When a Child is Born

  “I thought this was supposed to be joyful”

Think of the birth of a new baby and most people will think of a happy event, full of love, delight and hope for the future. As a student midwife I remember looking forward to spending time on the postnatal ward and imagining that is would be full of women who would be feeling happy and fulfilled. I will never forget the reality. I soon learnt that transition to motherhood can be all the things I thought it would be, but it is often also mixed with not only physical discomfort and extreme tiredness but fear, bewilderment and an overwhelming sense of responsibility. I noted that some women actually looked ‘shell-shocked’.

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As a qualified midwife working in the community again the pleasure and the pain of the new mother was much on my mind. These women obviously love their babies, but the process of becoming a mother does not always match their expectations, leaving them feeling sad and inadequate in their new role.  Add to this the unrealistic media image of motherhood. Of smiling mothers with perfect, contented babies. Worse still the celebrities who are portrayed as miraculously ‘snapping back into shape’ and getting back to glamorous and seemingly effortless normality (within a weeks if not days of birthing) and the potential for feeling like a failure is huge.

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The reality is that many women find the transition to motherhood really hard. For most this will pass with no serious harm.  They may feel sad and low at times but they will get through it ok if they get the right support. However, other women will feel like this most of the time and they will not be ok. They may suffer from postnatal depression and/or other mental health problems. This is an issue for their long term health, their relationship with the baby and the health and wellbeing of the whole family. It is estimated that about 10-15 in 100 new mothers will suffer from postnatal depression in some form (Royal College of Psychiatrists website 2014).  Approximately 58% of new mothers with PND do not seek medical help (Research by The Charity 4Children report Suffering in Silence 2011). This is due to them not understanding the condition or fearing the consequences of reporting the problem.

With all this in mind and a BIG interest in compassion in practice, I attended Michelle Cree’s workshop on a Compassionate Mind Approach with Mothers and Babies.  This was part of The Compassionate Mind Foundation Conference in Birmingham last week

http://www.compassionatemind.co.uk/index.htm

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Compassion Focussed Therapy (CFT) has been developed by Paul Gilbert for therapists and healthcare workers to utilise when working with people with a wide variety of problems.  Michelle has developed the method for perinatal maternal health and beyond. Michelle works as a Consultant Clinical Psychologist for the Derby Perinatal Mental Health Service. She provides both individual and group therapy using Compassion Focused Therapy.

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It was a really fascinating day.  Michelle discussed the issues around the following topics:

  • The current way of how we live our lives compared to what we have evolved to need to best mother
  • our difficult evolved brain
  • brain changes that occur during pregnancy and early motherhood
  • experiences that have already shaped

Michelle explained how using the compassionate approach involves two main themes:

1) This is not your fault.  This is about moving away from self-blame, guilt and feelings of inadequacy

2) How to ‘grow’ your compassionate mind.  This is about learning to use compassion for self, baby and others as a tool for adapting to motherhood, relating to baby and building resilience.

One important point is that self-compassion techniques are vital. Compassion has to flow to self first.  Its like oxygen masks on an airplane.  In an emergency, the oxygen masks come down and you must put oxygen on yourself before you can help anybody else. Clearly you will be in trouble very quickly without your oxygen and thus will be unable to help anyone.  Same goes for compassion.

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There was much to learn on this workshop. I was interested to learn that many Family Nurses have already been taught how to use this approach with younger mums. We were shown ways of spending a few moments being mindful (or checking in on yourself).  This is a useful tool when feeling anxious or angry. The CFT approach teaches the woman how to:

Put her compassionate self into the centre of her life and make her compassionate self her authority and her sense of safeness. This will assist her to enhance her mood, confidence and bonding with baby.

The CFT approach gives the woman some valuable life skills which she can use when she experiences feelings such as disappointment, anger, anxiety or inadequacy.

I am convinced that this approach could be really helpful if utilised by community midwives when working with women in the post-natal period. Midwives have an important role in detecting and referring women who have signs of postnatal depression but they need more skills to support all women with the very real difficulties of adapting to parenthood. Better still why not teach women the principles of this approach in the antenatal period so that they have some of these skills in place rather than just waiting until the child is born and screening for problems?

 

 

 

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Walk a Mile in my Shoes

On Friday I went to an extraordinary event at Lewisham Hospital called ‘Whose Shoes’. Extraordinary because it started with a brave and powerful story from a woman who had a very sad birth experience. Then we sat around in groups and played board games! You may ask why?

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The participants included midwives, support workers, doctors, managers, commissioners and maternity service users.  Whose Shoes is a board game developed by Gill Phillips initially for social care settings.  She has now developed a maternity version (Whose Shoes Maternity Experience) or if you are on Twitter follow the hashtag #MatExp

      http://about.me/whoseshoes

        Gill Phillips

Gill Phillips

The game cleverly facilitates constructive discussion about how maternity services can be improved and because all the right people are involved and are listening to each other it is the sort of talk which could quickly be translated into commitment, planning and action.

Playing Whose Shoes Maternity Experience

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Lets face it, its not rocket science its just all the right people round the table getting to the heart of the matter and finding ways to move forward. Its extraordinary because in my experience having all the right people (including service users) round the table at the same time just does not happen often enough in maternity services. When it does it is not always constructive because of people prioritising their own interests. Whose shoes gets players to examine a wide variety of issues from the negative language routinely used in maternity settings to how to improve skin-to-skin opportunities for women and babies. It enables the players to really listen to all the different perspectives and work as a group to cut through the perceived barriers and find a way forward. Its a simple but brilliant idea and one which could be used at many different levels from strategic planning to staff training and development.

Being able to put oneself in another’s shoes is a vital aspect of compassionate practice. Compassionate practice requires empathy and according to Roman Krznaric in his book: ‘Empathy: Why it matters and how to get it’, empathy is the art of stepping imaginatively into the shoes of another. It involves understanding their feelings and perspectives and using that understanding to guide your actions. It is different to sympathy which comes from a position of pity. Neither is it about “doing unto others as you would have them do unto you”. Although at first glance it may sound admirable, If I did that it would assume that the other persons interests and tastes are the same as mine. Only by really listening and making that imaginative leap of stepping into another’s shoes can I start to understand their perspective and provide them with appropriate, personalised and compassionate care.

California Dreaming!

II am not dreaming I really am writing  this blog from San Francisco, California USA where I have been attending Compassion Week.

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This has been a week of conferences on:

The Science of Compassion

Compassion in Healthcare and

Empathy and Compassion in Society

Some of the leading experts in the field have been presenting their work this week. Professors of Psychology, neuroscientists, neurosurgeons, psychiatrists,  anthropologists, research fellows, senior managers, leaders of charitable and clinical work are among the  people sharing their work.

So whats an ordinary midwife from Warwickshire doing in a place like this?

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I have to admit that I have felt a little out of place at times.  As far as I know I am the only midwife here and certainly the only UK midwife. But i am here to see what I can take from the conference and apply to midwifery back home. I have been hoping that there will be information that will resonate with midwifery practice. Am I just dreaming?

Well I don’t think so. One of my favourite presenters has been Sue Carter Professor of Psychiatry at University of North. Carolina.

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Sue’s research has included the role of oxytocin in compassion and kindness.  When compassion is shown oxytocin ( the hormone of love, birth and bonding among other things) is produced both in the giver and the receiver.

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For labour, bonding with the new baby and breast feeding to go smoothly oxytocin is needed. Care in labour should support the work of oxytocin.

We have long known that one-to-one midwifery care for women in labour is associated with better labour and birth outcomes and increased job satisfaction for midwives. It may seem obvious that continuous care from a known midwife allows a more personal relationship with the woman and a chance to get to know her, understand her needs and provide kind and respectful midwifery support. It may seem obvious that midwives find this satisfying and rewarding work. But Sue’s work goes a long way in my opinion to explaining the physiological mechanisms behind this. Her work has shown that oxytocin is a physiological metaphor for safety. Feeling safe is essential for normal birth. Both the relationships with care givers and the environment of birth need to support oxytocin’s magic.

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I said magic! But of course another way of saying it is science and that’s where Sue’s work comes in. Her  work gives real credibility to the need for ensuring that this type of care is a fundamental part of maternity care.  Compassionate midwifery care provided in the context of a trusting relationship impacts on birth at the hormonal level. This has the effect of changing birth outcomes and the experiences of women (and midwives) for the better. Midwives and women know what sort of care works best but we live in a world where we need scientific evidence to show that we are not just dreaming this up!

We all just find ourselves here in the flow of life: Tweeting

I am a midwife who believes that compassion has the potential to transform practice. I was talking to the amazing Sheena Byrom on the phone a few months ago.  Sheena has a deep interest in this too and she (together with Soo Downe) have a book coming out soon which is all about  kindness compassion and respect in maternity care. I think it will mark the start of a real shift of focus in midwifery.

I have long admired Sheena and Soo and eagerly await this book which is pre-ordered! Sheena advised me to keep connecting with others who felt the same and use Twitter as she does – Sheena is a prolific tweeter (@Sagefemme). As I write this blog Sheena is at an international homebirth conference in Prague (#PragueHB14) and is keeping her 5747 followers connected throughout with details of key speakers and presentations from around the world.

There are many others and I cannot do justice to even a fraction of them here but I will just have to mention @JennytheM (Jenny Clarke) a midwife with a passion for promoting skin-to-skin for mother and baby following the birth.  Also not to forget Teresa Chinn (@AgencyNurse) who started up @wenurses and @wemidwives tweeting communities.

JennytheM

Jenny Clarke

http://jennythem.wordpress.com/2014/10/21/skin-to-skin-and-the-who-checklist-board/

 

 

Teresa Chinn at ehi Live 2014 speaking from the Social Media Village

#wenurses #wemidwives (there are #wedocs and others too!)

I didn’t know how to use Twitter!  I had an account but it didn’t seem to make much sense and I didn’t think I could say anything worthwhile in 140 characters or less. But I was encouraged by others to have a go. I lurked a bit and then just went for it.  I am still a beginner and learning all the time but I now feel part of a much wider community which includes midwives, nurses, doctors, health service managers, mothers and many others.

Social media has had a bit of a bad image in the midwifery and nursing at times.  This is usually connected to examples of unprofessional behaviour online. It is important to adhere to NNM guidance on this and I think the vast majority of health professionals do.

http://www.nmc-uk.org/Nurses-and-midwives/Regulation-in-practice/Regulation-in-Practice-Topics/Social-networking-sites/

So far what I have seen on Twitter has been professional in every sense of the word. My experience has been one of sharing of ideas and enthusiasm for our work with others. It has been part of my professional development. It provides a broader, national and international perspective. It has provided a real sense of professional support. Above all It has been a compassionate connection. Surely any method of communication that facilitates this is worth taking seriously. I would urge midwives and student midwives to think about using Twitter to feel more connected to a wider midwifery community.

Connecting with others (however you want to connect) in a kind and respectful way is so important.  Why??

Well we all just find ourselves here in the flow of life, trying to make sense of it as Paul Gilbert says in his book The Compassionate Mind.  On this planet, at this time, with this body and brain and genes.  If you think about it – none of that is under our control – it just happened to us. Some people have very hard lives and others are more fortunate. What we were born into was just the luck of the draw.  But at times life has its challenges for every single person.

Kind, respectful behaviour towards one another has huge benefits and that is why it is hard-wired into human behaviour.  Its been an important part of survival on this planet and its one of the reasons we have become such a successful species. Its how we build communities. Communities where we can work and live co-operatively, feel connected, find meaning in our lives, have friends and families and look after each other.  It makes us more than the sum of our parts.

Compassionate connection can be achieved in many ways but I can see that Twitter provides a powerful way of doing it. I am hoping to take learning from my attendance at Compassion Week next week and explore how it relates to three areas of midwifery practice:

  • compassionate care for the women we support and work with
  • building compassionate teams to work in
  • self-compassion

So as I prepare for my journey to San Francisco to attend Compassion Week 2014 I am planning to connect with others in as many ways as I can.  I would love you to be part of that connection by following my blog and following me on Twitter @Dianethemidwife #CompassionWk2014 #compassionatemidwifery

Blog Virgin finds Passion

Well its blog number one! The reason I have started this blog is to share some of my thoughts, ideas and experiences about the value of compassion. How did this passion for compassion start? Well earlier this year the group of Supervisors of Midwives I work with decided to look at the 6 Cs (care, compassion, competence, communication, courage and commitment) in more detail and we each looked at different Cs.  By default I ended up with compassion.  Little did I know what this was going to lead to.

I have to admit that (initially) I was a little cynical about the whole 6Cs thing. I grant you its catchy and has 6 important words which all conveniently begin with C and the logo is quite nice and who could disagree with the sentiments?  But exactly how could it impact on the nursing and midwifery profession? How could this improve care? That’s what I wanted to know.

On the 6Cs leaflet    http://www.england.nhs.uk/wp-content/uploads/2012/12/6c-a5-leaflet.pdf it says:

“The compassion and humanity we show shapes the culture of our health service and our care and support system”. I know this is true and I believe that all of us who came into nursing and midwifery came to it wanting to show compassion and humanity to those we support and provide care for.

I started to find out more about compassion and the science behind it. Lots of reading followed but one book among all others changed things.  The Compassionate Mind by Paul Gilbert is a fantastic read and has literally changed my life. Paul Gilbert is one of the most notable scientists studying compassion. He explains the evolutionary and social reasons behind our reaction to threats with self-protective behaviour but also how our brains are hardwired for compassion and kindness.

Here is a link to an interview with Paul Gilbert:

http://www.bbc.co.uk/programmes/b011p6yv

As I gained knowledge about compassion I saw more clearly how it applied to practice.  I wanted to share it. My colleague Sue and me worked to produce a short presentation on compassion and its relevance to midwifery practice. It covered some of the basic information about the science of compassion.  It also involved a short role play of me being a woman in advanced labour and Sue being my midwife.  Which was quite funny to do (I think funny to watch too) but it illustrated the importance of compassionate connection with the woman and really listening to her. We were a constant presence for a day on the maternity unit from 8am to 8pm.  In this time we did our presentation over and over, to most of the staff on duty, in clinic, community or on the wards. We even made an appointment with The Trust’s Chief Executive and did the presentation to him! The day really seemed to raise awareness and feedback was good. But it was clear that actually most midwives really want to practice compassionately.  That’s what they came into the profession to do. But sometimes things get in the way. Things that block compassion.  Like having too much to do and not enough time, feeling exhausted, overwhelmed, fearful, bullied, unsupported or belittled.  We have all been there and I think all of us can remember times that we were not as compassionate as we would like to have been under such circumstances.  Which just goes to show why compassionate leadership and compassionate supervision is important and why it is vital that we work in supportive, compassionate teams.  Plenty of work to be done in these areas me thinks?

Then another breakthrough, one of the midwives I supervise recommended a book by Kristen Neff called Self-Compassion.  I cant thank her enough! Another life-changing book in my opinion.

http://www.self-compassion.org/

Neff explains that this is not about making excuses for yourself or being soft on yourself its about building our emotional intelligence and resilience.  Its obvious really but it is just as important to treat ourselves with compassion and respect. In fact it is an essential part of sustainable compassionate practice.  So compassion in practice is about compassion for those we care for, those we work with and ourselves.

So six months on and I have become passionate about compassion. I continue this learning journey and I am committed to sharing it with others so that it may impact on practice.

Next Sunday I fly to San Francisco for Compassion Week http://compassioninsociety.org/index.php?option=com_content&view=article&id=1011

This is a five day series of back-to-back conferences:

  1. The Science of Compassion Conference
  2. Compassion in Healthcare
  3. Compassion and Empathy in Society

Please follow me on Twitter (dianethemidwife) or Facebook if you don’t do Twitter and please follow my blog.  I will be blogging in the run up to Compassion Week as I make preparations and then when I am at the conferences you can follow them with me as I share some of the ideas, presentations and workshops.