Ep 86 Bev Jervis on the Need for Persistence in Midwifery Reform to Navigate Childbirth Services

Ep 86 (ibit.ly/Re5V) Bev Jervis on the Need for Persistence in Midwifery Reform to Navigate Childbirth Services

@PhDMidwives  #research #midwifery @SalfordUni @radmidassoc #mentorship #leadership #maternalmovementduringlabour #homebirth

What if your own childbirth experience could inspire a career dedicated to empowering women?  Bev Jervis joins us to share her transformative journey into midwifery, sparked by personal experiences that highlighted the need for informed choice and support during childbirth. From a disempowering second pregnancy to a fulfilling career, Bev's story is a powerful testament to the impact of compassionate care and informed consent in maternity services.

Throughout our conversation, Bev provides an inside look at the contrasting cultures within maternity care settings, having trained in both large hospitals and smaller local ones. She opens up about overcoming personal challenges, like a relationship breakdown during her training, and how these experiences shaped her professional path. Bev also recounts her pivotal role in establishing a successful home birth team, underscoring her commitment to collaborative, woman-centered care and her passion for continuity.

As the conversation unfolds, we tackle the pressing challenges facing maternity services today, from systemic strains to the emotional toll on healthcare professionals. Bev offers her insights on how socio-political influences and COVID-19 have exacerbated these issues, while also discussing her academic journey and the serendipitous opportunities that arose. With a focus on future research and advocacy, Bev shares her hopes for systemic reform and the potential for midwifery practices to shape maternity care positively. 

Transcript

Path to Midwifery

Speaker 1 0:27

Thank you very much for joining me, as per usual. Can you introduce yourself, please? I?

Speaker 2 0:32

can? My name is Dr Beverly Jervis. I am a midwifery lecturer at the University of Salford in Manchester in the UK. I'm not very good at introductions because they tend to go on for quite a while.

Speaker 1 0:48

Well, that's all right, I can keep asking you questions and you can do from that if you want. Oh okay, okay, let's start with the easy one. Then. How did you get into midwifery?

Speaker 2 0:57

How did I get into midwifery? Okay, so it was from my own experience really. So I find this a really fascinating question and I did actually ask this on my PhD. But yes, I had my first child at 24. Um had a wonderful birth experience on the midwife led unit. Um literally gave birth, breastfed, all normal and fantastic and fantastic experience. So at 27 I was pregnant again and had my second child. However, I went to 40 weeks and I had an appointment with an obstetrician. I mean, and this was in the, this was in the 90s, in the late 90, and I didn't want to be induced. So it was how can I say?

Speaker 2 1:56

At that point in life, I left school, not a lot of qualifications, didn't really have a direction in life, worked lots of different jobs, didn't have education beyond my sort of then O levels, but it was sort of a really how can I say so? I come from a very feminist perspective now and I think that was within me then because I was taking a step back and I'm like, why are all these people telling me what I've got to do and they're not giving me all the information? And basically they were telling me I need to be induced and there was sort of I didn't have all the information. Why, why, why it? And it was um. I was seen by a very junior doctor, had a vaginal examination and he was saying, oh, yes, yes, everything is OK. And the midwife behind him at my well, this would have been 42 weeks in the hospital clinical environment because I had kept declining appointments was standing behind him shaking her head and I was thinking, oh, what's going on here? And from there, really, I would say, I was coerced into an induction and I was told my blood pressure was high and it was very high and I had to be admitted straight away. But nobody ever told me what my blood pressure was. And looking back now I'm thinking, well, surely I would have had bloodstone, I would have had a 24 hour collection and nothing was done. I was just you need to be induced, you need to be admitted now. And I was like OK, so I was admitted to the consultant led unit at the time, I was admitted, and to the consultant-led unit at the time and it I wasn't.

Speaker 2 3:59

As how can I say, as um forthright as I am now, because I probably would have challenged a lot more it's just like oh, that's what the doctor says, and I'm not really comfortable with this anyway. So I think myself had started off in labour anyway, I was having those early labour signs and I went on anyway. The next day I had started the induction, with the most horrendous thing being ARM, with fundal pressure, which was horrendous, just the worst thing. So again, looking back with my midwifery knowledge now, there must have been a high head and I'm thinking, oh dear, but um, I labored really quickly. I mean, I had a really quick, normal labor, my first, and but I was, I labored really quickly once I'd had some of the the prost in and it was only a couple of hours start to finish.

Speaker 2 4:43

So, uh, yeah, but it just left me really questioning a lot of things. I felt very powerless, I felt very ill-informed and the wonderful experience that I'd had first time, um, I mean, it wasn't a poor birth, it was a normal birth and everything was fine and I went on to breastfeed and you know all that lovely bonding and everything. It was all there. I I just felt that I could do that. I could, I could.

Speaker 2 5:15

You know, women need to know, they need the information, they need to know, um, what is going on with their bodies. Because, again, at that stage I was like I had friends who'd had babies but we never really spoke about it and what happens with your body when you go into labour and been to antenatal classes. But it it felt really disempowered and I hadn't had an informed choice really to say, um, use our uh buzzwords now. But yeah. So I thought, right, I'm, I'm going to train to be a midwife and I will give women information and I will give them choice and I'll support their choices, whatever they want to do. So that's how I got into midwifery, really. So I waited until my uh, my son, was two and a half and I started on an access course and then went on to do my midwifery so you went through direct entry pathway, didn't you?

Speaker 1 6:13

yes, yeah, yeah, cool. So where did you? What did you enjoy about your undergraduate experience?

Speaker 2 6:22

well, and, and I think again, I wasn't really much. When I was young, I used to like, I like reading and I was interested in stuff, but, oh my gosh, I turned into a real midwifery geek.

Speaker 2 6:35

So I've sort of I've read everything and I think you know that's where I'm up to now and what I ended up doing with PhD, because I just love, I love the knowledge and I love learning about it. And then even in my undergraduate I'd go right off on a tangent and I'd look at all the underlying theory and I'd like miss the point of the assignment. I did fail a couple of times, um, but um, yeah, it was the learning. I mean I did like the practical, I did like the relationships with women and again, it was a very different environment to what the midwives are training in now.

Speaker 2 7:20

So I worked with a team of midwives, so the trust I trained in did team midwifery, so I really knew the midwives and the team was working with. I trained in team midwifery so I really knew the midwives and the team I was working with and I had the same mentor for the first two years and then another one for the third year. So those relationships were really, really strong and the trust that I trained in I really loved and I didn't realize this until I qualified that everywhere wasn't the same but the midwives really supported the women in their choices so I really loved that and the trust where I trained in was a pioneer of water births. So, yeah, so it was. You know, even women who had some complexities would be supported in in in water birth and yeah, so I did actually really love my training practically. But the theory I loved, the learning, I really loved it and I really aspired to my lecturers and it's like, wow, they've got all this knowledge and I loved it.

Journey to Midwifery Career Expansion

Speaker 1 8:32

I was like a sponge pulling it all in which, as from the opposite end, having students like that in the class is fabulous because it leads to some really fantastic conversations, but, as you said, you found a few things because you went off tangent and sometimes it's like no, no, it is the simple thing you're talking about. Follow that pathway. We're not looking at three levels above, we're looking at the simple pathway first, so you do get those that kind of go. But I understand this. It's like, yeah, but can you bring it down to this? This is what we're asking yeah, where did you go afterwards when you finished? Where did you end up finding your working? In what kind of system?

Speaker 2 9:11

so when I qualified I had in my head already right, I want to do this, this, this, this and this. So again me on the tangent. When I was doing my, my training, I had a breakdown in a relationship which was difficult. I looked right, where can I get support? So I joined the Association of Radical Midwives oh yes, who I still see now and they were an amazing source of support and through that I got to meet and make friendships with an amazing array of midwives independent midwives and midwives working locally, nationally, internationally. So that's sort of um again, loads of learning and support. So I sort of got a wider perspective which underpinned where I wanted to go.

Speaker 2 10:12

So at the time when I first qualified, I break down in relationship I trained 50 miles away from where my local area where I worked. So me at the time I wanted to work locally, yeah. So I worked in the local hospital, which was a lot smaller than um, where I trained um in the uk, a lot of uh maternity units the sort of type of cases that they have, if you like, are defined by the level of the neonatal unit. So just about uh trained had quite a large and quite complex neonatal cases.

Speaker 2 10:57

So it was, it was bigger and it was in you know, lots of city but the trust where I went to a lot smaller. The culture was very different but they did sort of um, they did team midwifery, but it was very much unlike what I trained in, but small community teams and midwives sort of came into the hospital, went out again. Uh, at the time there wasn't really a perceptorship like there is now. So I went straight in as a, as a qualified midwife. Um, yeah, I worked on um, an antenatal and postnatal ward for the first year, which was really good because it was a fantastic little team and the manager was, you know, lots of experience, so kind, so empathetic, such a really caring, compassionate manager and it was a really cohesive team. So that again, such a good grounding and really supportive environment and yeah, so I did that for a year.

Speaker 2 12:04

And then I went to work on labour ward for a year, um, and I can remember applying for a community midwife post at that time and I didn't get it and I was absolutely strong because I really wanted a community midwife post. But in hindsight it was good because I again I learned about the different culture and again, another fantastic labour ward manager and these all are. They were midwives with tons of years of experience and really women-centred and, yeah, again, I learned a lot. There wasn't a lot of complex cases like in the big unit, but the demographic that the hospital served was very different. So again, I was thankful for my training because that was a very diverse population.

Speaker 2 12:59

But, yeah, the culture was very, very different and I, yeah, traditional model but the consultant obstetricians there really held a lot of power. The, the consultant obstetricians there really held a lot of power and whereas where I trained the, the midwives would, um, have debates about care pathways and what you know women's wishes and what the things should happen. There was a healthy debate there and and, um, you know, it was very woman focused. But where I found it very strange that if the consultant said something, the midwives go, yeah, okay. And in the, in the unit that I first worked and I thought, oh, that's very strange. But at that time again, there was no separation between midwife-led care and consultant-led care. It was just during my training and when I first qualified, so it was very collaborative and it was interesting because nobody really liked using the birth pool there.

Speaker 2 14:02

But I was like, oh, yes, go around to the birth pool a lot of time and, yeah, I used to have, um, yeah, a bit of micka taken out of me because I always used to come out of a birth absolutely covered, because I always used to facilitate a lot of upright births, sort of yeah, oh yeah, getting splashed in all sorts because of the position I was in. Uh, so, yeah, I went, I went to that, but I always knew continuity was my. That's what I wanted to do at home birth and supporting physiological birth. So, and again, that's from my training and the research and reading inspirational stories from there was a journal at the time, stories from uh, there was a journal at the time, but it's still around, called practicing midwife and becky reed from the albany practice, and then you know, we used to write a lot of articles in there fascinating uh, so that was a really good resource, resource and the inspiration used to get from that. And so, yes, and I always knew that's where I wanted to go. So at the time when I was on labour ward, it was we need to support home births and that was my opportunity then. So there was a multidisciplinary team and, yeah, we set up a home birth team, which was phenomenal, the absolute highlight of my clinical career, really.

Speaker 2 15:34

So, yeah, I went to work in a continuity team then supporting women home birth and there was three of us. We started off with three of us but, yeah, that was that was fantastic because, um, how we worked, it actually worked really really well and we did have quite large caseloads, but we had a sort of an on-call system, so all three of us had met the women, we had groups and yeah. So I think, how long was it? I think after two years I just sort of did an audit and it would have been less than that. It would have been after the first year and the whole. We had a 10% requested home birth rate and between 6% and 7% actual home birth rate. It was really high in the UK at the time because the home birth rate was always around 2%. So I think we had the highest home birth rate in the UK. So that was brilliant, absolutely brilliant, yeah. So. So how long did you stay there for? That was two years.

Speaker 2 16:42

So I got to the point and again, the geek in me it's like right, I love this. It was really. You know, we learned a lot and I loved the team I was with and the team expanded. We went to six midwives and this is great and it's like right, I'm feeling now I need to do something else. So I did the continuity team for two years and uh, and then there was another midwife in the trust that were. She was the practice development midwife and she had just done a national institute for health research that is a part of uh nhs and they funded um nurses and allied health professionals to do masters and phds. So she'd just done her her fund, a funded uh masters in research. So I thought, oh, that looks interesting. So, yeah, I applied for that and got onto that course.

Speaker 1 17:42

So what did your area be for the um? For the masters, then it was quite interesting actually.

Speaker 2 17:49

So home birth, so, um, it was from my experience of home birth and um, it was, there was, it was made up of quite a few small um modules, but it was always around home birth and choices around home birth. And and my final project was a very small um focus group research project on why women chose home birth. Oh nice, only very small, because it was my master's. But uh, why did they choose home birth? Because it was right for them, but mostly because they felt safe, is there?

Speaker 1 18:33

so were they of a higher socioeconomic um level and education level no, it was quite mixed.

Speaker 2 18:42

And again, this was really interesting about um, the local area that I worked in as a home birth team, because I put um some um I can't remember now, goodness gracious me, how I advertised it, but I think it was in the local area of women um who chose a home birth and they had their own birth group there, but that was um.

Speaker 2 19:05

That was quite interesting about our home birth team. It covered a wide demographic of of people and it was interesting really because what I found was that amount of primates who chose a home birth because that's what felt right to them. But there was another, a good proportion of women who had poor birth experience and wanted to birth at home and they were from sort of all demographics and that was the really good thing about the home birth team. It sort of when women phone, when women had their booking appointments, they were asked you know, at this point, do you want a home birth or hospital birth? So if they wanted a home birth, they got referred on to us as the home birth team and it covered all uh demographics.

Speaker 1 19:57

So that was interesting so that was funded by the nhs at that stage. So the home is yet so a different system to what we've got. Which is why when we look at a lot of the home, the home birth demographics they are um higher educated and higher socio-economic. Because they have to pay for it and especially if they want privacy in practising unless they're going through an MGP for a home birth, so midwifery group practice then they have to do it independently, so it's not available as often as they would like within the hospital system.

Speaker 2 20:28

Yeah, oh, that's a shame. Yeah, I mean different in the hospital system. Yeah, oh, that's a shame. Yeah, I mean different in the nhs. I mean, obviously, this was when? Was this? 2008, 2009, 2010? It was um. Home birth is open to everyone in the uk and, however, it's very dependent on the service that the local hospital gives. So obviously we've done our research and done a lot of trial and error to see what, what worked best, but, um, yeah, it was quite an effective and a really valid choice, um and a um well-supported choice. But it's like in, you know, in the areas of more of deprivation, it was like, oh, woman up the road's had a home birth, I'm gonna have a home birth, I don't have to find child care, I don't have to go out anywhere yeah, midwives come to war, so yeah, it was a real beneficial choice for those women from that perspective really, so how did you then jump from a master's into a phd?

Speaker 2 21:40

so after I'd done my master's, he was like, oh, what do I do now? And I always knew I didn't want to go down the management route yep.

Balancing PhD, Family, and Identity

Speaker 2 21:55

I always felt I wanted more of a leadership role that was sort of inspiring and informed and not sort of how can I say, protocol and process and authoritatively underpinned, if you like so and um, and I went back into to be a community midwife. At that point the home birth team had been disbanded. We'd had a new head of midwifery so, yeah, that was a shame. So the home birth team was disbanded and I mean, obviously I've got lots of thoughts and, um, I came away with lots of insight about, uh, how to successfully do that kind of working, um, continuity in home birth, yeah. So back to community midwifery and I didn't want to sort of make a rash decision of where I was going and what I wanted to do, and I wasn't necessarily I want to do a PhD, it wasn't. It was like where do I want to go and what do I want to do? So while I was in my master's there was an opportunity and again a lot of funding has gone now from education but there was a. There was a um, there's a number of things that were open to us again and I went on a what was it called, I can't remember. Basically it was northwest of England. It was for PhD students, so a week. It's not a retreat, but it was like five days at a hotel, lots of PhD students, and it was really a what can I call it? It wasn't a course, it was like a oh dear sorry, menopause problem Can't find my words, but anyway. So it was lots of PhD students from around the Northwest and the whole idea of it was to open possibilities and opportunities for people with PhDs not to go into academia. So what could you do with a PhD? So that was that was really interesting. However, there was a whole mix of people there, so there were people who were being funded by large corporate, for example, to do their phds. There was your um science phds and and I think I was the only one from health service I mean, I was the only one doing masters but again, it was people who with phds working in in the private sector, not in academia, and I was saying what do I do? The only provider of maternity services is the NHS and they're not very open to change and how do you influence change and what can I do? Because that's where I wanted to go really, and and to make you know, based on my own experience, based on my clinical experience, based on what I was finding in my master's. There's all this sort of midwifery research. Really it it's not really implemented and we're stuck in this system. So where do you go and what do you do? And there's so many sort of bureaucratic things and people who hold power and it's really difficult to change maternity services and they're like I don't know it's. You know, who else did I speak to? So, yeah, so that was really interesting. And and then I spoke to somebody else who was an actuary and so that was really interesting. And and then I spoke to somebody else who was an actuary and again, that was really interesting. Wrong around that time, and he, his specialist area was head injuries, so we used to get a lot of maternity cases. He was saying, basically, it's always the midwife who gets the smoking gun. So it gave me a lot of things to think about.

Speaker 2 26:03

Yeah, doing my clinical at that time, young family um, yeah, and I thought, okay, so I will go through the same funding body, the NIHR, that I um did my master's through, because, again, it was a really, really good scheme and it is still available. But what you do, if you apply for masters or PhD. They pay your fees yep. They backfill your post, yep, within the trust that you work and you also. They also pay you your salary. You're on, perfect, yeah, so that was a real. So that was my master's and this is my phd, so that looks like a really good opportunity. Uh, yeah, so I did apply for that and I did um. I thought, well, if I want to make change, it's probably going to have to come from a, a legal point of view, because you know that's the thing that you have to work in in within legal boundaries, don't you? So I thought, well, what if I look at why women choose to um pursue litigation? Okay, yeah. So I put that together and got a lot of advice and, yeah, did some research around the area and very interesting.

Speaker 2 27:23

But then an opportunity came up at the university I do now work at, at Salford, for a funded PhD. I was like, hmm, what do I do? It was a stipend, so again, again, not a lot of money, but um, because what I had done once I put this phd proposal together I hadn't submitted anything, but it was difficult to get um because it was only a small unit I worked at. The head of midwifery was like, oh, we don't really need midwives as phds, so once you've gone off and done it and come back, there was really nothing for you to do. It's like okay. So then I took it to the um chief exec and said, well, the head of midwifery's seen this, this is the opportunity, this is what I want to do. And they okayed it. Yeah, yeah, so, um, so that was okay from there and I'd got all the proposal together.

Speaker 2 28:19

But so then I was like, oh, which, which one to go for? Because I could put this in, it wouldn't get accepted and then it'd be waiting for the next round. So I thought, well, I'll just apply for the funded, the funded PhD, which was um on maternal movement during labor. So I applied for that. But the whole reason that salford were putting out these, these phd studentships, was because they wanted to increase the number of academics with phds. So they saw this as a way of. So I did my teacher training alongside it yeah so, uh, yeah.

Speaker 2 29:02

So I got accepted on that and I thought, well, I've got accepted on that, I'd like to do the the the legal um aspects.

Speaker 2 29:11

But my PhD um, who was potentially my PhD supervisor as well a bird in the hand, yep. So I went with that one. So that's how I ended up doing it. But when I left the university after I finished my midwifery training, I always thought, yep, I want to come back here and I want to teach. So it was always sort of in the back of my mind. So yeah, so this is sort of doing the two things really. So that's how I ended up doing a PhD.

Speaker 1 29:44

It's amazing how kind of windows can open at certain times that you hadn't kind of even thought of going in that direction. Or you get the choice to make An opportunity seems to be a very common theme with starting PhDs. The opportunity arose, or a serendipity it's being open to opportunities.

Speaker 2 30:08

Yeah, absolutely. And seeing what's around and being very creative, and I was told I'd got that PhD because what they put out, I didn't think it was very strong. So I went in and said, well, this won't work, this won't work and that won't work, um, you know. So, uh, that's why I got in and again having the um, having a critical mind, I think, and challenging something that I'm thinking, oh, how will that work? So, yeah, it was like that. I'll go in and I'll just say this, because I don't feel that would be.

Speaker 1 30:52

So your supervisors were allocated to you. You didn't get to choose them.

Speaker 2 30:58

Mm-hmm. Yeah, and I was also given maternal movement and I was also given ethnography as well okay.

Speaker 1 31:03

So you kind of got given it to you on a platter and this is what you're going to do, um. So how did you balance that? Then, because you had a young you said you had a young family, um, and that you had a relationship breakdown, so you're still kind of looking after them. You've now got this funded full-time PhD, so how did you set yourself up so that you could still look after them and still make your milestones with your studies?

Speaker 2 31:32

It was it actually, I'll say that. So I absolutely loved it. Children were at school, so that was great. So it was really flexible. It was having the opportunity because I'd done my master's full-time, I'd done clinical shifts, you know, weekend, month or whatever, just to keep my hand in um, and a bit of extra money when I was doing a master's. So I sort of did the same with when I was doing a PhD. I really enjoyed it. The first three, the first three years doing it full-time. I did a bit of clinical at the beginning, I was doing a bit of teaching and the massive psychological struggle it was psychological more than anything else. Yep, um, because I think full-time PhD, on retrospect, is much better than doing it working, oh, absolutely. So it was more of a psychological struggle. I wasn't a midwife, I wasn't a midwifery teacher. Who was I? What was I doing? Where was my? I think that was the biggest struggle more than anything else, because I was sort of you know, you identify as a midwife, don't you?

Speaker 2 32:52

And that's your job and that's where your knowledge and passions lie. And I was like, oh, I felt very I didn't know where I belonged. It was really that was. It was more of a psychological struggle than anything else. Everything else just tipped along and I fit it in. So that wasn't. Yeah, advice If you can do a PhD full-time, do it.

Speaker 1 33:21

It's. As someone who's doing it part-time, I strongly recommend full-time, if possible as well. Um, yeah, how did that? Did that mean that you your psychological struggle with your identity? But did you then have also any kind of like moments where you wanted to just sit in a corner and rock and throw it all away and did your mental health also have up and downs? Or because you could kind of have this nice pattern that you developed in your masters? Did that help set you up for your phd?

Speaker 2 33:50

masters absolutely set me up for my phd. It was a masters in research. It was an absolutely phenomenal course and I think, talking to people when I was doing my PhD, I was like this is actually quite easy, it's very straightforward. I'm not really you know, I think it's because I was a midwife who read a lot.

Speaker 2 34:12

Yeah, um, I'd done my masters and it was just very much just doing it and I was really enjoyed it for the first three years and I was doing a bit of clinical on the side and then, once I'd done my teaching qualification, I was doing some teaching as well. So again, doing that teaching, that was a bit of a turning point really, because then I felt more part of the teaching team. They were very welcoming, very supportive. There was somebody else who was doing the PhD at the time. So we talk about our struggles. So I think that was a turning point and a massive helpful, supportive factor because I wasn't there on my own doing it on my own, being in the library on my own every day.

Speaker 2 35:00

I was then part of the team and I was just over a year in and I stopped doing clinical because then I wasn't doing teaching, because then it was getting a bit too much, which I do regret a little bit now, but it was right for me at the time. So I was used to being skint and always being skint, so it would. That was just a thing, um, so you know, that way it was fine. Teenage children managing them, that was really really hard. Yeah, um, uh, doing their PhD wasn't really that was, I wouldn't say, easy, but that didn't. I didn't get to that point then, when I was doing it three years, so that point came.

Speaker 2 35:41

I said what happened after three years so after three years my full-time funding stopped and the writing up time wasn't funded. So I had done all my data collection, I'd done about two thirds of my analysis. I was like, oh right, so you know, I still had some a lot to write up, really. I had to find a job because, although the university had set the studentship up, there were no vacancies at the time. So I was like, oh, my gosh, gosh, crying tears, what am I going to do? And oh, I'll go back to midwifery, um, but do I want to go back to the trust where I worked for? So, again, opportunity arose. So I had this little mini meltdown, uh, because I still still have analysis to do, but I was in the swing. So that wasn't.

Speaker 2 36:39

But then the sort of the writing up of the findings and um, so I applied for a job and, as I said before, continuity and home birth with my thing, and at the time the first First non-NHS provider of maternity care was. I had a contract in the Northwest and they provided midwifery care, predominantly home births, and I thought, well, I'll go and work for them and I'll do see if I can just work four days a week and then finish with the HD off, anyway. So I put an application um, but then I got a phone call saying well, I can see you. You know you've done a lot. Uh, we've got a PhD to finish. But yes, I can come and work for you again.

Speaker 2 37:47

It wasn't clinical, it was practice development and supporting students um and doing um a septic, basically um sorting that out. So again in my area of interest, home birth continuity and I again I learned such a lot from that fantastic opportunity. I should be forever grateful for that. But that just showed our a small non-nhs organization can work uh implementing uh the research evidence, uh implementing best practice, supporting women's choices. Again, that was a really good opportunity. I I sort of went part-time then with my phd and I didn't um do a lot on it for 12 months, but then I went down to four days a week with that organisation and then finished it then.

Speaker 1 38:48

So thinking back now to your PhD, what is the most memorable thing that kind of jumps to mind about doing the PhD, about the results that you got?

Speaker 2 39:01

It's the frustration, the massive frustration, because really my PhD I got movement and I got ethnography, so I sort of combined that into a socio-political, feminist approach to look at the culture of maternity care and why, basically, why isn't the evidence around physiological birth implemented? That was my biggest frustration. So, uh, like I say, I really enjoyed it full time and that was really good. Struggle came when I was doing it alongside a very intense job and doing it part time, which I just about got it together for my viva. But yeah, so I really enjoyed it.

Speaker 2 40:03

Yeah, it was the findings. It's coming out with the findings and it was like the findings really were no surprise to me, having worked in the system. And but it's the frustration now I've got these findings and I sort of knew, anyway, the issues that I potentially could find. That was sort of the evidence to support what we were seeing and I mean, other things came out as well. But yeah, I think it's a sadness really that we know this, that we know what works for women, we know how to support women. Yeah, there's all this evidence, I'd sort of confirmed it, but we don't implement it. So it it's a sadness really, a real sadness. We've done it. I did the PhD and it was so. These are all the barriers, but the system, the system barriers.

Speaker 1 41:01

Yeah, yeah, here I ask how do you feel today when not a lot's changed and there's still the same issues?

Speaker 2 41:11

I'm very hopeful.

Speaker 1 41:12

Yep.

Impending Collapse of Maternity System

Speaker 2 41:14

Because I think the service again. I finished my data collection 2015, so it's almost 10 years and I got my PhD. I submitted it 20, because I was under such tight deadlines. I submitted it on time, but I knew that there was still some work to do. For example, the reference list is I'm just submitting something, I'm thinking I know I'm going to get corrections, so, uh. So I submitted it 2019 and, uh, I got it in january 2020. Um, so what happened in 2020? Yeah, yeah, so few.

Speaker 2 42:00

My belief is that the system has gone down and down and down with the rates of cesarean section, the rates of the rates of um induction, this separation between midwife led care and consultant led care I think that's something that came out the phd. That's not really great for women um and knowledge sharing. But what I think is the system is about to collapse and again, this is socio-political. So I was looking into government and I was looking in. So you know we had a conservative government for x amount of years. They have systematically decimated the nhs, because that's the political will and I think this is all intentional of where it is um and I think the current system is going to break, but then that'll be like phoenix from the phrase blames, won't it? It'll give the opportunity for a new system, hopefully, and I think it's got to break do you think covid exacerbated that and has sped?

Speaker 2 43:11

that up potentially. I think. I think it's been a perfect storm really. You've got the political will of where the intention for not just maternity services but health services is going, and then the loss of and again the Royal College of Midwives was saying, was saying you know, we're going to end up in crisis points. We've, we're going to be losing all these midwives. So we've lost a lot of older midwives who hold a lot of experiential knowledge. They've all gone. Same happens in obstetrics as well, and we've got a lot of you know all that that um knowledge, but also the knowledge of working in a different type of, I want to say, era where the focus wasn't on oh my god, I'm gonna get sued um, uh, so there was probably more confidence there. So we've lost that. And then we've got um. I think covid again broke down the system just that little bit more um, those midwives who probably were thinking of going probably went and then impacted on education then. So those students who've trained during covid perhaps didn't have the the um education that those students before did.

Speaker 1 44:50

So yeah, yeah, I think it's multifactorial and In fact, your first PhD topic on the legal aspects, actually would be perfect to do now.

Speaker 2 45:07

Yeah, yeah, yeah. I think, again, there have been a lot of changes. So, as I said before, I was a member of the Association of Radical Midwives and that allowed me the opportunity to speak with midwives from Europe, and I've recently been doing work in Finland. So, again, I think the realisation that because we haven't got that social system, that because we haven't got that social system, um, so there has been a little bit of research been done on it before, and then we had a large um policy called better birds come out in 2016, and an aspect of that is um access to I want to say compensation, but I'm not sure but funds.

Speaker 2 46:00

If you did, you know your baby did have a poor outcome to sort of remove that humongous cost to um the nhs, but um, I don't think that is fully being realized. So, basically, from my understanding, is, if you do have a poor outcome, you need to sue Because social care isn there um supporting people with um, children with additional needs, whether resulting from birth or or whatever, um, so I think it's yeah, it would be interesting to get a more nuanced view, but you know, reading around that area, I think now we're not so much I think it's physical health, but psychological and emotional well-being.

Speaker 1 47:13

Well, one in three having birth trauma. It's just ridiculous.

Speaker 1 47:17

Yeah yeah, and there's so much we can do to prevent those numbers. That is low cost, that is about staffing numbers, it's about being mindful, being there, it's about kind of having adequate antenatal education, having that we know Midwifery Continuity Care and the World Health Organisation have just put out their statement on midwifery continuity of care as well. So there's an awful lot that we could do that would help reduce those, because people I think a lot of the people who come in and make these changes from a management situation and also political situation, they're looking at short terms, they're looking at the next election cycles. They're not understanding the fact that this is intergenerational consequence. Yeah, yeah, I'm very conscious of the time and that you've got a busy day ahead of you. The important question how did you celebrate? How?

Speaker 1 48:13

did I celebrate, oh my gosh completing it because you were in. If it's celebrate oh my gosh completing it because you were in. If it's January 2020, you're coming up to a slightly kind of like difficult time yeah, I think at that time I was very beyond.

Speaker 2 48:29

I was, I was so sick of the goddamn thing. Uh, it was just a celebration itself, getting rid and passing it, so it didn't do a lot actually, I think I had a bottle of champagne with my partner and that was lovely.

Speaker 2 48:47

I don't bless him. He was only there for the end journey when I wanted to go and boil my head. But yeah, when was it? It was when some of the restrictions were lifted, so it would have been in the july, and it was somewhere where I had a party in, in the garden do you know of any changes to practice or any impact that your phds had?

Speaker 2 49:14

no, no, no. And and it's a difficult one because really I should do some writing up and I haven't. And I don't think the findings would change anything because you know there is that much work anyway about midwifery practice and how that supports women and wellbeing and and and everything else you know there's loads out there.

Speaker 2 49:41

It's, it's the action and again, it's feminist. There needs to be action that comes from this and I you know I on my own can't do anything it needs to be. We've had quite a few in the UK, protests and things like that, but it's it's. It's got to be political will, because that's that's the only thing really. Uh, oh, what's it called positive disruptors? So who? I worked for? Uh, in the um one-to-one midwives. It was called, uh, the organization I can't. You know joe parkinson, who actually put a lot of work into setting that up. Uh, and you know, working to the research. It's right. This is all the evidence. This is how we can change. This is how we can make things better. It needs the opportunity and again, I think that will come.

Speaker 1 50:48

Your PhD is adding to that body of knowledge. So it's adding to that evidence, it's supporting that which is adding that strength and that credibility to it. To it to say, look, this is what it is, you've got this study, you've got this study, you've got this study.

Speaker 2 51:03

All of that will eventually become too much to ignore yes, well, I can remember going to the normal um normal birth conference and, uh, range over sons and lancet series. Yep, mary went through, was there and I was going. We've got all this research. Why isn't it? Why isn't it implemented? But it's again. It's medical homogeny, biomedical model of style has got the authority or authoritative knowledge, the political will, and until something significantly changes, I mean I don't know how low we have to go. I really don't. And and again, feminists, you, you know it's women who are suffering here, you know, with like the birth trauma.

Speaker 2 51:50

Yes, you just like men and in families as well. But you know it's a huge feminist issue, um, and you know we live in a patriarchal society, don't?

Speaker 1 51:59

we, so we do. We have to keep producing the evidence, we have to keep getting midwives who are at the tables where the conversations are happening across the whole sphere, and leadership, governance, politics, all of those decisions, yeah. So my final question to you is what's next?

Researching Successful Midwifery Practices

Speaker 2 52:15

what's next? Oh, I, I don't know. I'm, I'm watching, I'm waiting for, for this change. Yeah, I don't know. I'm teaching at the moment, which is great. It's really hard supporting students and in the environment that they're working in. I'm trying to.

Speaker 2 52:36

You know, in my current role, it's you know, we need to work to the evidence, we need to work to the nmc. Uh, you know, knowledge is power. You need to know your research. I'm I'm doing that at the moment. I'm not entirely sure. I'm not entirely sure, actually, what this is.

Speaker 2 52:52

I come up for a postdoc. I had an idea. I was, you know those moments that you're just lying, that'd be really good for a postdoc. Oh yeah, um, what I really wanted to do and it is a shame because I didn't have time brain space and all the rest of it is look at things like, um, one-to-one midwives. Why did that work? What was it about that organization? I mean, sort of, there's a lot of knowledge about why it it failed and the way it did. It's fitting in the current system, but the nuances of the team working, yeah, and how, you know, there were some fantastic teams that worked so well and it, it. I think that would be a good piece of research, but we've sort of lost that now. But, um, I don't know. I'm waiting for the change. I'm waiting for the change and and seeing what's going to happen.

Speaker 1 53:46

I think there's a place, definitely a place, for appreciative research, because we do look at the badness and what's going wrong. We don't necessarily focus on what is actually going right and how can we replicate it.

Speaker 2 53:58

Yeah.

Speaker 1 53:58

So that's kind of I think, well, you never know. I'm going to say you haven't got to that yet because you never know what window is going to open. No, Well, that's it.

Speaker 2 54:08

I'm just waiting for the universe to say here's your opportunity. You never know.

Speaker 1 54:16

Thank you very much for your time you're very welcome.

Speaker 2 54:20

Thank you for inviting me. It's been a real honor and privilege after posting links to this podcast to my students absolutely.