt about the difference NHS Change Day makes, take a look at these wonderful stories.
So I am delighted to introduce my J*DI ‘partner in crime’ Florence Wilcock, a.k.a . #FabObs Flo @fwmaternitykhft, who tells her powerful and very human story:
3am the phone rings “There’s a massive obstetric haemorrhage in maternity theatre 2”, I leap out of bed, throw clothes on and get into the car. My mind is racing through causes of haemorrhage, how severe is it? what have the team already done? As I drive into work, I ring to speak to the midwife in charge seeking information and checking off a mental list: pulse, blood pressure, estimated blood loss, blood cross matched, consultant anaesthetist. Brain whirring. By the time I get there, it could be sorted or life threatening, which will it be tonight? Drive carefully, ignore your heart pounding, the adrenaline flowing; don’t be distracted, people are depending on you.
In my role I might be invisible to you if everything is going well and all is normal. You will never meet me, know my face or name, despite my being an essential part of the team and often the lead. One component of my job is to do nothing, to stand back, to not intervene and to teach others how to do likewise. My job is to master the art of being there only at the critical time, to run in and save the day, keep calm whilst doing so and to never get that judgement wrong. An impossible balance of risk vs. choice, art vs. science, clinical outcome vs maternal experience.
My name is Florence. I am an obstetrician.
I’d like to tell you the story of two births.
Birth 1: Twelve days overdue with a first baby, this mother expected a straightforward normal birth. That was what her mother and grandmother had experienced. Her waters broke before labour. The mother was told she had to be induced. She reluctantly went into hospital where she started a hormone drip. She later had an epidural as the midwife kept pressing her to. She had an emergency caesarean after twelve hrs of drip, being only 3cm dilated; it felt the inevitable outcome. The epidural didn’t work, so she had a spinal for the surgery. On the table she felt disconnected, almost like an out of body experience, she felt vulnerable. When the baby was born, she was disinterested and didn’t want to hold her. She was in pain after the surgery but the staff didn’t believe her and told her she had already had the maximum dose of pain killers. She lay rigid and still in pain, watching the clock move slowly until she thought she could reasonably ask again. At home it took months before she could talk about the birth without crying. She had failed.
Birth 2: Same woman, four days overdue planning a VBAC (Vaginal birth after caesarean) contractions started, went to hospital overnight. Next morning, 3cm dilated, offered the birthing pool. Wonderful warm water, giggling with gas and air and the midwives keeping the obstetric team out of the room so they wouldn’t interfere. Sadly after many hours 5cm, so got out of the pool and had an epidural and her husband kept her entertained reading from the newspaper. Later, still 5cm dilated, choices offered, caesarean or hormone drip, joint decision: caesarean now probably safest. A wonderful anaesthetist distracted her with football chat and suddenly a baby daughter was here. Exact same outcome: emergency caesarean, healthy baby girl; exact same hospital: but she felt she’d had her opportunity for a VBAC. She had been listened to, supported, valued, and positively involved in her care.
That mother was me. My name is Florence. I am a mother.
At any social gathering, I inevitably get a blow by blow account of at least one birth story, if not several. A birth experience stays with us forever, we remember it like it was yesterday, it is a pivotal moment in time. I am privileged to witness incredibly special moments and emotional events on a daily basis. Often when I listen to these birth stories, we obstetricians and midwives seem to be portrayed as the villains of the piece, especially the obstetricians. I find this negative stereotype particularly annoying. No doubt there are less empathetic or more obstructive obstetricians as there are imperfect members of any profession, but most will be hard working and diligent and simply trying to do their best for women in their care. From my own personal experience both as an obstetrician and a mother I can see the importance of maternity experience. I often wonder: how have we come to this polarised position? how did maternity staff become the bad guys, upsetting the very women we are trying to care for and what can we do to change this?
How the #MatExp campaign was born
For this reason I volunteered to lead the London maternity strategic clinical network sub group on ‘patient experience’. London had six of the seven worst performing Trusts in the country in the 2013 CQC Maternity women’s survey; we needed urgent action. In contrast, at Kingston Hospital NHS Foundation Trust where I work, we have had consistently excellent feedback from women in our CQC survey. I thought this was perhaps an opportunity to work out what it was we were doing well; to ‘bottle it’ so that others could copy.
I wanted to find an innovative way to explore the issue and ignite the feeling that experience is everybody’s business including women themselves. I had recently started tweeting (My NHSChangeday 2014 pledge) and stumbled across Gill Phillips @Whoseshoes and the idea for #MatExp workshops was born.
With the support of Kath Evans and a team at NHS England London, Gill and I have collaborated to design a bespoke maternity version of her ‘Whose Shoes?’ board game. We have used real scenarios from users and staff to examine maternity experience from all angles and perspectives.
The aim is to use the workshop as an ‘ignition tool’ to build connections and relationships across the broad maternity community. We want to enable true collaboration, co-design and ongoing conversations to improve maternity user experience.
We have run 4 of 5 pilots in London, bringing together people from the whole broad maternity community: users and their families, acute and community staff, managers, commissioners and lay organisations. Getting everyone in mixed groups round a board game in a relaxed environment, babies welcome, refreshments on hand, gets the creative sparks flying. It is essential to remember that each person is present in multiple capacities; professionals are also mothers, fathers, sisters, friends and family with their own stories and birth experiences; users often bring knowledge and expertise from other aspects of their lives such as job, culture, education that are invaluable too. Respect and equality are essential ingredients; discussion starts from the assumptions that ‘best can always be better’ and ‘Wrong is wrong even if everyone is doing it, right is right even if no one is doing it’. We have been fortunate to have wonderful graphic facilitation by Anna Geyer @New_Possibiliti which both provides excellent feedback on the day but also a permanent visual record of actions which goes on generating new conversations.
At the end of each workshop each attendee is asked to pledge what they as an individual will do differently to improve maternity experience. This brings a personal sense of responsibility for the actions, the outcome is not the sole responsibility of the traditional hierarchical leaders but of us all.
“The resulting actions are already taking us in directions I could never have imagined such as user co-design of maternity notes, improving antenatal information for fathers and starting a midwifery team twitter account.”
Despite believing myself to be already very ‘person centred’, as I work on the project I am finding a succession of small changes spilling into my own everyday practice. I am thinking increasingly carefully about the choice of language I use and the way we behave. No more ‘are you happy with that?’ when explaining a plan but ‘how does that sound to you?’; explaining to women why we have come on a ward round; having a father in theatre when his wife had to have a general anaesthetic so that they didn’t both miss the birth; using the intense listening I have learnt in coaching to understand women’s perspectives in my clinic.
Through social media the #MatExp project has generated interest from women and maternity staff up and down the country. We have held a train-the-facilitator day to look at how to roll out the workshops both in London and more widely. But the conversation has already become much broader than the board game, with people from the maternity community energised to talk about maternity experience and actions they can take. The project appears to be prompting people to speak up, share and act on their ideas. Linking with NHS Change day on 11th March is a fantastic opportunity to spread the message and get those vital conversations started.
So what can you do?
The beauty of #MatExp is anyone can do anything, however big or small, whoever you are: user, partner, community group or NHS staff. Your action could be one of those simple suggestions listed or could be your own idea. The sky is the limit! Imagine if we designed maternity care from scratch what would it look like? Would it even be called maternity? How about transition to parenthood? Every action we each take, however small, keeps the #MatExp conversation going and makes a small improvement. If we all take action together, we have huge potential to improve maternity services and an experience that has an impact on us all.