West Side Stories

Ep 1: Ann Remmers and Asha Dhany

• Health Innovation West of England

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In our very first episode of West Side Stories, Senior Project Manager, Asha Dhany, is in conversation with our Maternity and Neonatal Clinical Lead, Ann Remmers, who looks back at her 50+ years in midwifery. 

Ann reflects on the changes she's seen in the profession and shares the insights she's gained in senior leadership roles. Ann also talks about the continuing success of the Black Maternity Matters collaboration, which is delivering anti-racist training to help tackle the awful disparity in outcomes for Black and Brown mothers.

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Hello and welcome to the very first episode of West Side Stories, the new podcast from Health Innovation West of England. My name is Vanesther Hamer and I'm the communications lead for the network. Our ambition for this new channel is to bring you a really rich and diverse array of conversations with all kinds of people from across our health innovation community here in the West Country. So whether you're looking for practical advice on how to develop or spread innovation, or you want to hear about the latest digital transformations, or you're interested to learn about the different ways we are tackling health inequalities, we really hope that West Side Stories will offer a thought provoking, deep dive into some of the incredible work happening across our network, leading to positive change for our local communities. As well as asking our guests to talk about the work they're involved in, and to share some of the lessons they've learned along the way. We'll also ask for their resource recommendations, something that's inspired them, perhaps a book or a film or a training course, or maybe another podcast. And as is the way with innovation, I'm sure the format will flex and develop along the way. And if you've got any suggestions for future topics or guests, we'd love to hear from you.

Our first guest in the West Side Story Studio is our maternity and neonatal clinical lead, Ann Remmers, who looks back at her fifty plus years in midwifery. Ann is in conversation with Asha Dhany, a senior project manager here at Health Innovation West of England and another midwife in the team. Asha gets Ann to reflect on the changes in midwifery since she first started in the profession back in the seventies. As well as sharing the insights she's gained in senior leadership roles, and Ann also talks about the continuing success of the Black Maternity Matters collaboration, which is delivering anti-racist training to help tackle the awful disparity in outcomes for black and brown mothers.

Asha Dhany: So good morning. I'm Asha, I'm a senior project manager at Health Innovation West of England. I've also been a midwife for just over twenty six years, and I'm delighted this morning to be interviewing Ann Remmers. Ann, do you want to introduce yourself?

Ann Remmers: Good morning. Asha. Yes. Thank you. My name is Ann Remmers, and I am maternal and neonatal clinical lead at Health Innovation West of England. I'm delighted to be here.

Asha Dhany: So Ann amazing. You've been a midwife for over fifty years, haven't you? And I'm really excited to have a conversation with you this morning and talk about your career.

0Ann Remmers: Thank you. Thank you, Asha, for reminding me.

Asha Dhany: So I want to take you right back to the beginning of, um, even before your career and ask you. Ann what drew you to midwifery and what has kept you committed so long?

Ann Remmers: Um, I, I think I was initially, um, at school wanted to go into nurse training, um, because that was the traditional way. Anyway, that you got into midwifery, uh, there wasn't a direct entry course, um, as we used to call it. so I did my nurse training at Guy's Hospital in London. Um, and then it was quite a common thing that nurses would then go on to do their midwifery. It was almost like you hadn't really completed everything until you'd also done your midwifery. So that's when I applied to do my midwifery in Bristol, because I thought it was a nice city to move to from London.

Asha Dhany: So just thinking what are the standout moments in your career over that time? Ann as a midwife.

Ann Remmers: I guess, uh, the first standout moment was actually qualifying as a midwife because it just felt amazing. It felt amazing to be able to say, I'm a midwife. then came the dawning of I'm a midwife and I've got all the responsibility now is on my shoulders. I'm not a student anymore. And then I think just gaining experience in different places, working in different environments where I was a midwife, um, that enabled me to sort of look at things very, very differently. So I consolidated my midwifery training for a little while at Southmead, and then I went to Australia for three uh, and I got the opportunity to work in a birth centre, which was, which was very cool. You know, birth centres at the time, um, were quite a new thing. And that was, that was, that was quite a thrill, really, to be able to do that. Um, other standout moments, I think I really loved being a community midwife. I absolutely loved that. Um, that was where I could be kind of get to know the family and be with them all the way through. So, yeah, those are those are a few of the sort of standout moments, I think, from my early career.

Asha Dhany: midwifery offers such diversity, doesn't it? In setting

Ann Remmers: Yeah.

Asha Dhany: that you work and the people that you meet and those environments and in terms of kind of over those five decades, what are the most significant changes you've seen in maternity care?

Ann Remmers: Um, there's been an awful lot of change. I mean, um, when I first started my training, it was a it was not that long after, uh, the peel report, which came out in the nineteen seventies, advocated that all births should be in hospital. So prior to that, I mean, sometimes I watch Call the Midwife, and I think this is getting very, very close to when I was working. Um, so, um, that does feel a bit weird. Um, and so we, we'd moved away from the, the sort of vision of a community midwife on a bicycle like they are in Call the Midwife to. It's safer for a woman to have a hospital birth. So then, it was a very controlled environment. Um, working in the labor ward, you know, we were monitoring women all the way through. We weren't, um, um, supporting them to move around. They were lying flat on the bed. So, um, that was very, very different. And then we realized, you know, that this was not necessarily aiding birth. You know, that moving around was a good thing to do. Um, and actually kind of a less medicalized birth, um, and experience was an overall better experience for the mother and baby. Um, so that was a big difference. And then, um, we kind of moved into, much more of a focus on, on continuity of care. Um, and obviously, um, you know, later came, um, changing childbirth. Um, that was in the early nineties. And then later again, we had better births, which was around twenty fifteen, I think, which advocated continuity of care. So we've kind of that in that respect. We'd come back kind of full circle. Um, from, um, from the, from the seventies. Um, and now I would say it's probably shifted back a bit more towards a medicalized, approach. And that's, you know, in many cases that is for very good reason, because it allows women with more complex medical needs to give birth. Who wouldn't have been able to way back when, when I first started, or they would have had more complications. We didn't have the diagnostic tools so we could a diagnose when things were going wrong and also diagnose things. Um, that might not be, uh, going well for, for the baby. So, so that's that's kind of been a good thing. Um, but it's also meant that it's probably changed, as you would know, Asha. Very much changed the environment on the Labour ward. So I think now you've you've still got those continuity of care. You've still got your team midwifery, you've still got your birth centres tending to be in the hospital rather than standalone, but you've also got a higher caesarean section rate and more medical intervention. So it's

Asha Dhany: Can

Ann Remmers: a bit

Asha Dhany: you

Ann Remmers: a full circle.

Asha Dhany: an what the caesarean section rate was when you first started?

Ann Remmers: I can actually, um, it was six percent when I first started.

Asha Dhany: Wow.

Ann Remmers: Um, and I can remember there was a period I, uh, in the eighties, I think, where it had it had started to increase, obviously, because for the right reasons, you know, to ensure that you had a safe birth, a healthy mum, a healthy baby. There are times when you you needed to do a caesarean section. And I remember the World Health Organization Actually saying that the optimum would be fifteen percent. So but then it's obviously it's for various reasons crept up from that. So I think we're in we're in the sort of forty to fifty percent now, which is is quite considerably different for cesarean section rate.

Asha Dhany: Definitely a big change. Do you think it would go back round again at all? Do you think we will be back promoting, um, birth units and lower risk care?

Ann Remmers: I don't think it'll ever go away. I would hope that women would always have that choice. as long as it's a safe option. Um, so, you know, keeping birth, uh, keeping pregnancy, as normal as possible. but also identifying when there needs to be intervention for the safety of the mother and baby is obviously you know, that's that's key, that's paramount. So a lot of it is going to be dictated around that and also women's choice. I think that women may choose to have a caesarean section today, possibly because they're more worried because they hear things that where things don't go well, and that's that's must be really hard and really stressful. And I think it would be lovely to be able to give everyone that confidence that they can have a safe birth no matter what. mode of birth, that they choose.

Asha Dhany: Absolutely. And I think you've touched on some really important points, haven't you, about the choice of the woman and that information, um, and decision making and really listening to our service users voices throughout. So. Ann you've done a variety of leadership roles, haven't you? I know you've been a director of midwifery, a clinical director in a trust, and then across the South West region, and now you're working as clinical lead at Health Innovation West of England. With all of those years leadership experience, what are your top tips for being an effective midwifery leader?

Ann Remmers: Well, I think don't be afraid to put yourself forward for things, because actually, just thinking when you said that, I remember applying for the clinical director role in a trust, and at the time, um, it was the all the other clinical directors were doctors. Um, consultants were expected to be clinical directors, not not midwives. So, um, I think I must have, um, had a bit of confidence there to even put my hat in the ring. Um, but I was fortunate that that, uh, the trust, um, appointed me as a clinical director. So I think I got a great opportunity, but it kind of showed that we don't have to stick in the the lanes that we think we should be in. I think you can test and try other things. And that was so helpful. I felt because it gave me a voice at another table, um, it gave me the opportunity to influence a bit more, um, how the, you know, the sort of ethos and how the organisation of maternity services. Um, it kind of gave me an equal voice, I guess, with the, with the medical staff, which was, um, I think incredibly helpful. and hopefully, um, influence and gave midwives a greater voice. Um, and I did the same thing when I went for the clinical director for the South West region. Um, I thought, well, I'll, you know, I'll try this, But I think overall, um, the other thing is that you never stop learning. So always, you know, always, always be open to learning new things. Um, and there is a sort of I think there's a bit of a tendency you get into a senior position and you think I should know it all, and I've been there where you think I should know it all. I shouldn't have to ask any questions. I should be the one that everybody comes to. And I know all the answers, and you don't. And actually, that's okay. It's okay to not know all the answers. It's okay to say, well, actually, I think you probably know a little bit more about this than me. So so tell me, help me to understand. So I think you kind of learn that as you progress as a leader. Really.

Asha Dhany: And that's great to hear, isn't it? That you are. And I think you're right. In midwifery you're always learning or in any role. And how great that you did put yourself forward for those clinical director roles and give midwifery, Um, a voice and be such a great advocate for midwives and women. Um, so I want to go on, on Ann ask you about what makes a maternity service truly safe in your view.

Ann Remmers: Oh, so many things. Um, it's so important, I guess. You know, the leadership. Um, and that's right at the top of the organization. You know, your chief executive, um, chief nurse, um, overall has that responsibility. But the midwifery, maternity leadership, medical leadership in obstetrics and neonatology, working as a team together, um, all having, you know, the same goals and. Absolutely. I mean, it goes without saying, I know, but putting the mother and the baby, the birthing person and the baby at the absolute center of everything that we do. Um, and I think that's something that we've learned over the years, again, to listen to, mothers and families about what's important to them, what matters to them, what makes them feel safe. So you need you need the training, the right education. You need to select the right people for the right roles at the right time. You need to support staff so that they can grow and develop and they can get promotion. They can become leaders as well. And you need to constantly look at your data, your statistics. How well am I doing? Am I doing as well as as a neighbouring trust? If not, why not? So you're constantly making sure that you're at the you know, you really are at the top of your game because it's so, so important to get it right.

Asha Dhany: I love your answers. They're so important, isn't it, that MDT working in in perinatal services and really, truly listening to mothers voices and taking that all into account and and your skills as a leader and your listening and kindness that all comes through so, so much.

Ann Remmers: I think that's that's so true because, um, around the team working, I can't emphasize enough the, the programs, the projects we've been most successful in are where the teams have worked together. Um, you know, we I think probably that's something that has really improved over the years. We're not sort of the midwives are here, the obstetricians are here, the neonatologists are there. We are one team because we all provide that care. The health visitors, perinatal mental health, so many other people, um, that provide care for that family. So if we don't understand what each other's roles are and what impact it has, then we can't possibly provide that total safety for the woman and her baby and and and improve outcomes.

Asha Dhany: Absolutely. I completely agree. Kind of, you know, we work best, don't we, as a team when we pull all our skills, and there's that culture and civility. And, you know, we all work for the same goal and to provide the best care for the moms and babies.

Asha Dhany: Thank you, Ann. so most recently you've done lots of work on inequity and racism and outcomes for black and brown mothers. And you've been really integral to the development of the Black Maternity Matters collaboration, which is supporting perinatal teams to offer safer and more equitable care. So for listeners who don't about black maternity matters, this is an incredible six month program. And I'm talking from my own experience here as I've completed it myself, and it's really changed my practice. So Black Maternity Matters focuses on anti-racism action to address the poor outcomes faced by black mothers and their babies in the NHS service. And the programme really delivers that in-depth anti-racism training to multidisciplinary clinicians and senior leaders through a combination of in-person whole day sessions, supplemented with the book groups that are online to really embed that learning and take it forward. And then we know that a really important component of this programme is that participants are supported to develop quality improvement projects to help turn their kind of insights into learning and real action and changes. And I just wanted to talk to you next, Anne, a little bit more about what first prompted you to focus on this?

Ann Remmers: I think that working in patient safety, it was something that was very much, uh, on our, on our radar that the outcomes for, um, black and brown mothers was so much worse than for their white counterparts. we had the embrace reports that showed that black mothers were significantly more likely to die in pregnancy and childbirth. Um, it's now nearly three times as much. there's a huge gap really between the outcomes for black and brown mothers and white mothers and also for babies as well. So, um, that baby's nearly twice as likely to be stillborn, So. we were thinking, what can we do about this? We need to educate people. We need to increase awareness. But we were mindful that we have been doing that for a few years. I mean, the collective we across across maternity services and running workshops, running two hour sessions, and it just didn't seem to be making any difference. So we talked to mothers, we talked to black mothers. We we were so lucky that we met, um, black mothers matter. Um, Noshin my colleague had a conversation with Sonah from Black Mothers Matter. Um, about is there something that we could do? Because, look, this is the area we work in. We work in improvement. We work in educating people. Um, our focus is to improve outcomes and an experience. Um, if we kind of put together something that was an education program, um, and aim it at NHS staff so that we're really teaching them, um, to make, to try and make a difference. Does that sound something that you think would work? Um, and Sonya's response was, that sounds amazing, but if you're going to do an education program, make sure that the the outcome of it converts into change. So the learning converts into action. So what you are teaching people actually makes a difference in the maternity unit in the community where they're receiving their care. So so that was the very first kind of, um, nub of the idea really. and then knowing that we weren't the experts in anti-racist education, we then had conversations with Katie from Be, Coco and Aisha from Representation Matters who were delivering anti-racist education and said, can you work with us? Can you help us to build this programme of education for NHS staff so that we can really start to change things and make a real difference? And they said, absolutely, yes, we can. Um, so we then had a, you know, the logistics of it. We had some support from the Health Foundation. It was very timely that they were offering support for pilot projects. So we were able to to get a little bit of funding to get us going. Uh, we talked to the organisations because obviously, um, you know, if the if the trusts weren't able to send their staff on a, you know, on a six month programme, then, you know, we couldn't take it anywhere. So, um, we did work a little bit on kind of persuasion, I think, um, because it was a very difficult time. It was, um, you know, I think it was just post Covid staffing situation and we're going along saying, we'd like you to send your staff on a six month anti-racist education. And their thinking is that instead of the two hours, I could send them on. So we had to do a bit of convincing. Um, and we were very lucky that in Bristol we had two trusts, that said, yes, we'll we'll give it a go. We'll, we'll try it, we'll um, and because we said, look, we'll do a pilot, just, just help us do a pilot. So that's how it started with midwives and maternity support workers. and the the outputs from that were were incredible, that people really felt this had made a difference, that had shifted their view, that had made them start to think in a different way, see things in a different way, unlearn things that they'd learnt. Um, and coming up with amazing ideas of how they could, um, put that into practice. then we could then say to the other trusts in the West of England, we're going to run some more cohorts. Will you take part? But also we learned that we needed the perinatal teams to be working, you know, taking part in the education together. So, including midwives and maternity support workers, but also the doctors, the neonatologists, the obstetricians and wider, you know, health visiting, perinatal mental health. the The evaluation then went down really well, but people were then saying, but we haven't got the senior leaders in the room. Um, so when I go back to work, um, it doesn't always. It's quite hard sometimes for me to say, I think we should do this. So we then started to run programmes of senior leaders, and that's that's made an amazing difference to how the whole organisations really can start to look at anti-racist policies and practice. So it's gone. It's really gone from strength to strength. But I suppose the most heartwarming thing is when Sonah says, women are coming to our Black Mothers Matters group and saying we can feel the difference. We can tell the difference when we go into to have our babies. So, uh, that's really important that that we know we're making a difference there.

Asha Dhany: That's amazing. Ann it really has gone from strength to strength, hasn't it? Black maternity matters. Why do you think disparities in maternity outcomes have persisted for so long

Ann Remmers: Yes, yes. I mean, you know, you're absolutely right, Asha, because if you come from a poorer socioeconomic background, um, and if you're non-white, there are many kind of groups that feel the impact of inequality. I think we we've not really looked at it through the eyes of the people experiencing it. I think that's what I've learned from black maternity matters as well. It's probably easier to describe when when we talk about, um, anti-racism because I think, my personal experience as a white person is that I didn't see racism. I didn't need to see racism because it didn't face me. It didn't. It didn't impact on me. So I think one of the things that is the kind of light bulb moment, if you like, for people that undertake the program, is I never realized that. I never realized that because I haven't felt that, because I haven't walked into a room as a black woman, So I think it was it's almost like a blindness. You don't see it. And so you don't think it happens. The key that unlocks it, I think, is really asking, women, people, mothers, families, what is it like? What is it really like for you?

Asha Dhany: Thanks Ann, I completely agree. Having done black maternity matters myself, it's a real process, isn't it? Going through that course and that learning and and seeing, seeing things and seeing them and and I know certainly it's really shaped my practice. And when I work my clinical shifts, you know, it's in the forefront of my mind now. how many people have gone through black maternity matters.

Ann Remmers: think we're nearly six hundred now, so. And that's across the west of England. Um, some we've done right across some cohorts, right across southwest. Uh, we recently launched in northeast London a program and very exciting. We are planning on launching a cohort in Birmingham very soon. So, um, yeah, it's going from strength to strength.

Asha Dhany: that's amazing, isn't it? Just spreading that that, um, experience and those, you know and changing that practice.

Ann Remmers: And

Asha Dhany: you.

Ann Remmers: think just the, the, the, the fact that, um, you know, the organizations are willing and want to take part that, that I mean, we couldn't do it without them.

Asha Dhany: And that buy-in is so important isn't it. So for anyone listening today that hasn't been fortunate enough to do black maternity matters yet, is there any one resource that you could recommend that you found interesting or that gives maybe some of those insights? Yes, I think I mean, there are a number of great books that we were provided with as part of the program, as you know, but I think the one if you're going to pick one, I would pick, uh, divided by Anabel Sowemimo. Um, it's racism, medicine and why we need to decolonize healthcare. And it really is if you're working in the NHS. it's it's such a great book, full of resources, full of thoughts, insights. I don't know anybody who hasn't read it and said this should be on the curriculum for, um, doctors and midwives and nurses in training because it's it's a really powerful book. So that's that's the one I would recommend. Amazing. Thank you. So that brings us to where we are now. Ann and this new year you were awarded with an OBE, weren't you? Which is absolutely fantastic for all your incredible work. Can you tell me what did receiving an OBE mean to you?

Ann Remmers: Well, it was a shock, I have to say. It absolutely was. Um, it was amazing. I mean, you know, just what an amazing, um, you know, to to to to receive that, uh, really towards the end of my career, um, to feel that, um, you know, someone had thought I should be nominated for it was was an incredible feeling as well. Um, I mean, I feel incredibly lucky. You know, I probably said it a few times, but I do feel lucky that I've been able to work with some amazing people. Amazing teams had this opportunity. Really. Um, so, you know, I think because I've had the opportunity to do different things and, um, that that probably really helped me to get into being nominated for the OBE. But it is. Yeah, I am incredibly proud of it. It is a real honour.

Asha Dhany: and so well deserved. So just to finish, Ann what advice would you give to midwives starting their careers today?

Ann Remmers: I think that keep an open mind for a start. I mean, the the training itself is, you know, it's hard work, but you're you're going to learn so much. I really think being with a woman, uh, looking after her, whether that's throughout the whole pregnancy and the birth and the postnatal period or a part of it, is an absolute privilege. It is it is a wonderful, wonderful career. Um, so don't be disheartened by the the times that are hard, because there are always hard times when you're tired, um, and you maybe feel you haven't given your best, um, you know, there's always somebody to talk to, and that's where the team comes in to support you. And I would say, look, look around you. What other things are going on? Can I can I connect with, um, another, you know, sort of organization as well as working as a clinical midwife. So for example, the health innovation networks, you know, we're absolutely, uh, you know, love and need to work with, with midwives, whatever stage in their career. Um, because, you know, you're the ones that are really there experiencing that every day. So yeah, you you are in an amazing job. Um, and look for support where you need it.

Asha Dhany: There are so many amazing things in your career. What's next for you?

Ann Remmers: um, coming up soon. Um, I'm actually going to be retiring. Um, so that sounds very strange. After all these years, I don't think I'll be completely letting go, though. Um, I'm probably going to be around popping up, doing a couple of other things with the Health Innovation Network, um, like, uh, Black Maternity Natters podcast. That's, uh, so look out for that. But yeah. It has been just an amazing, amazing job for me to do, um, you know, working in maternity and neonatal services for, for the time that I have. Um, yeah.

Asha Dhany: Gosh. Ann what will we do without you? I'm so grateful to have spent some time with you this morning talking about your fantastic career and all the things that you've

Ann Remmers: Oh.

Asha Dhany: achieved, and I'm finishing it with that OBE. Um, this new year, I could have spent all morning talking to you all day talking and learning from your insights. So thank you again so much.

Ann Remmers: Oh, it's been an absolute pleasure, Asha. I've really enjoyed it. Thank you.

We really hope you've enjoyed this first program, and a huge thank you to both Anne and Asha for being our brilliant guinea pigs. We'd love to hear your feedback on West Side Stories. You'll find ways to contact us in the programme notes. Thank you for listening.