Live webchat with David Bogod, president-elect of the Obstetric Anaesthetists Association, Thurs 3 March, 8-9pm

[GeraldineMumsnet]

Following the discussion about epidurals on this thread, David Bogod got in touch because he'd read the thread after seeing it mentioned in the Sunday Times. We're very pleased to welcome him to Mumsnet for a webchat.

David is consultant obstetric anaesthetist at City Hospital, Nottingham, where he's worked for 21 years and carried out more than 2,000 epidural procedures. His unit has around 5,700 deliveries a year, with an epidural rate of around 25%.

He's also president-elect of the Obstetric Anaesthetists Association and vice-pres of the Association of Anaesthetists of Great Britain and Ireland.

David has two grown-up boys (one delivered by forceps, one spontaneous delivery, both under epidural).

If you've got any questions to put to David about the scientific, political or social aspects of epidural pain relief in labour, or any other issues relating to childbirth, then please come and join him on Thursday evening. Failing that, please post your question here as usual.

[working9while5]

I personally believe that if a representative from the RCM was answering questions on a webchat, we might find that the responses are highly professional and that there is much greater understanding of individual women's experience than has been shown on recent threads.

It's great that MN has such a variety of professionals who post on the boards and I think that many of us have been helped by countless professionals who have given of their time e.g. I know I accessed high quality support wrt breastfeeding in the early days of my son's life, I have also had signposting from legal professionals.

This is to be welcomed. However, entering into adversarial debate with service users as a health professional is dodgy ground indeed. I don't want to see any health profession brought into disrepute at this financially sensitive time so as these threads have proved controversial, I would really welcome a more "official" view to be put forward by the professional body of midwives, the RCM.

I really think it won't be anything like recent threads.

[mathanxiety]

'In unfortunate social, economical, political and financial times, it seems that The Midwife is a breed hunted from all angles.

Please don't add to the ammunition by your attempt to bring the profession into disrepute.'

Oh for heaven's sake -- do you think you'll be burned at the stake? The profession brings disrepute upon itself by its own members' words and actions and attitude, ReggaeMudda, and it is not up to the clients it serves to paper over any cracks or excuse any faults it finds in the service it receives. Nobody wants to know how hard it is top be a poor, unfortunate, put upon midwife with some sort of target on her back, certainly no-one going through a horrible, unnecessarily painful delivery or who has had that experience in the past. Responsibility for the reputation of he profession lies squarely in the hands of the members.

What is this 'with woman' baloney I keep on reading? The nurses who attended me did a fine job (with one exception). There's nothing magical about having a midwife attend you.

[ReggaeMudda]

If we could only walk a mile in each others shoes, maybe we would meet half way.

[mathanxiety]

The idea that a woman who sees her job as being 'with woman' feels separated by some sort of chasm of misunderstanding from the women she is 'with' is richly ironic.

[DrMcDreamy]

DrMcDreamy, you have every bit as much of a fortress mentality here and are not doing your profession any favours.

I must be posting in Swahili. Because the message that I agree that women deserve adequate pain relief in labour doesn't seem to be getting through. It must be my giant midwife hat that I am wearing.

[working9while5]

Certainly, if there was a bit more evidence of reflective practice vs "it's not our fault, women just don't get it the ungrateful cows, no one loves us", it might help with the shoe swapping.

I would imagine that there are many, many empathetic midwives in the UK who are able to recognise women's negative experiences and reconcile these with resource issues in the system without feeling personally affronted.

I want to hear from those women (or men!). I want to hear the "inside" view but as mathanxiety has put, I don't want to hear how put upon midwives are. Explain the resource issues and target-driven mess factually, yes, but not by throwing one's hands up to the air and lamenting the insufferable ignorance of the woman in labour who just doesn't get how hardworking her midwife is.

Health professionals can be critical of their own services and the constraints placed upon them in a professional way in a context like this. It's one of the amazing things about here: it can allow us to walk in eachother's shoes.

That only works, however, if those health professionals posting anonymously can be really honest about the shortcomings of the system vs "blaming" the woman who complains: if they can reflect on their own experience vs imposing a reflection onto another person e.g. "See the way you feel? You were probably wrong."

I have no doubt that there were many, many factors that led to my own traumatic delivery. Perhaps midwife care was an issue, perhaps not. I didn't know one way or the other at the time (didn't have continuous monitoring during the epi, that's for sure!). That - quite frankly - is irrelevant. What's relevant is that I don't expect to be told that if I post about it that I am "jumping on the bandwagon" or to hear horror stories about drunk anaesthetists etc. I expect to hear data from evidence-based professionals who refer to their own experience only in so far as it illuminates the points made by service users not to air their own grievances with "hard to please" or "unpleasant" women.

The more I contribute, the more I think trolls must be at work as I truly don't want to believe that an NHS professional would engage with a member of the public by talking about how unfair it is that people blame their personal and highly subjective experiences on a particular profession.

[MistyValley]

Yes, the 'with woman' thing is pretty ironic, since the system is geared up to keeping women AWAY from midwives for as much time as possible while they are in each stage of labour and recovery.

[MistyValley]

DrMcDreamy - perhaps it is posts such as this one you posted yesterday which have people wondering about your personal attitudes to pain relief?

"Ok now have I read this somewhere or just made it up but some animals gave birth using epidural anaesthesia actually rejected their offspring? I'm going to bed right now following a busy night of epidural denying (that is a joke btw) but would be interested to know if this did happen or I dreamt it up in my post night shift catatonic state."

Phrases like 'rejected their offpsring' in the context of a discussion about human pain relief during labour is pretty inflammatory. Of course thoughts like this may not influence your day to day work decisions at all, but you can't blame people for wondering.

[thornykate]

Maybe the personal affront comes from personal attacks?

I know I have seen MWs referred to as bitches, evil, liars, cheats and bastards on threads recently.

As an NHS professional yourself surely you do not condone such name calling? Inferring that MWs believe women to be ungrateful cows is extremely unprofessional on your own part.

IMHO.

[working9while5]

Not condoning name calling is very different to taking issue with it in a public forum. I don't generally condone any name calling online, tbh, but I tend to ignore it.

Also, as an NHS professional, I recognise that if a poster says "all x's are lying bitches" that they're not talking about me. They are talking about their own experience, which I don't know the full details of. They are also usually posting from a position of vulnerability and grief/pain/annoyance.

Starlight wasn't lying. She has said that my profession is useless and that we're about as much good as chocolate fireguards. I know exactly why she feels this way, I can empathise on many levels. I try to share that behind closed doors, many of us fight for better than she has received yet I would never tell her or another service user that they were wrong or that they were being unfair to me. It's got nothing to do with me! If a parent shouts at me about the care I deliver, even that is rarely about me but about all sorts of issues that constrain the delivery of care.

You have to be able to distance yourself from this. If you don't, you will burn out and be, well, about as much use as a chocolate fireguard.

Most of us work in organisations where there are constraints placed on what we can share about service delivery models. However, we are all free to share evidence. We are required to share evidence, in fact. My hope is that by communicating openly with clients and service-users about evidence (and not justifying those occasions when it is not adhered to against the evidence because it is what we had to do), we can forge a path to a better future.

There are complexities here, of course. There is a need to be sensitive to when it's okay to share and when you just need to let people rail at the unfairness of it all. There are times that people receiving services have been treated shoddily. The fact that this may be correlated with poor midwife staffing ratios etc is not coincidental and can be shared.. but not in a personal "poor me" fashion.

It's not personal, it's political.

[Margles]

Don't forget that this debate started because someone talked about being tricked out of an epidural. In my book that is emotive language.

However, if this article is to be believed I could easily see midwives being a thing of the past:
www.guardian.co.uk/society/2011/mar/06/midwives-volunteers-help

Fancy having an unpaid volunteer to sit with you when you have your epidural?

[working9while5]

The mistake is to reject best evidence because it doesn't fit with current resources. In my field, therapy is indicated three times a week for one client population who nationally are "lucky" to receive 45 minutes of therapy once a half-term. There are huge variations in service delivery across postcode areas based on resourcing constraints that have nothing to do with evidence and everything to do with budgets.

If we tell our patients that they don't require x therapy or x dosage because we can't provide it, we prop up a failing system. Service users deserve the right to campaign for better and/or seek private services (if they are in any position to obtain it, which is an issue for another day).

If we get cross because they are outraged at being told that they didn't need x to find out, when their grief/pain/shock subsides that actually, they needed it three times a week, then we are failing them - and ourselves.

We have to advocate for our clients. We have to question our own professional practice and be honest with ourselves: how much of what we believe is based on evidence and how much on what we know is available in the current system?

We might need to do that in our departmental meetings or locally behind closed doors. We don't necessarily need a placard.

We do need to be open and listen to what our clients tell us without feeling affronted, even if what they say is not palatable and even if we don't agree. We still need to listen, and listen hard.

That's the only way..

[working9while5]

Cross posted with you Margles. This is the situation we all face, isn't it? This is why it is important NOW more than EVER to ensure that we are listening and open vs defensive and closed. As with the recent universities bill, the government will make decisions based on public consultation vs consultation based on evidence. As professionals we need to get the message out there about the impact of proposals like Margles has mentioned vs engaging in divisive debate that might make a service user feel midwives were less necessary than evidence says they are.

It has to be about matching evidence with client experience in an empathetic fashion. Sod the names. They don't matter. What matters is maintaining quality of care and campaigning for better in an uncertain time.

[thornykate]

We may have to agree to disagree as I still believe you were wrong to infer that MWs believe women to be lying cows & that sort of inference from a fellow NHS professional is potentially more damning to NHS professionalism as any other statement you have cited from other posters.

Frontline NHS workers are at substantial risk of aggression & violence from members of the public. It is never OK to shout at NHS (or any) staff even when we are upset, ill, in pain etc & I suggest you get support if you are expected to tolerate this. Thats not just my opinion it's the official party line from The NHS security management service.

If we accept name calling & shouting what else must we accept?

Sorry to digress from the thread I just feel strongly that it is important not to minimise name calling or accept it without challenge.

[working9while5]

I wouldn't accept aggression at work for the reasons you mention, but it is different online - no? You don't need to participate and you are not in any danger.

At work, I assume you are told to tell the person that you will not engage with them (if you feel you are safe enough to do so). Don't we all have conflict resolution training to ensure we don't inflame the situation by telling people that their feelings are wrong? We state we will not tolerate the behaviour. We apologise if necessary. We try to listen and resolve in the first instance. That's not what's been happening here.. what's been happening is a lot of hand-wringing about how awful it is for midwives which is exactly what you are told not to get into with service user's sharing their negative experiences, isn't it?

But am fine to agree to disagree, too! .

[working9while5]

Incidentally, "inference" is not wrong. It's a perspective. You "can't" be wrong in inferring something. Inferring is "reading" something a certain way based on a combination of the words and individual experiences.

I certainly never said that midwives were "lying cows". I said that some posts seemed to me to be implying that women were ungrateful and that midwives' experiences needed to be heard by service users. There was a specific post where a supposed midwife said that she had served many women who were unpleasant and difficult to please. That's unprofessional.

You seem to be saying that NHS professionals have a duty to band together against the public? Really? I am also a member of the public and a service user - each of us is.

[ReggaeMudda]

9-5, you would make a good midwife.

[working9while5]

(Incidentally, I am far from convinced that the posts I am referring to are from a registered health professional).

[ReggaeMudda]

Starlight, debrief is something that is being well promoted within the maternity services at present, allowing women to meet with the people responsible for their care and discuss what happened and why in order for them to gain insight and highlight areas for improvement by the maternity team.

[thornykate]

I suppose we could accept personal insults that don't place us in physical danger but I do feel that in a culture where NHS staff are subjected to a lot of abuse it should be challenged whenever possible wherever it occurs no matter what form it takes. Hopefully that way the culture can change in time.

No 9-5 I am not suggesting NHS professionals band together against the public I am referring to NHS official guidance on verbal aggression in the workplace & I'm pretty sure that isn't suggesting we band together against the public either.

Yes you can infer words however you wish but IMO it was unfair and not professional language. That may be my own rule of thumb though- if I wouldnt want to write it in a report I dont say it out loud!

Starlight that is good advice for people on either side of the fence on how to deal with problems in healthcare.

[working9while5]

thornykate, I follow similar thinking when posting as a professional in my own field. However, here I am both professional and patient. I wouldn't write about my delivery in a report either. It changes things.

In terms of what you are querying re: my professionalism, you seem to be taking issue with this line:

"Certainly, if there was a bit more evidence of reflective practice vs "it's not our fault, women just don't get it the ungrateful cows, no one loves us", it might help with the shoe swapping"

This was a response to a post saying we should all walk a mile in eachother's shoes. It should be fairly clear from the context of the whole discusison am not inferring in the least that midwives (e.g. the whole profession) think in this way. It should also be clear that the portion in inverted commas is an interpretation of a number of posts which focused on the midwive vs the patient experience.

I think it's a little bit disingenuous to take issue with one line when I have written quite a lot on this thread about the need not to extrapolate from the views of anonymous posters representing themselves as midwives about the whole profession - indeed, I have been clear that I am not even convinced that the particular poster with whom I take most issue (who, after all, took issue with me as a patient "jumping on the bandwagon) is even a midwife.

Your issue is with one phrase. One phrase in numerous posts. You have not responded to the more general point about engaging in positive vs negative ways in public fora with patients/prospective patients.

In that errant phrase - to be clear, just in case there is confusion - I was saying that I have inferred e.g. deduced logically from my reading of words by both (supposed) midwives and patients that some posters were suggesting that women were ungrateful. This conclusion is based on the words I have read e.g. it has been inferred based on my understanding of the text (which, although it will be coloured implicitly by my experience, was inferred in good faith). There seem to be a number of posters who share the same reading, which suggests there must be some evidence for my thinking.

In this instance - as again, I should think is clear - I have laid my cards on the table. Yes, I have some professional knowledge of the NHS which informs my thinking on this issue and in particular, informs my understanding of how health professionals should interact with the public and serviced users. This is inevitable. But I came to this thread with the perspectives of a patient. I fear you are creating a strawman here and trying to discredit a pretty straightforward and uncontentious position that healthcare professionals would do best to listen to patient experience and be sensitive to that experience even on an online forum.

[working9while5]

Also, "professionalism" is so narrowly defined sometimes in our culture. It is supposed to imply a certain type of character, method and spirit: surely professionalism, in the context of this discussion, is better represented by advocating for open dialogue between clients and those who care for them and discussing the need for trust and confidence between patient and professional vs picking on the phraseology of one minor point (which, in itself, was as much a rhetorical device as a serious point to argue).

I think it's interesting that the core point I have made ad infinitum has been ignored: do you think that my overriding contention - that it is most important to maintain core standards with reference to dealing with potential service users (empathy and compassion/listening skills/prioritisation of the patient experience/transmission of appropriate evidence base/advocacy for clients) - is nullified by one phrase which you disagree with? You honestly believe that using one phrase "in the vernacular" is more unprofessional than arguing with women about their experiences and berating them for saying general (not specific) negative things about midwifery vs engaging with them to enhance their understanding of their care?

I think some midwives have tried to do that - but not all. And again, who knows if Alimat is even a midwife? We need a proper representative to engage in a proper debate who can inform people who want to know, people who are patients (like me, actually!) what's what right now in maternity services.