0

Exploring ‘obstetric violence’ and ‘birth rape’

trauma hiding.jpg

Recently, the wonderful Ibone Olza (Perinatal Psychiatrist and Childbirth Activist from Childbirth is Ours, Spain) contacted me about her work on obstetric violence, birth rape and professional trauma. After reading her papers and watching her present her work, I was compelled to document and reflect upon some of the issues raised, here.

The following points are made within the paper: Fernández, Ibone Olza. “PTSD and obstetric violence.” Midwifery today with international midwife 105 (2013): 48-9.

Birth trauma has been defined as “Actual or threatened injury or death to the mother or her baby” (Beck 2008). Yet such trauma lies in the eye of the beholder, therefore, any trauma experienced by either the mother, newborn or the birth attendant may be due to a subjective experience of stress which does not need to fit any particular criteria necessarily. This means that some traumatic events may be subjective in their nature, and as such, we cannot judge what may or may not cause another person trauma. It is a personal interpretation or perception.

A meta-ethnographic analysis of studies about women’s perceptions and experiences of a traumatic birth reported that women are often traumatized as a result of the actions or inactions of midwifery staff (Elmir et al. 2010). Whatever, such inactions or actions may be…women often use words such as ‘barbaric’, ‘intrusive’, ‘horrific’ and ‘degrading’ to describe their mistreatment (Thomson and Downe 2008).

For Hodges, drugging or cutting a pregnant woman with no medical indication is an act of violence, even when performed by a medical professional in a hospital. Inappropriate medical treatment is also clearly abusive, although few women are aware that this is deliberate mistreatment (Hodges 2009).

The term ‘birth rape’ has been used by women who feel that their bodies have been violated. Kitzinger highlighted that many women who have experienced a traumatic birth display similar symptoms to rape survivors (Kitzinger 2006). The video below explores these issues in greater detail, as we can hear the lovely  Ibone Olza  sharing this work.

 

One of the things I was most encouraged about, was that  Ibone Olza  considers the wellbeing of the midwifery staff in her work. Birth attendants are often also traumatized by these acts, and may feel powerless to intervene. In a recent study by Beck, 26% of obstetric nurses met all the diagnostic criteria for screening positive for PTSD due to exposure to their patients who were traumatized (Beck and Gable 2012). Being present at  abusive deliveries can magnify staffs’ exposure to birth trauma.

staff use phrases such as…

“the physician violated her”

“a perfect delivery turned violent”

“unnecessary roughness with her perineum”

“felt like an accomplice to a crime”

“I felt like I was watching a rape.”

….to describe the guilt that ensued when they felt like they had failed women or they did not speak up and challenge/question…

Article 51 establishes that: The following acts implemented by health personnel are considered acts of obstetric violence:

  1. Untimely and ineffective attention of obstetric emergencies
  2. Forcing the woman to give birth in a supine position, with legs raised, when the necessary means to perform a vertical delivery are available
  3. Impeding the early attachment of the child with his/her mother without a medical cause thus preventing the early attachment and blocking the possibility of holding, nursing or breastfeeding immediately after birth
  4. Altering the natural process of low-risk delivery by using acceleration
    techniques, without obtaining voluntary, expressed and informed consent of the woman
  5. Performing delivery via cesarean section, when natural childbirth is possible, without obtaining voluntary, expressed, and informed consent from the woman

(D’Gregorio 2010)

trauma

Yet whilst people do bad things, it is important to remember that they are not necessarily bad people…

This work explains how professionals may exert obstetric violence due to:

  • Lack of technical skills to deal with emotional and sexual aspects of childbirth.
  • Unsolved trauma. The medicalization of childbirth produces more severe iatrogenic
    complications (Johanson, Newburn and Macfarlane 2002; Belghiti et al. 2011). If the
    professionals do not have a supportive space to reflect or to deal with this aspect of iatrogenic care, they may fall into a spiral of continuously increased medicalization as a defensive strategy. Childbirth is then perceived as a very dangerous event, “a bomb ready to explode,” without realizing that interventions cause more unnecessary interventions and pain.
  • Professional burnout in birth attendants will lead to increased dehumanized care and therefore never-ending figures of women experiencing childbirth as very traumatic.

..and so the challenge will be to identify and address these root causes to ensure that maternity staff are able to provide excellence in midwifery care. My work explores how we might support the psychological wellbeing of health care staff may increase levels of humanity and compassion in care. I hope to keep in touch with Ibone Olza and many others around the world who share the same passion for this work. Together we may collectively work towards a time where maternity workers are psychologically safer, and therefore better able to provide the excellence in care they strive to give.

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

Follow me via @SallyPezaroThe Academic MidwifeThis blog

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

References and further reading

  • Soet JE, Brack GA, DiIorio C. Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth 2003 Mar;30(1):36-46.
  • Creedy DK, Shochet IM, Horsfall J. Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth 2000 Jun;27(2):104-111.
  • Ayers S, Pickering AD. Do women get post traumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth 2001 Jun;28(2):111-118.
  • Beck CT, Gable RK, Sakala C, Declercq ER. Post traumatic stress disorder in new mothers: results from a two stage U.S. national survey. Birth 2011 Sep;38(3):216-227.
  • Allen S. A qualitative analysis of the process, mediating variables and impact of traumatic childbirth. Journal of Reproductive and Infant Psychology 1998;16(2-3):107-131.
  • Beck CT, Watson S. Impact of birth trauma on breast-feeding: a tale of two pathways. Nurs Res 2008 Jul-Aug;57(4):228-236.
  • Beck CT. Post-traumatic stress disorder due to childbirth: the aftermath. Nurs Res 2004 Jul-Aug;53(4):216-224.
  • Beck CT. Birth trauma: in the eye of the beholder. Nurs Res 2004 Jan-Feb;53(1):28-35.
  • Ayers S. Delivery as a traumatic event: prevalence, risk factors, and treatment for postnatal posttraumatic stress disorder. Clin Obstet Gynecol 2004 Sep;47(3):552-567.
  • Olde E, van der Hart O, Kleber R, van Son M. Posttraumatic stress following childbirth: a review. Clin Psychol Rev 2006 Jan;26(1):1-16.
  • Elmir R, Schmied V, Wilkes L, Jackson D. Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. J Adv Nurs 2010 Oct;66(10):2142-2153.
  • Nicholls K, Ayers S. Childbirth-related post-traumatic stress disorder in couples: a qualitative study. Br J Health Psychol 2007 Nov;12(Pt 4):491-509.
  • Ayers S. Thoughts and emotions during traumatic birth: a qualitative study. Birth 2007 Sep;34(3):253-263.
  • Thomson G, Downe S. Widening the trauma discourse: the link between childbirth and experiences of abuse. J Psychosom Obstet Gynaecol 2008 Dec;29(4):268-273.
  • Goldbort JG. Women’s lived experience of their unexpected birthing process. MCN Am J Matern Child Nurs 2009 Jan-Feb;34(1):57-62.
  • Sawyer A, Ayers S. Post-traumatic growth in women after childbirth. Psychol Health 2009 Apr;24(4):457-471.
  • Hodges S. Abuse in hospital-based birth settings? J Perinat Educ 2009 Fall;18(4):8-11.
  • Kitzinger S. Birth as rape: There must be an end to ‘just in case’ obstetrics. British Journal of Midwifery 2006;14(9):544-545.
  • Beck CT. The anniversary of birth trauma: failure to rescue. Nurs Res 2006 Nov-Dec;55(6):381-390.
  • Beck CT, Gable RK. A Mixed Methods Study of Secondary Traumatic Stress in Labor and Delivery Nurses. J Obstet Gynecol Neonatal Nurs 2012 Jul 12.
  • Perez D’Gregorio R. Obstetric violence: a new legal term introduced in Venezuela. Int J Gynaecol Obstet 2010 Dec;111(3):201-202.
  • Callister LC. Making meaning: women’s birth narratives. J Obstet Gynecol Neonatal Nurs 2004 Jul-Aug;33(4):508-518.
  • Johanson R, Newburn M, Macfarlane A. Has the medicalisation of childbirth gone too far? BMJ 2002 Apr 13;324(7342):892-895.
  • Belghiti J, Kayem G, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case-control study. BMJ Open 2011 Dec 21;1(2):e000514.

 

 

Advertisements
1

Why we should welcome feedback and listen to those who raise concerns in both healthcare and research

Criticism and feedback can feel uncomfortable to both give and receive. It can be an awkward exchange, where both parties may be reluctant to let their guard down, concede to oversights, reveal any flaws and relinquish any feelings of responsibility. It can also be incredibly frustrating on both sides.

Image result for writing frustration

But lets look at both sides of the coin rationally. Firstly, Why would someone offer feedback?

  • They want to make something better
  • They see an opportunity to improve something
  • They want to help you
  • They want something corrected
  • You, or someone else have asked them for feedback
  • They want to offer you their unique outsider/fresh eyes view of something that you may not be privy to.

These are all gifts, learning opportunities and avenues toward creating our best outputs. Here, we theorise that everyone who offers feedback has good intentions, which some may argue is unrealistic and naive. However, I am personally unwilling to lose out on the potentially invaluable gold dust of feedback for the sake of those who wish to meddle in mischief. The vast majority of those who enter both the healthcare and academic professions do so in order to contribute positively.

In order to feel valued and perform to the best of their abilities, healthcare staff must feel heard. This is the same for those in research. As such, whether we agree with the feedback we are given, it must be heard, examined, considered and then either acted upon or rebutted respectfully.

If you are doing your best, feel passionately about what you are trying to achieve and have worked hard to achieve something amazing, it can be hard to hear that there may be cracks in your work, despite all of your well intended efforts. You are also in the job to give your best and contribute positively. But you cannot know everything…so keep listening to those who have the ‘fresh eyes’ to see what you may not.

Image result for ICEBERG OF IGNORANCE

Denial only denies you an opportunity to do better.

Lets look outside the box:

What is going on here?

Restaurant owner:

  • Wants her food to be good
  • Believes she has done her best
  • Defensive and protective about her achievements

Customer & Gordon Ramsey:

  • Wants good food
  • Wants mistakes corrected
  • Wants things to be better
  • Wants to be helpful and constructive
  • Has a new ‘Fresh eyes’ perspective from outside the organisation

The negative response to this feedback could mean:

  • The customer probably won’t return to the restaurant
  • The customer will avoid offering any further feedback
  • A missed opportunity to make things better
  • The expert will at some point back away from offering further assistance
  • The restaurant may fail to reach its full potential

FYI – These restaurant owners always achieve great things for their restaurants once they listen and act upon feedback

Reflection: Can we apply these roles to some of the roles active healthcare and research? (Including our own)!

Don’t despair!… If you get everything right, all of the time, you miss new opportunities to learn

Image result for take a chance

Some of my early academic papers were really very terrible. Some of the work I do now is muddled at first. I make mistakes, everyone does. I am in no way perfect, nor do I alone have all of the skills to change the world. I need help. I welcome help and input from those who can fill in for the skills I do not have and the knowledge I cannot yet see. This is why I welcome feedback and listen to those who raise concerns. In fact I grab every opportunity to do so.

In exchange for this, my work improves, I see new opportunities to thrive, new ideas are generated and collective collaborations make our outputs much stronger. Success.

If I had been steadfast in feeling that because I was so passionate about the work I was doing, nothing could possibly be wrong with it, then I would have missed the chance to create something better. Yes, it used to be frustrating to hear criticism. But this frustration can be turned around.

Once you see that a criticism is not a personal attack, it becomes a welcome guest.

Image result for welcome

More recently, I had a paper accepted ‘No revisions required’. I was worried. I wanted feedback, I wanted changes made, I wanted other people to weigh in on my work and check for anything I may have missed. This is because I knew it would be a stronger paper having been ripped apart and then put back together again….made better.

Everything I have ever done has always been made better when others have offered their ‘fresh eyed’ feedback. Here are my top tips for making the most out of feedback.

  • Welcome and invite it
  • Listen to it, consider it and evaluate it
  • Let down your defenses (It is not an attack – people want to help)
  • Feedback on your feedback – Tell them how it was used
  • Actively search for those who can offer a ‘fresh eyed’ perspective on your project
  • Never attack those who offer you valuable feedback (They will avoid doing it again!)
  • Know that it is OK not to be perfect, you cannot do everything all of the time
  • Avoid blinkered approaches like ‘I know what is best’ & ‘Nothing can be wrong because I worked so hard for it not to be’.
  • Offer your own feedback to others – It will not only help them, but it will make you feel good and contribute toward the collective goal!

We all want to be the best we can be. We need to role-model and make things better for everyone. We need to lift each other up with support and praise.

Let go of your defenses and welcome new opportunities for success.

Free stock photo of typography, school, training, board

Until next time, look after yourselves and each other 💙💜💚

 

0

Mentorship in healthcare and research: Role modelling for excellence

Image result for bad mentor

Mentoring, coaching, role modelling, training…. leading….Whatever you want to call it, I would be nothing without it. That phrase was once hurled at me as an insult…

YOU WOULD BE NOTHING WITHOUT ‘X’ – Well yes..That is true.

Image result for mentor

Workplace cultures in healthcare and research are created and shaped by what we do rather than what we say. Simply put, the way we behave is how we end up living. Although we can all be influenced by what we see, hear and experience …YOU can choose how you will and won’t behave. You can equally decide what behaviour you will and will not accept from others. But who will show us the way we want to go?

Image result for behave how you want to live

As I remember training to be a midwife, many people said …”‘take the good bits and leave the bad bits’ out of your own practice, as you develop and grow alongside your mentor”. I did this, and yet it took me a long time to define who I wanted to be as a professional. Some mentors were good, and some mentors less so – personal preference perhaps?… Many tried to direct the way in which they wanted me to go, and it took great courage for me to challenge this directive behaviour. However, as my career progressed, I was able to study Leadership in health and social care at Masters degree level. This really helped me to understand the theories behind good and bad mentorship…

Image result for good mentorship

A good mentor:

  • Has confidence in you
  • Trusts you
  • Empowers you
  • Gives constructive feedback
  • Wants you to succeed
  • Supports your new ventures
  • Listens to your new ideas
  • Identifies your strengths and helps you develop them into constructive outputs
  • Identifies your weaknesses and helps you manage them effectively
  • Shares their wisdom
  • Gives you wings to fly
  • Behaves with integrity, professionalism and dignity
  • Inspires you
  • Is kind to you (and others)!
  • Feeds your passions and thirst for new opportunities
  • Invites you into their network of expertise
  • Grows with you as you as a professional

A bad mentor:

  • Is concerned only with their own success
  • Talks about doing things that never happen ‘All talk’
  • Is always negative about everything and everyone
  • Is never around
  • Cannot commit to your development
  • Bullies you
  • Dictates how you must behave
  • Doesn’t pay attention to the way you would like to develop professionally
  • Never admits when they are wrong
  • Refuses to believe that you may know more than them in certain areas
  • Compares you with others (negatively)
  • Never lets you progress
  • Kills your confidence
  • Makes you feel bad about yourself

Once you find your way, it is important to find the courage to decide which behaviours you are willing to accept, and to role model yourself for the benefit of others. These are important choices to make, as they will contribute to the cultures in which you and your colleagues will be working. Ask yourself the following:

Image result for question time

  • What do you need in order to be productive?
  • What do you need from others in order to thrive professionally?
  • How do you want to behave?
  • What are you willing to accept?

The answers to these questions must be acted upon. Have the courage to communicate these needs…Others will want you to succeed, they will appreciate this information…

…If not…..are you willing to accept that?

My final tip for ultimate success is to find your flock. Gravitate towards those who inspire you… hang around with those who allow you to fly…. learn from those who lift others up and share your thoughts with those who seek out change.

I would be nothing without my ‘Flock’…my wonderful mentors and my inspiring colleagues.

Each and every one of us ‘mentor’ a growing professional every day (whether we realise it or not)! Therefore each and every one of us needs to decide how we want to behave every day..We all create the workplace cultures, leaders and workforce of the future. Lets create something wonderful…

Image result for success

Thank you to all of you wonderful mentors out there….

Until next time, look after yourselves, and each other 💙💜💚

0

The #DNAofCare …Listening to #NHS staff Stories #Exp4ALL

dna-of-care

This excerpt from Patient Voices explains  what this project is about…”Just as care in the NHS is free at the point of need, NHS staff carry within them a vast reservoir of expertise and experience that is free at the point of telling: their unspoken, unheard stories of care and caring.

The intertwined relationship between patient care and staff well-being has been likened to the double helix. And so the stories we tell each other are like the DNA of care, transmitting information and shaping cultures, offering learning opportunities and, sometimes, healing.

There is often a cost to gathering these stories, but… as the wonderful Dr. Karen Deeny (Head of NHS staff Experience from NHS England) explains…

In the first half of 2016, NHS England funded Patient Voices workshops for staff to create their own digital stories about working in healthcare. The intention is that the stories will be used to help other people understand the reality of working in healthcare so we may all learn from experiences, both good and bad; sharing stories in this way helps contribute to healthcare that is safer, more dignified, more humane and more compassionate for everyone.”

Image result for ica london

The event in London on the 2nd November 2016 was a showcase and celebration of these stories, in a bid to make real change and create new knowledge and understanding within the healthcare services. I really enjoyed the day, made some wonderful reflections and saw some real transformations. I was honored to be there and hear these private, powerful and passionate NHS staff stories shape the DNA of the care that we all give.

We sat in a wonderfully intimate London Cinema patiently waiting to hear the stories and insights from NHS staff in relation to a multitude of clinical and very personal events. The storytellers were able to introduce their stories personally, having created them over a period of 3 days, where they had clearly invested their heart and souls in communicating the greatest joys and pains of their work and their lives as they experienced them.
Thank you for sharing.
All of the staff stories can be accessed here… But for me, the most powerful story was Claudia’s story…’Pieces’..
Claudia has worked and lived in different countries, and different parts of one country. Medicine, healthcare, cannot save everyone and when death, severe illness or harm happen unexpectedly ,a serious untoward incident (SUI) has to be reported. This is one story of one incident and one team in a hospital somewhere.
This story really shows how an entire team of staff can be directly affected by a patient event. This is really poignant when we look at a case from the ‘back door’… the ‘locked door’ that most of us rarely think of or see. When a patient dies….we are patient and family focused. It perhaps feels selfish or wrong to think of the pain, fear and blame that staff may simultaneously be feeling….Feelings of ‘What if’.
Lessons are learnt and improvements are made. But the staff may leave, react poorly or feel unable to go on. They will also be shaken to the very core….their professionalism and competency tested to the limits of idealized ‘coping’. Nobody can take ‘The magic resilience pill’ for this.
As a midwife, I could personally relate to the story graciously shared by Rachel Scanlan (@rgscanlan) – There are no words to really add to this deeply emotive story. To me it was actually an experience to be seen and reflected upon in private silence. The respect and dignity of the events shared are highly personal, and yet I know that many midwives will be able to relate to these same thoughts, feelings and experiences. The tenderness described between those involved is truly heartwarming. I can only wish for greater targeted support for those midwives who share these emotionally laborious life experiences in partnership with colleagues and the families they care for. Thank you for sharing this. I will certainly be sharing this story in order to drive better outcomes for maternity services and the midwifery profession as a whole.
It was poignant that we listened to emotional NHS staff stories on . There were many strong messages I took from the day.

Dr. on the importance of a positive Staff experience. “It’s not an ‘indulgence’…it drives better outcomes!”

 

Two final thoughts or observations for me were as follows. It was seemingly the brightest and most passionate NHS staff who had been worn down and disenchanted by their NHS workplaces, having been left unheard and unsupported. These bright sparks were then moving into academia where their ideas and talents can be nurtured and turned into really meaningful change. In essence, we are loosing the brightest talent from front line services, as they are told to ‘keep their heads down and get on with the job’. This experience resonates with me personally as I too.

Ultimately it is this message that I took from the day…

It is also this message that I intend to take forward in my own collaborative work projects. The collaborations and inspired connections that I made at this event makes me ever more hopeful that we will all come together with this shared vision and drive to make things better.

The way we intend to make things better is by focusing on the relationship between the NHS patient experience and the NHS staff experience….the .

As you can imagine, the Twitter activity on this event was fairly inspiring -> Check out  for more reflections from this event…

0

Our new research needs to know what #ShowsWorkplaceCompassion – Use the hashtag to let us know

In addition to my PhD work, I am currently working with NHS England and Coventry University on a new work programme which looks at how we might improve the staff experience in healthcare work. This new research needs to know what #ShowsWorkplaceCompassion, so that we can inform new initiatives and define what it is that we need to do in order to improve the workplace experience for healthcare staff. To do this, we need those who work in healthcare to use the hashtag (ShowsWorkplaceCompassion) on twitter to share their thoughts.

Examples might be:

‘Letting me take my lunch break #ShowsWorkplaceCompassion’

‘Finishing the meeting on time #ShowsWorkplaceCompassion’

‘Respecting my work/life balance #ShowsWorkplaceCompassion’

You can follow the research account on Twitter: @NHSStaffExp and me on Twitter @SallyPezaro. I also wanted to thank @FabNHSStuff for sharing the information on this project here

We plan to analyse all of the tweets that contain the hashtag #ShowsWorkplaceCompassion and produce a research report that consolidates all of our findings in order to share them with the wider healthcare community, policy makers and whose who are looking to implement change.

Please read and share the full details of this project here -> http://bit.ly/22HurbF

You can tweet as many or as few times as you like about any aspect of healthcare….Just make sure that you include #ShowsWorkplaceCompassion in your tweet in order to take part.

If you choose to take part in the #ShowsWorkplaceCompassion research campaign, please read the information which tells you all you need to know about being a participant.