A few years ago, I saw Sheena Byrom talk at an ARM conference. Sheena (OBE) is one of those über dynamic midwives who makes you believe that change is actually possible (she is all over Twitter as @sagefemmeSB). On that day, Sheena spoke about the importance of giving positive feedback, not just among midwives, but also to our medical colleagues. By telling people what they do well, Sheena said, we reinforce good practice and make them feel good. This advice struck me as being eminently sensible, so I’ve been putting it into practice ever since. A couple of weeks ago, I told a neonatal doctor that I really liked how he explained things to new mums and dads. He blushed. It was lovely.
So where do you - our mums - come into this?
There is a huge drive in the online mum community to support positive birth experiences for other women - the Positive Birth Movement has 25k followers on Facebook, and 400 groups worldwide. Organisations like this are doing great work, but how do we ensure that their influence makes its way back into the hospitals where - still - most women in the UK choose to give birth?
Well, parents need to start giving specific feedback - good and bad - and making sure it reaches the right ears.
We’ll deal with good feedback first, because it’s the most simple (and nicest). As a midwife, I promise you that, for those 12 or so hours that we are looking after you, we are, as a general rule, working our proverbial tits off - because we really and truly care! When my cousin recently gave birth, she called me to ask me what she should give her midwives as a thank you present. I told her to give them some personalised written feedback and then whatever else she liked. Because it is 100% wonderful to read your name (spoken of positively) in a card, letter or email, especially if this missive has first passed through the hands of your Trust's Head of Midwifery.
The ubiquitous ‘Friends and Family Test’ provides another opportunity to leave feedback. This survey, distributed on maternity units and in the community, is a Government initiative, asking you to rate your care experience based on one question, ‘Would you recommend this service to your friends or family?’ It is a simplistic tool, which allows easy comparison among hospitals, but why shouldn't we use it to gather more meaningful feedback? Instead of grumbling about how long it takes to get discharged from postnatal ward (and it does take ages to get discharged from postnatal ward), you could be helping change the face of maternity care in the UK! I bet you didn’t think of it like that, did you?
Now onto the thorny issue of how to complain...
It might surprise you to know that, once we qualify, we are remarkably unobserved in our practice. Sometimes, we work with student midwives, who will occasionally tell their tutors or mentors if they see something they consider to be unsafe. But it takes a brave student to this, because that same midwife they’re complaining about could well be signing off their skills in a few weeks time. The truth is, if parents who experience poor care do not feedback to maternity managers, there is often no way to know it is happening.
Now, I understand why parents don’t complain. By the time you get home, you are tired and, through your own folly, have a brand new baby to look after. A few days pass, memories of the birth begin to fade, and you start to wonder whether, really, it was as bad as all that. After all, everyone else was so nice. And who wants to make a fuss?
My sister-in-law gave birth to her baby at 36+ weeks. He was a good size, breastfed well from the get go, needed no resuscitation and, within a matter of weeks, was one of the most enormous babies you have ever seen. But shortly after the birth, one midwife took him away, gave him a bottle of formula without first asking consent, then returned him with no real explanation of why this had been done. When my brother told me this, I was stunned. Sometimes, when breastfed babies are unwell or have low blood sugars, it is necessary to give them formula; rarely, this need is so urgent that parents cannot be consulted first; always, it is possible to explain fully to the parents afterwards what has been done and why. I will never know now whether or not that formula top-up was clinically indicated and, really, now it doesn’t matter. The point is, that midwife did not communicate well on this important issue, and, had my brother or sister-in-law fed back to the unit, this midwife would have had a valuable opportunity to improve her practice.
And it doesn’t always have to be a show down, you don’t have to go in guns blazing and say ‘I want this midwife OUT!’ What you can do instead is say, or write, ‘I understand that your maternity service promotes breastfeeding. While I was on your ward, midwife [insert name] gave my baby formula without first asking us for consent. We wondered if you could take a look at our notes and see if there was any need for this, and feedback to her that we would have liked to have been asked first. Please let us know what steps you will be taking to make sure this doesn’t happen again.’ If you want to, you can put a sweetener at the end, ‘You can tell her we were happy with every other aspect of her care.’ I hope that most Heads of Midwifery will be wise enough to give such feedback the time it deserves.
Constructive feedback - good and bad - is a necessary and important part of improving maternity care. And everything I've said also applies to community and homebirth midwives - your feedback, especially when it's positive, can help strengthen these services, which are often under threat, thereby increasing your choice in childbirth.
We love it when you say thank you! And, as a general rule, don’t relish receiving complaints. Just the thought of it makes me feel a bit sick. But that’s hard luck for us. We have to be able to stomach criticism and turn it into an opportunity to reflect on and improve our practice, otherwise bad habits simply do not change.
To conclude, if you want to give us flowers and feedback, we’ll happily take both. But, if I have to choose one, personally, I’ll take the feedback.