How do health professionals use social media?



In preparation for an article I am writing for a midwifery journal, I decided to conduct a short survey to ascertain why health care workers use social media in a professional capacity.  The survey ran from 10/4/14 until 27/4/14, and was disseminated via Twitter and Facebook.

321 individuals responded, and the brief results are outlined below. The full article will be published in June edition of MIDIRS as the Hot Topic, authors Sheena Byrom and Anna Byrom

The questions asked were:

1. Do you use social media for professional reasons?

Screen Shot 2014-04-28 at 20.00.09

2. Please indicate your profession

Diagram 1

3. In what country do you currently reside in?

Respondents were from Australia, Brazil, Canada, England, Ireland, Netherlands, New Zealand, Northern Ireland, Scotland, Spain, Switzerland, USA, UK, Wales.

4. Which social media network do you prefer?

Screen Shot 2014-04-28 at 20.07.04

5. How often to you log into social networks?

Screen Shot 2014-04-28 at 20.08.21

6. If Facebook is your preferred network, what are the benefits to your professional role?

These included widely used, networking, sharing, support, with a significant amount using private communication through closed groups. Even though the question wasn’t asked, several respondents mentioned the fear of  recrimination.

‘Posting information to my audience, getting them involved by comments. They get to know me and recommendations come from being known’ Participant 2

7. If Twitter is your preferred network, what are the benefits to your professional role?

Benefits included fast responses, more professional than Facebook, access to wide network of individuals and groups,  connecting with other professionals, flattened hierarchy (access to leading professionals), support, sharing, global contacts, easy to use.

‘Enables conversation – debate – information and knowledge exchange- encourages active student engagement – modelling professionalism – relationship building and networking’ Participant 161

8. Please rank the benefits of your social media use


Screen Shot 2014-04-28 at 20.09.56

9. Please give examples of how social media has helped you in your professional role.

The responses further elaborated on the above factors,

‘Connecting with health professional who have enabled me to reflect and learn Increasing my professionalism Enabling me to have a voice and communicate my value’ Participant 98

‘It helped launching CenteringPregnancy in the Netherlands! Connections with obstetrians outside my area. Enlarged my view on midwives, emancipation, women, public health etc’ Participant 107


I would like to sincerely thank all those who participated in the survey.

Help to connect more midwives around the world (and be a ‘Twitter Buddy!’)


With the International Day of the Midwife imminent, and the countdown to the International Confederation of Midwives 30th Triennial Congress (ICM) from 1-5th June, I want to try to engage with midwives around the world, to encourage and support them to connect through Twitter. I started ‘tweeting’ approximately 18 months ago, and I haven’t looked back. Here’s a glimpse of what Twitter does for me.


Nurses and midwives are generally reluctant to use Twitter. Not Facebook, just Twitter. Yet those using it can’t imagine life without it-Twitter has opened so many doors for them, and offered oodles of support. @WeNurses founder and social media expert Teresa Chinn @AgencyNurse is also a registered nurse, and offers thoughts on her blog why nurses and midwives SHOULD engage with Twitter , and some of the reasons why they don’t!  If you are worried about using social media professionally, then listen to this podcast by Dean Royles @NHSE_Dean  CEO of NHS Employers, as he slays some of the myths.


Infographic with kind permission from   @AgencyNurse

IF YOU WOULD LIKE TO JOIN TWITTER, JOIN UP HERE. If you are going to ICM in June, and considering using Twitter, please do so BEFORE you leave home. It will be much easier! If you are a health organisation, and you would like to know more about using Facebook or Twitter, check out Social Media toolkit for the NHS. I have facilitated a midwives chat space for 12 months…@WeMidwives (part of @WeNurses) has gone from zero to 3,133 followers, many from around the world. And now it’s time to really try and engage with more! SO….. Would you be a Twitter Buddy? At the ICM I am charged with sharing the event’s highlights through Twitter and other social media platforms, and I will be producing Storify updates each day. I will also be delivering workshops on using social media, but this won’t include ‘how to’. For that, I need ‘Twitter Buddies”. Twitter Buddy If you are going to ICM in person or joining LIVE online streaming, or you are planning to tweet during ICM using #ICMLIVE then read on! I am building a team of  midwife and student midwifeTwitter Buddies‘ on the recommendation of social media expert @VictoriaBetton.  If you would like to help spread the advantages of Twitter by sharing your skill with least one other person during ICM week (1-5th June), then I’d love you to be part of the project! Here is the simple plan:

  1. If you want to be a Twitter Buddy let me know, via Twitter, using #TwitterBuddy. I’ll then add your name below!
  2. During ICM week connect and sit with an interested midwife colleague, and show her/him how to use Twitter on a 121 basis. Aim for at least one midwife recruit per day!
  3. Tweet me the Twitter handles of the new midwife Tweeters, and at the end of the week the results will be collated.
  4. The Twitter Buddy who launches the most midwives on a new Twitter journey will be announced the week after the conference!
  5. Direct your Twitter recruit to this blog post for encouragement.

ANOTHER REMINDER IF YOU WOULD LIKE TO JOIN TWITTER, JOIN UP HERE.  If you are going to ICM in June, and considering using Twitter, please do so BEFORE you leave home. It will be much easier!  COME AND JOIN IN THE CONVERSATION And HOT OFF THE PRESS, my daughter Anna Byrom and I have written our first article together. It’s about social media, so you may find it interesting! Here it is


  1. Anna Byrom @acbmidwife  
  2. Shawn Walker @SisterShawnRM
  3. Simone Valk @sljvalk 
  4. @linsyrjls
  5. @llisa01
  6. Jane Morrow @MorrowJane
  7. Cassie McNamara @MamaConference
  8. Carmel McCalmont @UHCW_Midwife
  9. Jenny Clarke @JennyTheM
  10. Nalonya vd Laan @nalonya
  11. Sarah Johnson @sarahjohnson222
  12. Elly Copp @EleanorCopp
  13. Tracey Cooper @drtraceyt
  14. Amanda Firth @LaughingMrsM
  15. Heather Franklin @Twidmife
  16. Midwife Supervision @midwiferyWAHT 
  17. Lola the E-Midwife Lola_emidwife
  18. Carolyn Hastie @CarolynHastie 
  19. Sara Bayes @SaraBayes
  20. Alison Brodrick @AliBrodrick
  21. Lizzie Bee @Li33ieBee 
  22. Pam Wild @pamoneuk 
  23. @Dashing_d_leo
  24. Claire Fryer-Croxall @ClaireCroxall
  25. Hana Ruth Abel @Hana_Studentmid 
  26. Ali Searle @alisearle 
  27. Karen Yates @karenyatesjcu
  28. Lyn Ward @linward
  29. Nicky @twixynicky1
  30. Anita Fleming @AnitaFleming7
  31. Lorna @berrybird71
  32. Trudy Brock @TrudyBrock1
  33. Geraldine Butcher @gbutcher17
  34. NHS Midwife @midwife_foz
  35. Anjuli Lord @anjulilord
  36. Linda Wylie @uwslindawylie
  37. Janet Fyle @consideredview
  38. Joanne Camac @CamacJoanne  
  39. Jane @Midwife2b0514
  40. Claire Omand @clarabell080
  41. Mary Stewart @midwife_mary
  42. Francesca @Francesca343
  43. Hannah Bowater @funking-nora 
  44. Sarah Johnson @sarahjohnson222
  45. Kathryn Ashton @KathrynAshton1
  46. Birthing Instincts @birthinstincts
  47. Dawn Gilkes  @dawnmidwife 
  48. Debby Gould @DebbyGould
  49. Sarah @sarah_pallett
  50. Laura Fyall @LauraFyall
  51. Tracey Hunter (need link)
  52. Alison Taylor (need link)
  53. Elsie b @LesleyBland
  54. Alison Power @alisonpower31
  55. Aku Bidan, Kamu? @BidanBidanku
  56. Linda Ball @BallLinn
  57. MaggieMoo @MaggieBakesBuns
  58. Mhairi @Stmwmhairi
  59. Kate @Dottymom
  60. Jude @beetrooter
  61. Kylie @smileyhudders
  62. Lillian Bondo @LillianBondo
  63. Mitra Kadarish @mee_tra
  64. Annabel Nicholas @annienicholas68
  65. Jenny Clarke @JennyTheM
  66. Jacque Gerrard @JacqueGRCM
  67. Kelly Stadelbaur @KellyStadelbaur
  68. Brigid McConville @Brigid_McC
  69. Natalie Buschman @Birthsandmore
  70. Jayne Case @jaynecase8
  71. Sarah Stewart @SarahStewart
  72. Beth McRae @outbackmidwife1 
  73. M. Michel-Schuldt @emma_von_mumm
  74. Vanessa Shand @vshand 
  75. Julie Wray @JuWray 
  76. Hari Ani @hunnyhunnymuch
  77. Soffa Abdillah @soffa_abdillah
  78. Fardila Elba @elba_cholia
  79. Kerry Spencer @miffymoffit
  80. Macavity @elusivesarah
  81. Marjolein Gravendeel @MGravendeel 
  82. Wendy Warrington @wendywarringto1
  83. Nicolette Peel @NicolettePeel 
  84. Hannah Harvey @hannahharv13
  85. Helen Young @helenyoungmw
  86. Ashleigh @ashleey_latham
  87. Linda Bryceland @LyndaBryceland
  88. Claire Macdiarmid @Mcdaddymacswife 
  89. Janie @janiealalawi 
  90. Sophie @sophieinpariss
  91. Leigh @Leighree
  92. Laura Williams @Laura4_x
  93. NHS Midwife @NHSmidwife
  94. Maria Anderson @MariaAnderson17
  95. Louise Randall @LouiseAJRandall 
  96. Mary Ross-Davie @MaryRossDavie
  97. Ans Luyben @luybenans
  98. Roa @Roretta 
  99. Inisial Z @zidemanjaya 
  100. Jupuut @juliaputriutami 
  101. Berty @me_b3rty 
  102. Mel @Mel_meilina
  103. Qorin @QorinDias
  104. Yennita Maharani @nypinyip
  105. Michelle Anderson @michellemidirs
  106. Cathy Ashwin @CathyAshwin 
  107. Jane Pilston @janepilston 
  108. Kookie Salt @kookie31
  109. Joanna Lake @JoLake87
  110. Hannah Telford @TelfordHannah
  111. Mahasiswa Kebidanan @Mahasiswa_Bidan
  112. Sisilh @Hilmasilsil
  113. Indira A U_tami @indie_utami
  114. Ikka Zullianti @ikkazz
  115. Nuy @stnurjanah08
By sheenabyrom

Obstetric violence and humanized birth in Brazil

Student Midwife Oli Armshaw @olvinda has written another post for my blog. With others, we have been corresponding by email over the past few days, following the horrific revelation below.


Adelir Carmen Lemos de Goés, with her daughter after the forced caesarean

Adelir Carmen Lemos de Goés, with her daughter after the forced caesarean


With sadness and horror I read about Adelir Carmen Lemos de Goés, a 29 year old pregnant woman, in Torres, Rio Grande do Sul, Brazil, being forced by the authorities to have a caesarean, on 1 April.

On 31 March, she had a scan and was examined by a doctor, who said she needed an immediate caesarean as she had already had two previous caesareans, the baby was breech and her pregnancy was 42 weeks.

Adelir, saying she would prefer a VBAC (vaginal birth after caesarean) in the hospital -although there was no staff to support her choice, signed a document taking responsibility for her decision and went home to await labour, with her doula, Stephany Hendz. In the middle of the night, when Adelir was already in established labour, armed police and medical personnel arrived in two military police cars and an ambulance, to force her to Hospital Nossa Senhora dos Navegantes, for a caesarean. In the name of risk to the unborn baby, the doctor had asked judge Liniane Maria Mog da Silva, to issue an injunction to bring her in for caesarean section. She was submitted to surgery by force, against her will. Yesterday, the result of her ultrasound scan circulated on Facebook, showing a gestational age of 40 weeks.


Brazil’s major press, including Globo G1, reported the story on 2April, which you can see here and also translated here.   According to Adelir, “Two military police cars came and an ambulance to take us from our house. I was very anxious. I was all but handcuffed,” she said, alleging verbal abuse by police.

Here, you can see Adelir speaking about the terrifying experience of police arriving at her house when she was in established labour, contracting every 5 minutes, and being forced to hospital for surgery. You don’t need to understand Portuguese to see how she feels.

The response in Brazil has been mixed: Most Brazilians do not sympathize with Adelir, the outraged birth activists or the ‘crazy feminists’, who support a mother’s right to make her own choices about birth and risk. But there is a strong, groundswell movement for the humanization of birth, fronted by ReHuNa (League for the Humanization of Childbirth), which considers this brutal incident to be an unacceptable breach of human rights, and is demanding that the Justice Department take action to address it. Peaceful protest demonstrations are being staged on 11 April in São Paulo, Rio de Janeiro, Torres, Belem and across the world at all Brazilian embassies. The UK embassy of Brazil is at 16 Cockspur St, London SW1Y 5BL. For more information please visit:


Birth activists have started a petition on Avaaz, which you can sign here, to oppose the infringement on civil liberty, and extreme technical incompetence of doctors and government. They claim the incident not only breaches the Code of Medical Ethics, but goes against basic evidence: “Labour is a safe and appropriate choice for most women who have had one or more previous caesareans” and “pelvic planned vaginal delivery of breech babies may be reasonable under the guidelines of hospital protocols.” (ACOG Bulletin for clinical practice No. 115, 2010). You can read a full translation of the Avaaz petition here.

A formal complaint has been lodged at the Secretariat of Justice and Human Rights of the Presidency of the Republic by Artemis, a Brazilian NGO promoting women’s autonomy and the prevention and eradication of all forms of violence against women. Here, you can see their letters on Ligia Moreiras Sena’s blog. @birthrightsorg have responded with this excellent blog on obstetric violence and use of ‘risk’ to legally justify treating women’s bodies “as public objects subject to the whims of the medical profession backed by the coercive power of the state” (Birthrights, 2014). Read also @KathiValeii’s powerful and passionate blog, ‘The war on women just got bloody brutal’ at Birthanarchy.

As Daphne Rattner, president of ReHuNa points out, this incident has occurred in the week that Brazilians are counting fifty years since the military coup d’etat in 1964, making it all the more grimly poignant that armed police were involved in forcing Adelir to hospital for unwanted surgery. It has Brazilians wondering who will be next to be dragged away by police, and if Adelir or her husband, Emerson, had resisted or reacted, would they have been shot?

Thanks to The Iolanthe Midwifery Trust, I’m going to Brazil for an elective midwifery placement at Hopsital Sofia Feldman, a beacon for the humanized model of care in Brazil, and attend the 9th Normal Labour and Birth Conference. It’s going to be an incredible journey back to Brazil, the country I adore. I anticipate learning a lot from the brilliant midwives there, who are committed to supporting women to birth their babies where, how, with whom, and when they want; and fighting for an end to obstetric violence of all kinds.

“Humanized Birth”, as Elis Almeida puts it so powerfully in her blog Parto Humanizado no SUS, (translated here) “contrary to what most people think, is not background music and/or low light at birth, but a set of actions aimed at a satisfying birth experience, in which the woman and the baby are the protagonists, where attention and care are fully focused on the mother and baby dyad, and not on the doctor and institution”. A bill was passed by the government on 25 September 2013 legislating for humanized conditions at birth, but ‘what’, asks Almeida, ‘is the point of having a law if it is not supported and enforced by existing policies and practices?’

I trust that Adelir’s case will mark a turning point, a pivotal moment in the ongoing fight against obstetric violence, and catalyse lucidity and urgent action to humanize childbirth in Brazil.


Oli Armshaw @olvinda, April 2014 #NOobstetricviolence





Oli Armshaw @olvinda, April 2014


C/S Photo source

Born to Safe Hands: with a few battle cries


Two exceptional midwives from Bolton, in NW England, decided to plan a conference after being inspired whilst attending MAMA conference in 2013. Joanne Camac and Annabel Nicholas wanted to hold an event to celebrate birth centres, and chose the name ‘Born to Safe Hands’  from their family experience/visitors book.  Jo told me ‘a lovely family that Annabel and I looked after wrote this and we felt it was just perfect for our conference‘.  So they set about inviting potential speakers, collaborators, film makers and researching venues. Last week the conference happened. From the moment I arrived, I knew I was part of something special. The wonderful Oli Armshaw (@Olvinda), a student midwife from the University of the West of England attended (see photo below), and has written a superb reflection of the day.


Student Midwives Oli (left) Jude and Heather

When Sheena asked me to write a reflection on Friday’s Born to Safe Hands conference, I did what I always do, which is, a) instantly say yes without considering how on earth I’ll lever it in around family/full time placement/exam revision and, b) consult Twitter – and there it was, the whole marvelous day to be relived, one #B2SH tweet at a time!

On 28th March 2014, 180 midwives, mothers and a few doctors converged on the home of Bolton Wanderers football club for Born to Safe Hands: a conference to celebrate birth centres, beautifully brought to life by Bolton Birth Centre midwives, Joanne Camac and Annabel Nicholas. I’m still buzzing from the vibrantly positive atmosphere and sense of building a community, a living network – not just within the walls of the Reebok stadium conference room, but as far afield as Perth, Rio de Janeiro, Edinburgh, wherever Twitter stretches. The midwifery ecosystem keeps growing, inspiring us to keep up the fight for women’s rights to informed choice and dignity in childbirth, and to keep looking for ways to be ‘with woman’ – for all women, not just those who fit admission criteria.


Certain battle cries stood out from the day:


‘Put on your leadership hat and fight for women!’ Cathy Warwick incited every single midwife to be innovative, imaginative and creative about the woman-centred agenda, do research, challenge practice and use emerging evidence. As we all know, it’s not just the birth rate putting midwifery under pressure, but the complexity of the women we are looking after, and we need to keep this complexity in perspective, as it’s not always a problem. Cathy highlighted the need to adapt our care and policies to the over 40s mothers, who are the most rapidly increasing group, and to learn from each other about keeping the numbers up for birth centres and freestanding midwifery units.


‘Why can’t labour wards look like birth centres?’ Denis Walsh demanded, as he enthused about normalizing birth for older mothers, women with high BMIs and other complexities. He calls for a change in how we assess risk, and to make the point that change can and does happen, told us about the ACOG’s game changing revised active labour thresholds: “Cervical dilation of 6 cm should be considered the threshold for the active phase of most women in labor. Thus, before 6 cm of dilation is achieved, standards of active phase progress should not be applied.” and “A prolonged latent phase (eg, greater than 20 hours in nulliparous women and greater than 14 hours in multiparous women) should not be an indication for cesarean delivery.”


It’s the baby’s blood anyway! cried obstetrician, David Hutchon confronting the misnomer ‘placental transfusion’. No one can still be in the dark about the benefits of timely cord clamping to prevent neonatal hypovolaemia, though third stage practice is slow to change.


Love or fear?’ Soo Downe, made it very simple, binary even: Love or fear. Which one are we working from? Which drives our decisions and actions? I enjoyed her every word about belief and salutogenesis: the fundamental belief that birth is salutogenic – ie seen from a perspective of wellness.




To illustrate the effects of being watched, and the power of belief, Soo showed us this chilling image of Jeremy Bentham’s Panoptican penitentiary (1791). The concept of the design is to allow a single watchman to observe (-opticon) all (pan-) inmates of an institution without them being able to tell whether they are being watched or not. Although it is physically impossible for the single watchman to observe all cells at once, the fact that the inmates cannot know when they are being watched means that all inmates must act as though they are watched at all times, effectively controlling their own behaviour constantly. It reminded me of the main office on delivery suite where 8 women’s CTG traces can be viewed at once on a huge screen – not exactly the ‘private, safe and unobserved’ conditions recommended by Dr Sarah Buckley as the optimum environment for undisturbed, physiological birth.


Sheena Byrom’s whizzy Prezi explored the pitfalls of using guidelines-policies-protocols interchangeably, and linked the importance of supporting women to make autonomous decisions with human rights and the dignity agenda. @SagefemmmeSB is a massive advocate of Twitter, as her ‘I love you Twitter!’ video shows, eulogizing about the potential for getting and giving support; sharing ideas and news; building relationships, communities, networks and social capital; influencing change; starting or engaging in debate about practice. She implores all midwives to adopt Twitter, to respond to evidence and articles, to challenge what’s being said, to question and connect with each other. Bring the birth revolution!



Twitter pals meet. What next?


‘Is hospital birth a riskier choice for healthy women and babies?’ It was the first time I’d heard Mary Stewart speak and I loved her ‘coming clean’ as a passionate advocate of homebirth. She tackled the knotty concept of risk, swapping the word risk for chance, when talking about out of obstetric unit (OU) birth and transfers to OU from home. Mary urged us to be responsible when talking to women about place of birth, providing balanced information about planned hospital birth as well as planned home birth.


What I found most stimulating about Born to Safe Hands, was the social bonding, and positive community building of it all, which Lesley Choucri, director of midwifery at Salford University, related to Cooperider’s work on ‘unleashing the positive revolution of conversations’. Thanks to Twitter, the potential reach of the normal birth conversation at Born to Safe Hands stretches way beyond the immediate 180 people present in the room. In fact, Twitter stats  suggested that 123,228 unique users saw #B2SH and the number of impacts was over 2 million, i.e. the potential number of times someone could have seen #B2SH. This is very exciting.


photo 2

Denis Walsh with Jo Carmac


Born to Safe Hands really was a celebration of the inspiring woman-led work going on in birth centres around the country – an antidote to fear and feeling disheartened, that we are losing our grip as birth becomes ever more medicalized, as women become more complex, and less curious and trusting of our bodies. Born to Safe Hands has revived my vigour and clarity about how to develop and nurture the new midwifery and bring to life the benefits of being truly ‘with woman’, for all women – the benefits of which span generations.


Oli Armshaw @olvinda


A Storify from the conference is here, and a selection of comments:

‘best study day ever! Thank you – it’s been wonderful’

‘Best conference I’ve been to in years (and I go to a lot!). Well done. Make it annual! Make available on DVD for sale!’

‘Wonderful, wonderful day, loads of evidence and positive stories to take into my practice, thank you so much for organising’

‘Had a fabulous time, brilliant speakers. Feel ready to return fully invigorated’

‘Lovely to her what committed, expert birth centre midwives are doing in Bolton and around the UK’

‘More than exceeded my expectations, totally fantastic day, will look forward to the next one’

‘I came today to be uplifted and inspired as my unit feels very negative and de-motivated. I feel much more confident, have learnt something and feel so inspired and enthusiastic’



So Annabel and Jo, we hope you will start to plan next year’s conference soon, and make it a annual event. As Jacque Gerrard said ‘This could be the North West’s answer to MAMA!’


We are NOT using the evidence: it’s time to change


I am posting this on #NHSChangeDay 2014.

I pledge to continue to make the case for change in maternity services, until ears listen.

Recently, my lovely Italian midwife friend who is a Doctoral student in England, told me of her confusion. ‘What I can’t understand’, she began ‘is why practice in maternity services in UK remains unchallenged when you have so many esteemed academics and the some of best research evidence in the world? She made me think.

Last week I was invited to present evidence related to continuity of care and choice in place of birth at one of the Personalised Maternity Care stakeholder events, in Leeds. The events are being held around the country, and are hosted by NHS Health Education England in response to a request from the Permanent Secretary for Health, Dr Dan Poulter. Dr Poulter wants to explore the ambitions for future Maternity Services and what such services might look like by 2022.

You can read info via the tweets here.

So on finding the evidence it became very apparent-we certainly aren’t using it.

Here are my slides.  I decided to share them widely to enable discussion and hopefully receive comments and ideas from readers to help inform the Minister.

Slide 1: There is an abundance of policy, guidance and results of surveys directing maternity services, which is largely being ignored. This is alarming, though not surprising. Yet let us consider: why was the Peel Report (Ministry of Health 1970) directing 100% hospital ‘deliveries’ given urgent attention, and fully implemented WITHOUT  evidence presented or women’s opinions to back it up?


Slide 2: We are not using latest research evidence, and according to the National Audit Office report (NAO) and the Public Accounts Committee report  (PAC) there is no measuring or reporting progress, no data, no assurance of value for money, and huge variations in cost, quality, safety and outcomes. In addition, women and families are reporting dissatisfaction with their care (Birthrights, CQC, Women’s Institute), few women are receiving continuity, and choice in pace of birth (NAO, BirthChoice UK). Furthermore, stillbirth rates in England are highest in UK, and litigation costs increasing.

Slide 3: Margaret Hodge MP spells it out for you to read. Maragert chairs the PAC, and her observations are, I believe, a true reflection of maternity services in England today.

Slide 4 and 5: Reality for midwives. Desperation which often leads to leaving the profession, and for those can’t leave, numbness which increases risk of substandard care. There is a link to another post on this blog, where many comments have been made.

Slide 6: The NHS Mandate gives some direction for the future. Named midwife. What does that mean? The NHS England definition is ‘a midwife who co-ordinates all the care and delivers some of the care’ .   Continuity of care is another misused phrase, but if continuity is good, surely there would be improved responses to ‘mental health concerns’.

Slide 7: Highlights the main references for the research evidence for continuity of care

Slide 8: Reveals some of what this evidence tells us. How can we not take notice?

Slide 9: Did you know that the National Service Framework for children, young people and maternity services was still the current directive for maternity services?  And it states that every woman should be able ‘to choose the most appropriate place and professional during childbirth’

Slide 10, 11 & 12 : The evidence for choice in place of birth has NEVER been so strong as it is now, for women with no or expected complications. These are the key findings of the Birthplace Study but in general it tells us:

Giving birth is generally very safe

-Midwifery units appear to be safe for the baby and offer benefits for the mother

-For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother

-For women having a first baby, a planned home birth increases the risk for the baby (this is very small- four more babies in every thousand births had a poor outcome as a result of a planned home birth in first pregnancies).

-Women planning to give birth in a midwifery unit experienced substantially less medical intervention than those in an obstetric unit.

For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother

 For multiparous women, there were no significant differences in adverse perinatal outcomes

between planned home births or midwifery unit births and planned births in obstetric units.

 For multiparous women, birth in a non‐obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.

Important points I would like to make here, for those working closely with expectant parents:

Do you mention the above evidence when talking to women about their choices? I expect most will remember to mention the small risk for first time mothers wishing to birth at home. But do you advise women about the potential increased risk of unnecessary  medical intervention?

How do you make evidence accessible for parents? How do you deliver the evidence, do you know what it says? This is a brilliant article on how to share evidence based information. It’s a must read.

Slide 13: Is self-explanatory. Note the decrease in obstetric units (OU) and increase in alongside midwifery led units (MLU). This coincides with the number of amalgamated Trusts, and the aforesaid NSF. There is only a slight increase in the number of freestanding midwifery units (FMU), probably due to closures corresponding with others opening.  The slide informs us that very few women have the full choice guarantee as proposed in the NSF in 2004.

Slide 14: Because of the above, the slide shows that most women (87%) give birth in an OU.

Slide 15: Two recent media articles demonstrating ongoing constraints of providing home birth and birth centre births, yet the evidence is clear that women choosing to birth in these venues are there less to endure unnecessary interventions, and the service is more cost effective.  Does that make sense?

Slide 16: The best estimate of women eligible to have their baby in a non OU setting (low risk) is 50%, although WHO estimate this should be between 70-80%.   Taking 50% of 2012 birth rate (700,000) = 350,000  and deducting 89,000 women who actually had midwife led births in non OU setting, leaves us with the shocking figure of 261,000 women and babies who, according to Birthplace Study, are potentially exposed to unnecessary medical intervention.

This is unacceptable. Yet it remains silent, unspoken, when the small risk of home birth is magnified out of proportion. In addition to the human cost in terms of morbidity, there are financial implications, and pressures on the workforce. So now we have the evidence, and things MUST to change.

Slide 17: Some of the effects of the previous slide, in terms of mode of birth, and maternal feelings. Diagrams taken from the Dignity Survey 2013.

Slide 18: The potential consequences of current maternity service provision.

Slide 19: What Personalised Maternity Care should look like, including flexible use of clinical guidelines, to support women’s choices.

Slide 20: Relevant and important recommendations from the Public Accounts Committee.

The following slides give and example of maternity services in East Lancashire, where I worked for 35 years. I have highlighted these award-winning services to demonstrate how choice and continuity can be achieved. The service is situated in one of the most socially deprived Local Authorities in England, and has undergone a significant reconfiguration in 2013. With 30% of 6,700 births per year in the three birth centres (2 FMUs and 1 AMU), they are maximizing opportunity for women and staff, with excellent results.  The slides demonstrate financial gain from the model of care, and how mothers, midwives and managers feel about the service.  The key factors of success for the model in East Lancashire are:

-Model of care: midwives work in the community AND the birth centre, providing continuity and accurate and positive information sharing about place of birth

-Collaboration: obstetricians, midwives, neonatoligists, service uses, auxiliary staff support each other, and work together to ensure the woman and her family are supported.

-Leadership: the service has strong midwifery leadership at all levels.

The last slide is of my newest granddaughter, Myla. When Myla is of age to have children of her own, I want her to know that the evidence we now have was used well, to give her the best chance ever to have a positive experience and healthy baby.

Please leave your comments. We musn’t give up.

Screen Shot 2014-03-06 at 18.46.46

Table: Dodwell and Newburn (2010) 


Ministry of Health (1970) Domiciliary Midwifery and Maternity Bed Needs: the Report of the Standing Maternity and Midwifery Advisory Committee (Sub-committee Chairman J. Peel), HMSO, London

Photographs used in slides are owned by Sheena Byrom and East Lancashire Hospitals Trust

By sheenabyrom

We need more midwife Care Makers! Check out what Liverpool students did!


I received an email today from the Royal College of Midwives, asking me to post this wonderful news item on my blog. And I was delighted to, for many reasons.

As I regularly use Twitter and connect with nurses and midwives at all levels, I read about the massive impact the Compassion in Practice strategy is having on the NHS…both at the bedside and on social media. I’ve been enthused by the role of Care Makers, and have been trying to encourage more midwives to join. So if you are a student midwife, or a midwife, this may encourage you!

Care Makers are health and social care staff (student and qualified) who act as ambassadors for the 6Cs. They are selected for demonstrating a commitment to spreading the word about Compassion in Practice across the NHS. Care Makers create a unique link between national policy and strategy to staff working with patients. The aim is to capture the ‘spirit’ of London 2012, learning from the way Games Makers were recruited, trained and valued and  instilling the spirit of energy and enthusiasm they created.


(L-R) Student Midwives Ela Yuregir, Emily Lamb, Tisian Lynskey-Wylkie, Clare Bratherton and Sophie Cavanagh

This January five Liverpool John Moores Midwifery Students represented their University at a Nursing and Midwifery Celebration Event at Liverpool Women’s Hospital.
These students (pictured above) volunteered as Caremakers at the event, which showcased services at Liverpool Women’s Hospital. The day was a huge success, with notable external speakers, stakeholders, staff and service users in attendance. Nursing and Midwifery workforce also got the opportunity to make a commitment to their patients in part of the new strategy at the Women’s titled “Our Promise to Patients”.


(L-R) Ela Yuregir, Tisian Lynskey-Wylkie and Sophie Cavanagh

Three of the students also represented the University and Trust as Student Quality Ambassadors – a new role developed in the North West of England for students to champion and highlight good practice and challenge areas needing development in the practice areas of their placements.
Student Midwife Ela Yuregir said “Having just started my Midwifery training I am keen to get involved in the sphere of Midwifery both at a local and regional level which is why I chose to become an SQA at The Women’s Hospital. Events like this one really inspire me as I can see the staff here are so passionate about the women they care for, and it’s great to see the Hospital are so pro-active in acknowledging and improving their great standard of care”
Student Clare Bratherton comments on her experience taking part in the “Me Effect” video launched at the event: “I was really proud to be asked by Liverpool Women’s hospital to represent LJMU by taking part in  video.  It highlights the impact that every individual has on patient experience and care.  The nursing and midwifery celebration day saw the launch of this and to be present as a Caremaker was a real privilege.”
Tisian Lysnkey-Wylkie explains how the event highlighted to her the passion that her mentors still have “As a student midwife in the middle of my training it’s great to be part of an event and see my mentors keen to engage in the trust they work for, and be proud to work at LWH. That to me shows that they are still motivated and passionate about midwifery and include themselves in progressing to provide better maternity care for our women. I am proud to be a student learning in a trust that is so dedicated to women’s health and look forward to the rest of my training here. As an SQA it’s part of my role to highlight good practice an developments that benefit those in the NHS, at a time when midwives are under pressure celebration days are needed to show the appreciation that midwives deserve, more events should be done to acknowledge their hard work
The event was a great success overall and the students hope that their roles as both Care Makers and SQAs will inspire current and future JMU Midwifery Students to get involved with their local trusts.

WOW! What incredibly motivated and passionate student midwives…well done to all of you for representing your organisations, the NW of England, and MIDWIFERY! Thank you!

So come on fellow midwives…join the crew


By sheenabyrom

EXCLUSIVE INTERVIEW-Toni and Alex changing the world


Alex Wakeford and Toni Harman

Toni Harman and her partner Alex became known to me when I saw a short clip of one of their outstanding videos, on a social media channel. This was several years ago, and since then I have stayed in close contact with them, assisting and supporting them whenever I can. To say that they took the birthing world by storm is an understatement. This unique partnership has given birth activists the voice they needed, and their expertise in documentary film making means we now how a powerful medium to share knowledge to more people.

As Toni and Alex have just launched their exciting new campaign MicroBirth, I asked Toni if I could interview her for my blog (and she agreed!)

Hi Toni, thanks for agreeing to answering my questions, hope you have fun! Can you tell us a bit about yourselves in a nutshell?

 Toni: Thanks Sheena for inviting us to do this! 

Alex and I met at London Film School 20 years ago, (back then it was called the London International Film School). After we graduated, we formed a company called Alto Films and started making films together. We made documentaries, short films and even a psychological thriller feature film. Then six years ago, we had a baby. And that changed everything.

We started making films about birth. We made a documentary about doulas called DOULA! then we started looking into the bigger picture of childbirth.

Three years later, we’ve travelled 35,000 miles and interviewed over 150 world leading experts – amongst them, academics, lawyers, scientists, midwives, obstetricians, psychologists and anthropologists. We’ve released short videos on our One World Birth website and started building a community of people on Facebook.

In 2012 we released FREEDOM FOR BIRTH, a 60 minute documentary that exposed human rights abuses around the world, particularly highlighting the story of the imprisoned Hungarian midwife Agnes Gereb.

In December 2012, we started looking at possible subjects for our next documentary. We started researching the science around birth and the more we read, the more “levels” we seemed to uncover. It was fascinating but also, deeply troubling. So in the summer of 2013, we started filming, first in the UK and then we flew out to the United States and Canada. What we learned shocked us to the core – we realised this film had the potential to change everything. And so MICROBIRTH was born.


ONE WORLD BIRTH is a now well known name globally, and FREEDOM FOR BIRTH  is a huge success. What impact do you think you and the campaign has had so far ?

Toni: That’s very kind of you to say. I think ONE WORLD BIRTH is perhaps well-known in the birth world, but outside the birth world, I don’t think many people have heard of it.

Same goes for FREEDOM FOR BIRTH – I am really proud of its “success” in terms of the number of people in the birth world who have seen it, or at least have heard about the film. With the premiere launch, we had over 100,000 people see the film at over 1,000 screenings in 50 countries in 17 languages – all on one day.

 And I’m very proud that the film has played a part in starting to change maternity policies worldwide so that the rights of birthing women are respected. But realistically, outside the birth world, I’m not sure how many of the “mainstream population” have heard about it or know about the issues.

Unfortunately, women’s rights in childbirth are still being abused every day all around the world – many expectant women are not being given full informed consent, home birth attended by midwives is not available as a supported choice in many parts of the world and indeed, in the past year, many more midwives have been criminally prosecuted for supporting women giving birth at home. I remain optimistic that change will happen so that all women’s choices are fully respected everywhere around the world and I am excited by the potential of the formation of Human Rights in Childbirth and Birthrights as organisations that will help further the cause.

 I am so excited about your new project MICROBIRTH -do tell us about it please, and a something about the inspiration behind it?


Toni: MICROBIRTH is our new feature-length documentary asking if medical interventions in childbirth could be damaging the long-term health of our children and have repercussions for the whole of our species.

We wanted to make a film that looks at birth in a whole new way, through the lens of a microscope. This has never been done before and we believe the science the film is revealing is the missing piece of the jigsaw. This could change birth around the world, forever.

The film explores the latest scientific developments in the fields of microbiology, physiology and epigenetics.

Some scientists are starting to question if there is a link between medical interventions in childbirth (specifically use of synthetic oxytocin, antibiotics, C-section and formula feeding) with an increased risk of our children developing non-communicable disease later in life.

Non-communicable diseases include heart disease, asthma and other respiratory diseases, diabetes, autoimmune diseases, some cancers and mental health disorders. They are already at epidemic proportions around the world and are the world’s no. 1 killer. But these diseases are on the rise. It is predicted that the cost of non-communicable disease could bankrupt world healthcare systems by the year 2030, an event that could have catastrophic consequences for mankind….

The campaign’s 9 minute pitch video features some of the scientists we have filmed and explains a bit of the science of the microbiome. The film also tells more about the event that we’ve been describing as “global warming for the species”:

What are your plans for this campaign?

Toni: We need to raise $100,000 to complete filming and to get the film seen around the world. So we’ve launched an Indiegogo campaign to help us raise the funds we need. If we can raise enough money, then we want to film at the Human Microbiome Project in New York, the United Nations, the World Economic Forum and the World Health Organization as well as filming the top people at leading obstetric organisations to hear their view about the potential long-term consequences of medical interventions in childbirth.

The most exciting part of this project is how we want to release the film. Just like we did with FREEDOM FOR BIRTH, we want to have thousands of premiere screenings of MICROBIRTH held all around the world on one single day. We want to create a global simultaneous event with screenings in every community, in every country so that we can grab the attention of the global media and we can grab the attention of decision-makers including our Presidents and Prime Ministers. It sounds ambitious, but we truly believe that if we can do this, especially if we have the the support of strong-minded, strong-willed individuals committed to making change happen.

In terms of what we want this film to achieve, we want to raise awareness that there could be long-term consequences arising from the medicalised way we are giving birth today, both for our children and for our whole species. We want to get everyone talking about this and taking this issue extremely seriously for the future of humanity could be at stake. And we would love to see much more scientific research looking at the potential long-term consequences of medical interventions in childbirth, before it is too late.

 What’s the most important thing you have learnt since beginning this amazing journey of campaigning for better childbirth?

Toni: We’ve been very fortunate in being able to film interviews with over 150 experts across so many different fields.

But I think there’s two pivotal moments in our journey so far.  The first birth I filmed completely changed my world view. It was four years ago and it was a home water birth in the UK with the mother and father supported by a doula and two wonderful midwives (it was the first birth featured in our DOULA! Film). It was a completely physiological labour, birth and 3rd stage with no pharmacological pain relief, not even gas and air.  The labour and birth was the most beautiful, amazing, calm, wonderful, inspiring thing I have ever seen. It was perfect. I saw with my own eyes what birth could be like. I know some women might not want a home birth. And some women might want or need pain relief and other medical interventions. But the beauty of that moment, well, it was simply life-changing.

The second pivotal moment was last summer when we were filming for MICROBIRTH. We filmed a Professor of Immunotoxiciology at Cornell University. He told us exactly why and how interventions in childbirth could be damaging the long-term health of our children with implications for the whole of mankind. We had huge goose-bumps. I still have them now as I remember that moment.

If I had a magic wand, and could grant one wish to ensure all women had a positive birth experience, what would you ask for?

Toni: After we made FREEDOM FOR BIRTH my hope was that every woman on the planet has the best possible birth wherever, however and with whom she chooses to give birth. I hope that all women are fully informed about their birth choices and that these choices are fully respected by every healthcare provider.

But now with MICROBIRTH, I have one more wish. That every expectant mother and healthcare provider is fully informed about the importance of seeding the baby’s microbiome with the mother’s own bacteria. That even if a mother needs to have a C-section, that she is still fully supported with immediate skin-to-skin contact and with breastfeeding. It sounds a technical, scientific wish, but if this was possible on a planet-wide basis, I believe that this could make a significant difference to the future health of mankind.


Toni and Alex after the birth of their baby girl, born by C Section

And lastly, what drives you both, as a couple, to stay motivated and passionate about your work in this area?

Toni: When we were at film school, we were told to never make a film unless you felt that it had the power to change the world. So every film we make, we honestly do set out to change the world. That’s what drives us forward. That’s what motivates us. The thought that we can use our skills as filmmakers to make a significant difference to the world.

With MICROBIRTH, we think this could be a game-changer. This could be THE ONE. We feel that this is the most important film we will ever make. But to get it finished and seen around the world for maximum impact, we need everyone’s support – not just financially in terms of contributions to our fund-raising campaign, but in sharing links and in spreading awareness, both now and when the finished film is released this September.

Thanks Sheena for asking me to do this. It was fun!

By sheenabyrom

It’s 2014. Time to listen, and hear what midwives say


Earlier this month a health correspondent from The Independent contacted me via Twitter to ask me if I would be willing to comment on this article, written the day before.

The piece quoted the words of a very honest and courageous midwife, and I applaud her. I don’t usually like commentaries which could potential cause fear amongst women who use our maternity services…and I am always wary of journalists, for this very reason. However this article is very accurate, and I am sure 80% of midwives would agree with what is written.

I wrote about these issues here.

The RCM are continuously campaigning for more midwives, and although NHS England have published a staffing strategy placing onus on Trusts to ensure safe standards in terms of capacity and capability, there aren’t enough midwives to fill posts. Support staff are crucial, as often midwives are doing non midwifery tasks, but often organisations can’t afford them either. We are constantly reminded that there are increased pressures within maternity services due to an increasing birth rate and complexities of those using the service, but external and internal reviews of NHS organisations and departments, and risk management agendas (including processes relating to CNST) are adding to the strain through increased bureaucracy and fear.

It seems some midwives possess professional resilience to pressure and adversity in the workplace, managing to stay positive and motivated despite the increasing demands placed upon them (Hunter and Warren 2013). . One of the themes from this study findings was ‘building resilience’, where participants demonstrated the development of strategies to help themselves and others to cope. So where do student midwives and midwives get the support from, to help them to cope on a daily basis? Do they know whom these ‘resilient midwives’ are, to help them to build coping mechanism for preservation? Sometimes sharing a crisis moment with a work colleague or supervisor of midwives does the trick, and support is there and continues. But there are times when practitioners fail to share feelings for many reasons, including time, confidentiality, and confidence.

I had specific colleagues that I turned to in stressful times or moments of crisis, and I knew the things I could do to help me re-focus and keep things in perspective. In the early 1990s I had read Caroline Flint’s book, ‘Sensitive Midwifery’ (Flint 1991), and I loved and used the suggestions Caroline gave to midwives on self-care. I think they helped me.

I have written a short piece in February’s edition of Practising Midwife, about how social media and online resources can help practitioners to stay in touch with like minded individuals and to glean tips to try to stay positive at work. And later this month I have written a @wemidwives chat to share ideas with nurses, midwives and students. Join in if you can!

In the meantime, these were my suggestions to the journalist, about how we can try to help midwives and improve maternity care:

The Government needs to hear and act in terms of resourcing increased midwife numbers. The problem will not go away. Choice, continuity of care and carer and the sustainability of independent midwifery are all crucial issues that need urgent attention, BUT WE NEED MORE MIDWIVES.

For maternity services, there needs to be a shift of focus on wellbeing instead of illness, and kindness and compassion instead of punitive culture where fear and blame prevails. The latter adds extra burden on an already pressured service. Although midwives are leaving due to increased stress at work, there are many who can’t, and they need to be valued and cared for.

We need an invigorated focus on reducing unnecessary medical intervention during childbirth, mainly because there is emerging evidence that the consequences are potentially catastrophic.

What are your thoughts?


Flint C (1991) Sensitive Midwifery Butterworth-Heinemann Ltd London

By sheenabyrom

What happened to my blog! Thanks to all readers in 2013

The stats helper monkeys prepared a 2013 annual report for this blog.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 46,000 times in 2013. If it were a concert at Sydney Opera House, it would take about 17 sold-out performances for that many people to see it.

Click here to see the complete report.

England needs more midwives: but legal services are fine


I was interviewed on Radio 5 Live yesterday, in relation to the news coverage of the National Audit Office revelations of maternity care.  The report confirmed the fact that England IS short of midwives, and revealed that the NHS spends nearly £700 on clinical negligence cover for each live birth in England. I wonder how many times audits and reports will confirm what we midwives have known and shouted about for years, and how long the message will continue to fall on deaf ears.

The Royal College of Midwives,  National Childbirth Trust, AIMS,  Women’s Institute and other organisations have campaigned long and hard for more midwives, needed urgently for the rising birth rate and increasing complexity in caring for mothers and babies. But there is something else going on here. The financial implications of England’s current negligence insurance scheme (Clinical Negligence Schemes for Trusts) mentioned above are bad enough, but associated processes also significantly increases the workload of maternity care staff, and adds to the growing culture of fear in maternity services.

In an attempt to increase safety through implementing standards of compliance, activity related to the scheme potentially increases risk by putting extra pressure of individual members of staff. ‘Tick box’ activity, extra form filling, and duplication of records add to the human cost and potential for mistakes. In many organisations midwives are taken out of generic posts to work as ‘risk midwives’ or governance leads. Usually these midwives are highly competent clinically, and their absence in the clinical area is missed-adding to the risk.


However, an important impact of our legal system is related to practitioner’s fear of recrimination, and fear of litigation. Defensive practice or ‘covering your back’ ‘just in case’ is a recognised symptom of fear of litigation-and subsequent over treatment increases the risk of iatrogenic harm.  The increased and often duplicated recording of information becomes the focus of ‘care’, as practitioners complete patient records which are audited for insurance purposes. What the carer writes becomes more important than what she/he does, and women and families increasingly experience this distraction negatively.

The medical negligence solicitor who took part in the radio programme with me yesterday, said midwives and doctors need to increase their skills, and he suggested that England’s medical negligence processes were the envy of the world. I have a different opinion. Ensuring safety through appropriate skills is crucial, and whilst mistakes will happen, there is no excuse and we should continually work on improving services. Along with others, I believe improvements will only come if NHS workers are sufficient in number to have time to care, and that they are supported and nurtured enough to feel safe themselves. Where fear prevails and defensive practice in normal, women and families will continue to suffer. Radical but carefully planned changes are needed. Malpractice claims are rising, and there is little evidence that safety is improving, despite the laborious and bureaucratic systems and process imposed in the name of such. Our negligence claims insurance schemes aren’t working, and midwives are on their knees. Even though politician Dan Poulter is an obstetrician by profession, his responses to the NAO report reveal limited insight into the detail underpinning the facts that matter. We’ve said it before many times. If we don’t get it right for mothers and babies at the beginning of life, the impact can last a lifetime.

Childbirth has far reaching public health implications. This specilist medical negligence solicitor reveals the fact that many of the claims she sees are the result of pressures within the maternity systems, and calls for more resources to be invested.  Maybe it’s time to revisit a no-fault compensation scheme, the attempt in 2003 was never taken forward. Scotland has pursued this in light of the success in other countries.

Whatever we do, we can’t continue in the same vein. I would love to know your thoughts.