The 11th of August was a day to remember if you work in maternity services. The news story of the day was about how the RCM had “dropped their normal birth campaign” and almost immediately a storm erupted on social media.
The context behind the story was, in essence, that a change in language was required as the word “normal” could impose feelings of failure in women who required intervention during their labour and could imply that midwives are only interested in supporting women who have a vaginal birth with no intervention.
As midwives we of course know nothing could be further from the truth but, personally speaking as someone who has an interest in parent-infant mental health, I welcomed the change in language as “normal” has never been a word I am particularly fond of simply because one persons definition of normal will vary hugely from another and feelings of failure and inadequacy often feature heavily in women with post natal depression. That said, the role of the midwife is, and always has been to be an expert in “normal” childbirth. Now the term has been replaced with the word “physiological” I do not see the role of the midwife changing with the introduction of this new terminology and nor should it.
The debate on social media, in particular on Twitter, became increasingly heated as various interested parties expressed their views and was both interesting and difficult to observe because, aside from the inevitable sensationalistic input from some journalists and other elements not necessarily with insight into maternity services in the U.K., those entering the debate although polar opposites in their position on the surface of things, actually all demonstrated such passion and commitment to safe maternity services and ensuring women are supported and cared for throughout pregnancy and birth I felt strangely reassured that whilst these fantastic people continued to hold each other to account for their views, maternity services will always feature highly on the health agenda. This can only ever be seen as a positive.
My only concern throughout the debate was over the link made between the normal birth campaign and the findings of the Kirkup Report on the enquiry into the deaths of 16 babies and 3 mothers at Furness General Hospital between 2004 and 2013. Undoubtedly a toxic culture had evolved where relationships between midwives and doctors were described as “dysfunctional” and where midwives had failed to escalate concerns about complications with devastating consequences however as a practising midwife myself I find it hard to link these behaviours to our role as the expert in “physiological” birth when the NMC code is explicit in ensuring we remain within our scope of practice and escalate when necessary.
These behaviours are endemic in a culture where good relationships between the multi-disciplinary team are not nurtured and mutual respect is not fostered. I have been very fortunate in the fact that every maternity unit I have worked in has a culture where the MDT has a shared priority of communication, respect and working in partnership to ensure the families we are caring for have the best possible outcome and experience, I feel this is the case in most units across the UK.
Training together as a multi-disciplinary team, for example PROMPT training, affords staff the opportunity to drill themselves in emergency scenarios to gain a mutual understanding of the importance of each other’s roles in managing complications and most importantly empowers staff to escalate when situations deviate from the straightforward. It enables the multi-disciplinary team to come together in a safe, non-threatening space and for me, epitomises everything the word team encompasses.
I personally feel that merely changing a word will have no impact on outcomes because I do not feel it is the word “normal” that is the problem.
Breaking down the barriers which exist within some units and changing cultures to ensure that the multi-disciplinary team is indeed a team is the answer and the way forward in ensuring families get the care and support they need during pregnancy and birth and that staff are equally supported in delivering high quality care.