Webchat with Cathy Warwick, RCM Chief Exec, on Tuesday 23 May at 12.45pm

[BojanaMumsnet]

Hello,

We’re pleased to announce a webchat with Professor Cathy Warwick CBE on Tuesday 23 May at 12.45pm. Professor Warwick is Chief Executive of the Royal College of Midwives (RCM), and has recently been part of a major review of maternity services in England (Mumsnet was also represented on the Review).

The RCM aims ‘to influence policy on behalf of women, forging collaborative relationships with a broad range of organisations with common interests and working closely with obstetricians, gynaecologists and paediatricians and their Royal Colleges.’

Commenting on our campaign for Better Postnatal Care: Aftercare, not Afterthought, Cathy has said: ‘For women the postnatal period can often be a very difficult time – and this is when the highest level of care and support is needed most for some women. It can also be an extremely exhausting and worrying time, particularly for first-time mothers. Surveys of women's views of maternity care including this latest one repeatedly inform us of their unhappiness with the current provision of postnatal care and in 2017 this is certainly not good enough. If we are to invest in better postnatal care for women we must invest in more midwives. England currently remains 3,500 midwives short and our maternity services will continue to struggle in supporting women if the shortage is not addressed. More midwives means women will get the care, time and support they truly deserve.”

Please do join us on the day - Tuesday 23 May at 12.45pm - but if you can’t make it, post a question in advance on this thread.

Please remember our webchat guidelines: one question each, with a follow-up to the webchat guest's response if appropriate; please don't keep posting 'what about me/please answer my question'; and please be civil/polite.

Thanks
MNHQ

Oh fabulous. Cathy warwick is great. . I'm doing a shameless reminder to think of something intelligent to say.

Would love to know what Cathy's views are on improving collaboration with health visitors.
As a HV myself, I'm v aware of the recommendations of more effective collaboration to the benefit of families, particularly around fully establishing HV's antenatal contacts and enabling smoother transition into parenthood, but not aware of MW's being so aware/wanting to work with us.

Is it university-educated professionals we need more of when most of the complaints registered on the Mumsnet thread were about dirty facilities, lack of accessible food and water, inconsiderate fellow patients and their visitors, and polite, compassionate, respectful care?

Where does Cathy think she gets off telling women they shouldn't be able to choose a section for social reasons?

www.nursingtimes.net/caesareans-should-not-be-chosen-for-social-convenience/5038290.article

She then goes on to talk about allowing it after appropriate counselling, but this is contradictory because some women will, after that, still want ELCS for social reasons.

And why has she said sections cost more than normal birth when the appropriate comparison is ELCS v attempted VB (which includes all EMCS, instrumental deliveries and severe tears)? That's either a deliberate attempt to obfuscate or a sad lack of understanding- I suspect the former given her position.

I have two questions but one is a bit similar to the question posted by Idontmeanto so I'll go with the other.

Lots of women on the Better Postnatal Care thread (and other threads elsewhere on the site) have said that they are not comfortable sleeping in shared bays with overnight partners/strange men for various personal and cultural reasons. A major hospital where I live was going on allow partners to stay overnight in shared bays and had to cancel the scheme before it even began due to the volume of complaints and objections received. There are a lot of women out there who do not want partners to stay overnight in shared bays (private rooms are another matter however most wards are shared bays so often a private room isn't an option).

Given that all providers of NHS-funded care are expected to eliminate mixed-sex accommodation, except where it is in the best interests of the patient or reflects their personal choice, why are women expected to share sleeping space in multi-bed bays with unfamiliar men/partners if this goes directly against their personal wishes and is not in their best interests? Nowhere else in the NHS would this sort of scenario be accepted as the norm so why is it foisted on women and - in your opinion - would recruiting more midwives remove the need for partners to stay overnight in order to plug gaps in care?

Hi Cathy. I would like to know how many maternity units have a special room away from the maternity ward for bereaved parents?
When my eldest son was born prematurely 22 years ago he lived for two hours. After he died I was placed in a private room in the middle of the maternity ward and had to hear women in labour and newborn babies crying.
I wouldnt wish that on anyone. I think every maternity unit should have one and if they dont how long till they do?

84charing that is heartbreaking and an excellent question, it's something that should be available in every unit

Why on earth are women who have just given birth expected to go and fetch their own food when on every other hospital ward it is brought to them? I work in hospitals and have had a baby and I was disgusted. Even wards with 'medically fit for discharge' patients have it brought to them. Meanwhile, I had a 3rd degree tear and a catheter which made walking very painful and no information given that that was how it worked. And I had to hobble there and back unless my partner was visiting.
I couldn't wait to get home where I'd find it much easier to recover as at least my kitchen wasn't that far.

What is your view on digital solutions to improve the care women get during pregnancy?

Hi Cathy,

As a RN and a mother it is interesting to see how focus is very much on the Baby to the detriment of Mothers' health. Very often basic understanding of Adult physiology is lacking - and this can be attributed to the direct entry onto midwifery courses.

Would not a return to an 18mth top course be more appropriate so recognition of the deteriorating patient/ signs of distress within the mother can be noted earlier and acted upon? I ask this as someone who has also been on the inpatient side of post natal care and had a crashing BP with associated tachycardia but only 2 nurses (both 'old school') noted the signs of this. The others weren't aware of monitoring for allergic reaction during transfusion - this is basic nursing care.

I understand that staffing is an issue - I do permanent bank across a wide range of areas both acute and community - and the quality of nursing care has declined whilst the demands have increased - a lot of this is changing demographics in the nursing profession and the increased cost of training plus the emphasis on university theory to the deficit of practical placements with quality mentorship.

So in terms of question - would you be prepared to say that there is a deficit in nurse training which is undermining the quality of care Mothers receive post natally (after all,, although childbirth is natural when a mother has an inpatient stay there is the suggestion that there are underlying causes separate to fetal development - such as CRF/ CHD/ T2DM/ PreEclampsia/ Recognition of HELLP etc etc) separate to staffing levels?

Birth is an important milestone in many womens' lives and it is unfortunate that so many women feel overlooked and undervalued considering the immense nature of the task of birthing. The concept of 'getting on with it' and 'getting over it' when faced with difficulties really puts back feminism as whole and promoting womens' values. After all, women know their own bodies and know whether through gut instinct or past experience when something 'isn't right' and this is soo soo important to acknowledge in clinical practice alongside interpretation of results - especially when faced with a medical profession overladen with male consultants.

RNs and RMs primary purpose should be the return to health where possible and the advocacy of the patient - both mother and child.

Thanks in advance.

I will be watching this thread with interest tomorrow afternoon!

With the removal of the government funded bursary for midwives and nurses do you expect a decline in the volume of applications for university places? We are constantly told through the media that there is a lack of midwives and nurses which may be to detriment of care, however there seems to be very heavy competition for university places. Why is this?

Hi Cathy

My postnatal care was great, as were my hospital births, and two of the midwives who helped me will always be part of some really happy memories for me. Just wanted to say that! It must be a great job sometimes.

Some of the accounts on here on the postnatal threads have been really shocking though. It feels as though the 'birth is not an illness' philosophy has been taken too literally by some health workers. Of course birth is 'natural' but torn perineums, section wounds and sleep deprivation are all things that merit proper nursing care - aren't they?

Are postnatal wards fundamentally different from other kinds of inpatient ward, in your view?

Hello Cathy

My question is: do you think every mother should be allowed to have an epidural when she asks for one? If so, why isn't this happening?

Would love to hear your thoughts on this!

What do you think about Bounty ladies being allowed on postnatal wards? Are there any other wards where you'd like to see commercial sales reps wandering around so long as they pay the NHS a bit of money for the privilege, or is it only postnatal women who are fair game for this?

Thank you.

How many healthcare assistants are we short of?
From my experience giving birth twice (formal complaint made first time about postnatal care, no problems second time except for my needing lots of support because of the first time), the midwives ended up having to do lots of the basic tasks that laypeople would consider 'nursing' that I think are the remit of HCAs?

Picking up babies and passing them to the mother who can't sit up or get out of bed, helping a mother to the toilet if she can't walk, cleaning the bed if mother has had diarrhoea, ensuring mothers get fed... do those jobs need to be done by qualified midwives?

Assuming not, what is being done to get more women into doing those roles, along with ensuring there are sufficient cleaners to keep the ward clean?

Cathy, there was a thread on MumsNet recently where women were talking about their experience of labour and something that came up again and again was women being told that they weren't in established labour or that they had hours until they delivered and being encouraged to go home only for them to deliver 5 minutes later. Several women recounted telling the midwife they could feel the baby's head but simply weren't believed. I know some labours can progress very quickly but I was shocked that so many women had had this experience.
There was also a recent thread on here discussing whether women should routinely be informed of the risks of vaginal births like they are with C sections e.g. told that some women tear so badly that they need surgery, that some women are too sore to even contemplate having sex for months or years after giving birth or that some birth injuries are permanent. Do you think women should be given more honest information about the possible aftermath of vaginal birth?

I trained as a midwife in the 1970s.
We were all qualified SRNs with staff nurse experience.
We trained in the maternity hospital with lectures and exams all "in house".
The wards were staffed by midwives, enrolled nurses, nursery nurses, auxiliaries. We also had ward maids who cleaned and did the water jugs and meals.
We thought we were only just adequately staffed then. It is much worse now.
What do you think would be the quickest, most cost effective but safe way to improve staffing?

@KipDynamite - not everyone gets an epidural if requested?! (Where medically appropriate) honestly ? That's awful.

Do you stand by the belief that women should be able to choose their place of birth and who leads the care? Even those with uncomplicated births who still choose a hospital and consultant-led care?

There was also a recent thread on here discussing whether women should routinely be informed of the risks of vaginal births like they are with C sections e.g. told that some women tear so badly that they need surgery, that some women are too sore to even contemplate having sex for months or years after giving birth or that some birth injuries are permanent. Do you think women should be given more honest information about the possible aftermath of vaginal birth?

I think that's a really good question and hope Cathy answers it.

She's talked in the past, I recall, about informed consent for sections. That's vitally important, I am glad she's raised it and I hope we'd all support her on that one. I'd like to know if she's also in support of informed consent to attempting vaginal birth.

I would love to hear the official position on Tongue Tie. As a mum of three sons who've all had TT, a Peer Supporter who's supported loads of parents and TT babies, and a friend who's been asked to help a lot with breastfeeding support, I am shocked that this is still such a huge issue for so many families.

So my question is - is the recognition and treatment of the different types of Tongue Tie taught on all or any midwifery courses; and if not, how can it be added to the core curriculum for postnatal infant feeding support?

Thanks so much for any light you can shed on this x

What do midwives think postnatal care should be?

I feel there was a real disconnect between the light touch care, poor facilities and self reliance expected of postnatal patients and the reality of wards full of women recovering from surgery, needing to manage medical conditions and dealing with poorly babies. I feel everyone who might have benefitted from the care being offered went home six hours after giving birth. Is there a case for postnatal to be a medically led ward?

I would be interested to know your views on postnatal care and advice for women regarding birth injury.

I had a prolonged 2nd stage of 4 1/2 hours, but due to delays, I ended up pushing my baby out without instruments, "just" episiotomy. Not one member of staff ever told me that this experience is not normal, that it had been a very prolonged pushing phase. Pelvic floor exercises were just for incontinence/ no mention of prolapse. I would like to see women who have instrumental delivery or complications being told that their risk factors are higher and what to do to minimise these in the postnatal period. Or, physio- like in France- being offered to every woman postnatally.

You, along with the majority of other relevant health professionals, all reiterate that many more midwives are needed for things to be improved. This seems to have been the case for a long while. Why in your opinion has this not happened? Do you think campaigns like this will help get the attention to get the necessary funds?