I attended the Positive Birth Conference on 20 July 2017 at City University in London. Being around birthing professionals is wonderful for me as a hypnobirthing teacher, as I don't get to do so very often. Feeding off their knowledge and enthusiasm is eye-opening, and this conference was no disappointment.
There was a fabulous line-up of speakers, including:
The day centred very much on the theme of what women are looking for when it comes to their birth experience. With each speaker looking from their professional angle how we can potentially give them a better birth experience.
So what would women like to experience?
They are looking to:
Where to give birth?
An area for improvement is to have consistent choices regarding place of birth. Not all women reported having been given choice - in some cases it was simply assumed that they would have the baby in hospital. The crux of it is; choices are constrained by reality (e.g. in remote parts of the country the choices that are available are not the same as those of a big city; mothers being considered low risk/high risk may rule out the birth centre, for example).
The Better Birth initiative states that women should have three choices of place of birth, NICE – the National Institute for Health and Clinical Excellence – recommends four: Obstetric Unit (hospital), Alongside Maternity Unit (birth centre within a hospital), Freestanding Maternity Unit (standalone birth centre), Home. This initiative aim that all women, regardless of where they are in the country, should be able to make a choice from all offerings.
Midwives are advised not to just accept women asking for what they want, but to ask them to explain why they have made that choice. The midwife should then ensure that the potential risks and of that choice are understood by the mother, as well as making sure that all other choices have been explained in the same way. This allows the mother-to be to make choices in an informed way.
Continuity of Care
Some areas of the UK have been criticised for their lack of continuity in antenatal and postnatal care - although this is starting to be addressed in some Trusts with the reintroduction of case-loading (seeing the same midwife/small team of midwives throughout pregnancy). It was said that more could be done to have a smoother handover from the midwives to the health visitors, so that upon the first appointment with a health visitor they are already aware of the woman's pregnancy and birth experience.
Ellinor Olander spoke about this subject and her study identified issues that women said we/weren’t important to them:
Continuity of care is especially important for women who have experienced some degree of trauma.
Professor Ayers did a presentation on Birth Trauma: Risk and Resilience in Women. She shared her research on women who have suffered some degree of trauma during labour and birth; who, as a result, have experienced Post Traumatic Stress Disorder (PTSD). Evidence shows that 4% of women experience Post Traumatic Stress Disorder in pregnancy and a further 3-4% develop PTSD as a result of birth. Most women however, who have had a traumatic birth, don’t go on to develop PTSD (55%). Risk and resilience factors have been identified during the study and medical professionals are using these findings to prevent PTSD and enhance positive outcomes going forward.
The events that occur during pregnancy and birth are important, as these are what contribute to Post Traumatic Stress Disorder and Post Natal Depression. However this is subjective based on the individual's thoughts around the events, rather than the events in themselves - some women are more acute to situations than others. It could also be that the event in isolation wasn't the trigger, but a number of factors that have contributed to the woman’s life experiences.
Even though it has been cited that 3-4% of women experience PTSD in pregnancy, this figure can be as high as 39% for those who have a history of abuse.
PTSD can result in:
If a mother is stressed during pregnancy, this carries over to the baby. Evidence shows that these babies have an increased response to stress, which carries into their lives later on.
Women who experience birth trauma and who receive support, find strength and resilience to move forward. The y find a way to give meaning to that event, which often sees them experience grow from the crisis.
Can risk be reduced?
Yes. The most common responses were by:
As a result of this study, a framework has been put together to identify women who are potentially at risk, in order to customise their care across pregnancy, birth and postnatally.
With this information being fed back into the team and shared across Trusts, it will be possible to offer personalised care to women who have been identified as at risk.
Octavia Wiseman, spoke about the REACH Pregnancy Programme, which is a five year study, currently about half way through.
This study aims to identify women who may not usually seek full antenatal care, possibly due to one of the following factors:
Pregnancy Circles have been introduced - this brings together women who are at similar stages in pregnancy and who live near each other. The Pregnancy Circles offer clinical care, information-sharing and social support. They aim to provide a woman-friendly, community environment for antenatal care. These meetings are 2 hours long, rather than the 15 minute appointments expectant mums would normally receive. So far these meetings have been positively welcomed.
The final speaker of the day Milli Hill. As a co-cost of Havering’s The Positive Movement, it was wonderful to hear how she has inspired so many women to take up her movement and bring women together to look at birth positively. She centred her presentation on Carl Jung’s Shadow Theory. Jung saw quite clearly that failure to recognise, acknowledge and deal with 'shadow elements' often is the cause of problems between individuals and within groups and organisations. Hill challenged participants to consider the 'shadows' in birth, midwifery and within ourselves.
It was a thought-provoking day where I continued to learn so much from my peers. I long for the day that maternity care that is stripped of red tape; where midwives, who go into the profession wanting to be with women, can dedicate their time caring for them consistently. Continuous care is not a new thing. We all strive for better births. These conferences help solidify our ambitions towards a positive birth experience. If only it could happen a little faster.