Caroline Flint

Caroline Flint is a former midwife of 37 years clinical experience, NCT teacher of 47 years experience, past President of The Royal College of Midwives and author.  She lives and has always worked in London, UK.  carolineflintmidwife.com   She was and is, along with Ina May Gaskin, UM's chief midwifery inspiration.

Caroline put continuity of carer firmly onto the midwifery agenda.  In the early 1980s she led the first randomised controlled trial of continuity of carer, The Know Your Midwife Scheme, which clearly showed the benefits of care by a small team.  She knows how continuity of carer works at a daily, practical level.

Now in her late 70s, Caroline's passion for continuity continues and she has made a short film to encourage those taking up the Better Births message that continuity is the lynchpin to safe and effective maternity care: https://www.dropbox.com/s/8pm7oltjinulou7/Caroline_V10.mp4?dl=0

"A prophet is not without honour; save in his own country" [St Matthew's Gospel] and Caroline has not always received the recognition she deserves from the UK midwifery establishment, generally made up of less maverick, splendid and visionary people than she.  But the fact remains that we would be in a poorer place as UK midwives had she not got up and voiced women's need to know their midwives.

Another Independent Midwife before the Nursing & Midwifery Council

Being investigated by the Nursing & Midwifery Council is an occupational hazard for independent midwives in the UK.  This state of affairs has gone on for many years and is an abuse of professional regulation (in UM's honestly-held opinion).   Please follow Kathryn Weymouth's case or attend if at all able to get to Stratford, East London.  The case is scheduled to last 5+ weeks from 23rd September (yes really).

https://www.facebook.com/pg/SupportForKathrynWeymouth/community/?ref=page_internal

Caesarean section is overused and underplayed

The recent unscientific attack in the UK on normal birth and the women and midwives who keep it in their sights as a desirable goal either presumes or posits that intervention in birth is safe, advantageous, scientific, and desirable to any right-thinking woman.  The pursuit of normal/physiological birth is conversely posited as a dangerous obsession, a primitive madness in a modern world or even a "cult". 

In fact, it is the over-use of Caesarean section and the all-too-ready recourse to it when labour stalls or takes longer that is becoming an increasing danger to women and babies.  No-one including UM disputes the value of surgical intervention when lives and well-being are at risk.  But most long, stalled, difficult labours are the result of women trying to give birth in uncomfortable clinical environments, in non-physiological positions, surrounded by strangers watching clocks and fetal heart monitors.  Neither the human pelvis nor the hypothalamus were designed to function outside a comfortable, free, loving, darkish and gentle environment.

The Lancet has recently (2018) published three excellent papers that really should reach a wide audience and be made known to women and their families (free to access and download).
https://www.thelancet.com/series/caesarean-section

The first paper deals with the global epidemiology of CS, the second (and read this one if you only have time for one) covers the short and long-term effects of CS in women and babies, and the third looks at interventions to reduce unnecessary CSs. 

Over 6 million excess (not medically indicated) CSs take place annually.  The fact that higher-educated women are more likely to have a CS shows how good information about CS is not reaching women of child-bearing age, and enabling them make choices that may protect them. 

The most promising "interventions"?  One-to-one support in labour, midwifery-led continuity of care and birth in non-medical settings such as birth centres.  The problem with this, of course, being that many policy-makers and doctors and self-appointed patient-safety gurus want to throw more technology at the problem rather than midwifery time.

Lovely freebirth story

There's a rather wonderful series on British TV this advent called Our Yorkshire Farm (four episodes I believe, one for each season) following the year in the life of a family who live in Upper Swaledale in Yorkshire.  In yesterday's 2nd episode (Spring), Amanda Owen tells her story of giving birth to her eighth child (the Owens have nine children) in front of the fire in the middle of the night with one of the dogs and a cup of tea for company.  She explains her how she came to her decision and evokes a sense of place, time, calm and peace.  A lovely, lovely narration and well worth a viewing (UM is fast becoming a Yorkshire Shepherdess addict):

https://netpro.website/series/356069/1/2

Amanda has her own website: https://www.yorkshireshepherdess.com/

Birth centre and home are safe for low-risk women: new systematic review.

Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis

https://www.sciencedirect.com/science/article/pii/S0266613818300974

This is a paper by Vanessa Scarfe and colleagues [Australia] looking at the combined outcomes of 28 studies involving more than half a million women across a number of countries.  It demonstrates that the evidence for the safety of home or birth centre for birth for low risk women is broad, substantial and clear.  Not that this hasn't been known and shown before, but it is good to remind the world of this at regular intervals, given the continued commitment of the anti-homebirth, anti-normal birth, anti-midwife lobby to their Project Fear agenda (for example but by no means the only example, Amy Tuteur's regular pseudo-skeptical pronouncements e.g.http://www.skepticalob.com/2014/04/just-how-dangerous-is-childbirth.html
and https://www.youtube.com/channel/UCnYRie_neROaEuTQslggVvg )


 

Why mobility in labour matters...really, really matters!

Below is a link to a blog written by birth physiology expert Margaret Jowitt.  Margaret Jowitt is also the designer of the Osborne Kneeling Chair (see earlier posts in this blog), based on her unique understanding of the anatomy and physiology of birth.  Margaret has also written a book "Dynamic Positions in Birth" which expounds her theories and is probably one of the most important books on birth physiology to have been written for at least a century.

Her insights should change the way women are cared for and the whole design of institutional labour environments across the world.  Her work also has implications for the all-too commonplace intervention of Induction of Labour and the crude manner in which this is currently carried out.  Understanding the onset of labour may lead to much better ways of inducing labour rather than the dreadful beating of the uterus with syntocinon that currently occurs (in the small minority of cases where starting labour may be helpful to mother and/or baby).

This work needs to find its way into textbooks and the teaching of midwifery and medical students.  It is really a back-to-basics where the foundation of physical care is based on an understanding of anatomy and physiology. 

https://softbirth.com/new-model-uterine-function/

https://softbirth.com/hi-lo-birth-support-birthing-chair/ 

https://www.waterstones.com/book/dynamic-positions-in-birth/margaret-jowitt/9781780661155 

New blog on birth and politics

A group of experienced birth activists, writers and campaigners have got together to write a campaigning blog focusing on threats to choice, continuity and control for women in the UK, Ireland and beyond.  This group has an impressive line-up, already has a couple of well-written posts on key issues, and you can subscribe quickly and easily. Link is also on the Useful Links facility to the right ->.

https://www.birthpracticeandpolitics.org/

Sad but truly excellent film about recent maternal deaths in Ireland and the commemorative quilt made in memory of the women who died.

Heart-wrenching but essential and inspiring viewing - well done to all involved.  It's beautiful.

https://vimeo.com/202475404

Being a bigger woman doesn't necessarily mean big birth risks.

The Birthplace Study continues to publish interesting analyses, this one about the birth risks associated with larger BMI (over 35 kg/m2).  

https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.12437

Multiparous women with BMIs over 35 appear to have a lower risk of adverse events than primiparous women with BMIs within the 18 to 25 range, and to generally have fewer problems associated with birthing their children than we may have believed.  Of course, primiparous women generally  have a lot of meddling with their labours and births and only a minority have straightforward births without interventions, so the comparison is not without its problems.  However the data does show that higher BMI in women who have given birth previously is probably being over-played as a "risk" factor.  

Perhaps consultant midwives and Birth Centre managers in the UK will be able to get the criteria for Birth Centre care altered to reflect this evidence.

While I am on the subject of bigger mothers, here is a link (will also post in useful links section) to the blog of The Well-Rounded Mama and her previous excellent website.  Lots of information here and a positive approach to birth and mothering with a well-rounded body!

https://wellroundedmama.blogspot.co.uk/p/about-this-blog.html 

http://www.plus-size-pregnancy.org/firstindex.html

The contemporary bullying and adversarial culture of UK midwifery and Jane Greaves RM

Update: Jane Greaves reinstated!!  AND the story is covered by today's Sunday Express.

https://www.express.co.uk/news/uk/946014/jane-greaves-midwife-petition-job-sacking-unfair-dismissal-wakefield 


What is going on in midwifery in the UK?  Weekly UM hears of a midwife who has been sacked or suspended, or who has been forced out of the profession.  If these were careless, uninterested, uncommitted, lazy or rude midwives, that would be one thing.  But almost without exception, the midwives involved have a long history of woman-centredness, commitment to their profession, kindness, and standing up for services and colleagues.  

The UK is chronically short of midwives but many managers show little sign of wanting to retain those they have.  Contractual hours, policies, shift times, shift lengths, lack of study opportunities, inadequate responses to legitimate concerns and complaints from staff, favoritism and the nurturing of cliques, all combine to make the lives of many midwives very difficult, and result in a huge percentage of midwives working part-time or "taking a break" from the profession.  

Many (not all) senior posts in UK midwifery are filled by those who fit the corporate blueprint, show themselves to be loyal to the business (and Foundation Trusts are businesses run by managers and accountants from non-clinical backgrounds), not rock the boat, accept cuts sorry transformation and persuade their staff to work harder sorry smarter.  If you challenge this model of healthcare organisation (e.g. want choice for women that may require more staff, reject shoestring continuity models, oppose the downgrading of a birth centre etc), then promotion will not come your way. 

Malicious or unnecessary referrals to the NMC are made to settle scores and to consolidate power.  Threats and lies are common.  One Head of Midwifery in a northern English city recently told a midwife that she might be sued, not over clinical malpractice or neglect, but because another NHS Trust was annoyed by something she had written.  As her writing expressed an honestly-held opinion and accorded with the scientific evidence, this was palpable nonsense.  So why say it, if not to instill fear and dread, in other words to bully the midwife? 

Another midwifery manager (again in a northern English Trust, but it is happening all over the country) has sacked a midwife called Jane Greaves.  Jane has an excellent track record for caring for women and defending the service, but the manager, citing her sickness record, feels the service doesn't need her, despite the midwifery shortage in the area. A petition started by a friend has attracted over 30,000 signatures in a week.  UNISON, the union involved, appears to be hanging out the Trust to dry in the local media and this is a welcome change to the Royal College of Midwives (RCM)'s common approach of stay quiet, say nothing.  

You can sign the petition for Jane Greaves' reinstatement here:
https://www.change.org/p/mid-yorkshire-nhs-trust-support-nhs-midwife

And view the local paper article here:
https://www.yorkshireeveningpost.co.uk/news/wakefield-midwife-fired-over-sickness-record-after-suffering-kidney-infection-claims-no-time-for-trips-to-loo-due-to-hospital-understaffing-1-9075856

Needless to say, the friend has come under pressure.

So why are midwifery managers so drawn to the unkind, adversarial, and punitive approach and outcome rather than one that is solution-focused, trusting, and compassionate?  UM feels it is basically an issue of skills and knowledge as well as one of misplaced loyalty and deficient understanding of the wider picture.  

Midwifery is a global profession with a history as long as the human story and its current connection with the NHS in the UK is a minuscule part of that history and this planet, and even tinier is its shackling to the pseudo-market-orientated NHS of the 2010s.  I don't think that anyone enters midwifery to be part of the latter, we become midwives to be part of the ancient and universal energy of women and birth.   The health of that connection is shown by actions not words.  Yvonne Rowlan, the Head of Midwifery who may have personally sacked or was involved in the sacking of Jane Greaves, gave this vacuous statement to the Yorkshire Evening Post:

"We are dedicated to providing excellent patient care and supporting our staff to do this.  In every aspect of our work we adhere to a set of core values which underpin not only the care we give to our patients but also the care and respect we show to each other as members of staff."   


Fine words but empty ones in the face of loss of livelihood, vocation and workplace friendships.  Empty in the face of anxiety, stress, mental ill-health, suicidal thoughts, and depression caused by heavy-handed approaches to common and manageable workplace differences and challenges.  Empty in the face of no staff loo.

are dedicated to providing excellent patient care and supporting our staff to do this.

Read more at: https://www.yorkshireeveningpost.co.uk/news/wakefield-midwife-fired-over-sickness-record-after-suffering-kidney-infection-claims-no-time-for-trips-to-loo-due-to-hospital-understaffing-1-9075856

“We are dedicated to providing excellent patient care and supporting our staff to do this. “In every aspect of our work we adhere to a set of core values which underpin not only the care we give to our patients but also the care and respect we show to each other as members of staff.

Read more at: https://www.yorkshireeveningpost.co.uk/news/wakefield-midwife-fired-over-sickness-record-after-suffering-kidney-infection-claims-no-time-for-trips-to-loo-due-to-hospital-understaffing-1-9075856

“We are dedicated to providing excellent patient care and supporting our staff to do this. “In every aspect of our work we adhere to a set of core values which underpin not only the care we give to our patients but also the care and respect we show to each other as members of staff.

Read more at: https://www.yorkshireeveningpost.co.uk/news/wakefield-midwife-fired-over-sickness-record-after-suffering-kidney-infection-claims-no-time-for-trips-to-loo-due-to-hospital-understaffing-1-9075856

Read more at: https://www.yorkshireeveningpost.co.uk/news/wakefield-midwife-fired-over-sickness-record-after-suffering-kidney-infection-claims-no-time-for-trips-to-loo-due-to-hospital-understaffing-1-9075856

The RCM is currently more part of the problem than part of the solution, having a schizoid relationship to its members: it appears to be most comfortable with those at the top of the NHS hierarchy spending time befriending, liaising with and hobnobbing with them at all sorts of dos and events, but like a rabbit caught in headlights when confronted with the multiple problems of the thousands and thousands of its members who are not senior managers, but on whom it depends for the bulk of its subscriptions.

The position of shop-floor midwives trying to get proper representation is also often invidious.  Those who become RCM workplace representatives generally have two mutually exclusive reasons for doing so:
Either they want to climb the slippery pole, get close to management, and show how compromising they can be;
Or they want to represent and serve their colleagues and challenge injustice and unfairness in the workplace.
The latter group often become subject to the same investigatory and disciplinary processes that they have helped others through.  The RCM, often as thick as thieves with midwifery managers (whom it often mistakenly refers to as "midwifery leaders"), appears uncomfortable with its dual role as a trade union, recruits full-time officers from its own stewards rather than from a TU background, and often fails to stand up for its members as strongly as it ought.  The RCM line is all too usually to advise repentance and to show remorse and accept the punishment.

UM suggests:

• If the RCM is serious about representing midwives, it has to pull its finger out and join with  those who are fighting to heal the toxic culture of contemporary midwifery in the UK.  The Caring for You Campaign is not biting deep as the RCM's own report shows (their December 2017 Evaluation of the CfY Campaign showed an increase in workplace bullying in services signed up to it).
• Midwifery managers need to stop indulging in mutual self-congratulation on their various get-togethers but get down to some serious work of self-scrutiny and objective criticism.  They need to rediscover (or discover) midwifery and public service values and kindness and solution-focused approaches to their differences with midwives. 
• There should be a complete moratorium on malicious referrals to the NMC.  
• Midwifery managers should stop threatening and bullying their staff and stop promoting their acolytes over those whom they know are the better midwives.  They need to turn their attention from those in the corporate offices to the women they serve and the midwives who care about serving them.

Postscript
Before you all go away thinking the north of England is the midwifery pits, UM would like to pay tribute to Airedale Hospital Trust and its midwifery managers for the solution-focused approach it has taken with Yorkshire Storks Midwifery Practice to address the independent midwives indemnity insurance issues.