I felt honoured and inspired when I read Mary Newburn’s article in the March 2017 edition of MIDIRS Women changing maternity services. A look at service user involvement in the UK. It’s a love letter to a movement with a long history, an active present, and an important contribution to make to Better Births implementation.
It is so easy, as we know in the MSLC and now Maternity Voices Partnerships (MVP) movement, for there to be confusion between engagement (focus groups and similar), and real involvement. We experience – or work for! – real and sustainable involvement in multidisciplinary forums. Local partnership groups, in which service users serve in equality with other members. In which recent service users are mentored by their peers to stay and become advocates and leaders.
This post is the text of an article I wrote earlier this year, around the time Better Births, the report of the National Maternity Review, was published. The original title was ‘Stillbirth: what politicians and the media fail to understand.’ What I think many fail to understand is figures and their context – and research evidence more broadly.
It seems to me that we can only have consistently evidence-based health policy when we have a shared commitment in public life, and in public discussion, to a National Information Standard for talking about research evidence, and indeed for promoting public health messages.
Why do I keep tweeting NICE CG138 s1.5.24 – which is a National Information Standard, if people will choose use it? Those of you who have read ‘Thinking Fast and Slow‘ will understand why we need it: thinking about risk often involves ‘shortcuts’ and ‘rules of thumb’ that serve well in some cases, and less well in others (another blog post is needed to explore the topic!) We can, of course, support Each Baby Counts and the work of MBRRACE-UK, and acknowledge that addressing stillbirth rates is very important, while being equally clear that each and every time data is presented it must be properly contexualised. It serves women, their babies, and their families, poorly to present information without using absolute figures, framed both ways, (when possible) in a variety of formats.
So I wrote this article to express my frustration – that the public is so often presented with partial information, or information without context. And that this ‘problem with figures’, and indeed with understanding research evidence more broadly, seems to extend to, and affect, public policy initiatives. Continue reading
My second CG190 blog on monitoring the fetal heart rate – this time focusing on CTG use and trace interpretation. What is the evidence, and what is new and different about these recommendations? (Please do also read my previous post to understand this summary in context.) Again, I am assuming a basic familiarity with the evidence.
While writing this post, I have come across this fabulous resource of which I was unaware! Here on NCBI is a fully interactive version of Chapter 10 including Appendix P (all the Appendices are there!) Recommendations below are from the NICE online version and the Full guideline is here (with Appendices) on the NICE website, along with pathways, and the Quality Standard.
Note that significant sections of the CG190 fetal monitoring recommendations have been brought within the scope of the Intrapartum Care guideline for women at higher risk of complications currently being developed – see link below (under ‘Resources’) for full details. See introduction to my previous post too.
(28 May 2016, published 5 June 2016 SEE NOW most recent updated version of CG190 of current fetal monitoring recommendations – noted added 2022) Continue reading
This post is an introduction to ‘monitoring the fetal heart rate’ in NICE CG190 2014 (care of healthy women & their babies in labour & birth). I am going to assume a basic knowledge of the evidence and terminology. A post about ‘interpreting the fetal heart rate when using a CTG machine’ follows. For a more accessible introduction to the topic of monitoring in labour, you will find information from NICE here and here (note that it is a more general introduction – for women, whereas this blog is ‘a bit technical’ – it is about sharing how evidence is reviewed and recommendations are made. )
I am beginning blogging CG190 with monitoring of the fetal heart rate because, for me personally, the 2014 recommendations about CTG use felt very important, and some of the reviews of the research evidence really surprised me.
Also, NICE has decided to look at some of CTG evidence for both ‘low risk’ and ‘high risk’ populations as part of ‘Intrapartum Care 2 – care of women at higher risk of complications in labour & birth (‘IPC2’). Knowing that some of the CG190 ‘Evidence to Recommendations’ sections may be replaced by the deliberations of the IPC2 guideline development groups, I want to acknowledge the work done on looking at monitoring evidence (as it was in 2014) that the CG190 text represents. (28 May 2016, published 5 June 2016)
Chapter 10 of the Full CG190 guideline, on monitoring the fetal heart rate in labour, begins by comparing cardiotocography (CTG) and intermittent auscultation (IA). The text extracts I include here are from the Full guideline document.The recommendations are taken from the online version of the guideline. Continue reading
In a previous post I mentioned blogging the NICE CG190 ‘Intrapartum Care for healthy women and babies’– care during labour & childbirth (the national clinical guideline in England & Wales) chapter by chapter. Let’s have a quick look first at what NICE guidance is, and how it is made. (8 May 2016)
Making national guidelines for health and social care is a national process in which everyone has a stake. The public are people who use health and social care services – so what guidelines say will affect the choices you are given, the outcomes for you and the experiences you have. If you are a health or social care professional, the guidance will shape your work. Continue reading
Notes for MSLC Members & Maternity Commissioners
The NHS Constitution, and the 160-page Handbook, that accompanies it are interesting & exciting documents. Worth a browse if you are interested in co-design as an MSLC member, whether a service user or professional member. Key to your work if you are a maternity commissioner. Here are some notes from an hour, a cup of coffee, and some musing on what this means for us in maternity (as at 1st May 2016)
So, looking at and working with the NHS Consititution:
- Some highlights
- Driving improvement in maternity care
- Designing services
- A message to Commissioners – benefits of involvement & co-design
January 2016. We’re awaiting the publication of the National Maternity Review report and recommendations. The work has been undertaken in less than a year. If you haven’t read the 1993 Changing Childbirth Report, which was also chaired by Julia Cumberledge, do borrow a copy and read it soon – lots has changed since then, but not enough. (Who would have thought that in 2015 22% of women* having a straightforward vaginal birth would give birth in stirrups?)
This is a very long post – you’ll see why. Best to say aloud now, I think, what my concerns were at the outset of the current review. I am hoping so very much to have been needlessly worried. I wish so very much for everything to turn out well – for the recommendations to be evidence-based and excitingly forward-looking. I know that all involved are sincere and well-intentioned. If bringing about changes in maternity care were a simple thing, though, Changing Childbirth would have changed the world more than it did. Continue reading
The starting point for this post is an article about birth, from The Guardian, in December 2014. It was published in response to the updated clinical guideline NICE CG190 Intrapartum Care – care of healthy women and their babies during childbirth.
The Guardian article:
We talked about this article on the #MatExp Facebook group in September this year. This is an edited version of what I said in reply to concerns there that the tone of the article might be seen as offensive towards the medical profession: Continue reading
Calling all midwives, maternity lay advocates, doulas, obstetricians and other doctors concerned with birth, and students too! And commissioners and Clinical Commissioning Group clinical advisers too – so important.
You need to read the recommendations. Really, you do.
Because after that we’re going to do the updated chapters of the full guideline, chapter by chapter.
It’s fun. And it’s important.
Take the cup of tea challenge!
Cup of Tea
Read the NICE #IPCare recs Link here
Tweet something! #IPCareTea
Catherine Williams@BerksMaternity #MatExp #mslc