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Merry Go Round! Are you an 'older monkey'? Are you throwing poo?

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Merry Go Round! Are you an 'older monkey'? Are you throwing poo?

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Love this episode! :) Blog post by Gill Phillips, co-founder of #MatExp

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I am a big fan of the Obs Pod. It is such a wonderfully simple and yet creative idea. Florence Wilcock, a highly experienced consultant obstetrician, muses and reflects each week on different aspects of maternity care. I don't think anyone has done this before ... and certainly not in Flo's unique style.

The Obs Pod has become a phenomenal resource. I think it is time for it to be shared very widely on all the main maternity websites. Or perhaps it is too radical, too real ?

Many of the podcasts include really practical information and insights that many pregnant women, new parents and families would benefit from greatly. Other parts will appeal more to healthcare professionals or students looking at career paths - there is something for everyone.

In typical #MatExp style, Flo's many friends and followers are being drawn in to help.

I wanted to create a more visual way to search by topic and theme and enable people also to dip into Flo's many blogs and videos, so I made this new Padlet, themed in line with the key categories of the Ockenden review, a bit like a mini website. I was thinking about how best to collate the 'zesty bits', which pick out the weekly action points but was beaten to it by Deepa Santosh, leaping forward with a plan to create infographics. How amazing would that be!

That is the nature of the #MatExp community - energy draws in more of the same and people find themselves going the extra mile, innovating to amplify each other's stories.

As the creator of Whose Shoes, my interest in the Obs Pod is more to understand the world of the NHS, its behind-the-scenes ebbs and flows, the targets, the politics.

So when I saw the title of this weeks episode - 'Merry-go-round', I got excited. I thought this was going to be a trip behind the scenes, a look back-stage, so to speak. I was not disappointed. In fact I think this episode takes the podcast series to new heights. It is bold, it is real - it is a tour de force, skilfully combining the voice of experience, observing constant movement that doesn't necessarily go anywhere, with the joy and potential offered by a constant flow of fresh-faced innovators. I expected it to be challenging; I certainly didn't expect it to include older monkeys sitting in the trees throwing poo at the upstart younger monkeys below. What a brilliant analogy. 😂

Now, you simply have to listen to it, don't you? Episode 58 Merry Go Round (buzzsprout.com)
So here are my reflections on the merry-go-round episode and how it resonates with my work:

Reinventing the wheel is a time-honoured tradition, particularly in public services.

As an even older monkey than Flo, and having spent many years working in local government, the image I have regularly seen is more of a concertina. The love of endless reorganisation. Structures moving from national to regional to local and back again, several times. Departments merging and then dividing again. Playing a merry tune possibly, but achieving very little.

The image I often have in my mind about the development of Whose Shoes has Merry-go round elements, but is rather more optimistic. It looks like this:

Things go round in circles but simultaneously build.

Seeds are scattered but often seem to fall on stony ground; they lie dormant but then might be gathered up in the breeze and germinate elsewhere: a different project. Flo refers to this with regard to our 'Nobody's Patient' project. It has been frustrating to see how much support there was for our initial work but then, apart from a few rare exceptions such as the extraordinary work in Liverpool, very little effort to use the resources, even though they are now available in at about 80 NHS trusts. Obviously Covid hasn't helped any of this, but I am talking pre-Covid. It is as if it is 'Nobody's Project': consigned to the 'too difficult' box because it actually requires work between departments and organisations, rather than just sitting neatly within one sphere of command.

I have become a philosophical monkey and generally don't throw too much poo. I sometimes get ranty, but hopefully not too often because then people switch off - I think they are more likely to be listening when you are generally positive and then ... go ballistic from time to time.

Change takes time. Culture change in particular takes time. The most powerful #MatExp Whose Shoes concept is our 'lemon lightbulbs' - our belief that people come to their own realisation, they 'get' it; and then this influences their behaviour from that day onwards, not just being told something on a training course .

External things can influence to a point, certainly we can create the conditions for lemon lightbulbs to happen. But it is when people see for themselves what needs to change, and hearts and minds are engaged, that real change happens.

Impatient people like Florence, like Helen Calvert, like Joanne Minford who just grab change by the horns and run with it, are the unusual ones; they are very special leaders who drive us all. I am so proud and privileged to work with such amazing people.

In 2008, I jumped ship from my day job to create Whose Shoes. It has always been a coproduction tool, essentially the same tool as it has always been.

Flo and I talk about tipping points (the same now applies to her podcast and what will help it truly take off). I have learnt that tipping points come and go. But the underlying spiral keeps building. That is probably a more sustainable model?

Fast forward to 2021. Apparently, learning from Covid, the NHS has embraced coproduction at the highest levels. The corridors of power, no less. Coproduction is now to be the 'default way of working'. The way we do things around here. I am on the Coproduction Task and Finish group - Flo's 'Merry Go Round' podcast suggests that this is a very optimistic title, but I will try to be a well-behaved monkey and remain optimistic.

However, I do see a fundamental tension between a) wanting to predetermine the outcomes whilst getting people with lived experience to work with you to achieve them and b) genuinely listening and involving people and valuing the ideas equally at every step of the journey, which by definition might lead to a totally unforeseen outcome. It is exciting, it is scary. It takes a leap of faith. And probably more time than a Task and Finish timeframe - we'll see!

Flo includes a lovely section about her Random Coffee Trial (RCT) meeting with Andrea Gibbons and talks about the power of both formal and informal networking. Networking, for me, is the most underrated QI methodology, but it is catching on.

Things like RCTs would not have happened 10 years ago. Why, when you are so busy, would you randomly meet up with someone that you had never even heard of?

Shock! Horror! Probe! What if you meet .someone who is more senior or more junior than you - the hierarchy in tHe NHS is very strong, so it is good to see our #NoHierarchyJustPeople mantra gaining ground.

In my Whose Shoes work, I will frequently try and link hospitals and teams and ask if they are already connected? The answer can be defensive. Yes, yes they say - but in practice, it is frequently the Heads of Department who are connected. What about the rest of the team?

It is so energising to find an opposite number in another trust who is struggling with the same challenges as you. You can help each other, you might well become friends - it can be fun. Finding our shared humanity is a key theme that runs through all of our work. It cuts through perceived barriers.

I have often felt that some people in the upper echelons of the NHS love Whose Shoes until they hate it. It can be seen as opening a can of worms. It takes a level of confidence and belief to do true coproduction - to uncover the real issues and find out what people think, and then work together to do something about it. Most of the people I work with are passionate leaders; they get this and we make the magic happen together.

Flo gives a really wonderful shoutout in the podcast to my networking skills:

"Gill Phillips @WhoseShoes, who I do so much of my maternity experience work with, is a wonder at networking. she's absolutely amazing at building connections, introducing people with ideas that may work together, lending things from one area of her work to another and also networking people up and down the country. We''ve recently done a couple of workshops on Zoom on continuity of care and we have linked various different hospitals and individuals from different hospitals so they can share ideas on what their approach is and try and test out different ideas together and learn and benefit from that experience."

I genuinely love connecting people, in fact I can't stop myself. I worry that I can be a bit of a pain - I see people doing amazing things and know that they will be stronger together. I link them in my tweets and smile like a Cheshire cat when they connect, especially if they go on to meet in person. It is important. It can be life-changing.

As Flo says, I am now looking to use the 'Nobody's Patient' resources with new networks of people who are interested in improving the working relationships between maternity and neonatal care. A lot of serendipity is happening, The right people are coming forward, and it feels good. No merry-go-rounds in sight.

Flo's podcasts always end with zesty bits. Please listen to her top tips this week on how to avoid going round and round in circles.

Networking to learn and share and NOT keep re-inventing the wheel.

Listen to women and families, particularly flagging up the simple things that can so easily be changed.

Final thought: It was lovely to see the photo of Flo enjoying the merry-go-round. It felt very symbolic. Here I am as a young mum, celebrating my daughter's first birthday.
What goes around, as they say, comes around. Keep going. 😉

I am a big fan of the Obs Pod. It is such a wonderfully simple and yet creative idea. Florence Wilcock, a highly experienced consultant obstetrician, muses and reflects each week on different aspects of maternity care. I don't think anyone has done this before ... and certainly not in Flo's unique style.

The Obs Pod has become a phenomenal resource. I think it is time for it to be shared very widely on all the main maternity websites. Or perhaps it is too radical, too real ?

Many of the podcasts include really practical information and insights that many pregnant women, new parents and families would benefit from greatly. Other parts will appeal more to healthcare professionals or students looking at career paths - there is something for everyone.

In typical #MatExp style, Flo's many friends and followers are being drawn in to help.

I wanted to create a more visual way to search by topic and theme and enable people also to dip into Flo's many blogs and videos, so I made this new Padlet, themed in line with the key categories of the Ockenden review, a bit like a mini website. I was thinking about how best to collate the 'zesty bits', which pick out the weekly action points but was beaten to it by Deepa Santosh, leaping forward with a plan to create infographics. How amazing would that be!

That is the nature of the #MatExp community - energy draws in more of the same and people find themselves going the extra mile, innovating to amplify each other's stories.

As the creator of Whose Shoes, my interest in the Obs Pod is more to understand the world of the NHS, its behind-the-scenes ebbs and flows, the targets, the politics.

So when I saw the title of this weeks episode - 'Merry-go-round', I got excited. I thought this was going to be a trip behind the scenes, a look back-stage, so to speak. I was not disappointed. In fact I think this episode takes the podcast series to new heights. It is bold, it is real - it is a tour de force, skilfully combining the voice of experience, observing constant movement that doesn't necessarily go anywhere, with the joy and potential offered by a constant flow of fresh-faced innovators. I expected it to be challenging; I certainly didn't expect it to include older monkeys sitting in the trees throwing poo at the upstart younger monkeys below. What a brilliant analogy. 😂

Now, you simply have to listen to it, don't you? Episode 58 Merry Go Round (buzzsprout.com)
So here are my reflections on the merry-go-round episode and how it resonates with my work:

Reinventing the wheel is a time-honoured tradition, particularly in public services.

As an even older monkey than Flo, and having spent many years working in local government, the image I have regularly seen is more of a concertina. The love of endless reorganisation. Structures moving from national to regional to local and back again, several times. Departments merging and then dividing again. Playing a merry tune possibly, but achieving very little.

The image I often have in my mind about the development of Whose Shoes has Merry-go round elements, but is rather more optimistic. It looks like this:

Things go round in circles but simultaneously build.

Seeds are scattered but often seem to fall on stony ground; they lie dormant but then might be gathered up in the breeze and germinate elsewhere: a different project. Flo refers to this with regard to our 'Nobody's Patient' project. It has been frustrating to see how much support there was for our initial work but then, apart from a few rare exceptions such as the extraordinary work in Liverpool, very little effort to use the resources, even though they are now available in at about 80 NHS trusts. Obviously Covid hasn't helped any of this, but I am talking pre-Covid. It is as if it is 'Nobody's Project': consigned to the 'too difficult' box because it actually requires work between departments and organisations, rather than just sitting neatly within one sphere of command.

I have become a philosophical monkey and generally don't throw too much poo. I sometimes get ranty, but hopefully not too often because then people switch off - I think they are more likely to be listening when you are generally positive and then ... go ballistic from time to time.

Change takes time. Culture change in particular takes time. The most powerful #MatExp Whose Shoes concept is our 'lemon lightbulbs' - our belief that people come to their own realisation, they 'get' it; and then this influences their behaviour from that day onwards, not just being told something on a training course .

External things can influence to a point, certainly we can create the conditions for lemon lightbulbs to happen. But it is when people see for themselves what needs to change, and hearts and minds are engaged, that real change happens.

Impatient people like Florence, like Helen Calvert, like Joanne Minford who just grab change by the horns and run with it, are the unusual ones; they are very special leaders who drive us all. I am so proud and privileged to work with such amazing people.

In 2008, I jumped ship from my day job to create Whose Shoes. It has always been a coproduction tool, essentially the same tool as it has always been.

Flo and I talk about tipping points (the same now applies to her podcast and what will help it truly take off). I have learnt that tipping points come and go. But the underlying spiral keeps building. That is probably a more sustainable model?

Fast forward to 2021. Apparently, learning from Covid, the NHS has embraced coproduction at the highest levels. The corridors of power, no less. Coproduction is now to be the 'default way of working'. The way we do things around here. I am on the Coproduction Task and Finish group - Flo's 'Merry Go Round' podcast suggests that this is a very optimistic title, but I will try to be a well-behaved monkey and remain optimistic.

However, I do see a fundamental tension between a) wanting to predetermine the outcomes whilst getting people with lived experience to work with you to achieve them and b) genuinely listening and involving people and valuing the ideas equally at every step of the journey, which by definition might lead to a totally unforeseen outcome. It is exciting, it is scary. It takes a leap of faith. And probably more time than a Task and Finish timeframe - we'll see!

Flo includes a lovely section about her Random Coffee Trial (RCT) meeting with Andrea Gibbons and talks about the power of both formal and informal networking. Networking, for me, is the most underrated QI methodology, but it is catching on.

Things like RCTs would not have happened 10 years ago. Why, when you are so busy, would you randomly meet up with someone that you had never even heard of?

Shock! Horror! Probe! What if you meet .someone who is more senior or more junior than you - the hierarchy in tHe NHS is very strong, so it is good to see our #NoHierarchyJustPeople mantra gaining ground.

In my Whose Shoes work, I will frequently try and link hospitals and teams and ask if they are already connected? The answer can be defensive. Yes, yes they say - but in practice, it is frequently the Heads of Department who are connected. What about the rest of the team?

It is so energising to find an opposite number in another trust who is struggling with the same challenges as you. You can help each other, you might well become friends - it can be fun. Finding our shared humanity is a key theme that runs through all of our work. It cuts through perceived barriers.

I have often felt that some people in the upper echelons of the NHS love Whose Shoes until they hate it. It can be seen as opening a can of worms. It takes a level of confidence and belief to do true coproduction - to uncover the real issues and find out what people think, and then work together to do something about it. Most of the people I work with are passionate leaders; they get this and we make the magic happen together.

Flo gives a really wonderful shoutout in the podcast to my networking skills:

"Gill Phillips @WhoseShoes, who I do so much of my maternity experience work with, is a wonder at networking. she's absolutely amazing at building connections, introducing people with ideas that may work together, lending things from one area of her work to another and also networking people up and down the country. We''ve recently done a couple of workshops on Zoom on continuity of care and we have linked various different hospitals and individuals from different hospitals so they can share ideas on what their approach is and try and test out different ideas together and learn and benefit from that experience."

I genuinely love connecting people, in fact I can't stop myself. I worry that I can be a bit of a pain - I see people doing amazing things and know that they will be stronger together. I link them in my tweets and smile like a Cheshire cat when they connect, especially if they go on to meet in person. It is important. It can be life-changing.

As Flo says, I am now looking to use the 'Nobody's Patient' resources with new networks of people who are interested in improving the working relationships between maternity and neonatal care. A lot of serendipity is happening, The right people are coming forward, and it feels good. No merry-go-rounds in sight.

Flo's podcasts always end with zesty bits. Please listen to her top tips this week on how to avoid going round and round in circles.

Networking to learn and share and NOT keep re-inventing the wheel.

Listen to women and families, particularly flagging up the simple things that can so easily be changed.

Final thought: It was lovely to see the photo of Flo enjoying the merry-go-round. It felt very symbolic. Here I am as a young mum, celebrating my daughter's first birthday.
What goes around, as they say, comes around. Keep going. 😉

Twitter - Join the@MatExpBazaar!

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Merry Go Round - reponse to #TheObsPod Episode 58

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I am a big fan of the Obs Pod. It is such a wonderfully simple and yet creative idea. Florence Wilcock, a highly experienced consultant obstetrician, muses and reflects each week on different aspects of maternity care. I don't think anyone has done this before ... and certainly not in Flo's unique style.

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Obs pod perfect snapshots for trainees - exam revision & CBD opportunities!

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Obs pod perfect snapshots for trainees - exam revision & CBD opportunities!

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Really enjoyed the latest one on oxytocin which I’ve recommended to our O&G trainees. The length of the podcasts are perfect for listening in the car on commutes to and from work and make easy listening with important points to mull over and consider

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Flo Wilcock, Consultant Obstetrician, Kingston Hospital NHS Foundation Trust; Producer, The Obs Podcast

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Student midwife festival presentation Nov 2023

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Student midwife festival presentation Nov 2023

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I was delighted to talk at the maternity and midwifery forum student experience festival . You can watch my talk here

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Flo Wilcock, Consultant Obstetrician, Kingston Hospital NHS Foundation Trust; Producer, The Obs Podcast

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The Student Midwife Experience Festival 2023

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Quitting smoking is the single most important action a woman can take to improve the health of her baby. I am ashamed to say I don't know much about the best way to tackle this discussion in the antenatal clinic. In this episode I discuss some tra...

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This episode follows on directly from last week's episode on fluid balance as the urine we produce is such an important component of that balance. Hear why caring for the bladder in labour is so important and why in some labours and births a catheter tube in the bladder may be an essential part of treatment.

Want to explore more?

https://www.rcn.org.uk/-/media/Royal-College-Of-Nursing/Documents/Publications/2021/April/009-553.pdf
https://www.bladderandbowel.org/bladder/bladder-treatments/bladder-management-and-childbirth/
https://www.nhs.uk/conditions/urinary-catheters/

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

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This episode follows on directly from last week's episode on fluid balance as the urine we produce is such an important component of that balance. Hear why caring for the bladder in labour is so important and why in some labours and births a cathe...

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With a bit of a heatwave this week by UK standards we are encouraging pregnant women to drink plenty of water, but is there a downside could we actually be causing a problem? Surely water isn't harmful right?
Join me to discuss fluid balance in labour, why its important and how to manage it.

Want to know more?
https://hsib-kqcco125-media.s3.amazonaws.com/assets/documents/peripartum-hyponatraemia-findings-from-the-hsib-cohort.pdf
https://resolution.nhs.uk/wp-content/uploads/2019/02/Case-story-Hyponatraemia.pdf

You may need a hospital or institutional log in for the full article on these two but the abstracts are freely available
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/tog.12809
https://fn.bmj.com/content/98/Suppl_1/A48.2

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

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With a bit of a heatwave this week by UK standards we are encouraging pregnant women to drink plenty of water, but is there a downside could we actually be causing a problem? Surely water isn't harmful right?Join me to discuss fluid balance in lab...

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Today I am talking about the thyroid gland and what we think about if it is under or over active in pregnancy. These women are often referred to an obstetrician.

Want to know more?
https://thyroiduk.org/having-a-baby/
https://www.bda.uk.com/resource/iodine.html
Currently out for review

https://www.rcog.org.uk/media/4v3hsepc/thyroiddisordersinpregnancyvpeerreviewfinal.pdf

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

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Today I am talking about the thyroid gland and what we think about if it is under or over active in pregnancy. These women are often referred to an obstetrician.Want to know more?https://thyroiduk.org/having-a-baby/https://www.bda.uk.com/resource/iodine.html Currently out for reviewhttps://www.rc...

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Water can be used for pain relief during labour and giving birth. It has incredible benefits but why are only approximately 10% of women using water ? do we truly provide access to a birthing pool for all women? In light of the evidence of its positive effects shouldnt we be looking at this?

Want to know more?
https://bmjopen.bmj.com/content/12/7/e056517
https://www.tommys.org/pregnancy-information/giving-birth/where-can-i-give-birth/how-prepare-water-birth
https://www.nct.org.uk/labour-birth/your-pain-relief-options/water-births-and-labouring-water-questions-answered

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

# data[].attributes.attachment_link.description
Water can be used for pain relief during labour and giving birth. It has incredible benefits but why are only approximately 10% of women using water ? do we truly provide access to a birthing pool for all women? In light of the evidence of its pos...

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Episode 145 Born Before Arrival - The Obs Pod

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What is a BBA? What do we mean by born before arrival and how frequently does it happen? What are the options for women that may have experienced this in the past?Want to know more?https://www.britishjournalofmidwifery.com/content/supervision/bor…

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Episode 138 Baby's movements - The Obs Pod

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As obstetricians we can be ignorant of infant feeding issues and its not our fault incredible as it seems we have no training in this and it turns out loads of other professional don't either. To help me discuss this sometimes tricky issue I am joined by Lyndsey Hookway lactation consultant, researcher and author.

Want to know more?
https://courses.abm.support/courses/team-baby-getting-ready-to-breastfeed/ course for parents and family
https://kellymom.com/ fact sheets and advice
https://www.laleche.org.uk/ find local support
https://llli.org/ resources

https://courses.abm.support/courses/abm-breastfeeding-support-training-foundation-module/ course for professionals
https://www.unicef.org.uk/babyfriendly/training/e-learning/ e learning for professionals
https://www.breastfeedingnetwork.org.uk/drugs-factsheets/ medication and breastfeeding
https://www.bfmed.org/ for guidelines and research

You can find Lyndsey here
https://lyndseyhookway.com/
Instagram @lyndsey_hookway
Twitter @FeedSleepBond

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

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Episode 137 Infant feeding - A chat with Lyndsey Hookway - The Obs Pod

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As obstetricians we can be ignorant of infant feeding issues and its not our fault incredible as it seems we have no training in this and it turns out loads of other professional don't either. To help me discuss this sometimes tricky issue I am jo...

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A chat with Terri Gavin-Jones on her work to reduce inequality and cultural curiosity films

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Its Ok to Ask

Florence: [00:00:00] I'm welcoming today to the podcast. Teri Gavin Jones and Teri um, got in touch about a series of brilliant films and really interesting work that she has been doing. So Teri, perhaps you can just tell people a little bit about yourself and your role to start off with.

Teri: Thanks, Florence. Yeah, so hi everybody.

My name's Teri Gavin-Jones. I am a midwife first and foremost. Um, but my title is Senior Clinical Lead for Maternity and I work across an LMNS and. If you don't know what an LMNS is, because we like a lot of acronyms in the nhs, it's a local maternity and neonatal system. So I cover three different maternity units and that's um, two in Suffolk, so Ipswich and West Suffolk, and one in Colchester.

Florence: fantastic. And you got in touch with me [00:01:00] because you had made these films and the films immediately grabbed me because the title was, it's Okay To Ask. Mm-hmm. and I, I like the comedy show, the Last Leg. I dunno if you've watched that. Yeah, I know it. Yes. And they have a hashtag. Is it okay. And I really like that because you are allowed to ask all the stupid questions that might be offensive or difficult to ask.

Ah, so when you sent me these films saying It's okay to ask my interest was immediately peaked. Yes. And I thought this could be good. And um, definitely I I, I've really enjoyed watching them. But what I wanted to understand before we move on to the films is a little bit. Of background. So they're cultural curiosity films.

Yes. Um, aimed at educating or getting us to question and think [00:02:00] about the different cultures that we see within maternity care. So, would you like to tell us a bit about how this came about?

I'd

Teri: love to. So I, I really, you know, want to highlight the, the terminology and the language. So we've used cultural curiosity quite deliberately.

I think there's a lot of different phrases banded around, and a lot of it tends to be about cultural awareness training or cultural competency, which, um, really scares me if I'm honest, because I just don't feel qualified to be culturally competent. And that's not to say that I'm always striving to be it without a doubt.

But it, it terrifies me that I could do some e-learning and tick a box and be culturally competent. Yes. Because for me it's a journey, isn't it? It's just evolving the whole time. Yes. So, so I think the cultural curiosity is about us opening a conversation with [00:03:00] somebody else to say, actually, I know a bit, but I really don't know very much and I'm really relying on you to share and, and tell me your story.

So that's the first thing to say about this. And for the background, we had to submit a five year equity plan to NHS England last year. Um, every LMNS in the country did so, and you, and probably lots of your listeners will be really aware of all of the data that's coming out of Mbrrace around the Health inequalities

yes. You know, the, the disparities are quite stark and, and really startling and I know for us as maternity services, we are genuinely worried about it. And, and, and, but genuinely saying this is complicated. There's not one thing that we could do to fix it. It's multifaceted. There are many, many things. So we had to start, and where I started with was with an equity forum.

So I gathered together the leaders of our local, voluntary and community sector [00:04:00] and I said, would you come and meet with me monthly And, and just. Let the whole process be driven by you. Tell us what we're doing, just tell us and, and what we're doing wrong actually, and where are we going wrong. Mm-hmm.

that was the start of it, really. And we've got a really diverse equity forum, and we do all get together once a month and, and we meet and I say to them that, you know, I'll, I'll throw a topic out and they'll, they'll come back and talk about their community's experience within that. So that was important, I think, to, to hear and, and to learn about their voices.

And, and through that journey, uh, as a maternity service, we decided to invest some money in the voluntary and community sector. And I, I found, um, six organizations that we wanted to partner with. And we put it out to tender and we said if we, if we gave you some money and if we partnered with you, what could you do in terms of, I, I suppose lifting the profile of maternity and, and, and us engaging with that community.

We talk about those kind of [00:05:00] hard to reach or seldom heard communities. Yeah. Which again are just, uh, statements. Really upset me. You know, they, their seldom listened to is what I've discovered on this journey. So it was those communities that I went to and, and naively on the staff of this, honestly, Florence, I was so naive around, um, what I knew and, and still what I know.

And I went to one organization, which is called African Families in the uk and they're an amazing organization out in Colchester. And I met with their, um, leader, uh, she's an, a wonderful woman called Rachel Walton. And I sat down and I said, look, we know that maternity services are not doing a good job for your community.

How can we make this better? Can I come and can I survey your. Hmm. How I ask them what we could do better? Can I sit with them and ask them questions and take the survey results and get some work done around this? And she looked at me and she looked me in the eye and she said, no. No, you cannot do that.

[00:06:00] She said, you have surveyed our women nationally. You understand that black women are dying. Yes. You know that. Stop asking questions. Why don't you just start doing something about it? , lovely. Love it. I love, I I immediately loved her. I'm going to be really honest. I, I could get it. Although it set me with fear because coming from a background where we ask questions and survey people, um, You know, I, I, I, I, I said to her, well, well, what should I do?

She said, come and spend time with the community. Walk with them. Yes. Eat with them. Yes. Share their stories. You know, they wanna feel heard. Yeah. That's how I started. So I sent an email to my boss saying, if you need me, I'll be out with the African families in the uk . So, um, so we started this journey and it's a real, a real collaboration and in my head I thought if I'm really honest, that I'm the clinician, I'm gonna go to the African families in the UK and to the five other organizations cuz there are six of them.

And what I'm gonna do is [00:07:00] teach them maternity. I'm, I'm gonna, I'm gonna give them a bit of an update on maternity. Yeah. How it works. Bearing in, in mind that they work with, um, some of the organizations work with refugees and people seeking sanctuary often. Um, some of the people cannot speak English as a first language, so, so there are some real marginalized and diverse groups.

I thought, oh, I'll go, I'll go and teach them maternity. That's what I'll do, because that's my thing. Yeah. So, so I rock up to teach them maternity. Again, naive and stupid, if I'm really honest. And I completely underestimated a how, uh, amazing they all are. And be my knowledge in, in terms of I had to sit and listen and learn before I could really share any of my skills or experience with them.

Yes. And that's, that's been profound. They taught me so much. Um, and you know, the, it's, it's about taking maternity as I know it. And turn it on its head and saying, right, well you drive it, then what, what do you need? And, and let's listen to [00:08:00] you. So that was a real journey. Um, there's another organization in Ipswich that I'm working with called Phoebe and Phoebe work with.

Um, they're a feminist organization. They work with black and brown women who, as they describe, are on the margins of society, right. Lots of these, um, women have left abusive relationships. Lots of them are here in this country, a country on a spouse's visa, so with no paperwork of their own. Many of them can't speak English, so.

They are, they are people often pregnant or with small children, but they are women on their own and they've been through the system in, in the UK where they've found no help and Phoebe's often the last place that they go for some refuge, right? Phoebe's are their advocacy service as well. So I started to work with Phoebe again.

I thought, do you know what? I'll work with your, because what they've done is work up ambassadors and advocates [00:09:00] for us. Phoebe said, right. We'll give you advocates and those advocates will work in the community with our women, but you can work with the advocates to update them on maternity. So that's that.

I thought, great, that I'll do that. So I met with the advocates and I went with my midwife brain. And as a midwife, I'm all about choice and personalization. So I said to them, look, let's, um, let's talk about the choices that, that women in the UK and birthing people have today. Let's talk about the fact that if they want to birth at home or in a birthing center, they have those choices.

Let's talk about if intervention is suggested that they can question it. They can ask for a. Second opinion, they can make a birth plan that suits them and it went really quiet. And I knew I'd just, I'd said something horribly wrong, but I just didn't know what I'd said. Yeah. . And they said to me, you really do not understand our women and our culture.

These are women who have come from areas in the world [00:10:00] where medical services are really rare. Um, they are not gonna question a doctor. They're not gonna ask you not to induce them or not to have a cesarean birth. This, this is not. What we need. Yes. We need you to understand the context and the background of this they are

grateful. Yes. And so there was a whole conversation, a, a reset in my mind where I, I I kind of mind blown thinking, I have just been doing this so wrong for so many years. Yes, yes. Does

Florence: that make sense? It does. And I, I, I think that's really valuable what you are saying actually, because I think I've been part of things where it.

Let's go out and talk to this, that, and the other, um, community group. And what I'm taking from what you are saying is, is not only gonna say stop surveying because we know what the problem is. Yeah. But also the thing of actually we just need to [00:11:00] go out and build relationships and take that time. Yes. And I think that is a challenge, isn't it?

for you to say to your boss, well actually I'm gonna be out with the African families. Mm-hmm. , they've got to realize that that is valuable. Yes. And actually more valuable than you saying, oh, I'm surveying 200 people, or doing this, that, and the other. Analysis. Yeah. Um, so actually being able to go and spend that time and then.

For it to start opening your eyes is, is a really big deal. And I think that's quite a big shift because in the N H s we like to be able to kind of check off and tick, we've done whatever, um, task. . Um, yes, we've done our equality engagement as, or impact assessment. Yes. Tick Mm-hmm. [00:12:00] rather than actually doing something much more meaningful, but is much harder to put in a box and say, yeah, we've done it.

Teri: And, and in reality, you know who, we all know how pressured maternity is. We all know the staffing capacities, the national shortage of midwives. How, how lucky am I to be in a role that actually I've had the capacity to go and do this, and I, so I, I do get the challenges of. An organization trying to work up their services to meet those needs.

Um, I'll tell you the story that Rachel Walton told me the first day I met her after she'd scared the life out of me cuz she's, she's a fierce woman. You know, , she said to me, I, I'm gonna tell you this story. She said, I used to work for a charity. And don't quote me. I think it was in Rwanda. I could be wrong.

But anyway, she worked for a charity, she said, and it was really interesting because the village that I was working in, she said the nearest clean drinking water was five kilometers away. Right. So every [00:13:00] morning the women would get up and they would walk the five kilometers to the taps where they could access drinking water.

Um, and they would bring it back to, uh, the rest of the village. And she said it was interesting cause the charity came in and looked at this situation. and said, no, no, no. This is, this is not acceptable. So we're going to, we're gonna stop by putting taps in right on the edge of the village so that you don't have to walk the five k

and that's exactly what they did. And they were very, very pleased with themselves. And the women used the taps for a few days, maybe a week, and they noticed that on the second week, the women walked straight past the taps and continued to walk the 5K to get their water. Um, and this just, yeah, this just ca continued and carried on.

And when they were questioned about it, the women. When we get up in the morning and we walk our 5k, the time is for ourselves. Um, the small ba the babies come with us, but the men and the teenagers, they all stay in the village. It's too long a walk. We get time to talk about our [00:14:00] lives and our emotions and our wellbeing.

And when you put the taps at the edge of the village, the men came, the teenagers came. We had no time for ourselves. You didn't ask. if we wanted taps. Yes. You just put them in because, and I think I, it's, that really struck me as something we do in the NHS over and over again. Yes. We see a problem and we say, right.

We're gonna fix it. Let's put some taps in. Yeah. And we don't ask the community if that's the way that they'd like to go, or if it would benefit them. We just do it.

Florence: Yes. Yeah, we make a massive assumption the whole time,

Teri: don't we? Yeah, yeah. This is about not making assumptions. So that was one of, again, I've, I, I've, in terms of my partnership with these organizations, I have grown and learned so much more than they could ever.

Yes. Gained from me, uh, if I'm really honest. So we started to talk. We, and, and so this has involved a whole year of me meeting with them, usually monthly. Yes. I go and meet with different organizations. It's been really interesting. [00:15:00] So the Phoebe organization have worked out something that they call the grandmother's group.

Florence: Brilliant. Tell us about the grandmother's group.

Teri: Well, so when I was having a meeting with them, we, I did with the leaders, I did, I did a kind of zoom meeting via a screen, and, um, and I said to them, can, can you ask again? I was still in my NHS midwife brain saying, can you ask, can you ask your women about this?

Can you ask them about that? Can I tell them this and that? We were talking about birth plans, actually at the time. I love our birth plan as a midwife, you know? Yeah. All over that. They looked at me again. I knew I'd said something wrong, and she said, I don't understand the birth plan. I don't, I we don't get this because where we come from, you don't write a birth plan.

You just don't. Yeah. And I said, well, how, how do the women in your community then, how do they understand ways of giving birth? And, and how do they then communicate that to the rest of us? Yes, she says, she said, when, when somebody gets pregnant in our community, there is an [00:16:00] innate birthing wisdom. And that wisdom is passed from that woman's mother and her grandmother down.

Yes. They talk, they talk a lot. She said that the grandmother in our community is revered and her word actually is law. And then again, she looked me in the eye cuz she's quite a scary woman and she said, We are going to accept what you tell us, Teri because you are a midwife and we respect you. She said, but to, for us to change our ways, the information that we take on board has to be wiser than the grandmothers' information.

And she looked at me and she said, you are not wiser than the grandmothers

Florence: wow. That, that's a high bar, isn't it?

Teri: Yeah. But you know, challenge accepted. I thought, well, Good. Okay. I accept that. I ex completely, so, so the next question is then if the grandmothers are so influential in this society,

Then we have [00:17:00] to educate the grandmothers surely , we have to link with them. so Phoebe said right we have a lot of women that come from other countries they have left their social networks behind

would you come and work with the grandmothers? So I said, yeah, yeah, that'll be great. Um, so I walked into a room. There were 21 of. Amazing. Most of them over the age of 70, and quite a lot of them interestingly, are retired midwives from, um, Rwanda and Zimbabwe. Um, and, and they were fierce? All of them. Yes.

They, they, they had an attitude of, okay, well, Come on, then impress, impress us. with your silly midwife. brain. Yes. , impress us. So again, I went in and I'd l I'd learned quite, I, I felt a bit more learned by the time I got to the grandmother's. Thank goodness. So again, I will go and meet and I meet with them, um, on the first Monday of every month.

And I really look forward to my grandmother's meeting. And then, and each time there are more of [00:18:00] them. There were 31 the last time, last month when I went there. Amazing. I

Florence: know, but you must be doing something right. Then. Honestly, you're drawing in more grandmothers.

Teri: Well, they stare at me the whole time and they, they've, but they're very interactive.

They ask some hard questions and at the end, at the end of it, I'm always a little bit unsure if I've kind of met their brief and Yes. But the, a couple of months ago, um, and it was just before Christmas, I said, right, well, that's the end of our session and, and it'll be probably the new year before I see you.

And one of them, she said, you are coming back though, aren't you? When will we see you again? Oh, ok. And I thought, Okay. I'm doing something right. So we, some of the topics we've talked about. Um, so Waterbirth, one of them, interestingly, they could not understand why anybody would want to submerge their body into a bath of water to give birth.

Just did not laughed like drains when I told them that waterbirth was a thing. Okay. So then we talked about the physiology though of, of waterbirth and, and the relaxation of muscles. Yes. And the, uh, the gate control [00:19:00] theory and the oxytocin levels. And they were very, very interested the changes of positions that you can adopt in water birth.

Yes. And at the end of it, I mean, they're such an amazing group of women because at the end of it, they were saying, we absolutely get it. We get it if it's appropriate and if it's possible, let's, let's recommend waterbirth. We, we can see the benefits. So, so these are the conversations I'm having. One of the biggest things for me has been to talk about the birth herbs.

Because I've learned from the grandmothers that every time a woman goes into labor from their community, they, they take some birth herbs and they make a tea, and they drink this tea. Okay, interesting. I've, I've been a midwife for, oh, 106 years, I think, and I've never heard , long time, never heard of the birth herbs.

Never. But what I found out, and I've asked a lot of my communities, . All of the women take the birth herbs. They just don't tell the midwives. They don't tell them, oh,

Florence: so what are the birth herbs? I'm now interested, I've never heard of this. Yeah,

Teri: I was gonna say as, as [00:20:00] an obstetrician, have you ever heard the birth herbs?

No. No. me either educate me. I can't because they won't tell me what's in them. They dunno. They're secret. Oh, okay. A lot of the time the women in this country receive the birth herbs from their country of origin through the post. When I ask them what's in it, they don't. Oh. But they do know that it's grandmother's wisdom and it's going to be useful.

Now, as a clinician, I start to get a bit sweaty about . I'm sure you are as well. Oh, I dunno. But I think this whole process has taught me that this has been going on for years and years and years and I've not been aware. Yeah. And this is cultural, traditional wisdom and knowledge. Yes. And who am I, uh, midwife?

Yes. To come in and say, please don't take the birth herbs it's not my job. No. So that's about letting go and accepting and, and respecting. That actually it's important in that community. Yes. Yeah. So we've had conversations around the herbs. I still dunno what's in them. It's [00:21:00] not my job to know, but we do have to accept that that is something that happens in, in some communities for sure.

We, we had a conversation one month about labia pulling, which was very interesting to me. And, and again, some, you know, I've seen a million labias years. I'm sure you have as well. Yes. Yeah. But what, um, what I've found is, and not in all cultures, but in a, uh, some specific cultures as a girl, um, has her first period, she's taught by her mother to stretch her labia because it's seen as something very attractive to her, a prospective husband long labia, right.

Oh, okay. Yeah. Did not know that. No. Yeah. I've learned, yes, yes. And, and information and knowledge that has only come with building relationships. And partnerships obviously. So this is the context around the films. And if I'm gonna come back to the films, um, because I've digressed, but one of the, what we know is that at the same time I was, I was doing all of this, I was also going out to [00:22:00] some of the midwives who I work with, who I did survey Cause Yes.

You know, they're quite used to surveying. And in the survey, I, and it was a small survey, but I said to them, do you talk to people who come into your service about the effects and the risks of ethnicity? Yes. So we know that they're at higher risk. Um, if you are black or brown, you are absolutely at a higher risk than a white woman.

So do you have those conversations? Do you open those? And the the answer was mostly no, no. Or sometimes, well, we had less than 50% of, of midwives said Yes, I do have those conversations, but over 50% either were a no. Or sometimes, and when I dug a bit deeper, the, it wasn't that people don't want to have these conversations, it's they just didn't know how to open that dialogue.

Yes. They were afraid of offending, of appearing ignorant and, and having no, again, it's the cultural understanding or awareness. Yes. [00:23:00] Yeah. So there's a real gap, isn't

there?

Florence: I think so, because I feel also it's, it's difficult to know. How to say you are in a group that we know it has a higher chance of complications and problems.

Yes. Because is that higher chance because of inbuilt systemic racism? Yes. Or, and therefore, if I say, You are in that group? Am I immediately making assumptions and being racist? Oh yeah, this, am I gonna, am I gonna frighten the woman because there's nothing she can do about her ethnicity or cultural background.

Um, it's a bit like when we were. Um, there was a guidance for morbidly obese women that we should tell them that they're at higher risk of this, that, and the other. And I would have poor women come to see me and, and cry and say, the midwife [00:24:00] said, I'm in a high risk group for this, that, and the other, and I've got to come and see you.

But you know, I, I'm pregnant. There's nothing I can do, or very limited amount I can do at this point. Um, I'm in this situation and you're just frightening me. So I think there's that, that. And then the other thing is, if I don't raise it, , which I must admit, I'm not embarrassed to say I, I often don't.

Mm-hmm. , I am sitting there thinking, right. I've got to be really conscious and really listen to what this woman in front of me is telling me and make sure that I'm putting to one side my assumptions or my yes, possible inherent bias. And I've gotta really think, because she is, More at risk than someone else.

So maybe I've got to do more investigations or take her more seriously Yes. Than I might imagine [00:25:00] so that I don't miss something. Yeah. So I, I tend to, to that. Rather than,

Teri: but without maybe sharing. Yeah, exactly. So you're not sharing your concerns with her. And I think again, that's, no, it's quite a paternalistic, it's mod model of care, isn't it?

Um, and I, I completely get what you're saying because I think this is what I'm hearing from. From lots of staff is, well, she can't change the color of her skin or her ethnicity, so why would I frighten her? But again, is is it for us to own that information, not to share it? I think from the people that I've talked to in our community, they have said, It reassures me that you are going to take more care of me.

I feel reassured that you are, um, being more protective, that you, you are monitoring me in because, because of my ethnicity, right? I think, you know, it is, it is diverse and, and the reasons for the poorer outcomes, as you say, are [00:26:00] multifaceted. And, and there is something about institutionalized racism within maternity services.

I, we cannot shy away from that conversation and about our attitudes about, um, black women don't feel pain in the same way as white women and, and, and about the offer of care that we give to some people. I, all of that comes into it. Um, You know, it might be a translation service or a communication problem.

Yes. Yeah. I just, there it is such a, a multifaceted thing that I think we have to be really careful, but I, I, I have come to the conclusion that, uh, people should absolutely be involved in that care and involved in those decisions, and yes, we have to share that information and stop being so paternalistic about it.

Florence: Yeah. No, I completely see what you're saying and I, and I agree, and I think, like you were saying earlier about. everything being a journey and you can't be culturally competent because that suggests you can't. You're done. You nailed it. . Yes. [00:27:00] And And you're not going to do that. It's a bit like all my work with women on women's experience in maternity care.

Mm-hmm. , I thought I was quite a good doctor to start off with, but now if I look back, I think, well, I'm definitely a way better doctor. Hopefully in the future I'll be even better and more able to have these conversations and, and judge it. Right. But I'm, I'm not competent, I'm incompetent. No, and, and I haven't got it right yet.

So I, I think, um, that was then listening to the films and exploring the films. , it kind of made me think, oh my God, there's loads here that I didn't know. I'm really ignorant.

Teri: me. Well, me too, Flo, honestly.

Florence: And, and then I was thinking if I've learned that much from watching a 10 minute film on, you know, whichever topic.

Mm, this is a whole fantastic range you've produced, then imagine what I could learn [00:28:00] from even more or yes. Um, and, and I. There's a slight fear of, oh my God, now I've understood the depths of my ignorance. Mm. But you have to do that to start learning, don't you? I mean, I'm ashamed to say so. So you've done 11 films?

Yes, and I, I think I could safely say I probably learned something from almost all of them. I think I did slightly better on the film about. Women Seeking Sanctuary simply because I've done a podcast on that recently. , right. Ok. . Um, but I mean, even something as basic as. There's a film on the Roma community.

Yes. And then a film on the traveler or gypsy community. And for me to understand that those are distinctly different groups, not absolutely not ashamed to say, when I first glanced, I thought, [00:29:00] Why are there two films on that? Yeah. And then when I watched the films, I thought, oh my God. Yeah. I've been making an assumption.

This is the same group of people. Yes. For my whole life. So, you know. Yes. Even those 10 minutes or even the titles, yes opened my eyes to something new.

Teri: Uh, and I agree completely. You know, I've learned so much. I really wanted, and I wanted for the staff that I work with, the title of It's okay to Ask. It's okay to say, I dunno much about your community.

I dunno much about the Roma community. So please tell me everything you know and, and I will then go away and educate myself. But let's start somewhere. And with that acknowledgement that actually we, we cannot be culturally competent and it's okay not to know, but it's not okay not to ask. It really isn't Okay not to ask.

Yes. And you know, working with the black and African family, um, film, you hear Joyce in the film who is, who is an amazing woman, and she [00:30:00] says, ask me about my color. Ask me about my heritage. We, we, we are proud. We want to talk about where we come from and the color of our skin, and that leads you into a conversation about those risks that we are really reluctant to talk about.

You know, she, she, she said something really profound in our film, which really struck me. She said, We have naming ceremonies in our culture. Mm-hmm. We, we, names are really important. If you can't pronounce my name, don't just say, oh, can I call you this? Which is a, a westernized, um, you know, shortened version of my name.

That's not acceptable. And, and again, she said, I don't mind how many times I have to repeat my name. And you have to repeat it to get the pronunciation right. Yes. But it's really important to me and my culture that you say my name. Correctly. Yes. And, and I've learned so much from that. And, and I feel foolish now to think I, I've, I've avoided saying [00:31:00] somebody's name because it was hard, you know, it was hard.

And now I will just go over and over and over it. So, yes, I've learned, I've learned so much. One, one of the things that the, the equity Forum said when we were talking about how do we educate midwives, not just midwives. Public health and, and social services and health visitors and obstetricians. These are films for everybody.

They said, we want to share our stories. We want to tell them how it feels. Yes. And that's how the films came about. They wanted to share that knowledge and those stories with us because they felt it was more powerful to hear it, rather than us producing another e-learning. Yes. And ticking the box to say you're culturally

Florence: competent.

Yes. And I liked the films because you had. People speaking about their own individual experience, but you also had someone from that kind of cultural group in the community that you were working with that could kind of give [00:32:00] a, a broader context as well. And I thought that worked really well, having those different voices and different views.

Yeah. Um, Were, yeah, really helpful and I definitely felt like for all of them, there was something that I took away and I'm kind of thinking I need to go back and watch them again. Because I think you watch them and then you think you've taken away maybe one or two messages from that and you've gone and d digested it.

And now I'm almost thinking, ah, but I can't remember this, that, and the other. I, I, I would think that there'd be a resource that I could come back to. Yes, I agree again and again and again actually. And also it made me think. about the communities that are in my local area. For example, we have quite a big, um, cor Korean community.

Yes. And I'm [00:33:00] thinking, I don't think we've done, we did do, at one point, the, the mvp, we did a little bit of work with the Korean community, but nothing like the sort of depth that you are describing. And really,

Teri: why haven't we, you know that I think it's time, resources, capacity. Yes, exactly. But it's a poor excuse,

Florence: isn't it?

It's, it's completely so. I, I think you've, you've produced something really valuable to me. It was much more useful, like you say, the e-learning, I've done the n h s cultural competency. Yes. Whatever. E-learning. So basic, and so, I mean, I suppose you've got to start somewhere, but really I didn't feel it educated me.

I mean, essentially what it was saying is, , don't be biased. Don't discriminate. And, and it, and we'll, you know, I'm not stupid. I'm an educated professional, I know that. Mm-hmm. , but I have got, I've got [00:34:00] understand that there's unconscious bias and that there's making that connection with that woman or family.

and understanding them a bit might help me help them with their health. Yeah, because I can then, like you say, Put what I'm saying in the context that will be meaningful to them.

Teri: Yeah. I, and I think, you know, stories are always more powerful than an e-learning or somebody, uh, lecturing to you. So I think it's really important that we hear people's voices and, and that's exactly what this has done.

So each time I've listened to them and they are only six or seven minutes, I've learned something new and I have seen them a lot now. I, I had no understanding that. Um, a lot of, uh, people seeking sanctuary refugees and we've got a lot of those in our area at the moment who were put up in, in hotels. Yes.

And that it comes, [00:35:00] comes with a package, it's a food package as well. They get their breakfast, their lunch, and their dinner. And it was only until I watched the film of a professional saying, if you book that person an appointment, over lunchtime, they will have to choose whether they come to their antenatal appointment and see you or whether they miss their lunch and.

You know, that really resonated. I had not thought about small things like that. So there is a myriad of learning, I think, that we can all take away from each of those films.

Florence: Yeah, I, I completely agree with you and, and that's really why I wanted to get you on today and, and talk because I wanted people to, to realize that this resource is there and.

go and use it and spread it. And because you've put, you and the communities you're working with have put so much time and effort and energy into producing what is such a fabulous set of films.

Teri: [00:36:00] Yeah, I would've, I would hate for. Us to have just completed another tick box where I've said, right, well, I've created 11 films, and then they sit on a virtual platform somewhere and nobody watches them.

Yes. What a, what a shame, what a waste of our community's voices. So, yes. Yeah. Really, if, if we can get people to go and they're free to watch, you can, you can have the whole showcase of 11 films. And I've had lots of universities using them and student updates, um, and social services. The ambulance service, actually, yesterday contacting meetings that they're using them in their training, really happy for anybody to take them, share them, use them, because I think the learning is, is broader.

Florence: That sort of brings us to zesty bit in terms of what we want people to take away from the conversation. Definitely I will put a link to the films thank you in, in the program notes, and I would really encourage people to go and explore the films.

Like we've said, they're, they're quite short, five or 10 [00:37:00] minutes, and I would actually say probably, Take them one at a time because I must admit, I slightly binge watched them, and that means some of them have slightly blurred into one another, which I think I need to watch them separately, um, over a slightly longer period of time.

But, , go pick, pick one, explore it, listen to it. Maybe even, uh, look at it as a group and yes, yes, you know, whether that's at work or you know, with a bunch of friends or whatever. Just to have someone else to discuss it with and, and chat about it and reflect a bit afterwards. And also use them to hopefully start being.

Sort of brave enough to start having these conversations. Yeah, so kind of, I think for me, my takeaway is to move away from that paternalistic thing and, and to actually say to women, [00:38:00] actually, tell me a bit about what happens in your culture or. , does what I'm saying make sense to you? Or actually, is this so alien and different to what you are expecting that I'm, I need to think about it in a different way for you and also talking to people about, Actually, I am taking particular care of you cuz I, I know the stats and I am particularly concerned, I guess.

Um, the other thing is if you are, um, a pregnant, um, woman, a new family listening to this, um, about getting your voice heard. Um, and, and that, and that's hard because that's expecting you to come and do stuff on our terms, whether that's friends and family or maternity voice partnerships. Um, but I guess there's also a mechanism there within your community, um, of your talking within your community.

If we put the [00:39:00] onus on us to come out to those community voluntary groups, um, Making sure that those conversations are happening. Oh, I dunno. Teri, have you got suggestions about how we make things or how women can easily make their voice heard?

Teri: I don't think there's any easy, if I'm really, if I'm being really, really honest about this, I don't think it's gonna be easy.

I, I think we've created a system in maternity that is a, a complete, um, shape and we try to just fit everybody into that shape. Yes. And we've, we've been cramming them through the round peg or the square peg, and of course, most people don't. But what, what happens is that they don't say they don't fit because this is the system and we can't change it.

And we come with these expectations that it's a, it's fine. It's, it's, it's, it's alright. It's a bit flawed, but this is what it is. And I, I think it's unacceptable. We've [00:40:00] got to start hearing the voices of people. So, so my message to anybody who's pregnant and watching this is maybe take one of those films and, and know that we're starting, maybe you could take the film and watch it in your community or, Send it to your, um, midwife or your obstetric team and say, what do you think about this?

Yes. And if the care that we're offering isn't suitable, if it's culturally inappropriate or it doesn't fit with your expectations. Yes. There's nothing wrong with advocacy, and it might be a, a voluntary or community sector advocate. It might not be a healthcare professional because the, the odds are not stacked in people's favor.

We make the hierarchy, the language. Each, the whole system feels that the power base is with us. Yes. And it's not it, it really isn't, but it feels that way. Yes. So we, you know, there is, this is 11 films is, has not even scratched the surface. Yes, let's be honest, because the [00:41:00] hierarchy and the power base still sits in our organization and this really must change for us to improve outcomes.

So, so I urge pregnant people. Right across the country to get a bit more vocal if they can, to find some advocacy, to have really honest conversations with us, to say, actually, you are not meeting my needs and, and it's not acceptable anymore.

Florence: I think that is. Brilliant. I love that idea actually, of watch a film and send it to your midwife or bring it up in an appointment or, yes.

Yeah, I, I think that's a really good way in and yes, tell us, tell us if you are missing a meal or. No, we are trying to fit you in a hole that you don't fit. I, yeah, I totally agree. I think that's a brilliant place to end.

Teri: Me too.

Florence: Me too. Thank you so much. Thanks for having me, not only for coming on today, but for sending me a message and, [00:42:00] and drawing my attention to the films in the first place.

Thank you. And, and, um, I really hope that we can get more people watching them and spread the message because Yeah, me too. You and the communities you're working with are doing a phenomenal job.

Teri: Just the start, there'll be, there'll be more work. I'm, I'm filming 24 new films on antenatal education. I know, and a whole model, a whole model of antenatal education.

I'll let you know when that's done. That'll be weird

Florence: Towards the end of the year, I think you might have to come back and do another episode.

Teri: That would be amazing. Uh, there's lots and lots of things to, to discuss and talk about and, you know, one of, one of my big things is about nice guidance and, and again, that paternalistic kind of Yes.

Yeah. Stuff. The offer. . Yes. So yeah, let's, let's have some more conversations. But thank you for sharing. It's such an important topic. It really is. I'm so glad that you found that you have a voice that you could share it. Yeah. Nice. Really pleased.
Florence:
Its fantastic thank you so much
Teri:
Thank you Florence

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Episode 136 It's OK to Ask - The Obs Pod

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This week I am chatting to Teri Gavin-Jones about her work on health inequality and her journey with community partners resulting in a fantastic resource of cultural curiosity films titled 'It's Ok to ask'. I hope you enjoy this conversation as mu...

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Building Relationships to tackle inequality

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Building Relationships to tackle inequality

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A chat with Rosie Murphy about her Darzi fellowship working with communities

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Episode 139 Building community relationships to tackle inequality - The Obs Pod

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This week I am talking to the fabulous midwife Rosie Murphy about her Dazi project: 'Improving outcomes for women from minoritised ethnic backgrounds'. We discuss how a new approach is needed by not only maternity services but the wider NHS.Want t...

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Today I am talking about unstable lie when a baby is moving around loads at the end of pregnancy instead of settling to head down.

Want to know more?
https://fn.bmj.com/content/99/Suppl_1/A112.3
https://www.rcog.org.uk/media/3wykswng/gtg-50-umbilicalcordprolapse-2014.pdf
https://www.spinningbabies.com/when-a-person-is-told-they-have-an-unstable-lie/

You may need an organisational or institutional log is to access the full text
https://www.ejog.org/article/S0301-2115(17)30593-6/fulltext

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

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Chickenpox or varicella is a common infection , what happens if you get it in pregnancy or your child does?

Want to know more?
https://www.rcog.org.uk/media/y3ajgkda/gtg13.pdf
https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/chickenpox-and-pregnancy-patient-information-leaflet/

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

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Chickenpox or varicella is a common infection , what happens if you get it in pregnancy or your child does?Want to know more?https://www.rcog.org.uk/media/y3ajgkda/gtg13.pdfhttps://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaf...

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Episode 140 Low Lying Placenta - The Obs Pod

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Here I discuss what do we mean by a low lying placenta or placenta praevia & how can are for women with this pregnancy complication to keep them and their baby safe.Want to know more?https://www.tommys.org/pregnancy-information/pregnancy-comp…

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Here I chat to midwife coach and author Kate Greenstock about her book Flourish trying to improve emotional wellbeing and psychological safety for maternity staff

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This episode is out a day early to celebrate International Day of The Midwife 2023.
It's a chat with my colleague and friend Kate Greenstock , all about her newly published book 'Flourish: A practical and emotional guidebook to thriving in midwifery'
The book is just what it says it is, first acknowledging the emotional and psychological work of midwifery or any maternity staff for that matter, combined with heaps of practical ideas that may help us.

Want to know more?
https://www.flourishformidwives.com/

Kate can be found @wildrubiescoach on twitter and instagram

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

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This episode is out a day early to celebrate International Day of The Midwife 2023.It's a chat with my colleague and friend Kate Greenstock , all about her newly published book 'Flourish: A practical and emotional guidebook to thriving in midwifer...

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It costs me a small amount of money to maintain the podcast and keep it free and available with no adverts. If you would like to help contribute & you feel able to please buy me a coffee via this link. Any contributions gratefully received however small thank you so much for sustaining the podcast

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Thanks so much for coming to this page! I want my podcast to remain ad and sponsor free as its important to me to keep it unbiased and widely accessible. It does costs me a small amount each month. If you have enjoyed my podcast or found it useful and you have the means I would be very grateful if you would give me a small donation to keep it up! Thank you so much!

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Thanks so much for coming to this page! I want my podcast to remain ad and sponsor free as its important to me to keep it unbiased and widely accessible. It does...

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Whose Shoes: Improving Maternity Experience - talk by Flo & Gill, RCOG Labour Ward Leads conference.

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Talk from RCOG labour ward leads June 2023

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Talk from RCOG labour ward leads June 2023

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Whose Shoes: Improving Maternity Experience - talk by Flo & Gill, RCOG Labour Ward Leads conference.

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I was delighted to give this talk at the virtual international day of the midwife on collaborative working

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My thoughts on International women's day 2023

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Episode 135 Embrace Equity

Florence: [00:00:00] Episode 1 35, embrace Equity. I'm recording this episode on International Women's Day 2023, and the theme, the hashtag that we've been invited to highlight today is Embrace equity. Hence the title of this episode in my attempt to embrace equity, I've decided today to talk a bit about global trends in maternal mortality.

I'm recording this episode because of a shocking headline that I saw on social media a week or two ago. The headline said a woman dies every two [00:01:00] minutes due to pregnancy or childbirth, and it was published by the UN Agencies and the W H O, the World Health Organization. It took my breath away. That means in an average episode of 30 minutes listening to this show, 15 women will have died somewhere in the world

that's an absolutely shocking statistic. In some ways, it's not surprising. I'm aware that I'm very fortunate. I practice in a country where the maternal mortality is comparatively very low. Our rate is around nine or 10 women per hundred thousand.

but I know that this is not the case [00:02:00] in many other countries with less fortunate circumstances or less equitable healthcare system. So I decided to delve into the report in a bit more depth. , what's the information that lies behind that dramatic headline of a woman dying every two minutes due to pregnancy or childbirth globally?

And to give you some personal reflections as well as my kind of key points from the data, that statistic equates to the fact that 287,000 deaths occurred in a year. That's over a quarter of a million women dying every year from pregnancy or childbirth. [00:03:00] Where do these statistics come from? The headline was essentially related to the publication of a report that looked at trends in maternal mortality from 2000.

To 2020. This was a joint estimate by the W H O World Health Organization, UNICEF UN F P A World Bank, and the U N D E S A population division. So one can hardly argue with the quality or the objectivity. Of the data, if you read the press release relating to the data, it talks about the fact that there have been alarming setbacks for women's health in recent [00:04:00] years as maternal deaths either increased or stagnated in nearly all regions of the world.

The report discusses the sustainable development goals devised in 2015, the sustainable development goal relating to maternal deaths aimed to reduce maternal mortality worldwide to less than 70 maternal deaths per hundred thousand live births by 2030. Alongside this sustainable development goal is the ambition that no

country or region's maternal mortality rate should exceed 140 deaths per a hundred thousand live births. i.e. No country should [00:05:00] exceed more than twice the goal of 70 per hundred thousand. And as I mentioned, these goals were devised in 2015 and the aim is to achieve them by 2030, and here we sit in 2023 and we are far from there.

These goals were then broken down so that any country that already had a maternal mortality ratio, greater than 420 per hundred thousand were given that second target of a maternal mortality ratio of 140 or less by 2030. And if they were already less than 420, their target was to reduce maternal mortality by at least two thirds by 2030.

countries with maternal mortality ratios [00:06:00] already below the 70 by hundred thousand. Were also called upon to achieve equity in maternal mortality ratios across different population groups within each country, so that although our maternal mortality ratios are lower, We can't rest on our laurels because we know there is inequity across our population with certain groups, particularly from ethnic minorities having much higher rates of maternal mortality, which is unacceptable.

If you've listened to my previous episode on statistics, you'll know that one of the key important things when comparing outcomes between different countries is case ascertainment and definition. And the report very clearly lays out definitions for, for maternal death, what is considered directly related to pregnancy, [00:07:00] what is considered indirectly related, and also.

what is incidental and the timing of these deaths. I'm not a statistician, but a significant amount of the methodology is dedicated to discussing case ascertainment, and there's also significant amount of discussion about the level of uncertainty the estimation and use of the amount and quality of available data in some of the different countries.

We are very fortunate. We monitor our maternal deaths very closely and have done for more than 50 years, but other countries are not there. They may be monitoring maternal deaths but actually in some cases there may be no overall [00:08:00] monitoring of maternal deaths at all. So the report clearly lays out how likely it is that these estimates are correct.

There's a very detailed table box 4.1, which helped me as a person who's not terribly capable with data and what it said is that there's an 80% chance that the true 2020 global maternal mortality rate lies between 202 and 255 per hundred thousand. It then goes on to say that they're 90% certain that the true 2020 global maternal mortality rate is at least 202

okay, let's take that in context. Remember I said [00:09:00] that the sustainable development goal is for countries to have a maternal mortality rate of 70 per hundred thousand, and for the worst countries to have one of 140 per hundred thousand. Even if these estimates are inaccurate, we are a long, long way from achieving that sustainable development goal that we're hoping to in seven years time.

There's also the staggering statistic about the difference between regions detailed in the report with more than 70% of maternal deaths taking place in Sub-Saharan Africa.

giving a lifetime risk of maternal death of one in 40 in comparison with a lifetime risk [00:10:00] in Australia, for example, with a very low maternal mortality rate of one in 16,000. But those of us that think we are working in more developed countries and that we've got this nailed, cannot be complacent. If you look back at the press release, two of the eight UN regions show an increase in maternal mortality from 2016 to 2020.

The top one being Europe and North America, A rise of 17%. and the second one being Latin America and the Caribbean arise of 15%. Some other regions such as Australia and New Zealand and Central and Southern Asia experience significant declines. So it is [00:11:00] possible to make a difference. Okay, so this is a massive problem, but what do I think we can do about.

Well, the tragic thing is that when you look at the report and the W H O press release, it talks about the fact that many of these deaths were related to severe bleeding, high blood pressure, pregnancy related infections, complications from unsafe abortion, and underlying conditions aggravated by pregnancy

therefore, these are all largely preventable and treatable with access to high quality, respectful healthcare. It talks about the importance of antenatal care as well as postnatal care and access to modern family [00:12:00] planning. It talks about 270 million women lacking access to modern family planning, which takes me back to the podcast episode I recorded with Dr.

Benjamin Black about his experiences during the Ebola epidemic and the importance of reproductive healthcare and contraception. as part of humanitarian medical efforts. So we have massive inequity with different women in different countries being unable to access basic antenatal care, family planning, and postnatal care inequality due to region income.

Education and race the W [00:13:00] H O write that reducing maternal mortality remains one of the most pressing global health challenges, and that if we don't significantly accelerate progress to meet that sustainable development target, that global goal for reducing maternal. We are risking the lives of over 1 million more women by 2030 1 million women!

And let's not forget women of reproductive age. These are young women. These are women. Any time from the menarche to the menopause. So they're probably going to be somewhere between 15 and 50 years of age. , these are not old women. And not only is a woman dying in pregnancy [00:14:00] or as a new mother, a horrendous thought in itself, it has a ripple out on her, perhaps existing children, extended family, or local community

again. When I talked to Dr. Benjamin Black, he spoke about talking to women in Sierra Leone and explaining to members of the community that it was not normal for women. Their sisters, their mothers. their cousins to die during pregnancy or birth. So what's my zesty bit . I can't possibly hope to provide equity in healthcare to women across the globe, but I can, by speaking up and drawing attention to that [00:15:00] headline of a woman dying every two minutes, try and keep the conversation alive.

I can as an maternity worker, be an advocate. , we need to speak up. We need to make noise. We need to make sure that this is unacceptable, so that the world starts to accept that this is the global health crisis that the W H O discuss. . The report also details the fragility of healthcare systems, and you only have to turn to the news to see the impact of conflict in Ukraine, earthquake in Syria.

How precarious delivery of [00:16:00] healthcare to women in those circumstances can be . Surely as a global society, we need to stand up and clamor for women's health during pregnancy, birth, and reproductive years to become a greater priority, embrace equity. So for my zesty bit, please share this episode. Make sure everyone is having the conversation and do what little you can to make sure that women's voices are heard.

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Episode 135 Embrace Equity - The Obs Pod

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Episode 135 Embrace Equity Florence: [00:00:00] Episode 1 35, embrace Equity. I'm recording this episode on International Women's Day 2023, and the theme, the hashtag that we've been invited to highlight today is Embrace equity. Hence the title of this episode in my attempt to embrace equity, I've decided today to talk a bit about global trends in maternal mortality.

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I've recently undertaking some investigator training in readiness for the new NHS patient safety framework. Here I reflect on what I have learnt.

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Episode 134 Safety Clutter - The Obs Pod

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I have been doing some training to be ready for the new NHS Patient Safety Incident Response Framework (PSIRF). In this episode I reflect on what I have learnt and what the challenges there may be as we implement this new way of learning from inci…

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What is FGM and how can we talk to women who may have had FGM sensitively ?

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FGM or female genital mutilation can be a tricky topic that we feel uncomfortable talking to women about. Here I sign post some useful NHS training and resources and remind people its the little things , kindness and compassion that will make a di…

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The back story behind my talk

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Episode 132 TEDxNHS

Florence: [00:00:00] Episode 1 32, TEDx NHS regular and listeners will know that I took August off this year. Well off from the podcast. I didn't actually have August off at all. I was preparing for my very own TEDx NHS talk. Why am I coming back to this now? at long last, it's been released and it's there on the TEDx YouTube channel ready for you to see if you missed it on the day.

TEDx NHS was something I decided to do on a whim. You know, you see something when you're browsing on your phone and you think, I know I'll just bung in an application. I did it in about 10 minutes on my phone. didn't really give [00:01:00] it a second thought, so a month or so later, I was really surprised to get a phone call when I was standing in the middle of labor Ward telling me they loved my application and they wanted to know if I was free on a certain date in August, and was I up for it?

Well, I hadn't really thought through what doing a TED Talk or a TEDx talk would involve. , but I was up for it. TEDx is about spreading messages, spreading ideas. They're short talks. Have a look at the TEDx YouTube channel and you'll see they're about 10 or 15 minutes of someone standing, giving a talk on whatever topic they like with the idea of spreading ideas and inspiring.

when I've talked in the past and given presentations, [00:02:00] it's always been really important to me to do so alongside women. I'm a firm believer in co-production. Doing a TEDx talk was almost like having the ultimate co-production. You are allocated a coach and a co-coach, and they help you through an iterative process.

Write your talk. I had Ayse, who was fantastic, really helped me first broaden out all the various stories I wanted to tell so that I suddenly felt overwhelmed that I couldn't imagine how I was gonna bring it all together. And then with her help and the help of Carrie, who was my co-coach, tried to successively bring it down and narrow it.

think what were the key messages? What were the things I really wanted people to take home? [00:03:00] And then of course, alongside my official coaches, I had my unofficial coaches, Mr. Obs Pod, my husband, my two now adult daughters, and their partners. , all of them contributed in a massive way to the writing and performance because yes, unlike any presentation I've ever given, TEDx really is a performance of my talk.

I wanted to bring into my talk the voice of the obstetrician, much like I do in my podcast. I wanted to bring through what it is like to work in maternity care and that we are well-meaning and we are doing our best even when it appears that we are not. But equally, I wanted my [00:04:00] TED talk to be useful for midwives and obstetricians, people working in maternity.

For them to understand the impact that they have on the women they care for, and that for the women under their care, this is one of the most momentous days in their lives. These birth experiences are profound. They're life changing, they're pivotal, and that what we do at these incredible moments is absolutely crucial.

The closer and closer we got to the event, the more and more I thought, what on earth have I let myself in for? This is a really big deal, and I became more scared and this kind of culminated in the dress rehearsal where I felt absolutely petrified. And although the feedback was [00:05:00] that had gone well, I hadn't felt satisfied.

The way I delivered the talk and I'd missed out what I felt was really quite an important chunk and I was feeling really nervous on the day. We had a fantastic compare. She really put us at ease and I was waiting in the wings, feeling completely petrified, and she talked about how difficult her being, giving birth to her daughter and.

just how much she remembered that birth experience and the importance of birth experience. And that was great. It felt like a safe space. And as I stepped out onto stage, I felt in that spotlight with the lights on me like. , this is what I've prepared for. This is what I want to do. This is, I chose to do this.

I chose to spend this time, I have something I want to say about maternity [00:06:00] care for all those women being looked after in the NHS in an imperfect system, and I want to inspire other people to think about maternity care and take my talk and use. to inspire them and change things for those women. I have a voice and I want to use it.

That's why I'm on this stage, and that sounds a bit preachy, and I tried really hard not to make my talk too preachy, but I really felt motivated as I stepped out onto the stage. This is it. This is my opportunity. This is what I've worked so hard for, and I owe it to all these women up and down the country giving birth every day to try and nail this

and as I started the talk, I was nervous, I was shaking, and you'll see if you watch my talk. How I started was not easy, but it was important to me. And [00:07:00] as I got into the talk and I got through the bit that I'd fluffed in the dress rehearsal, I started to relax. I started to enjoy it. I started to feel like it was going the way I wanted it to, and I was saying my piece.

And I came off the stage absolutely exhilarated, pumped, full of energy and felt I had set out and achieved what I had wanted to. So that's my story of giving a TEDxNHS talk, and the zesty bit is now it's out on YouTube. Please do take the time to listen and watch it if you can spare. around 20 minutes and also the Zesty bit is go and listen to some of the other amazing TEDx NHS talks because I was one of a lineup of many speakers [00:08:00] on all sorts of different topics.

And yeah, go, go explore. Go explore TEDx. in general, not just TEDx nhs, because there are all sorts of ideas and motivated people in the run up to doing my own talk. I listened to some really fascinating, interesting, inspiring talks. And so if you need a bit of a pep up a you want to explore a topic, go listen to some of the fantastic talks that are freely available on the TEDx YouTube.

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Last summer August 2022 I gave a TEDxNHS talk. I wanted to bring the perspective of women giving birth but also that of the obstetricians and other maternity staff to try and encourage collaboration to find the sweet spot bringing safety and a pos...

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Here I discuss the timing of the cutting of the umbilical cord, should we be cutting it at all?

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Episode 131 Cord Blood

Florence: [00:00:00] Episode 1 31 Cord Blood. I hesitate in calling this episode Cord Blood because as Rachel Reed, I think said in the episode on the Midwife's Cauldron about this, this blood is not cord blood doesn't belong to the cord, it belongs to the baby, and that's probably where some of the problems start. Today I'm going to explore a little bit about. cord blood in terms of when you clamp and cut the umbilical cord. And also, what do we use cord blood, that is the blood within the cord for? This is not going to be a fully exhaustive scientific exploration of the topic. This is just going to be some of my thoughts and views.

Why this topic? When I thought about it, I thought it was a bit strange that I [00:01:00] hadn't done it as a topic, actually, because clamping and cutting the umbilical cord and the timing of that has been something that has definitely changed during my practice and is currently changing. Why is that? You may find when you explore the topic of clamping and cutting the umbilical cord discussion around early clamping , delayed cord clamping or optimal cord clamping.

So what do these things mean? In the womb, the baby is supplied by everything through the umbilical cord. It's literally a lifeline. It attaches to the placenta, and it's where the fetal circulation can come into contact with the maternal circulation and get everything that it needs. When a baby's born, at some point, it has to separate from that circulation.

[00:02:00] And historically, I was taught as a medical student and then as a junior doctor, as soon as the baby was out, we should clamp and cut the umbilical cord separating the baby from the placenta. It didn't occur to us that that could be a detrimental thing to do. The baby was out. The baby was breathing getting its own oxygen now through its lungs.

The fetal circulation changes at that point. The way the heart pumps the blood is different because it's got to get blood to the lungs in much bigger volumes, and the circulation to the placenta through the umbilical cord starts to shut down. So stopping it and clamping and cutting the cord never seemed like a problem.

It was the logical thing to do. We all did it. If you look at birth in the media, birth happens [00:03:00] maybe outside hospital. There's that traditional thing of finding a shoelace or something to tie and occlude the cord and subsequently cut it. Somehow it became part of our culture to cut and clamp the. . One of the things I love to do is to go on holiday to Wales and me and my family often go in spring.

It's lambing time of year. There's nothing better as an obstetrician than watching these sheep give birth instinctively. But what happens to the sheep? There's no one there to clamp and cut that umbilical cord. What happens in nature is that the cord and the placenta is still attached to the lamb and then snaps off or is [00:04:00] snapped by the mother.

So it's not designed that we should immediately separate. But a few years ago when I started to look at women's experience of maternity care and join. twitter which for me was an unbelievable new network. One of the things I came across was Amanda Burleigh @optimalclamping on Twitter and another hashtag Blood to baby.

And this made me start to question for the first time whether I should be immediately cutting and clamping the umbilical cord after birth. So I started to think about it and the more I started to think about it and read things about it, the more I [00:05:00] started to discover that actually I was potentially doing something quite detrimental.

So when was it that we started immediately cutting and clamping the umbilical cord? , my regular listeners will know I have a 1930s manual of obstetrics. So I looked in that and that says that the practitioner, having noted the hour of birth, should wait for a few minutes before tying the cord if anything is normal.

So clearly we used to do it the right. way . So when did we introduce doing it the wrong way? I wonder if it was to do with active management at the third stage in our eagerness to prevent and control maternal bleeding and giving an injection of syntometrine syntocinon and ergometrine to help the [00:06:00] womb contract and to assist with the birth of the placenta

was it then that we introduced the idea of immediate cord clamping? I think it might have been, so at that point, I think it was around about 2014, 2015, I started to be introduced to the idea of delayed cord clamping. If the baby didn't need to be immediately separated from, its mother that one could leave the cord intact.

Are there any other reasons why we might have been clamping or cutting the umbilical cord? Well, we use some of the cord blood sometimes for useful tests. So if we've done an assisted for vaginal birth or a cesarean birth for fetal distress , we might want to [00:07:00] take blood from the umbilical cord to look at what condition the baby was in at birth, a blood test from the umbilical vein and the umbilical artery.

Give us good information about that baby's pH. Its acidity, how well it was coping with the labor or birth, and that can give valuable information for our pediatric colleagues in how that baby's coping and adapting to life outside the womb. And if a baby's very unwell, this information can be extremely valuable.

The other situation in which that information can be useful is also in medico legal terms when you're trying to establish whether something was related to an event around the birth or not knowing what the baby's cold gases were, what [00:08:00] condition that baby came out in, in the immediate minute of its birth can be helpful in extrapolating and understanding whether something is likely to be birth related or not.

Although it's not an exact science, so we often take cord gases. Cord bloods for. that The other situation in which we take cord blood is if a mother is rhesus negative, and we need to establish whether the baby is rhesus negative or rhesus positive so that we know whether the mother needs anti-D injections after birth.

Taking blood from the umbilical cord in that situation means we contest the baby's blood without inflicting a blood test on the baby , the cord doesn't have any nerve endings. It's not painful for the baby if we take blood from the umbilical cord. [00:09:00] So sometimes we would clamp and cut the umbilical cord and we would double clamp it so that we would save some blood for us to take for tests, whatever tests were required.

So up to that point in my career, I would usually immediately clamp and cut the umbilical cord then what I discovered astonished me that the evidence was there, that actually doing this made a significant impact on the baby's iron stores and even its birth weight. If you turn to the 2016 version of prevention and management of postpartum hemorrhage, Greentop guideline, it details.

It talks about the timing of clamping and cutting the umbilical cord. It defines active management of the third [00:10:00] stage of labor using uterotonics, the syntometrine early clamping of the umbilical cord and controlled cord traction to help deliver the placenta more quickly and reduce blood loss. And it showed that active management

results in a lower birth weight reflecting, a lower blood volume from early cord clamping, and that a systematic review and meta-analysis of controlled trials found delayed cord clamping for at least two minutes is beneficial to the newborn. And what's more, the benefits extend into infancy. So this isn't something that is just affecting the wellbeing of that baby immediately in the hours after birth

this has a longer term impact. So in 2016, the Royal College of Obstetricians and Gynecologists, after I would say [00:11:00] significant pressure from people like Amanda who fought their corner, that actually this evidence should not be ignored, changed their guidance. , so the guidance from NICE the National Institute of Clinical Excellence now recommends that the umbilical cord should not be clamped earlier than one minute from delivery of the baby if there are no concerns over cord integrity or the baby's wellbeing.

Wow. If you look at the evidence on the timing of umbilical cord clamping, there's lots of evidence that. That it's beneficial. And in fact, if you look at the Cochrane evidence, there's no evidence that actually it worsens the outcome for the mother. So we're not seeing increasing hemorrhage rates [00:12:00] or bleeding.

And the Cochrane Review talks about cord clamping between one and three minutes, and although it seems to have made very little difference on bleeding. , there's very little evidence that it makes any difference. There is lots of evidence about important advantages of delayed cord clamping on hemoglobin. That's the molecule in the blood that carries oxygen, hemoglobin concentration, iron reserves, higher birth weight for up to six months.

So this then made me think, why have the pediatricians not been clamoring and asking for us to do later cord clamping or delayed cord clamping? And actually, I don't want to call it delayed [00:13:00] called clamping, because really what we're talking about is what's now being called optimal core clamping . So it's not that you are delaying something, which sounds like you're doing something too slowly, it's you're doing it at a better time for the mother and baby.

So when I started thinking about this and we started to introduce sometime after the birth of the baby at Cesarean birth, I expected. , the pediatricians I worked with really to be congratulating us and to be really pleased that we've made the shift in our practice and that this would be great and that, um, it would be so much more beneficial for them.

These babies would be better looked after and healthier, and we were doing a really positive thing , how naive was I? Not a bit of it. [00:14:00] So initially the pediatricians were actually really unhappy because this later cord clamping, there can be a little bit more jaundice in the neonatal period. And they started to question, why are you doing this?

We are seeing babies with jaundice this isn't a practice we want to encourage and it, we were in this really odd situation where we as obstetricians, were going to conferences and our fellow obstetricians were talking about the importance of optimal core clamping and really how we should all be changing our practice in terms of when we cut and clamp the umbilical cord, and then the very people that should be looking out for the babies were complaining to us

that we were changing our practice and that they weren't happy with it, which just felt [00:15:00] kind of the wrong way around. Very odd. So why is it so important? Well, it's becomes even more important if you are preterm. So if you are a preterm baby, , there is significant evidence that it actually makes a difference in survival.

If you look at the Cochran evidence that delayed cord clamping compared with early cord clamping meant that fewer babies died before discharge. This is preterm babies. , fewer babies had bleeding in the brain and they concluded that delayed cord clamping or optimal cord clamping reduced the risk of [00:16:00] death for babies born preterm and the early cord clamping probably causes harm.

They didn't talk about what length of delay was best, and if you've got a preterm baby, you've got to think really carefully. , you've got to be able to resuscitate the baby, um, and give it the care it needs whilst it's still attached to the mother. But that actually just needs a bit more logistical thinking through and equipment, thoughts, and a team that want to make it work.

But why? Why on earth? Why would we not give preterm babies? the best chance. Why would we immediately clamp and cut the umbilical cord? Because they need resuscitation when we know that makes a difference to their mortality. I mean, it's just mind blowing that we've been doing the wrong thing so [00:17:00] much. So there's a lot to think about here, and if you want to explore it more, there's Hannah Tizard

an amazing student midwife who founded the Blood to Baby Campaign, and she's got a great website, which I'm putting in the program notes and has lots of educational resources and things to think about, and one of the most inspiring people I've heard talk about resuscitation of a preterm baby with the umbilical cord intact is actually by Professor Andrew Weeks.

He gave a fantastic talk a few years ago to conference about this, and indeed he is working with Hannah on the Blood to Baby campaign to try and help medical professionals understand better how to do that resuscitation with the cord intact. [00:18:00] So really useful resources and things to explore. . What about the other uses of blood from the umbilical cord?

If it's not all going to the baby, some of it is left in the placental circulation. You may have heard that there are things that we could do with that. So you may have heard of stem cell collection or stem cell banking. What is that? , the blood within the umbilical cord is unique, so it contains stem cells and stem cells are incredible cells that have the ability to become almost any cell in your baby's body.[00:19:00]

a few years ago, the thought came about that actually you could use stem cells, you could bank them and keep them frozen, and then if your baby developed some kind of health problem in the future, you could use the stem cells from the umbilical cord to help. That health concern in your child in the future.

Therefore, people started collecting and storing stem cells, and there was quite a lot of concern about this at the time with the Royal College of Midwives and the College of Obstetricians and Gynecologists, because there were concerns that if staff were trying to collect. Or maximize the collection of blood from the placenta that [00:20:00] at the time of birth they would not be caring for and looking after that mother and newborn baby.

That was the first thing. So it was agreed that NHS staff would not collect and help collect and store stem cells. The other reason that this. deemed not something we should be doing was that there was a very theoretical chance that these stem, that these stem cells could be valuable to this baby in the future.

And I must admit, I feel that a lot of these companies that do this, it feels a little bit exploitative. So you're going. Take people that are about to become parents who are already a bit anxious about the wellbeing of their baby, and are they gonna be good enough parents, and is their baby going to have some kind of [00:21:00] future health problem and, and that they have a responsibility to safeguard this.

And then you charge them money for a private company to come and collect that blood and store it for who knows how long. With a view to maybe being able to use it in some potential way in the future. But actually so far over the last, I don't know, 10, 20 years, it's not been obvious that that's actually been achieved.

So it feels like quite a difficult topic, and I must admit, if parents do ask my opinion about stem cell storage, privately I do express my view that I, I don't think it's relevant or a good idea. If you are interested in banking stem cells, [00:22:00] then actually it's much better that you have a little look at the NHS cord blood donation options because it's possible that your baby's cord blood

could be of value to someone, a child or adult with an existing disease. So it is true that stem cells and use of cord blood stem cells could be of potential benefit and can be of actual benefit to certain people with certain illnesses. And there's lots more to explore on the NHS cord blood banking website if you are interested.

But please note it does say that if you're going to do delayed cord clamping or what I would prefer to call optimal cord clamping, then this may reduce the ability of you to donate blood from the cord [00:23:00] and from the placenta and explains they need a minimum of 60 milliliters, and they usually get somewhere between 60 and 150 milliliters of cord blood

if you think about that volume, I tend to think about volumes and weights as food. That's just the way my brain works. So to me, 150 milliliters is pretty much a small tub of cream. So if I'm buying some double cream to do some cooking or pour on a dessert, the one I reach for is 150 milli. So that means that potentially we are leaving a small pot of cream worth of blood in the umbilical cord and placenta that could be in the baby.[00:24:00]

So immediately, if you think about it like that, rather than thinking about the blood all spread out down the umbilical cord and through the placenta, . If you think about it in that little container, then immediately you can see that that's actually quite a significant volume of blood belonging to that baby.

So this brings me to my zesty bit. If you are a health professional, there is absolutely no excuse at the moment not to be doing optimal cord clamping a minimum of a minute, but. Considerably longer if you're clinically able to, for example, at a straightforward vaginal birth, there's absolutely no need to clamp and cut the umbilical cord until it's white.

The so-called wait for white, there's no need. If the baby's crying, the mum's enjoying skin to skin with her baby, she's not bleeding. [00:25:00] Absolutely no need to. . And likewise, if we're doing an assisted vaginal birth and the baby's in good condition and everything's gone well, equally the same, and still I find myself having to put my hand out to stop junior doctors or midwives picking up the clamps to clamp the umbilical cord and saying, wait, you don't need to do that.

Don't need to do that yet. There's no need. We're still very programmed into cutting and clamping, and I would say we've moved from cutting and clamping immediately. That is early to doing it after a minute. And the minute thing has come from doing optimal core clamping or delayed core clamping at cesarean birth, and that's cesarean.

A minute may be more [00:26:00] appropriate because the womb is open and while the womb is open, the woman will be losing blood, and therefore we don't necessarily want to delay closing the womb by having the baby attached for many minutes. So we've settled at a minute as kind of standard, but don't then extrapolate that minute to vaginal birth where the womb isn't open.

That isn't the case. That risk isn't there

and even at cesarean birth, sometimes in that minute, if the baby's in good condition and everything's going well, I will either clamp the blood vessels to prevent bleeding and we can wait longer. Or sometimes in that time, the placenta will separate and I can literally hand the whole placenta with the cord intact, still attached to the baby, to the midwife, and.

the woman can do whatever she wants. She can wait for white if she wants to. [00:27:00] So as health professionals, we must stop clamping and cutting the umbilical cord as an automatic thing. . And we really need to work hard now with our neonatal colleagues to think about how we do that for preterm babies, how we enable that early resuscitation of a preterm baby with the umbilical cord intact, because it will save lives literally.

And remember I said our pediatricians were skeptical. us doing optimal cord clamping and the effects this was having on babies and the their worries about jaundice. Well, we tried to talk to them about preterm resuscitation with an intact umbilical cord, and they were reluctant. And now a year or two later, they're coming to us saying, how can we do this?

Can we facilitate this? [00:28:00] So it's something that just has to happen if you are a woman giving birth or a parent whose partner is giving birth, make it clear to people in your birth plan what you want to happen and that it's important to you. If it is not to immediately clamp and cut the umbilical cord and understand what the pros and cons.

of private stem cell banking, and I would suggest don't do it because that blood, rather than being in a freezer somewhere stored for your baby at some potential point in the future that might never be used, could be in your baby's body immediately after birth. And for the first six months of its life doing what it's actually designed to.

and if you are [00:29:00] very altruistic and you want to think about donating your cord blood, then feel free. But actually the best place for the cord blood to be is within your baby.

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Episode 131 Cord Blood Florence: [00:00:00] Episode 1 31 Cord Blood. I hesitate in calling this episode Cord Blood because as Rachel Reed, I think said in the episode on the Midwife's Cauldron about this, this blood is not cord blood doesn't belong to the cord, it belongs to the baby, and that's probably where some of the problems start.

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Here I talk to Wan about her lived experience of seeking sanctuary and hear from Katherine about the work of City of Sanctuary Maternity stream

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Episode 130 City of Sanctuary - The Obs Pod

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Today I am joined by two very special guests to discuss City of Sanctuary Maternity Stream. Katherine is a midwife and Wan is a woman seeking sanctuary. We discuss some of the barriers vulnerable women face seeking maternity care and some very sim...

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Birth should be Special - My TEDxNHS talk

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Birth should be Special - My TEDxNHS talk

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Birth should be special | Florence Wilcock | TEDxNHS

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What is meconium and why do we worry about it?

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Re:Birth an RCM collaborative project all about the language to describe birth

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As we start the new year I thought I would build on previous episodes 23 & 24 on language by discussing Re:Birth a project looking at language by the Royal College of Midwives in collaboration with other maternity organisations published in Su...

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What is this and why don't we do it any longer?

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Episode 125 Fetal Blood Sampling - The Obs Pod

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What is Fetal Blood Sampling? How did we do it , and why I think it should it be abandoned if you haven't already stopped this procedure?Want to know more?https://www.nice.org.uk/guidance/gid-ng10174/documents/draft-guidelinehttps://obgyn.onlineli...

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What is it, and why I think we shouldn't be doing it anymore.

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Episode 125 Fetal Blood Sampling - The Obs Pod

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What is Fetal Blood Sampling? How did we do it , and why I think it should it be abandoned if you haven't already stopped this procedure?Want to know more?https://www.nice.org.uk/guidance/gid-ng10174/documents/draft-guidelinehttps://obgyn.onlineli...

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Here I talk about the pelvis and hopefully throw out some of our old ideas & encourage some new!

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Episode 124 The Pelvis

Florence Wilcock: [00:00:00] Hello, my name's Florence. Welcome to the obs Pod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy, call the midwife, maybe birth fascinates you, or you'll simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth.

Perhaps you work in maternity and want to know what makes your obstetric colleagues tick or you want some fresh ideas and inspiration, whichever of these is the case. And for that matter, anyone else that's interested? TheObsPod is for you,

episode 124. The pelvis. I've been thinking a bit about this episode for some time. [00:01:00] Pelvic shapes, the bony pelvis, the bowl like structure that the baby has to pass through on its journey down the birth canal. I've been turning this topic over in my mind for a couple of reasons. The first reason, Was when I was reading the Black Maternity Experience Report because there were comments in there about in inverted commas, the African pelvis, and I'm sorry to say that that rang a bell at some point during my training, either as a medical student, Or a junior doctor.

I definitely remember being taught about the African pelvis, so that prompted me to think really, is that really what we [00:02:00] were taught? Perhaps I should go back to my textbooks and have a look. The other reason I've been thinking about the pelvis is because of the increasing use of biomechanics. And this is the idea that the pelvis isn't a rigid skeletal bony structure after all, but actually is a mobile structure with multiple joints and how one moves in labor might influence the size and shape of that bony skeletal structure.

And I listened to a wonderful episode of the Birth Ed podcast with Molly, the midwife, who does a lot of training on biomechanics. So for these two reasons, I wanted to think a little bit about the pelvis, partly because when topics like these crop up, I [00:03:00] like to review what I know or what I think I know, and then find.

What's new? So here goes the pelvis. Regular listeners will know I have a textbook, a 1933 Glasgow Manual of Obstetrics. So I thought in thinking about the pelvis, I would go back and start with that. And in my episode where I talked about a hundred years of progress, many of you will remember that I talked then about the very distorted pelvic shape.

Contained within that book as such large numbers of women at that point in time had rickets and therefore significant pelvic deformity, which impacted hugely on their ability to give birth to their babies. So whilst in my medical student mind, I'm thinking about having been taught about different types of [00:04:00] shapes of pelvises when I go back.

In time to the Glasgow Manual of Obstetrics textbook from the thirties. Those pelvic types do not exist. There are lots of diagrams. It is true of different pelvic deformities and contractions, but they're all pathological. They're not in inverted commas normal shapes. They're what may happen to the pelvis with disease.

But there are clear descriptions of how to try and measure the pelvis, both with vaginal and external examination, and there's certainly no mention of that inverted commas African pelvis comment in that book. So next I thought I would [00:05:00] turn to my. Anatomy textbook. This is the book that I used as a medical student, clinical Anatomy for medical students by Richard Snell.

It was the absolute anatomical Bible. When I trained and qualified turning the pages of my copy, I discover that my edition dates back to 1986. Not surprising, really given I was starting out as a medical student in 1987, so if I turn to the page on the pelvis, there they are those four different types and shapes of pelvis that I remember being taught and they taught about the difference in the female pelvis.[00:06:00]

Versus the male pelvis. They talk about the pelvis being shallower and the bones smoother in the female pelvis than male. The size of the pelvic inlet being very similar between the two sexes, but in female, the pelvic cavity being larger and cylindrical, and the pelvic outlet. In both the anterior, posterior, and transverse diameters, so that means front to back and side to side.

Then it defines the four types of pelvis. And it's interesting because I've just told you that looking back in my textbook from 1933, these types of pelvis don't exist and here is the reason. [00:07:00] This classification of Pelvises was designed by Caldwell and Malloy in 1933. They divided the pelvis into four discreet groups, Gynaecoid Android, anthropoid and Platypelloid

The Gynaecoid pelvis they said is present in 41% of women and it's the typical female pelvis, the Android type present in around 33% of white females and 16% of black females is the male or funnel shaped pelvis with a contracted outlet. Let me pause there. Is that where. In inverted commas theafrican pelvis is coming [00:08:00] from the anthropoid type pelvis present in 24% of white females and 41% of black females is a long narrow and oval shape pelvis.

And then we have the Platypelloid type present in only around 2% of. , and this doesn't distinguish between Caucasian or Afro-Caribbean and is a wide pelvis flattened at the brim with the sacral promontory. That's the bit at the back pushed forwards.

So I distinctly remember having to learn these four types of pelvis.

To be honest, I found it quite confusing. It's not easy to remember obscure classically [00:09:00] derived names for different shapes and sizes, and it seemed quite irrelevant at that point in my career. Why would I need to know? There are four types of pelvis in the book. There's then a description of how to make internal pelvic assessments by vaginal examination.

And this interests me because in all the time I've practiced obstetrics and gynecology, we've never actually discussed how we might assess a pelvis through vaginal examination yet. This is something clearly. That doctors at some point in time were routinely undertaking, and I do remember a point when I was a medical student where part of your antenatal check was an initial vaginal examination, and maybe [00:10:00] this is what one was supposed to be assessing, but this certainly isn't part of our routine check anymore.

Thank. So there's a very clear description of how to assess the different diameters of the pelvis. First of all, the pubic arch spread the fingers under the pubic arch examine its shape. Is it broad or angular? You should be able to rest the examiner's four fingers comfortably in the angle below the synthesis comfortably.

Hm. Not that comfortable for the women. I wouldn't imagine. Lateral walls palpate the lateral walls that mean feel and determine whether they are concave straight or converging. The prominence of the ischial spines, those are the little bony prominences you can feel either side and the position of the [00:11:00] sacrospinus ligaments are noted posterior.

Palpate the sacrum to determine whether it's straight or well curved. Finally, if the patient has relaxed the perineum sufficiently, this poor woman, I doubt, she's very relaxed by now. An attempt is made to palpate the promontory of the sacrum, second finger of the examining hand placed on the promontory and the index finger of the free.

Outside the vagina placed at the point on the examining hand where it makes contact with the lower border of the synthesis. Trying to imagine even trying to do that. Ah, there's a helpful diagram. The fingers are then withdrawn and the distance measured. This gives the measurement of the diagonal conjugate, which is normally about five inches or 13 centimetres.

[00:12:00] Then estimate the anterior posterior diameter from Sacco coccygeal joint to the lower border of the synthesis. Maybe it doesn't matter. I was never taught this. Maybe this is a heap of old rubbish ischial tuberosities. The distance between the ischial tuberosities, those are on the outside can be estimated by using the closed fist.

Measuring about 10 centimeters, but difficult to measure exactly. No kidding. You mean all the other measurements were accurate then There is a little caveat. Needless to say, considerable clinical experience is required to be able to assess the shape and size of the pelvis by vaginal examination

marvelous. Just thinking of all the poor women that would need that examination for me to be able to be experienced to. . So when I do a vaginal examination, now, [00:13:00] I must admit, the thing I tend to notice, apart from obviously the position of the head and things I've discussed earlier on about the progress in labor is more the pubic arch.

How narrow or wide is the pubic arch? How prominent is the sacral pulmontory? Those tend to be the two things that I. And yes, I can think about is there space, um, and whether I can fit my hand in the vagina. And although that sounds awful actually, if you think about the size of your hand in comparison to a baby's head, that's not a bad guide that the baby's head will be able to come through.

If I can get my hand in, if I can't get my hand in, then actually it could be that there's not a lot of space between the sac called promontory and the pubic arch. So that's 1986, right? Let's move forward. In my career, it's 1997. [00:14:00] I've just become a registrar and I distinctly remember having to do some kind of a presentation or a little project.

Breech presentation, breech birth, and the use of pelvimetry , would pelvimetry that is x-rays of the pelvis and measurements of the pelvis be useful in predicting which women would be able to have a breach birth safely. I've trawled through the many things on my shelf because I'm a bit of a. And I expected to be able to just pick it up just like that, but for once in my life, it seems I've got rid of it or I can't lay my hands on it.

So I turned to the RCOG G library [00:15:00] and sure enough, 1997 find a paper all about the use of pelvimetry in breech presentation. And traditionally pelvimetry was x-ray. But of course, in the modern era, we have other options because the pelvis isn't just bony skeletal, there are muscles involved. So the paper that I remember is actually about could we use MRI or magnetic resonance pelvimetry.

For women with a breach presentation at term, it talks about the fact pelvic imagery is widely used, but that its clinical value hasn't been established. And rather than doing x-rays, they use MRI and [00:16:00] essentially they concluded that it wasn't terribly helpful. It might help you do what's. Selective breech birth.

So where you select which women you think might be more able to have a vaginal breech birth than other women. But there actually weren't any differences in the women that had pelvimetry versus women that didn't. When you look at the cesarean section rate, so breach is a whole nother topic and. I've got a whole episode bottom down about breech babies, but the principle of measuring a pelvis, whether that is with x-ray your hand, as I've just described in the 1986 book, or with the more advanced magnetic resonance imaging mri, [00:17:00] not particularly.

And I've explained this to women in clinic, perhaps they're coming, considering whether a vaginal birth after cesarean is a sensible thing for them to approach. Maybe they were told last time their baby was too big for their pelvis, or they were told that there was a problem with their pelvis because we can make off the cuff flippant remarks about things like that.

Without really thinking what the ramifications and implications are. In fact, only recently I've had a woman who was told after her first birth that absolutely she couldn't have a vaginal birth, that there was a problem with her pelvis and being sensible. She decided to question this and get a second opinion and challenge this.[00:18:00]

I quite appropriately did say because it wasn't true at all. So we need to be very careful about the comments we make about women's pelvis. But when women ask me, can you measure my pelvis? And I tell them that actually the evidence is, it doesn't make a difference. It's not helpful. It doesn't give us useful information.

They accept that. But I've always found that a little bit strange. Why can't we measure it? Why wouldn't it be useful? Why is the evidence so poor? So enter biomechanics, this isn't something that I'd heard of until recently. I know, sounds really dim, doesn't it? But the. Of the pelvis actually [00:19:00] being mobile and flexible and the dimensions changing not only with the changes of pregnancy, but the changes in positions Women adopt and you see them instinctively adopt.

When birth is undisturbed and unmedicated, then it starts to make sense. Because the actual measurements we take aren't dealing with the fact that the pelvis is actually dynamic. If you want to understand more about this, I am absolutely not the expert and I highly recommend you have a little look. Or listen to the birth ed podcast with Molly, the midwife who runs a lot of courses on biomechanics for midwives and women alike.

But we are [00:20:00] increasingly using biomechanics on the labor ward to try and help babies turn into good positions, preventing what we call mal position, where the baby's in an awkward position and that's slowing the labor. And to aid and assist descent of the baby's head. And we can use these dynamic movements even if a woman has an epidural and is relatively immobile.

So when I start to think about the pelvis as a dynamic object, then it starts to make complete sense Why taking measurements of that object at a single point in time in one position, Is useless, totally pointless and not going to give me good information. So thinking a little bit more about this episode, [00:21:00] I thought I will look at the Cochrane database.

Is there anything new I should be considering in the modern era? Is pelvimetry not helpful in deciding mode of delivery. And the Cochran database has published a useful little summary back in 2017, and it talks about all different forms of pelvimetry X-ray, CT scan, or mri. And what it found was just as I said, that the evidence is poor quality.

There's very little evidence and it doesn't seem useful to measure the size of a woman's pelvis in helping predict which women will or won't be able to have vaginal birth. And I suspect that comes [00:22:00] back much more. As I said to the idea of the pelvis being dynamic, and I've learnt this in my own personal.

Having had back problems for some years, I started first Pilates and then yoga, and oh my goodness, I discovered my pelvis moves. I can do a pelvic tilt, I can do a pelvic clock, I can move my pelvis around, and actually that has a massive impact on my posture. Pain in my back, which is a complete thing of the past.

Now I've learned how to keep my back and my pelvis flexible fluid dynamic. Okay, let's go back to the beginning. What about those four [00:23:00] classifications of the pelvis? Do they exist?

I love a little bit of research, a little bit of reading to help me think about a topic when I'm preparing the podcast, and I found a great little article in the British Journal of Midwifery, these guys, and I've put a link in the program notes. They decided to reevaluate that Caldwell Malloy 1933 classification of female pelvic.

Traditionally and still currently taught to students of midwifery and medicine. And they did this by using modern pelvimetric methodology and geometric morphometric analysis techniques. And what they found is, guess what? That it's. [00:24:00] Doesn't seem to be correct. There does not seem to be obvious clustering into the four distinct types of pelvis, gynaecoid, anthropoid, Android, and Platypelloid, and actually there's a much more amorphous, cloudy continuum of shape variation Who'd have thought?

So the idea of this basic pelvic classification, which I have always found impossible to remember, I'd always found difficult to explain or think about with students. Actually we've spent 60 years of teaching something potentially that totally isn't. And this article also tackles that [00:25:00] in inverted commas, African pelvis, the potential racist criticisms of the classification.

This study is completely fascinating and suggests that a lot more study needs to be done and that the way we are teaching traditionally midwifery, Medical and related professionals that there are four distinct types of female pelvis really need reviewing and reevaluating. It talks about it being much more helpful to have an awareness that pelvic shape has many components that may affect childbirth, and that to explain difficulties in labor obstruction.

Or a high head, the baby's head not descending into the pelvis. To attempt to [00:26:00] explain these events by categorizing the pelvis is not necessary, not affect the management of labor. And I would add, or possibly inaccurate and unhelpful. And I definitely remember at some point as a junior, Having it explained to me that African women were less likely to have a baby with an engaged head before labor, that the baby's head was typically higher up and then when contractions started, would engage and come down through the pelvis at a later point.

In comparison to Caucasian women, I have no idea. Why I was told this, or on what basis I was told this, but we have a problem if [00:27:00] this is the way we are educating people. Because if I hadn't read the comment about an African pelvis in inverted commas in the black maternity experience, I would not be thinking and questioning what I was taught and the fact that actually this is a microaggression and inbuilt racism.

Right? That's a little tour of my thoughts on the pelvis. What about my zesty bit? Well, if you are a professional and you're like me and you struggle to think about all the different types of pelvis, don't worry because you can pretty much bin them. But I would like you to come away and reevaluate what you think you [00:28:00] know about the pelvis and remember that it's dynamic and have a look at biomechanics and.

How you can help women understand the mobility of their pelvis and that pelvic shape will change depending on what they do, what positions they adopt, and the hormonal changes of pregnancy and birth. If you are pregnant listening to this and people tell you things about your pelvis or have told you in the past, so.

About the shape of your pelvis or the way your pelvis and your baby fitted or didn't fit in a previous birth. Then question that. On what basis were they making these comments? Perhaps go back to your maternity notes and discuss it with a health professional if you're planning more babies, [00:29:00] because clinging to those misconceptions may end up giving.

Poor advice on which to take decisions about your future pregnancies or births. Know that your pelvis is not a rigid skeletal structure, and there is a lot that you can do to keep pelvis mobile. And adjust the different diameters both during pregnancy to keep you comfortable and with your pelvis well aligned with your changing body shape, but also during labor to help the journey of your baby through the pelvis and down the birth canal.

I very much hope you found this episode of the OBS Pod. Interesting. If you have, it'd be fantastic. If you could subscribe, rate, [00:30:00] and review on whatever platform you find your podcasts, as well as recommending the obs pod to anyone you think might find it interesting. There's also tons of episodes to explore in my back catalog from clinical topics, my career and journey as an obstetrician and life in the nhs.

More generally, I'd like to assure women I care. That I take confidentiality very seriously and take great care, not to use any patient identifiable information unless I have expressly asked the permission of the person involved on that rare occasion when it's been absolutely necessary. If you found this episode interesting and want to explore the subject a little more deeply, Don't forget to take a look at the program notes where I've attached [00:31:00] some links.

If you want to get in touch to suggest topics for future episodes, you can find me at the obs pod on Twitter and Instagram and you can email me the ops pod gmail.com. Thank you for listening.

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Episode 124 The Pelvis Florence Wilcock: [00:00:00] Hello, my name's Florence. Welcome to the obs Pod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy, call the midwife, maybe birth fascinates you, or you'll simply curious about what exactly an obstetrician is.

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This episode in honour of world prematurity day is all about in utero transfer

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Episode 123 Transfer

Florence Wilcock: [00:00:00] Hello, my name's Florence. Welcome to the obs Pod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy, call the midwife, maybe birth fascinates you, or you're simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth.

Perhaps you work in maternity and want to know what makes your obstetric colleagues tick or you want some fresh ideas and inspiration, whichever of these is the case, and for that matter, anyone else that's interested, the Obs Pod is for you.

Episode one 20. Transfer this week is World Prematurity Day, the 17th of November, [00:01:00] a day where every year we think about, and remember those babies that are born prematurely. I've touched on premature babies in some of my other episodes. Might like to look back to the episode detour where I worked in a neonatal unit for a time, or possibly one of my baby loss episodes about signs of life, about very extreme prematurity.

Today in honor of world prematurity day, I'm going to talk about transfer. Imagine for a moment you're pregnant, you're excited, you're looking forward to having a baby. You're in the middle of your pregnancy. You've had your 20 week scan a few weeks ago. You've found out what sex [00:02:00] you're having. Maybe it's a boy, maybe it's a girl.

But you've started to imagine in your mind's eye this baby and start to plan for its arrival. Maybe you have a few twinges, Maybe you've got a bit of tummy pain. Maybe you've got an increase in vaginal discharge. You've decided to pop into the hospital, have a bit of a checkover. Suddenly you are whisked to the labor ward.

You're told to call your partner. You're told this could be premature labor. Maybe your baby's going to arrive soon. You're in shock. It's far too early for your baby to arrive. Maybe you are 25 or 26 weeks pregnant. You're scared, you're [00:03:00] not prepared, and you're worrying. How might this tiny baby survive?

You're in shock. You're trying to get your head around the fact that this baby might be going to arrive months ahead of schedule, and then a doctor or midwife walks in and starts to explain to you that they're going to need to send you to another hospital, not the hospital that's close to your home, not the hospital that you chose to have your care.

Not the hospital that you know and have become familiar with the staff, but a completely different hospital you're at possibly one of the most stressful times of your life and they're telling you they can't care for you. [00:04:00] What's this all about? So this is what's called an in utero transfer. And the point of it all is that the most preterm and smallest babies need to ideally be born in what's called a tertiary level neonatal unit.

So neonatal units have different grades depending on the skill of their staff and the equipment and facilities They have special care baby unit is where babies born from 30 to 32 weeks of pregnancy will receive their care. They might have some minor help with feeding, perhaps treatment for jaundice. It's neonatal care.

That's a level above what your baby might receive on the postnatal ward, but, [00:05:00] Minimal. Then you have what's called a local neonatal unit or level two. These units can look after babies that have some special care needs, and they may need some help with breathing support. Babies born after 27 weeks will often receive their care in this local neonatal unit, and that is the level of the neonatal unit in my hospital.

Then there's what's called a level three neonatal unit or neonatal intensive care. This can provide all bells and whistles, every aspect of care a baby might need, and babies that are likely to be, born before 27 weeks or a less than 800 grams in birth weight. Should ideally start their care at a neonatal intensive care [00:06:00] or level three unit.

So the difficulty is that not all units will have a level three neonatal unit. We've got to consolidate our staff, our equipment, our expertise in those level three units. Most local hospitals will have a level. Or a level one unit, Hence the problem we want, ideally, those babies born before 27 weeks, or estimated to be less than 800 grams birth weight to be born in that level three unit.

Why , Well, the statistics are actually incredible. If we can have all the babies. Of less than 800 grams or less than 27 weeks, born in a tertiary unit, [00:07:00] one more baby will survive for every 20 women transferred. And if a baby is not born in a tertiary unit, so it's born in the wrong place, it has a two to three times higher chance.

Of intra ventricular or per ventricular hemorrhage, that's a hemorrhage, a bleed in its brain that may result in some form of brain damage and a 1.3 times higher risk of death. So being born in the right place is crucial in improving not only the survival of your baby , but it's long term health. Place of birth of course, is not the only thing.

There are other things we are going to do to try and [00:08:00] optimize the health of your baby, such as giving steroids to try and help improve the baby's lungs, magnesium to try and reduce the risk of brain damage, and then antibiotics. To prevent infection. But where a baby is born is a crucial component. One of the four crucial things we can do that improves clinical outcomes for preterm babies.

And it kind of makes sense logically. So if you imagine we can either move you the woman you can get up and walk, or you can be in a wheelchair and your baby is transported, cushioned in the womb in its amniotic fluid, receiving blood supply from the placenta, [00:09:00] beautifully protected, or, if the baby is born in the wrong place.

Then we have to do what's called an ex utero transfer. So that is your very fragile, very preterm baby being put in an incubator, probably with some ventilation or breathing support with drips, with an intensive care nurse, with an intensive care doctor being put in an ambulance and sent to another place. So it's common sense that really the best thing to do, if at all possible is to transfer you.

Okay, Makes sense. Makes a big difference to outcomes. Why is it so difficult? Well, the reality is we have to try and decide who might be about to give birth to a very premature or [00:10:00] very small baby. And then we've got to balance that with is it safe to transfer you? Ideally, we want to be doing things early enough that we've got time to safely transfer you.

We don't want your baby born in an ambulance that's not good for you or your baby, but equally we don't want to transfer too many women because actually we thought they were about to deliver, but they weren't. And then we've potentially had a neonatal unit that had cots who's received a woman, and they're keeping a cot for that woman.

But actually, if we've made the wrong call and she wasn't likely to give birth, we've wasted a cot. So it's very difficult. Fortunately for us, there've been quite a few modern [00:11:00] developments that can help us decide which women might be the right women to transfer. So we can take a history, find out what are your symptoms, how are you feeling, what's been happening, and also look at your examination.

But we can also use something called Quip app, which looks at predictors of preterm birth. This might be the length of the cervix, the neck of the womb, or a quantitative fetal fibronectin. That's something that your cervix releases when it's likely to go into labor. These can be keyed in to the Quip app, website, by a doctor, or midwife, and it helps give us an idea about the likelyhood, Of going into labor prematurely in the next week.

It can't absolutely tell [00:12:00] us who's going to birth their baby very preterm, but it can give us a picture of who might not and therefore less need to transfer and move these women around. Whereas if you've got a higher percentage chance, we may then institute some of the treatments I mentioned. Such as steroid injections and magnesium sulfate, and we are more likely to want to move you to a tertiary neonatal unit so that you are ready just in case.

So once we've tried to decide if you are the person that's going to give birth very prematurely, then we've got to work to try and find somewhere for you to go , and this isn't easy. I work in London. There's masses of hospitals and [00:13:00] eight tertiary level neonatal intensive care units, so you'd think it would be easy.

I'm spoiled for choice. The reality is that you've got to find a unit that has a cot that is free, that has the right staff ready to care for that baby. They're not short staffed or having lots of people off sick, and then because you are being transferred and the baby is still in the womb, as well as making sure the neonatal unit have availability in staffing.

I've also got to make sure that the obstetric unit. Probably the labor ward also has space for you and appropriate staff. This can be a bit of a minefield. We can spend hours ringing round different neonatal units only to find, yes, the neonatal unit has a cot and can accept no. The labor ward's got a shortage [00:14:00] of midwives, or they're overflowing with women in labor.

Yes, this labor ward they can take, That's okay. Yes, The neonatal unit can take, Oh no, actually someone's just turned up and taken that cot so we have to make a series of phone calls and it can be very difficult to coordinate and all this while. We're also trying to look after the woman at the center of all this, because if her cervix is dilating more and she is laboring, then we've got a finite amount of time in which we can safely do the transfer.

Yes, we're gonna send a midwife or nurse with her in the ambulance, but we absolutely do not want this baby to be born in the back of an ambulance. This baby is vulnerable. This baby, yes, it would be better to be born in a tertiary unit [00:15:00] or a level three unit, but it definitely would be better to be born in a level two unit than on the road in the back of the ambulance.

So it can be quite a challenging juggling act because of this. Some places, including London, have really worked hard to try and improve the way we do an in utero transfer to try and coordinate better the phoning so that you have to phone one place with just one phone call, and this is the emergency bed service.

And the idea of this is to try and improve and reduce the number of babies that are born outside of the level three neonatal units who really should be born there. So there's been lots of work going on in London in [00:16:00] the last few years to try and streamline the process, make sure conversations are happening at a senior level

consultant to, consultant or senior midwife to senior midwife and better coordination so that you are making less phone calls and because the emergency bed service is run by ambulance control also, then ensuring that when you have located a cot, And located a maternity unit and you get the green light with much relief, you can then safely transfer the woman with a member of staff accompanying her in an ambulance in a time efficient way.

There's nothing worse than finally getting agreement from a neonatal unit and a labor ward and then having to wait a long time for the ambulance transfer. . [00:17:00] There's been a lot of improvement in the last few years, but it's still far from a perfect system. There's a lot to coordinate and a lot to think about, let alone explaining to the woman, her partner, her family.

Why? Why is that? You just can't look after them where they. And as a doctor or a midwife, it feels really difficult to have those conversations. It feels almost like you're rejecting that family. You're saying, We can't care for you here, but we really are doing it with the best of intentions.

A few years ago when we did the project, nobody's patient, I was inspired to write a poem. My perspective, the obstetric perspective of an in utero transfer. [00:18:00] So I'm going to read it to you now. The transfer dilemma, In utero , ex utero it seems very simple to me. Surely we know in utero is much the safest. Why is this decision always made so late in the day?

Those pesky obstetricians, they're so slow to decide. In the meantime, the neonatal team are taken for a ride. Please, let's not start an argument. Can I instead explain what may be going on in the obstetrician's head first for a start? I have to break a woman's heart. There's no easy way to say, I have to send you away.

The relationship and trust is shattered into [00:19:00] dust. Her views don't hold sway. It's just going to be this way. We can't care for you. Here are the last words she wants to hear. The reasons her baby needs care are quite another. , depending on the underlying condition, transfer can be a dangerous mission. It can be hard to predict what happens next, and therefore to think through what may be best.

We have to measure up and weigh the possible outcomes, or if we let her stay a birth, bleeding, or collapse on route are just a few of the risks we must compute. Whilst we are ringing to plan her care, checking for cots here and there, we can think its settled and arranged only to find the situation has suddenly [00:20:00] changed, ready to go.

Suddenly the answers no

now for my zesty bit , my zesty bit for parents is to understand if your baby arrives very preterm, we may well move you and it will be potentially inconvenient, further from home, more difficult for family to visit and not where you chose to have your maternity care. But this will be with good reason. Your baby, should it arrive early, will really benefit from the expertise of those staff who regularly look after such vulnerable and tiny or very preterm babies.

So whilst it's a shock [00:21:00] and you're gonna find it really difficult, hopefully you'll be transferred. Your baby will stay in the womb and you'll go home and it will all become a distant memory. But should the worst happen, should your baby need to be born so early on in pregnancy or so small, your baby is in the absolute best place for your baby to have the best chance of not only survival, but good health in the future

if you are a health professional listening. Then do explore the Quip app website. I've put a link in the notes and also the implementation guidance for In utero transfer, whether you are in London or not. There's some really helpful flow charts to think about the steps we go through. I've [00:22:00] attached the bpam antenatal optimization guidance, the things that we can.

As doctors and midwives that may have a big impact and benefit those babies that are born preterm, those that need that level three neonatal care and those that don't, that need less intensive care.

I very much hope you found this episode of the obs Pod. Interesting. If you have, it'd be fantastic if you could subscribe.

Rate and review on whatever platform you find your podcasts, as well as recommending the obs pod to anyone you think might find it interesting. There's also tons of episodes to explore in my back catalog from clinical topics, my career and journey as an obstetrician and life in the [00:23:00] nhs. More generally, I'd like to assure women I care for.

That I take confidentiality very seriously and take great care, not to use any patient identifiable information unless I have expressly asked the permission of the person involved on that rare occasion when it's been absolutely necessary. If you found this episode interesting and want to explore the subject a little more deeply, Don't forget to take a look at the program notes where I've attached some links.

If you want to get in touch to suggest topics for future episodes, you can find me at the obs pod on Twitter and Instagram and you can email me the obspod@gmail.com. Thank you for [00:24:00] listening

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The episode is out on Thursday this week in honour of World Prematurity Day 17th Nov when we focus on the fact the worldwide 1 baby in every 10 is born prematurely.Find out all about in utero transfers, what are they, why do we transfer between...

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I was proud to contribute to the development of this important report

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I was proud to contribute to the development of this important report

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Some of this report makes shocking reading, please do take a look & think about how we might improve care

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Want an inspiring multidisciplinary society working on improving birth in the UK look no further!

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About BICS

The British Intrapartum Care Society [BICS] was established in 2018 to promote excellence in intrapartum care.

Our aim is to standardise the care provided to women and babies across the British Isles during labour, ensuring safe practice through shared learning, high quality education and research.

Following the principles of co-producti

Show More

The British Intrapartum Care Society [BICS] was established in 2018 to promote excellence in intrapartum care.

Our aim is to standardise the care provided to women and babies across the British Isles during labour, ensuring safe practice through shared learning, high quality education and research.

Following the principles of co-production, working with women and families underpins our philosophy and strategy.

Our national and global network of specialists covering all multi-professional intrapartum disciplines provides a unique discussion forum for the dissemination of ideas, experience, innovation and regional good practice.

Through engagement with national bodies we both inform policy and support our members in the implementation of initiatives dedicated to improving women's experience of childbirth and promoting personalisation of care.

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Membership of the newest Specialist Society of the RCOG

Access to the BICS mailing list

Discount off the annual conference fee

Access to members area of the website [in development]

Opportunity to stand for election for the BICS committee

Opportunity to vote in BICS committee elections

Opportunity to contribute to the shaping of the society

Obstetricians, midwives, anaesthetists, neonatologists, neonatal nurses, GPs, Maternity Voices Partnership members, #MatExp members........ Anyone involved & interested in intrapartum care is welcome! Join BICS

Obstetricians, midwives, anaesthetists, neonatologists, neonatal nurses, GPs, Maternity Voices Partnership members, #MatExp member

Show More

Obstetricians, midwives, anaesthetists, neonatologists, neonatal nurses, GPs, Maternity Voices Partnership members, #MatExp members........ Anyone involved & interested in intrapartum care is welcome! Join BICS

Obstetricians, midwives, anaesthetists, neonatologists, neonatal nurses, GPs, Maternity Voices Partnership members, #MatExp members........ Anyone involved & interested in intrapartum care is welcome!

Show Less

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The British Intrapartum Care Society [BICS] was established in 2018 to promote excellence in intrapartum care. Our aim is to standardise the care provided to women and babies across the British Isles during labour, ensuring safe practice through shared learning, high quality education and research.

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What is sepsis, what is the sepsis six?

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This episode covers Sepsis & the sepsis six the mainstay of initial treatment for this serious life threatening illness. Warning this episode contains mentions of maternal death and baby loss.

Want to know more?
https://sepsistrust.org/
https://www.rcog.org.uk/media/ea1p1r4h/gtg_64a.pdf

https://www.gov.uk/government/collections/group-a-streptococcal-infections-guidance-and-data#management-

Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. Do explore my back catalogue of episodes and feel free to get in touch to suggest topics, I love to hear your thoughts and ideas. If you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. If you have found my ideas helpful please spread the word & help theobspod reach others who may be interested in exploring all things pregnancy and birth.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com Please also check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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This episode covers Sepsis & the sepsis six the mainstay of initial treatment for this serious life threatening illness. Warning this episode contains mentions of maternal death and baby loss.Want to know more?https://sepsistrust.org/https://www.rcog.org.uk/media/ea1p1r4h/gtg_64a.pdfhttps://www.gov.uk/government/collections/group-a-streptococcal-infections-guidance-and-data#management-Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.

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Here I reflect on the publication of Reading the Signals the investigation into East Kent Maternity services and think about the learning & recommendations

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It is a difficult time in maternity care in the UK, last week saw the release of the report into East Kent Maternity services 'Reading the signals' which has lessons for us all.
Join me as I digest and think about this report and the previous reports of maternity services failing families and think a little about where we go from here.

Want to know more?
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1111992/reading-the-signals-maternity-and-neonatal-services-in-east-kent_the-report-of-the-independent-investigation_print-ready.pdf

https://www.gov.uk/government/publications/final-report-of-the-ockenden-review

Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. Do explore my back catalogue of episodes and feel free to get in touch to suggest topics, I love to hear your thoughts and ideas. If you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. If you have found my ideas helpful please spread the word & help theobspod reach others who may be interested in exploring all things pregnancy and birth.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com Please also check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Episode 120 Reading the Signals - The Obs Pod

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It is a difficult time in maternity care in the UK, last week saw the release of the report into East Kent Maternity services 'Reading the signals' which has lessons for us all.Join me as I digest and think about this report and the previous repor...

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What do we define as a small baby and how do we monitor them?

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I can't believe I have managed to neglect the topic of a small baby up to this point especially given Episode 29 Big baby is now my most popular episode. Join me to rectify this omission as I discuss what we think about when a baby is small , and ...

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Here I talk to Benjamin Black a fellow O&G consultant about his incredible book Belly Woman the experiences of working in maternity care in Sierra Leone in the Ebola epidemic

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Have you wondered what it would be like practicing maternity care in a low or middle income country? What if you went to do that, and then found yourself in the middle of an Ebola Epidemic? Here I chat to Benjamin Black about his fascinating book Belly Woman , about his experiences of working in Sierra Leone and his reflections on differences and similarities with challenges in the UK.

Want to know more?
https://www.rescue.org/sites/default/files/document/4416/srhebolareport1172020.pdf
Belly Woman: Birth, Blood & Ebola: The Untold Story
by Amazon https://www.amazon.co.uk/dp/1911107577/ref=cm_sw_em_r_mt_dp_N96WGDT1GNTGJA595X5V?_encoding=UTF8&psc=1
You can find Benjamin on Twitter and Instagram @benjamblack
https://www.benjamin-black.com/

Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. Do explore my back catalogue of episodes and feel free to get in touch to suggest topics, I love to hear your thoughts and ideas. If you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Have you wondered what it would be like practicing maternity care in a low or middle income country? What if you went to do that, and then found yourself in the middle of an Ebola Epidemic? Here I chat to Benjamin Black about his fascinating book ...

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Episode 118 Postnatal Innovation a chat with Sunita - The Obs Pod

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Sunita Sharma is an obstetrician on a mission to improve postnatal care , listen to the amazing steps she is taking to try and do this important work

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Episode 118 Postnatal Innovation a chat with Sunita - The Obs Pod

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Meet Sunita Sharma a consultant in O&G with a passion for all things postnatal. Take a listen to the innovative work she is doing to improve postnatal care at her own hospital and across London. I am hoping our conversation will inspire plen...

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Here I talk about the story of my own birthday a reflection of how birth experience stays with us & our parents for life

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It's my birthday week so I am reflecting on birth stories and the story of my own arrival in the world.

Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. Do explore my back catalogue of episodes and feel free to get in touch to suggest topics, I love to hear your thoughts and ideas. If you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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It's my birthday week so I am reflecting on birth stories and the story of my own arrival in the world.Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podca...

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Have you heard of the maternity data ‘so what’ report hear my thoughts as I take a look

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My attention has recently been drawn to a report - The 'so what' of maternity data. Join me as I discuss my thoughts & reflections on the report as well as how we may equip ourselves better to understand data and make it useful.Want to know mo...

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Does the age at which you get pregnant matter ?

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Today I am discussing if the age a woman is when she become pregnant is important? Find out some stats and definitions of how age can have an impact on pregnancy outcomes for both mother and baby.Want to know more?https://obgyn.onlinelibrary.wiley...

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Episode 112 Blood clots, treatment and prevention - The Obs Pod

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Episode 112 Blood clots treatment and prevention

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Episode 112 Blood clots treatment and prevention

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Why do we worry about clots in pregnancy ?

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Episode 112 Blood clots, treatment and prevention - The Obs Pod

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Are we obsessed with blood clots , thrombosis in pregnancy? Why do we worry & what can we do about them.Want to explore more?Reducing the risk of venous thrombosis in pregnancy and after birth patient information leaflet | RCOGgtg-37b-1.pdf (r...

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Episode 115 The Black Maternity Experience Survey - The Obs Pod

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We must do better the disparity demonstrates in this report is unacceptable , take a listen and think what can you do to help improve this

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Have you read the FiveXmore Black Maternity Experience Survey published this year? If you haven't and you work in maternity then its essential reading. Here I discuss why its so valuable and my thoughts on some of the results.

Want to know more?

https://www.fivexmore.com/blackmereport
https://www.fivexmore.com/6steps

Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. Do explore my back catalogue of episodes and feel free to get in touch to suggest topics, I love to hear your thoughts and ideas. If you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Episode 115 The Black Maternity Experience Survey - The Obs Pod

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Have you read the FiveXmore Black Maternity Experience Survey published this year? If you haven't and you work in maternity then its essential reading. Here I discuss why its so valuable and my thoughts on some of the results.Want to know more?htt...

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Episode 110 Anatomy lesson - The Obs Pod

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How well do you know your own body? How much do we appreciate a women may need help understanding the terms we use and their body ?

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Episode 110 Anatomy lesson - The Obs Pod

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Do you know your anatomy? When we doctors and midwives use the word perineum do you know what we are talking about? Here I explore some research on the level of knowledge people have about female body parts.Wan to know more?https://www.theguardian...

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Do you need to travel whilst pregnant? Whether it be for work, holiday or visiting family this episode talks all about what to consider when travelling whilst pregnant

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When should you or shouldn’t you travel during pregnancy ? What are the issues you need to consider when planning a trip whether it be for work, family or holiday, home or abroad?Want to know more?https://www.rcog.org.uk/media/lrupol45/air-travel-...

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How do we care for women that are HIV positive and how has this care radically changed over the years?

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Why do we screen for HIV in pregnancy ? Here I give a little thought to women who are pregnant and HIV positive and how much their care has changed over the course of my career.Want to know more?https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/hiv-and-pregnancy-patient-information-leaflet/https://www.bhiva.org/file/5f1aab1ab9aba/BHIVA-Pregnancy-guidelines-2020-3rd-interim-update.pdfhttps://i-base.info/guides/pregnancyThank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.

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Here I talk to Megan about her PhD aiming to improve our understanding of running after pregnancy and how to return to running safely

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Episode 108 Running and Pregnancy and Postpartum

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Episode 108 Running and Pregnancy and Postpartum

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What is it like being the long suffering partner of an obstetrician - hear the other side of the story!

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What are platelets, what do they do & why are they important?

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All about the incredible QI project the World health organisation surgical checklist

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A fabulous conversation between Gill Phillips and obstetrician Alison Wright on the idecide tool and personalised maternity care

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I wanted to share this episode of WildcardWS podcast with my friend Gill Phillips. If you haven't already listened to her podcast its a set of incredible thought provoking conversations.
This one is a fantastic conversation with a fellow obstetrician Alison Wright currently working on the iDecide tool a tool to help ensure  informed consent in labour.

Want to listen to some more?
https://whoseshoes.buzzsprout.com/

Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. Do explore my back catalogue of episodes and feel free to get in touch to suggest topics, I love to hear your thoughts and ideas. If you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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I wanted to share this episode of WildcardWS podcast with my friend Gill Phillips. If you haven’t already listened to her podcast its a set of incredible thought provoking conversations.This one is a fantastic conversation with a fellow obstetrici...

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Episode 101 A Chat with Maria from Mothers for Mothers - The Obs Pod

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Episode 101 A chat with Maria from mothers for mothers 

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Episode 101 A chat with Maria from mothers for mothers 

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A focus on maternal mental health for maternal mental health week May 2022 incredible chat with Maria about her own story & the incredible work the charity mothers for mothers do

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To mark Maternal Mental Health Week 2022 I had a wonderful conversation with Maria Viner CEO of Mothers for Mothers a maternal mental health charity

Trigger warning - This fascination chat covers difficult but important topics of baby loss, maternal mental health, infant mental health and the covid pandemic.

Want to know more?
https://maternalmentalhealthalliance.org/news/maternal-mental-health-awareness-week-2022/
https://mothersformothers.co.uk/ For Bristol & SW
https://hubofhope.co.uk/ To find  help in other geographical areas

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Episode 101 A Chat with Maria from Mothers for Mothers - The Obs Pod

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To mark Maternal Mental Health Week 2022 I had a wonderful conversation with Maria Viner CEO of Mothers for Mothers a maternal mental health charityTrigger warning - This fascination chat covers difficult but important topics of baby loss, maternal mental health, infant mental health and the covi...

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What is the WHO checklist and why is it so important ? A stunning worldwide health care quality improvement project

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https://www.who.int/teams/integrated-health-services/patient-safety/research/safe-surgery/tool-and-resources
Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. Do explore my back catalogue of episodes and feel free to get in touch to suggest topics, I love to hear your thoughts and ideas. If you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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What are we talking about when we say we are doing The WHO? What is it? When did it start & why is it important?Want to know more?https://www.nejm.org/doi/full/10.1056/NEJMsa0810119https://www.who.int/news-room/questions-and-answers/item/safe-...

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Episode 102 Shoulder Dystocia - The Obs Pod

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What is it? What can we do about it?

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This episode looks at the emergency situation that is Shoulder Dystocia when there is difficulty with the birth of the baby's shouders after the head has been born.

Want to know more?
https://www.youtube.com/watch?v=UTz2eIiZOL8
https://www.rcog.org.uk/media/ewgpnmio/gtg_42.pdf
https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/shoulder-dystocia-patient-information-leaflet/
https://www.erbspalsygroup.co.uk/

Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. Do explore my back catalogue of episodes and feel free to get in touch to suggest topics, I love to hear your thoughts and ideas. If you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Episode 102 Shoulder Dystocia - The Obs Pod

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This episode looks at the emergency situation that is Shoulder Dystocia when there is difficulty with the birth of the baby's shouders after the head has been born.Want to know more?https://www.youtube.com/watch?v=UTz2eIiZOL8 https://www.rcog.org.uk/media/ewgpnmio/gtg_42.pdfhttps://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/shoulder-dystocia-patient-information-leaflet/https://www.erbspalsygroup.co.uk/Thank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.

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Episode 99 Lets Talk about Sex - The Obs Pod

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Here I am joined by urogynaecologist Swati Jha talking about sex during pregnancy and after giving birth . Full of interesting information on the topic we health professionals can sometimes struggle to broach yet is super important to discuss and provide support for women recognising changes in their bodies.

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Episode 99 Lets Talk about Sex - The Obs Pod

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Here I am pondering why we don't talk more about sex during pregnancy and after birth? I explore sex during pregnancy and I am joined by expert urogynaecologist consultant Swati Jha from Sheffield to talk about a range of issues such as sex after...

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What is it with all these awards ??

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Why are awards in the NHS or healthcare becoming common, are they a good thing or can they cause problems?

Want to know more?
You only have to google NHS awards and a myriad of categories and types pop up!

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Why are awards in the NHS or healthcare becoming common, are they a good thing or can they cause problems?Want to know more?You only have to google NHS awards and a myriad of categories and types pop up!If you have enjoyed my podcast please do sha...

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Episode 98 Book Before Ten - The Obs Pod

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Book before 10 weeks why is it important here Rose tells me all about her Book before ten campaign & the importance for getting the word out into communities

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NICE guidance suggests we should be seeing women for their first appointment before 10 weeks of pregnancy. Here I talk to Rose Ngadze O&G doctor about her Book Before Ten campaign run with her supervisor Dr Jivraj.
The Book Before Ten campaign encourages women to see their midwife before they are ten weeks or two and half months pregnant. The campaign also encourages healthcare providers to analyse their late booking patterns, engage women and take the necessary steps to reduce barriers to timely maternity care. Contact Rose on twitter @BookBeforeTen
https://myhealth.london.nhs.uk/maternity/now-what
https://www.nice.org.uk/guidance/ng201/chapter/Recommendations#routine-antenatal-clinical-care
If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Episode 98 Book Before Ten - The Obs Pod

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NICE guidance suggests we should be seeing women for their first appointment before 10 weeks of pregnancy. Here I talk to Rose Ngadze O&G doctor about her Book Before Ten campaign run with her supervisor Dr Jivraj.The Book Before Ten campaig...

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The Role of the consultant obstetrician in midwifery led care

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The Role of the consultant obstetrician in midwifery led care

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Pleased to have written this article all about teamwork

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The evidence demonstrating the benefit of midwifery care to both mother and baby is compelling. In the UK this is reflected in the current national drive to improve continuity of care and support choice of place of birth in midwifery led settings as a result of Better Births (National Maternity Review 2015). The commitment and focus on the importance of midwifery and improvements in midwifery led care can leave obstetricians feeling somewhat overlooked, unacknowledged and uncelebrated. Certainly, when our local midwifery led unit (MLU) and homebirth rates are applauded our obstetric unit team can feel unappreciated. This is unnecessarily divisive, and a simplistic way of viewing midwifery led care. The Birthplace study that so robustly demonstrated the safety of homebirth talked about the importance of clear referral pathways to obstetric care when something deviates from expected. Every midwifery led pregnancy and birth happens within the context of obstetric provision being available in the background. Likewise the success of continuity of care, and birth in midwifery led settings rely on a broader network of maternity professionals.

So where do I fit in this midwifery model in my role as a consultant obstetrician? I would argue doing less is more, what we do as obstetricians in the antenatal period can make a big difference. The outcomes many obstetricians are concerned to avoid such as severe perineal trauma and post-partum haemorrhage will be reduced if we can improve the uptake of midwifery led care. We need to promote midwifery led care where appropriate and have a responsibility to encourage & normalise birth in non-obstetric settings. The default idea of birth in a hospital obstetric unit being safest and homebirth being risky needs challenging by obstetricians as much as, if not more so than by midwives. The less we interfere with the continuity of care relationship in the antenatal period, the more we can build trust in the woman's midwife, the more likely the woman is to achieve the good outcome of both physical and psychological safety. In this way whilst obstetricians may not be in forefront of a woman's care, we are far from obsolete, still an essential component of midwifery led care.

How can we facilitate this midwifery led care & not disrupt it? I feel the clue is in the name consultant: The definition of a consultant is "a person who provides expert advice professionally". This is how a midwife needs to use the consultant obstetrician, by consulting them & the obstetrician providing advice. This leaves the midwife as the key healthcare professional for the care of that woman drawing in obstetric expertise when the situation requires. In practice this can work in several ways. In my role I am link consultant for several midwifery teams; perinatal mental health, homebirth and Emerald (birth after caesarean) teams. Having a specific link consultant obstetrician in this way means midwives from the team can email me for advice or support on a specific issue or give me information on a situation in advance of an appointment. This way of working means I can minimise disruption to the continuity of care pathway by giving the midwife instructions on blood tests to take or helping interpret results so that the midwife can modify care without the woman having an appointment in my clinic. Some women will obviously need to be seen by me and a small synopsis of the key important points the woman and the midwife wish me to consider can be very helpful, giving me context and enabling me to put a woman immediately at ease by telling them the midwife has been in touch about them. Equally if the midwives can build the woman's confidence in the link obstetrician ahead of time this results in the woman coming to an appointment more at ease and trusting that she will be given good information and her choices respected. Her midwife has told her about me (the consultant) in advance and reassured her that I will listen, that I will be prepared to think about her as an individual & support personalised care rather than through blanket application of guidance. The number of women I see who come prepared to 'do battle' feeling they need to advocate and fight for their choices is therefore reduced, the trip to consultant clinic become less daunting.

As obstetricians there can be a temptation to gather women. Once we have seen a woman in our clinic it is all too easy to give her a follow up appointment and more junior members of the team may be more likely to do this as they are less confident & more risk adverse. If a woman is triaged to attend the obstetric clinic at 16 weeks working in partnership with specific midwives also means I can send a woman back to midwifery led care with confidence. Seeing women repeatedly in obstetric clinic can result in more intervention, perhaps things that at face value may seem harmless such as an extra scan can steadily result in medicalisation. Minor factors such as glycosuria or a slightly borderline blood pressure can lead to a woman being labelled as 'high risk' and removing choices derailing midwifery led care. In the situation where obstetric review is required, I can work in partnership with the named midwife or consultant midwife co ordinating appointments so that we don't unnecessarily duplicate but instead share the care. For women who don't quite fit into the criteria for midwifery led care but who want it we can take practical steps to mitigate risk and help plan ahead; for example, sometimes I prescribe additional medication on a case by case basis for women with a higher chance of post-partum haemorrhage who wish to birth at home.

Modern technology such as email and electronic record systems can be used to enable communication. The midwife can clearly see my recommendations and advice, as well as planned appointments on our computer system. This means the women feel that their care is co-ordinated, all members of the team are fully briefed and know how we plan to support her whatever the eventuality. Building trust between members of the team, establishing a relationship between midwife and obstetrician as well as between the midwife and the woman mean that on those occasions when midwifery led care simply is not the best option the team can give consistent advice and support and work on alternative choices.

Working in this way inevitably brings its rewards. On an individual basis its lovely to receive feedback that someone has had the birth they wished for. On the occasions when things don't work out quite as planned, women are less traumatised, having thought through and prepared in advance for a range of options and often comment on this during the post-natal period. As our homebirth rate has climbed and continuity of care rates improve, I can celebrate knowing I have contributed in my small way. As we continue to champion continuity of care, we obstetricians need to adapt and support our midwifery colleagues in a new way. Similarly, the relationship needs to be reciprocal, midwives, need to build relationships with their obstetric colleagues and ensure they are not getting left behind but remain an integral and important part of midwifery teams and maternity care.

This article was provided by Florence Wilcock, Consultant Obstetrician, Lead Obstetrician for PNMH, Kingston Hopsital NHS Foundation Trust. Follow Florence on twitter at @FWmaternity and @TheObsPod and follow the podcast and many other resources here.

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The role of the consultant obstetrician in midwifery led care - Maternity & Midwifery Forum %

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It is of concern that there is inequity of access and outcomes within maternity services. Aiming to address the inequity the perinatal mental health team at NHSE South East region have created a filmed educational resource. In this article Jenny Walsh, Clinical Lead for Perinatal Mental Health, describes the creation of the film and discusses how it may be used to improve care.

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Find out a bit more about how we manage money in the NHS and why there is a flurry of spending in March!

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March is the end of the NHS Financial year. Does it matter to me as a clinician? Here I explore budgets, end of year money and why with a NHS annual spend of £136billion we still need to be thrifty.

Want to know more
https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs
https://www.hfma.org.uk/docs/default-source/publications/nhs-efficiency-map-updated-january-2017.pdf?sfvrsn=0

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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March is the end of the NHS Financial year. Does it matter to me as a clinician? Here I explore budgets, end of year money and why with a NHS annual spend of £136billion we still need to be thrifty.Want to know morehttps://www.kingsfund.org.uk/au...

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Thank you for taking the time to write your reviews 😊👏🏼

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Thank you for taking the time to write your reviews 😊👏🏼

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What if your waters break before labour? What are your choices

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One of the possible signs of labour is breaking your waters - actually this happens less often that you might think. Here I discuss what happens next and what advice we are or are not giving women on their options if the waters break before contractions start.

Want to know more?
https://www.tommys.org/pregnancy-information/giving-birth/what-expect-when-your-waters-break
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005302.pub3/full
Prelabour rupture of membranes: induce or wait? - Evidently Cochrane
Recommendations | Inducing labour | Guidance | NICE
https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.14821
https://neonatalsepsiscalculator.kaiserpermanente.org/
You may also wish to revisit Episode 66 Group B strep.

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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One of the possible signs of labour is breaking your waters - actually this happens less often that you might think. Here I discuss what happens next and what advice we are or are not giving women on their options if the waters break before contra...

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Episode 94 A chat with NCT Practitioner Laura James - The Obs Pod

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Episode 94 A chat with NCT practitioner Laura James

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Episode 94 A chat with NCT practitioner Laura James

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Ever wondered what an NCT teacher does? Here is your chance to understand more

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Through my work at the London Maternity Clinical Network I became friends with Laura James. Amongst other things Laura is an NCT Practitioner and a champion for maternity voice partnerships. In this episode we explore some common assumptions about NCT & talk about the importance of women's voices.

Want to know more?
For evidence-based information about labour, birth and parenting, further information about NCT courses and support in your area visit www.nct.org.uk
For further information about Maternity Voices Partnerships and to find your local MVP visit: https://nationalmaternityvoices.org.uk/find-an-mvp/

Laura James is a coach, mentor and NCT Practitioner. You can follow her on Twitter @laurajamescoach

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Episode 94 A chat with NCT Practitioner Laura James - The Obs Pod

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Through my work at the London Maternity Clinical Network I became friends with Laura James. Amongst other things Laura is an NCT Practitioner and a champion for maternity voice partnerships. In this episode we explore some common assumptions about NCT & talk about the importance of women's vo...

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What should we be eating during pregnancy are we giving good advice

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Sparked by some comments on social media about what is and isn't appropriate work wear for healthcare staff today I am chatting about all things uniform and examining the NHS Uniform policy.

Want to explore more?
https://www.england.nhs.uk/wp-content/uploads/2020/04/Uniforms-and-Workwear-Guidance-2-April-2020.pdf

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

# data[].attributes.attachment_link.description
Sparked by some comments on social media about what is and isn't appropriate work wear for healthcare staff today I am chatting about all things uniform and examining the NHS Uniform policy.Want to explore more?https://www.england.nhs.uk/wp-content/uploads/2020/04/Uniforms-and-Workwear-Guidance-2-April-2020.pdfIf you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch.

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Using the Whose Shoes? approach to involve men in maternity care in Uganda - interview with Dr Alice Ladur

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Dr Alice Ladur’s amazing PhD project is such an exciting way of taking our #MatExp work to a developing country I just had to include this inspiring story

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Questions & Answers

Where did you first come across the Whose Shoes? board game?

I first took part in a Whose Shoes? maternity workshop at University College London Hospitals in 2017. As professionals from different roles and backgrounds, we used the scenarios and poems to hold conversations with women and families, and looked together at how to improve certain aspects of maternity services locally and nationally in the UK. I learned so much from my colleagues that day, as the game gave us opportunities to pause and reflect on how, as citizens, we interact with health services and how that affects outcomes.

The workshop made me think about maternity care in Uganda. Perhaps it would help men to engage in their partner's care if they had an opportunity to come together in a safe space? It would give them a new opportunity to reflect on their own actions, community expectations and the broader structures that lead to inequalities within the Ugandan community.

When did you first become interested in male involvement in maternity care?

My interests in male involvement in maternal health started back in 2006, when I was working with post-conflict communities in northern Uganda to provide HIV/AIDS prevention services. We were running health education sessions for men using discussion, role play and drama, which resulted in an observed decrease in domestic violence. I was able to see first-hand the importance of involving a woman's immediate family in improving her health. This motivated me to carry on looking at how to work with families to improve health outcomes.

It is important to note that when we are discussing male involvement, this should never take away from women's choices. Male involvement is always dependent on whether the woman wants to involve her partner and immediate family, or not, and these interventions may not work for all women.

Can you explain some of the issues surrounding maternal care in Uganda?

Although there has been a steady decline over the past few years, Uganda still has a high maternal mortality rate. Antenatal care presents a unique opportunity for women and their families to learn about risks associated with pregnancy and to plan for delivery, but there are cultural barriers that mean many Ugandan men do not engage with their partner's antenatal care.

In Uganda, pregnancy and childbirth hold very significant meanings, one in which women find their identity and social status. That means there is a lot of pressure placed on women to produce children and extend the family lineage, with a special preference for male children. The pressure to give birth often comes from the pregnant woman's in-laws, husband and community, so it is important for us as researchers and professionals to understand the importance of family structures. We need to consider how to integrate family members in interventions to improve maternal safety. In Uganda men have considerable control over resources and decision making, and because of this, we need to work with both men and women to improve maternal health.

In addition, there is a cultural focus on communalism in Uganda, which means that individuals are subordinated to a group, and this has a direct impact on how people seek healthcare.

How did you adapt the game for use in rural Uganda?

We designed a pilot study which we ran with Ugandan men based in London. It was important to test the idea, as I didn't know whether a game format would be acceptable. Once the table was set with the board game and the little shoes, the men were captivated; everyone wanted to look at the shoes! They immediately started throwing the dice and picking up cards. Without any formal introductions, I let them carry on playing the game, and they really got involved.

I learned a lot from the pilot study, for example, that I would need to make the messages more specific and hard-hitting. This was particularly true around addressing cultural ideas that affect women during pregnancy and create barriers to accessing health services.

We also realised we would need to translate all the Whose Shoes? materials so that the game was immediately accessible to users in the rural Ugandan communities where we were going to use it.

Where and how did you run the Whose Shoes? Sessions in Uganda?

We ran the sessions from a primary healthcare facility in rural Uganda, a long way from the capital city. The community healthcare setting made it more accessible for the women and their partners. We had to get ethical approval and approval from several community structures to run the sessions.

We asked pregnant women accessing the healthcare facility whether they would be interested in their partners taking part, and were careful to promote each woman's choice in allowing her partner to be part of the project. We then invited the partners of women who consented, to come and take part.

There was some political unrest around the country at the time of the fieldwork and this came out in the sessions, when the colours on the board game took on political meanings for participants. Uganda was then divided along colour lines - yellow and red - and these groups disliked each other. When playing Whose Shoes?, those that loved red were leaning towards everything red in the game and detesting everything yellow, and vice versa. I had to spend home time reintroducing the colours in the context of the game and explaining the purpose of the study. Although it was a challenge, it gave us an opportunity to reinforce the fact that maternal death knows no colour divide or political affiliation.

I engaged a male facilitator to run the sessions, due to the cultural dynamics of the setting. He was very skilled and humorous - there was always a lot of laughter at the sessions! It was great having a male facilitator who had first-hand experience of maternity services; he had been at the birth of both of his babies, so his presence really reinforced the idea that it is possible for men to be part of their partners' maternal care.

What response did you get from the men who took part?

Despite the political unrest and the tensions, the sessions went really well. Some of the more tragic scenarios had a real impact and helped to drive the message home about the importance of antenatal care.

Many of the men were able to open up and share some of their fears. One participant said, "The game gives room for everyone to share their mind and encourages participation, you think better as you are talking. And I think I learned from my colleagues here." The feedback we received really reinforced the idea that Whose Shoes? creates safe spaces to reflect, share experiences and learn from each other.

The sessions also revealed issues we did not know about before, such as a perception among the men that antenatal care clinics were spaces where women went to 'report' them, and that's why they took so long at the clinic. We were able to allay these fears and explain that the real reason that antenatal appointments took so long was a shortage of staff and high demand for services. It allowed us to widen the discussion and reinforce the reasons why antenatal care is so important, because there is a prevailing perception that you should only seek health care when you're physically sick.

For me, the highlight of the whole project was seeing pregnant women coming back to access antenatal care services a lot happier and more relaxed. When I spoke to them, they attributed this to the men knowing about the importance of antenatal care.

What did you learn about factors that can make coproduction more effective?

I learnt that it's important to adapt health messages to suit local context. For instance, during antenatal sessions, women are encouraged to think about improving their nutrition by eating more green leafy vegetables and animal products. But I observed that in response to this, women tended to grumble or whisper to each other that making these diet changes was impossible because of the dynamics at home. In their community, it is generally men who make decisions around buying food and what dishes appear on the table. So it was important to integrate messages about healthy eating during the board game sessions. I observed that after the sessions, some of the men were going to the market and buying animal products and green leafy vegetables. This was really exciting as it showed that the messages were being taken seriously by the men after engaging in Whose Shoes? board game.

Some of the feedback from the participants reinforced the importance of adapting interventions to each specific cultural setting. One man said, "The people who thought about this game, really thought so well."

Do you have any plans to expand the project, or use your findings in other areas?

For me, the next step is to complete the write up of a paper on the Ugandan study and then share the results widely. I think there is also an opportunity to explore the long-term behavioural impact of Whose Shoes? in maternity care.

Further reading

Podcast: Using Whose Shoes in PhD work with men in Uganda to improve maternity outcomes (12 December 2021)
Safe maternal and newborn care: World Patient Safety Day 2021
Maternal care and safety in low- and middle-income countries
NHS - Experience of care: Creative Coproduction using Whose Shoes? (10 November 2021)
Whose Shoes: Keeping the conversations alive during the pandemic to build the future of health and social care

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Using the Whose Shoes? approach to involve men in maternity care in Uganda - interview with Dr Alice Ladur

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In this interview, Dr Alice Ladur talks about her experience of using the Whose Shoes? approach to increase male partners' involvement in maternity care in Uganda. Whose Shoes? is a co-production tool that uses a board game to help participants share experiences and reflect on their experiences of services.

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Inspired by the chaotic trailer for this is going to hurt find out all about the reality of cord prolapse

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Maybe you've seen the trailer for 'This is going to hurt' BBC First view depicting cord prolapse. Prompted by this dramatised version I thought I would talk about what a cord prolapse is like & what the modern approach to treatment would be.Wa...

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Find out how I started as a GP receptionist & why receptionists are such a valuable part of the team

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On entering most maternity units who are the first people you encounter? Why reception staff of course. Here I pause to think about the role they play and how we might value them a bit more given their crucial role in maternity units.

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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On entering most maternity units who are the first people you encounter? Why reception staff of course. Here I pause to think about the role they play and how we might value them a bit more given their crucial role in maternity units.If you have e...

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It’s lovely to get some feedback from listeners here I’ve included a few ….

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It’s lovely to get some feedback from listeners here I’ve included a few ….

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Why do we ask about genital herpes in pregnancy ?

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Why on earth does the midwife you meet at the start of pregnancy ask you about genital herpes? What business is it of ours. Here I explore the topic and wonder if we are perhaps missing the point...Want to know more?Layout 1 (rcog.org.uk)Prevale...

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Find out about this fascinating organ

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The Placenta is a simply awesome organ that grows and sustains the baby during pregnancy. Here I attempt to discuss how it forms , a baffling number of cell changes and 'invasions' of the mother's womb lining and blood vessels. Warning there is a brief mention of baby loss.

Want to know more?
https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/1471-0528.15306
https://www.tommys.org/pregnancy-information/pregnancy-complications/placenta-complications
https://www.tommys.org/research/research-centres/placenta-clinic
https://www.tommys.org/sites/default/files/legacy/CHI_Patient_Leaflet.pdf
https://www.cam.ac.uk/research/news/understanding-the-placenta-the-key-to-healthy-life

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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The Placenta is a simply awesome organ that grows and sustains the baby during pregnancy. Here I attempt to discuss how it forms , a baffling number of cell changes and 'invasions' of the mother's womb lining and blood vessels. Warning there is a ...

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My reflections on watching this documentary https://www.buzzsprout.com/961453/9920018

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Episode 85 WildObs Festive Special - The Obs Pod

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A festive musical special with my friend Gill aka WhoseShoes recounting some of our #MatExpAdvent - ures

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Episode 85 WildObs Festive Special - The Obs Pod

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Its the festive season & that calls for something a little special. In this episode I have clubbed together with my good friend Gill Phillips the creator of WhoseShoes & the WildcardWS podcast for an exploration of some of our maternity #M...

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A reflective look back at 10, 20 & 30 years ago in my career

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A reflective episode for New Year as I look back through the decades to what i was up to in 1992, 2002, 2012 & the present day. Join me as I think about some of the significant changes in the maternity world and in my working life.Wishing you ...

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Here I explore pre eclampsia & how we might treat it

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Pre eclampsia is a huge topic so these are my thoughts but not comprehensive coverage.If you want to go into more detail and explore guidance take a look at these resourceshttps://www.nice.org.uk/guidance/dg23/chapter/3-The-diagnostic-tests https:...

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Episode 83 An Average Monday - The Obs Pod

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What is my day like on labour ward ? Here I describe a typical day, average for me but unique for the people involved

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Every Monday I am on the labour ward, week in week out. For me it is routine but for the families I treat it is anything but. Here I discuss a typical labour ward day and reflect on some of the challenges I face. You might like to go back and listen to episode 18 handover as I refer back to this during the episode.

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Episode 83 An Average Monday - The Obs Pod

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Every Monday I am on the labour ward, week in week out. For me it is routine but for the families I treat it is anything but. Here I discuss a typical labour ward day and reflect on some of the challenges I face. You might like to go back and lis...

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Recently took part in #fabnhs Changeday with my friend Gill. Open the tent & take a peek at poet’s corner

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Well this is your opportunity to catch up and watch at your leisure.

You can watch the video here

This is a summary of the Tent chat:

What does poetry mean to you?

Poetry for me is a good way to reflect on my experiences and what I want to do going forward.

I enjoy a bit of a creative buzz, not something i usually do as a doctor writing a poem so it's fun but also thought provoking

The first poem emphasises the need for meaningful daytimes in care homes and the second, reminds us to look at what we do through the eyes of the people we serve.

I think having a mix of poems and scenarios has led to some great discussion during our WhoseShoes events. I enjoyed writing a couple of poems myself too!

Silly Rhymes:

I guess my attempts at poetry are silly rhymes and it's fun for me to write them. Spike Milligan was one of my I do's.

Rachel the book is fabulous and such a great idea, everyone contributing means they have buy in and interest in the story. that is also how quality improvement needs to be people of all backgrounds, and walks of life working together

silly rhymes are the best we had someone write a wonderful limerick in our mind and body project

Have just realised Lilly rhymes with silly so will get my thinking hat on.

it also rhymes with Caerphilly which is a bit cheesey

You take the biscuit.

I am now thinking of mice! all this talk of cheese and biscuits

I'll drink to that... Hovis, it's terrific toasted.

biscuit rhymes with risk it

Throw away the rule books....risk it for a biscuit!

The Power of Poetry & The Little Things are the Big Things:

The little things are the big things, so go the extra mile. The best way to make someone's day, is to leave them with a smile

I know this may sound silly; but I'm in awe of Mr Lilley,

My Youngest daughter's middle name is the name of the midwife that took care of me throughout my labour

Little things are the big things/At least that's what they say/But big things only get little, when you're far away/The closer you get/The more you can bet/You'll do better/Know better/See better/...in every way!

The Blonde

Being creative

Thats lovely Dani and will be something that gives the midwife pleasure that she did a good job; like the poem Roy :-)

I'm sorry I'm late joining...I've written a poetry book about the pandemic which helped me to cope with being a physician and be a 'normal' mum and wife..

That sounds amazing Helen - is it available on Amazon etc?

Book Here: https://smile.amazon.co.uk/Reflections-through-Waves-Poems-Pandemic/dp/1838069291/ref=sr_1_1?keywords=Helen+Lane+poetry&qid=1638219335&sr=8-1

That's an amazing story of poetry writing giving you an outlet and expression of emotion and ability to unload your feelings

wow incredible work Helen a wonderful story thank you for sharing

Thank you for sharing, Helen, that was an incredible story

permission to be human and cry is so important

Validating other's emotions and thoughts can be really powerful

I'm no good at links...it's called Reflections through the waves and is on Amazon

I love that, thank you Rachael

That's fab Rachel

such talent love it Carol

I love that

Brilliant; very poignant

Thank You's:

Thank you Gill et al, what a great session

Fantastic poems!

Ace event in a tent and powerful poetry

thank you

Thank you I have loved the the Tent 5 experience!

I need to disappear too....thanks all !

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Well this is your opportunity to catch up and watch at your leisure. You can watch the video here This is a summary of the Tent chat: What does poetry mean to you? Poetry for me is a good way to reflect on my experiences and what I want to do going forward.

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Every minute counts in maternity care thats why we can sometimes seem obsessed with time

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Here I discuss our obsession with time and clocks in maternity care.
Are our decisions really that time critical?

Want to know more?
Decision to delivery interval of instrumental births in theatre vs in the room
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2007.01302.x
Caesarean categories and timing https://www.nice.org.uk/guidance/ng192/resources/caesarean-birth-pdf-66142078788805
Timing of third stage and delivery of the placenta
https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#third-stage-of-labour

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Here I discuss our obsession with time and clocks in maternity care.Are our decisions really that time critical? Want to know more?Decision to delivery interval of instrumental births in theatre vs in the roomhttps://obgyn.onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2007.01302.xCaesarean categories and timing https://www.nice.org.uk/guidance/ng192/resources/caesarean-birth-pdf-66142078788805Timing of third stage and delivery of the placentahttps://www.nice.org.uk/guidance/cg190/chapter/Recommendations#third-stage-of-labourIf you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch.

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Inspired by #Cop26 hear my thoughts about maternity care and climate change

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Hear how we summon help in an emergency and how we are trained to react

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Find out how we know when and where there is an emergency situation in hospital. Why is 2222 is such an important number for healthcare professionals and what does neonatal resus have to do with a G&T.If you have enjoyed my podcast please do s...

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What are the challenges if you don't speak English and you need maternity care in the NHS?

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Episode 78 Lost in Translation - The Obs Pod

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How can we make sure people who do not speak English get equal access to information and good quality care? Here I discuss the challenges and the importance of translation & interpreting services in maternity care.Want to know more?Guidance an...

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Want to know all about different types of twin pregnancy and birth?

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I was delighted when Gem offered to share her insights on her maternity journey as part of a same sex couple. masses of learning in this episode

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Gem is an obstetrician and has recently become a new mum with her wife Emma. I was delighted when she offered to share her journey to parenthood the good and the less than ideal so that we can learn how to improve our services to support same sex parents as they become a family.

Gem can be contacted on twitter @gem_goodyear

Want to know more?
https://www.hfea.gov.uk/i-am/fertility-treatment-for-lgbt-people/
https://www.nhs.uk/pregnancy/trying-for-a-baby/having-a-baby-if-you-are-lgbt-plus/
https://www.nct.org.uk/pregnancy/same-sex-parents/two-mum-families-sharing-experiences-and-support

& Slightly outdated https://www.stonewall.org.uk/resources/pregnant-pause-guide-lesbians-how-get-pregnant

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Gem is an obstetrician and has recently become a new mum with her wife Emma. I was delighted when she offered to share her journey to parenthood the good and the less than ideal so that we can learn how to improve our services to support same sex ...

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Jenny is an amazing midwife who has immense courage and championed #SkintoSkin in her hospital and beyond. we had a fab conversation and you can listen here

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Listen to a sparky and stimulating chat with JennytheM a retired midwife who has so much wisdom to offer on many aspects of maternity care from #Skintoskin to Courage Butter.

If you want to explore more of jenny's story and her fantastic blogs you can find her here
https://jennythem.com/ as well as on twitter @JennytheM

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Episode 77 A Chat with JennytheM - The Obs Pod

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Listen to a sparky and stimulating chat with JennytheM a retired midwife who has so much wisdom to offer on many aspects of maternity care from #Skintoskin to Courage Butter.If you want to explore more of jenny's story and her fantastic blogs you ...

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My thoughts on Black History Month 2021

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Episode 76 Black History Month - The Obs Pod

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This episode celebrates the theme of Black History Month 2021 - Proud to bePlease do also go back and listen to one of my previous episodes Ally and explore the Brown Mama Brown me podcast.Want to know more?https://www.bbc.co.uk/programmes/profiles/1p7r3fkpsWTbQ9shCFh1QXc/betty-campbellhttps://www.blackhistorymonth.org.uk/article/section/news/proud-to-be-black-history-month-uk-launches-theme-for-black-history-month-2021/ https://www.theguardian.com/books/2021/sep/25/bernardine-evaristo-on-a-childhood-shaped-by-racism-i-was-never-going-to-give-upIf you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch.

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This episode recorded for Baby Loss Awareness week 2021 talks about babies born at the extreme limits of survival 22 weeks and upwards

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This episode recorded for Baby Loss Awareness Week 2021 discusses the difficulties of baby loss at extremely preterm birth , the challenge of how you classify live birth and still birth & some of the implications for parents.
This may be an episode that triggers difficult feelings and memories for many so take care of yourself and make sure now is the right time for you to listen before you start.

Want to know more?
https://www.sands.org.uk/sites/default/files/Position%20statement%20Birth%20and%20death%20certificates%202014.pdf
https://timms.le.ac.uk/signs-of-life/guidance.html
https://timms.le.ac.uk/signs-of-life/guidance-visual-summary.html
https://hubble-live-assets.s3.amazonaws.com/bapm/file_asset/file/31/outcome-of-births-infographic-201909111005-colour.pdf
https://nbcpathway.org.uk/

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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This episode recorded for Baby Loss Awareness Week 2021 discusses the difficulties of baby loss at extremely preterm birth , the challenge of how you classify live birth and still birth & some of the implications for parents.This may be an epi...

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What role do ambulance services play in maternity care and how ca we collaborate with them?

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Episode 73 Diabetes in Pregnancy - The Obs Pod

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What does the NICE guidance actually say about diabetes & gestational diabetes ? Explore my thoughts

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How do we care for women with a diagnosis of diabetes when they are pregnant & why is the extra care we give so important? In this episode I explore existing diabetes and gestational diabetes and the differences and similarities between them and the impact they have on pregnancy experience and outcome.

Want to know more?
NICE guidance: https://www.nice.org.uk/guidance/ng3
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012327.pub2/full
GDM & the risk of stillbirth https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15659

Help & information for pregnant women
https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy/during-pregnancy
https://abcd.care/dtn-education/diabetes-tech-in-pregnancy
https://www.gestationaldiabetes.co.uk/gestational-diabetes-support/
https://jdrf.org.uk/news/nhs-access-to-cgm-for-pregnant-women-with-type-1-diabetes-begins-in-england/

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Episode 73 Diabetes in Pregnancy - The Obs Pod

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How do we care for women with a diagnosis of diabetes when they are pregnant & why is the extra care we give so important? In this episode I explore existing diabetes and gestational diabetes and the differences and similarities between them...

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My good friend Gill has just started this podcast talking to all sorts of fascinating & inspiring people about their ideas to improve the NHS

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Welcome to Wild Card - Whose Shoes! Walking in the shoes of more interesting people 😉 My name is Gill Phillips and I'm the creator of Whose Shoes, a popular approach to coproduction and I am known for having an amazing network. Building on my inclusion in the Health Services Journal 'WILD CARDS', part of #HSJ100, and particularly the shoutout for 'improving care for some of the most vulnerable in society through co-production', I will be chatting to a really diverse group of people, providing a platform for them to speak about their experiences and opinions. If you are interested in the future of healthcare and like to hear what other people think, or perhaps even contribute at some point, 'Whose Shoes Wild Card' is for you! Find me on Twitter @WhoseShoes and @WildCardWS and dive into https://padlet.com/WhoseShoes/overview to find out more! Artwork aided and abetted by Anna Geyer, New Possibilities.

Welcome to Wild Card - Whose Shoes! Walking in the shoes of more interesting people 😉 My name is Gill Phillips and I'm the creator of Whose Shoes, a popular approach to coproduction and I am known for having an amazing network. Building on my inclusion in the Health Services Journal 'WILD CARDS', part of #HSJ100, and particularly the shoutout for 'improving care for some of the most vulnerable in society through co-production', I will be chatting to a really diverse group of people, providing a platform for them to speak about their experiences and opinions. If you are interested in the future of healthcare and like to hear what other people think, or perhaps even contribute at some point, 'Whose Shoes Wild Card' is for you! Find me on Twitter @WhoseShoes and @WildCardWS and dive into https://padlet.com/WhoseShoes/overview to find out more! Artwork aided and abetted by Anna Geyer, New Possibilities.

On being a rebel & finding your tribe

Several lightbulb 🍋moments listening to Joan & Gill talk. I've never thought of myself as a rebel...... just trying to do the best for the families I've cared for. Like Joan, my first 'rebel' moment was 21 years ago, pushing the boundaries where this had never been done before. Gill has a fabulous way of drawing the very essence of care from her podcast friends. A great opportunity for reflection, curiosity & sense of community. Thank you

Fascinating & Challenging

A conversation with Gill & her incredible network will leave you with new insights and brimming with good ideas. I can't wait to follow her podcasting journey & enjoy those precious light bulb moments

Innovative and inspirational

Gill is as innovative as she is inspirational and her thought-provoking work and criticality of thinking is pushing for new ways of imagining and actualising better health and social care. Try the setting the scene episode to get the general picture. I look forward to hearing the interesting conversations with high profile guests in episodes to come.

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‎Wild Card - Whose Shoes? on Apple Podcasts

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‎Welcome to Wild Card - Whose Shoes! Walking in the shoes of more interesting people 😉 My name is Gill Phillips and I'm the creator of Whose Shoes, a popular approach to coproduction and I am known for having an amazing network. Building on my inclusion in the Health Services Journal 'WILD CARDS', p...

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World patient safety day today is focused on Safe and respectful maternity and newborn care so to celebrate I chose to record an episode about why I feel that means

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Today is World Patient Safety day World Pt safety day , this year focusing on safe and respectful maternity and newborn care.
Here are some of my thoughts on how we may provide that without our own opinions and bias getting in the way.

Want to know more?
World Patient Safety Day 2021 (who.int)
Alice Ladur's research
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1704-6
BRAIN decision making tool :
https://doulatoothers.com/using-brain-acronym-informed-choices/

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Today is World Patient Safety day World Pt safety day , this year focusing on safe and respectful maternity and newborn care.Here are some of my thoughts on how we may provide that without our own opinions and bias getting in the way. Want to know...

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How are we portraying motherhood & parenthood in the era of social media ?

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What is performative parenting ? How can we help new parents discuss how they really feel and talk honestly rather than perpetuating the myth of perfection portrayed on social media?

Want to explore more?
https://www.theguardian.com/commentisfree/2021/jul/03/why-be-a-performative-insta-parent-when-your-kids-will-be-happy-in-front-of-the-tv
https://www.buzzfeed.com/mikespohr/these-comics-are-shockingly-real-about-postpartum-anxiety
http://matexp.org.uk/matexp-mindnbody-a-holistic-approach-to-perinatal-mental-health/

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.

My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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What is performative parenting ? How can we help new parents discuss how they really feel and talk honestly rather than perpetuating the myth of perfection portrayed on social media?Want to explore more?https://www.theguardian.com/commentisfree/2021/jul/03/why-be-a-performative-insta-parent-when-your-kids-will-be-happy-in-front-of-the-tvhttps://www.buzzfeed.com/mikespohr/these-comics-are-shockingly-real-about-postpartum-anxietyhttp://matexp.org.uk/matexp-mindnbody-a-holistic-approach-to-perinatal-mental-health/If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch.

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Gem shared her experience of starting a family with her wife. With a rise of 50% in same sex pregnancies since 2015 this is an important topic

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Gem is an obstetrician and has recently become a new mum with her wife Emma. I was delighted when she offered to share her journey to parenthood the good and the less than ideal so that we can learn how to improve our services to support same sex parents as they become a family.

Gem can be contacted on twitter @gem_goodyear

Want to know more?
https://www.hfea.gov.uk/i-am/fertility-treatment-for-lgbt-people/
https://www.nhs.uk/pregnancy/trying-for-a-baby/having-a-baby-if-you-are-lgbt-plus/
https://www.nct.org.uk/pregnancy/same-sex-parents/two-mum-families-sharing-experiences-and-support

& Slightly outdated https://www.stonewall.org.uk/resources/pregnant-pause-guide-lesbians-how-get-pregnant

If you have enjoyed my podcast please do share your thoughts by leaving a review on your podcast provider or get in touch. I love to hear your thoughts and ideas. if you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

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Gem is an obstetrician and has recently become a new mum with her wife Emma. I was delighted when she offered to share her journey to parenthood the good and the less than ideal so that we can learn how to improve our services to support same sex ...

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What we do & don’t know about this liver condition in pregnancy

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Episode 69 Obstetric Cholestasis - The Obs Pod

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Understand why midwives and doctors worry about itching in pregnancy and what it might mean. Learn a bit about the latest research into treatment and how you might access support if you develop this liver condition in pregnancy.Want to know more?h...