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Resilience: Showing strength in the face of adversity #usmsconf17

Here are a few pictures and thoughts shared from the @ussumidwifery ‏ conference ‘Resilience: Showing strength in the face of adversity ‘… Thank you to everyone who came to see the great speakers at this conference. It was a great honour to present my work alongside some of the wonderful researchers listed on this programme…Having spoken at many conferences, I can also say that these student midwives really know how to look after their guests….Thank you  and ..❤🎓😍

Taken from The knitted midwife’s blog: ‘The Royal College of Midwives has highlighted that the UK is still short of 3500 midwives.  This is an update to the published report here.  The update to the report can be seen here. Whilst this is an improvement on the 5000 midwives needed three years ago, this chronic shortage adds to the pressures that midwives are facing every day in their working environment.  Additionally there is a ‘retirement time bomb’ as over a third of the current midwifery workforce is aged 50 or over.’…these knitted midwives represent the midwives missing from the workforce.

All of the speakers at this conference were indeed inspiring, but one message seemed to remain strong throughout…

”BUILD a tribe – don’t wait to find one’ – Prof Mavis Kirkham

Reminds me of the #Findyourflock story last year

We also had  from tell us to “find our tribe”

😊💛

One of the most inspiring parts of the day was seeing student midwife Hannah Cook get a standing ovation at … the future of midwifery is bright…..She will be re presenting her talk at this year’s  awards conference….If you can….get there!

✨

I too feel as if being a midwife is what I am…I also feel that it is written through me like a piece of rock. It is my professional identity. But having resilience as a midwife is not about ‘toughening up’ as  puts it…..

I am not even sure if resilience is the right word for what we are talking about here… Resilience is not a magic pill!

💊💉🌡

The most interesting conversations of the day in my opinion were around the ethics of caring for midwives, and bullying. There is still so much more to do….and I still see uncaring behaviors taking place. Are we an insecure profession?…trying that much harder to prove ourselves?…or are we embittered by another pill too difficult to swallow?…one this is for sure…

Image result for wrong is wrong quotes

This day gave me the chance to meet with and listen to some of my research heroes…Thank you to everyone who engaged in my presentation and to those who continue to engage as my work as it continues…

#usmsconf17

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 💚💙💜❤

 

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‘Making & Breaking the Maternity Experience’#Uclhmw2016 – A midwifery conference

Attending and presenting work on midwife wellbeing at , I was thrilled to see so much of one conference dedicated to supporting the midwife, as well as the mother. I was also keen to hear  Jacqui Dunkley-Bent update us all on the new plans for maternity services in 2017! – Bring it on!

-Improvement in Perinatal mental health in maternity services was highest on the agenda as we can see here – midwives were really responsive to making these a commitments a reality.

Yet we can see that NHS England is also looking to transform the workforce as part of this plan. There are so many ideas buzzing around my head at the moment that I am feeling dizzy… “so much to do and so little time” – As Willy Wonka would say.

We also saw how mothers are experiencing poor support in decision making…

Both  and  really must be heard by all midwives, everywhere, more often! Read more about these experiences here. …and here.

Women are roaring for change!

Christine Armstrong

There are so many great resources available from dignity in childbirth … We really need to challenge the way that women experience respect in maternity care.

And the #CaringForYou campaign?

Sadly, bullying still a real issue in midwifery, as  confirmed … punity, public shaming & undermining must stop.. We must be kinder to one another…remember why we became midwives in the first place and love each other for the critical safety of mothers and their babies.

…..more ❤️ is needed!

We must ‘Create a positive culture’ –   says at 

What can we do?

There is indeed much to be done. I wanted to personally thank , and @MaureenMcCabe15 (and their teams) for looking after me so well as a speaker at this conference myself. I have never been so well looked after at a conference 😘😍

And thank you to all of those who appreciated my presentation and engaged in this very important work. I love this particular image that people have been sending me (see below)…I believe it was created at the#BirthTrauma2016 conference & shares a powerful message 💜💙💚

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There really is so much to do and so little time!

Image result for so much to do and so little time willy wonka

As a last thought introduced to us by Sheena Byrom ‘Midwives are humming birds never too small to make a difference’

Until next time – Take care of yourselves & each other ❤💚💙💛

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💚💜❤Preventing Birth Trauma at #artofbirth16💚💜❤

Recently, I was asked by Dr. Gloria Esegbona from the @art_of_birth to share some of my thoughts on birth trauma at the latest  summit at Kings College London. My first thought, as always was…. do you mean physical? or psychological?… I was assured that her latest event would be addressing both. Time to learn & grow 💚💜❤

art-of-birth-event-with-sally-pezaro-2016

And so how can we as midwives prevent physical birth trauma?

“we can reduce ventouse to and with left lateral & slow head delivery

“Preventable physical to & caused by poor positions and outdated pushing practices

Quiz – Which methods of pushing during vaginal delivery and pelvic floor relate to which perineal outcomes?

(No peeking at the link to get the answers first!)

#Discuss #GetYourGeekOn

Methods:
-open-glottis technique?
-Valsalva pushing?
———————-
Outcomes:
-incidence of instrumental and cesarean delivery?
-incidence of postpartum hemorrhage?
-urinary incontinence
-Episiotomy rates?
-maternal satisfaction?
-fetal heart rate (FHR) abnormalities?
-Apgar score?

No peeking at the answers link before you comment/answer below!

(We are still awaiting more evidence in any case)!

The Art of Birth is promoting art in the science of to prevent #birthtrauma 

And so what about the psychological trauma and the 2nd victim…the midwife?

Can we begin to understand women’s experiences in relation to psychological birth trauma? How do we revisit the language we use during birth? Can we all be more compassionate in our practice?

I was quoted on this day when talking about “superhero midwives” – healthy, well-supported lead to healthy, well-supported mums. …It is true…so many people wanting to do good….some burning out. Some traumatised.

I thank you all for hearing about my work on the wellbeing of midwives in the workplace.

I had some really great panel questions too…What I loved most about this conference was that I managed to receive lots of  and create  with so many inspiring midwives, doulas, students and others wanting to support each other, share and learn  💚💜❤.. I can’t wait to see some of you in the near future and learn more about how you have turned these lessons into practice. 💚💜❤

Until next time – look after yourselves and each other #GetYourGeekOn 💚💜❤

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Birth Rights & Attitudes Towards Autonomy in Maternity Care

This blog post shares some of my learnings from and reflections of a seminar I attended recently, hosted by the Birthrights group at University Hospitals Coventry and Warwickshire. I have always found medical law very challenging to understand, even having studied it at Masters level…I am still largely perplexed by the complexity of it all. Yet this session seemed to simplify things for me, offering case studies and easy to understand facts…for which I am very grateful! For further learning, please see more factsheets here.

Many of the topics under discussion were drawing from the work of the White Ribbon alliance, which I am highly drawn to in their quest to promote the wellbeing of midwives for the benefit of services around the world. Below I will discuss a few of the topics highlighted which have aroused my interest in relation to my own practice.

“Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk”. – (Lancet 2010).

This publication evoked moral discomfort within me immediately. Having previously practiced as a home birth midwife, I am used to challenging the notion that home birth is a less safe option where mothers put their babies at risk. As with many studies which examine the safety of various birth places, I often see biases where the skill of the birth attendant and other relevant factors are seemingly ignored to promote the argument that ‘It wouldn’t have happened if you had only been in hospital’…But the thought that women are putting their babies at risk (and choosing to do this) fundamentally goes against my own clinical knowledge and beliefs.

This paper has led to some women having forced cesarean sections…surely this is a path which nobody wishes to go down.

The discussion and debate around fetal rights has also led to mothers being prosecuted for drinking alcohol during pregnancy. This is a moral pathway which sees the woman become a vessel for a means to an end, rather than being an end in her own right. Again, do we really want to take this path? Having explored ethical arguments myself, I think there is a better way..

In this same vein, the issue of when a fetus has rights or not has also been debated and contextualized. Now that the 24 week limit upon abortions has been lifted (decriminalized), it is clear that the mother has more choice in her reproductive decision making abilities. For me, this can only be a good thing.

Human rights-based approaches guided by the World Health Organisation

  • Non-discrimination: The principle of non-discrimination seeks ‘…to guarantee that human rights are exercised without discrimination of any kind based on race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status such as disability, age, marital and family status, sexual orientation and gender identity, health status, place of residence, economic and social situation’.
  • Availability: A sufficient quantity of functioning public health and health care facilities, goods and services, as well as programmes.
  • Accessibility: Health facilities, goods and services accessible to everyone. Accessibility has 4 overlapping dimensions:
    • non-discrimination;
    • physical accessibility;
    • economical accessibility (affordability);
    • information accessibility.

Healthcare practices that violate human rights: Drawn from the Charter for Respectful Maternity Care

Physical Abuse: Episiotomy , non consensual force, restraint, unnecessary procedures, failure to provide pain relief

Disrespect: Verbal abuse, bullying, blaming, shaming and reprimanding

Non-confidential Care: Unauthorized revelations and psychical exposure

Non-consented Care: Anything performed without adequate information or dialogue to enable autonomous decision making, or with undue pressure

Misinformed Care: biased, non transparent information given, which inhibits a woman’s ability to make an informed choice

Depersonalized Care: Inflexible application of policies or guidance, which fail to take into account of a woman’s individual circumstances.

Discriminatory Care: Unequal treatment based upon personal attributes (age, race, religion).

Abandonment of Care: Refusal to provide care due to inability to pay or birth choices (or any reason)!

Check out the Birthrights info on human rights in childbirth here

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Attitudes to Autonomy

Lastly, the following statement from a paper published in 2013 had me thinking about the impact of blame cultures within our maternity services.

“Both maternity care professionals demonstrated a poor understanding of their own legal accountability, and the rights of the woman and her fetus. Midwives and doctors believed the final decision should rest with the woman; however, each also believed that the needs of the woman may be overridden for the safety of the fetus. Doctors believed themselves to be ultimately legally accountable for outcomes experienced in pregnancy and birth, despite the legal position that all health care professionals are responsible only for adverse outcomes caused by their own negligent actions.”

The statement outlines how both midwives and doctors are happy to accept that the mother has the right to make any final decisions, yet they were under the impression that it was them a the practitioner who would be legally accountable for any adverse outcomes which occurred. This may be in part due to the nature of our regulatory and litigation systems, which can invoke a fear in practitioners that they will be ‘blamed’ in some way for any adverse outcomes.

Yet adverse outcomes occur all of the time, in any case, and sometimes cannot be controlled. This is of course very sad…yet it is also an inevitable reality of some women’s childbearing experience. Nobody’s fault.

When women have true autonomy and the power to make their own decisions around childbirth, they also have inherent accountabilities in relation to the choices they make.

That is why it is more important than ever to make sure that we are recording the conversational dialogue that we are exchanging with women. Consent forms really have no use unless the information can be recalled and maintained. The law dictates that we must be open, honest and avoid influence in open discussion with women.

I personally believe that these conversations would be best recorded in digital format. See my paper on this here.

As always, it is the relationships we build with women that will always be the key to building trust, opening dialogues and beginning advocatory conversations which support women’s ability to make truly informed decisions. We must work in partnership with women and the wider multidisciplinary team in order to ensure that women can make the right decisions for them, and in turn take accountability for the decisions they make. We can only do our best in managing any situation to the best of our abilities as midwives (and as any other clinician). That is what we are personally accountable for.

Image result for human rights
(Image via http://hakam.org.my/wp/)

Until next time – Look after yourselves and each other  💛💙💜💚

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Following #Expo16NHS..I could be replaced… ‘technically’

And so another NHS Expo conference comes to an end. It was a lively 2 days with lots of amazing people coming together to share new ideas about the future of health and social care.

The conference was largely dominated by the digital and technical innovations that may help to create the NHS of the future (and make it better presumably)… I have always been interested in how technology may make a variety of health care improvements…I have written about one of my ideas here.

Sir @DrBruceKeogh providing a broad outline on recent ground breaking digital innovations

The digital news as reported by @keithgrimes was as follows:

  • Patients will be able to book appointments, order medications, and download records, US ‘Blue Button’ style, on a revamped http://www.nhs.uk to be launched at Expo 2017.
  • Anyone will be able to access detailed stats on performance in key areas such as dementia, diabetes, and learning disabilities
  • There will be online access to 111, which can lead to direct appointment, signposting, or callbacks.
  • By March 2017 there will be a directory of approved apps from March 2017, with subsequent support for wearables
  • 12 hospitals to become “Digital Exemplars” – each receiving £10m funding, matched by trust, and partnering with world leader organisations.
  • The creation of a second round of ‘national’ excellence centres, with more detail to follow.
  • The creation of an NHS Digital Academy to teach Informatics skills to NHS staff and create the next generation of Clinical Chief Information Officers and Digital Health Leaders.

And for more digital ideas….

MY DIGITAL FOOD FOR THOUGHT…

Often, whilst working clinically as a midwife, I also find myself behaving like a robot… (Don’t worry… I obviously use my gut and intuition too)!…but really, as midwives we are calculating risk at all times….like a computer. Also…we follow certain pathways as midwives…if a blood pressure becomes out of range…we take the next prescribed step in making a referral or delivering a new treatment to fix it. A computer could do this.

Imagine a woman coming into a clinic to see a robot (of sorts). She is scanned, measured and given the full M.O.T that she would normally receive from a midwife, but it is the robot who calculates the risks and the next steps to take. At the end of the exam.. the robot gives the woman a print out report, which outlines what should be done next in light of any new findings. The robot can answer questions too…

…(hopefully better than google can)

…or it can tap into a Skype call with a registered health professional. Imagine a future like this..better or worse? In a pressured maternity service, this could indeed be the new way of things. Could I be replaced as a midwife?…’technically’?

I think not. But a digital future like this could certainly support midwives in practice. Would it be safer? are human errors more common than digital ones?… Certainly worth exploring I think.

What do women want from their midwife? A human face? compassion? Human touch?…None of these could be delivered by a robot (probably)… and so perhaps a digital future like this would afford midwives more time to be compassionate and ‘human’..

MOVING ON…

Also at Expo.. there was @roylilley….with @JaneMCummings

Singing ‘Always look on the bright side of life…’

🌅🌻⭐️👀🙊👍

Obviously they were doing this to celebrate and introduce 

..not far away now (19th October 2016)

And we also heard more singing as we enjoyed a very moving rendition of “I will try to fix you”…

💉💐💊🏥🚑

By the @NHSChoir for the  at

from with bonus live sessions from

My colleagues and I also presented our #ShowsWorkplaceCompassion research for the first time and some of the other work we have been doing in partnership with @NHSEngland to commission for a positive staff experience. Thank you to everyone who came along and shared thoughts and ideas to help us shape this project.

I was also invited to join sessions on the

Maternity Transformation programme: Delivering the 2020 Vision at #Expo16NHS #MatImp #MatExp #BetterBirths #BUMP

and the …

@empathymuseum at #Expo16NHS #WalkAMileInMyShoes via @HealthFdn.

Click the links to read more….

Next year, I hope to be sharing more research and ideas. No doubt I will still be on my quest to improve the staff experience within health and social care..after all… patient experience and staff experience are both sides of the same coin..

2-sides-of-the-same-coin

See the Twitter activity from#Expo16NHS here

Until next time…be kind to yourselves, and eachother 💛💙💜💚❤

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Reflections from a session in the @empathymuseum at #Expo16NHS #WalkAMileInMyShoes via @HealthFdn

One of the best things I experienced at this years NHS Expo 2016 was the @empathymuseum …where I was invited to #WalkAMileInMyShoes via the @HealthFdn. It was rather strange to be invited into a giant shoe box, but nevertheless… Just like Alice in Wonderland I found myself uttering….’curiouser and curiouser’..

As I wondered in to the cozy shoe box to sit on the sofa, I was asked to put on a pair of shoes.. Theatre shoes…(See below)…

I walked around and listened via headphones to the man who had kindly donated his shoes and his story to this project. He was a specialist nurse working in A & E. He spoke about how he had to face the reality of death at work every day. Not only did he have to do this, he then also had to engage loved ones and relatives in incredibly difficult conversations and help them to make the best decisions in the darkest hours.

This nurse was able to celebrate the incredible gifts people were able to give as organ doners, and see joy in how a family was able to see a part of their departed loved ones go on… All of this was very uplifting…and there was no doubt in my mind that this nurse was indeed a superb example of the profession. However…as I walked on…I found my self wondering whether anyone asked the nurse how he was? How long could he maintain this uplifting approach whilst dealing with death and emotional pain on a daily basis? Would cracks start to appear?

I often see examples of how we celebrate this service and self sacrifice…and to nearly quote Paul Simon… every generation throws healthcare hero up the award charts!.. and so we celebrate this eternal culture of giving. I certainly empathize with this nurse, and greatly admired his approach to his work… He is a hero..but he is also very vulnerable, both psychologically and physically as he continues to give all of himself to provide the best service possible.

My worry is that the more we place service and sacrifice upon a pedestal…the further our heroes have to fall…

 

As you can see from the film above…this really is an amazing and thought provoking project, as those who visit are asked to write messages to those they now share a new found empathy with.

I would have liked to have walked a mile in all of these shoes…and perhaps some day I will have time to…as you can soon also experience this project online here. So as a lasting thought on this amazing project…I would like to repeat my mantra…which is…always be kind to yourselves… and each other….

Until next time 💛💙💜💚❤

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Maternity Transformation programme: Delivering the 2020 Vision at #Expo16NHS #MatImp #MatExp #BetterBirths #BUMP

Two experiences really stuck out for me at this years NHS Expo (2016) and one of these experiences, was a session looking at how we now move on to make the Maternity Transformation programme a reality. I was honored to be invited to join this session, and was keen to see how things were progressing. The session was hosted by Sarah-Jane Marsh (@BCHBoss), CEO of Birmingham Children’s Hospital and now Birmingham Women’s too, Sarah-Jane is now also leading the work on the NHS England Maternity Transformation programme delivery.

Throughout the session, Sarah-Jane spoke passionately about how we might now see real change….All of us in the room were no longer talking about change…we were signing up to make it happen.

See programme here: Maternity Transformation programme: Delivering the 2020 Vision

Following Sarah-Janes introductions and visions for the programme, we were invited to join a live panel debate. This was very much an interactive question and answer session with some very highly motivated maternity experts (as you can see below!)

live-debate

This session was  filled with new ideas about how we can all come together using primary care and social services as key partners to implement #BetterBirths for all. Recommendations were that local maternity systems should support women’s participation in making new changes. Clinical networks and community hubs were also cited as ways to create and spread change. But at the heart of all this, it was clear that everyone can do their own little bit to implement the recommendations from the Better Births report. 

panel

As you know…for me, I do not believe that excellence in maternity care is achievable without the provision of a thriving and healthy maternity workforce, who can enjoy a psychologically safe professional journey. Therefore, I shall keep working towards effective support for midwives in order to create better births for women and their babies.

As a lived example of how one maternity unit is implementing real change, we were also introduced to the B.U.M.P @Project_BUMP

First…we see where we are… what do we have and what do we want to change…what is working? What is failing us?…Lets make a realistic plan!

As women’s circumstances change throughout pregnancy (as may also their decisions and choices)…any new system must be flexible enough to respond quickly to the needs of both women and staff. This model ensures that the journey through maternity services can be enjoyed in partnership with the right staff, with access to the right support.

In revising the pathways of maternity care, we are ensuring that we can provide services that meet the needs of every woman and staff member. Yet women must be able to move freely between these pathways as required. We must also move towards and help women to engage with the most appropriate pathways for them and their families. Often we know that the most appropriate pathway for women is midwifery led care….and so here we must increase capacity. We must also engage, educate and empower women to embrace this midwifery led model of care (where appropriate) as we work in partnership with them to achieve the very best in maternity care outcomes.

 

pdca_cycle

We also heard wonderful success stories from the University Hospitals of Morecambe Bay who were really using the ‘Plan, Do, check, Act’ tool to snowball their improvement activities…

And of course the  team were also rocking out the session in their usual style. However, I was personally most touched by the women who came along to this session in order to share their stories.

A powerful poem by ….

A poem inspired by @HeartMummy….

These experiences are always so powerful to hear, and really reinforce how the ripples of everything we do can resonate in both the smallest and largest ways. We must keep sharing…Thank you.

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#MATEXP COMPETITION – WIN A ‘WHOSE SHOES?’ WORKSHOP!

Great quotes from the session…

‘Pizzas are Delivered, Babies are Birthed’

‘We all have a part in bringing to life’

‘There are 28 recommendations. All important. Don’t cherry pick!’

‘Failure to dilate ? Incompetent cervix ? What do such words do to women ?’

‘The energy in Birmingham for & is infectious! programme’

Hashtags:    

The Maternity Transformation team are are now calling for expressions of interest from local maternity systems to test models of care to improve maternity services. Local maternity systems will need to align with Sustainability and Transformation Plan (STP) footprints, and so applications will need to be supported and approved by the identified leads for the STP footprint areas. Completed applications should be submitted to the Maternity Transformation Programme team by email to england.maternitytransformation@nhs.net by Monday 19 September 2016.

Have you signed up?

There is a real enthusiasm here for real change in the maternity services. It is where life begins, and it is here that we have the largest opportunity to get things right for our future. Let’s make sure we take every opportunity to get things right.

Until next time…Look after yourselves..and each other 💛💙💜💚❤