I was genuinely delighted to read that you have been appointed as our new Health Secretary. I remember meeting you in 2004, when you were the Public Health Minister, and I was invited twice to meet with the Prime Minister Tony Blair, in Downing Street. I felt an affinity with you as I was working as a consultant midwife, one of the countries first, and my focus was public health. We had a lot to chat about!

I’ve been a practising midwife since 1978 and would love the opportunity to share my brief perspective on today’s maternity services, in England.

I was interested to read your quote in The Guardian:

“I would worry about any mum feeling pressurised that there is somehow a kind of an ideal birth experience to live up to... you have to follow the evidence, you have to have informed choice.”

Thank you for highlighting the importance of evidence and informed choice. However, informed choice remains one of the biggest challenges in maternity care. Midwives and obstetricians simply don’t have the time to fully discuss the evidence, meaning many women and birthing people cannot make carefully considered decisions.

Also, while women in England can choose a caesarean birth, those who want a physiological birth, which the evidence suggests is what most women hope for, are often unable to experience one.

Across the country, women’s choices about where and how they give birth are being reduced. Midwifery-led units are closing, home-birth provision is being withdrawn, and continuity-of-carer schemes scaled back. Although national policy promises access to a range of birth settings, local provision increasingly fails to deliver it. Given this reality, it is difficult to sustain the argument that maternity care is unduly influenced by a commitment to ‘normal birth’. For many midwives and families, the system appears to be moving in precisely the opposite direction.

You also mentioned pressure. In my experience of more than four decades in practice, I have not witnessed pressure in relation to this ‘normal birth ideology’ (if this is what you were referring to). Instead, I hear daily from families and maternity staff who describe women feeling pressured into interventions they didn’t want. This reflects the findings of Baroness Amos’ independent review as you will probably know.

Where harm has occurred because of delays or failures to provide necessary treatment, it is inexcusable. But the reasons behind these tragedies are complex and deserve careful consideration, such as racism, toxic workplace cultures, workforce shortages and chronic underfunding.

I wonder if you would take time to read this article by eminent obstetrician Neel Shah. Dr Shah lays out clearly England’s maternity landscape in one article, and reflects on the global impact.

Women’s hopes for an ‘ideal’ labour and birth should not be treated as a threat to safe maternity care. Choice and safety can, and must, go hand in hand. Your record of championing maternity rights demonstrates what determined political leadership can achieve. I would welcome communication, if you have time, on how the Government intends to move beyond repeated reviews and deliver meaningful change - ensuring access to safe, supported physiological birth while providing timely intervention for everyone who needs or chooses it. A high-quality maternity service must be capable of offering both.

Warm regards,

When I consider the detail of this review and the other reports from reviews from England, my heart sinking further each time, I think about my years as a midwife in clinical practice, leadership and management positions and I recognise some of the scenarios. Toxic working environments, intimidating hierarchies, bullying, staff shortages and defensive practice – all made worse with increasing fear.

As a leader and manager I was often conflicted which caused enormous stress – alternating between listening to midwives in clinical areas struggling and distressed due to workloads and lack of staff to give appropriate care, then attending high level departmental meetings where when articulate the desperate need for more midwives, I was told savings had to be made. I remember coming out of one meeting where the finance director, a young man on a determined career pathway but also full of fear needing to meet the cost savings – suggested we freeze midwifery vacancies. I eventually left the meeting and cried in my car – because, with some courage, I had challenged him with a hypothetical scenario asking him how he would feel if there was no midwife to answer an emergency buzzer to attend to a family member of his. The room went quiet and I was given some disapproving looks. In my car I felt helpless, and it was only when the senior neonatologist saw me and came to comfort me, approving of my interaction – did I feel any sense of worth. This was just one instance.

Also, being bullied, even as a head of midwifery, and taking refuge in the office of the hospital’s medical director (also a senior obstetrician) was a regular occurrence. How can this be safe?

I did experience the opposite, however. I was lucky to have inspirational role models during my time in the NHS - who taught me the fundamentals of compassionate leadership without even knowing it. Strong, courageous and authentic leaders who transformed local maternity services when they were in the position to do so.

I must mention I worked with and managed staff who should never have chosen a caring profession. Clinicians who delivered poor care or had difficult attitudes - which was always a challenge. But the majority of maternity care workers wanted to care. Problems can arise when staff are overburdened and exhausted and when they can’t do the work they are qualified, expected and want to do. When they raise concerns and they are consistently ignored. This is moral injury, and when combined with excessive scrutiny pressures on the workforce increase. Gemma Stacey, Professor of Health and Care System Resilience, acknowledges this explaining why there is a need to address these issues as well as clinical failures if we want to make maternity care safer.

One of the first things I did after taking retirement from my position as head of midwifery was to collaborate with Soo Downe and to co-edit the book, The Roar Behind the Silence: Why kindness, compassion and respect matter in maternity care. In the book, readers can find the same challenges highlighted as in the reviews – with evidence based-solutions. But reading books, and reports, doesn’t always translate to action.

Before I end this post I want to share this with you. I remembered last evening that I wrote to the Secretary of State for Health in 2007. I found the email, and the reply so I’ve included the correspondence below. Obviously it didn’t have the intended impact but I wanted to demonstrate the fact that concerns have been raised at the highest level, for decades. By many.

From: sheena byrom

To: PatriciaHewitt

Subject: Clinical sounding board

18/03/2007 20:33

Dear Secretary of State,

I hope you are well. I have pondered for several days as to whether to send this email to you, but as you continually encourage clinical members of the sounding board to contact you with any issues, I have made to the decision to go ahead.

I have worked for the NHS since 1974, and been a practising midwife for most of that time. I consider myself, above all things, to be a positive, forward thinking health professional with a great pride in my work. Although very small in scale, my achievements have contributed to maximising opportunities for mothers, midwives and communities towards reducing health inequalities at a local and national level, and for these reasons I was nominated on two occasions to meet with the Prime Minister in 2004.

In addition, the senior manager of our maternity services (now retired) was awarded an OBE in 2005, for services to midwifery. I supported this colleague in her quest to provide woman centred maternity care, driven by national policy and local need.

I begin with these details to offer you a brief insight into my background; it is a very rare occasion that I complain, always working on the premise that there are solutions not problems.

However, I feel compelled to express my genuine concerns to you, in my duty as a member of your Clinical Sounding Board.

On the eve of the launch of the maternity services delivery plan, I am seriously concerned about the impact of financial constraints on maternity services as a whole, as the service continues to be relentlessly pared down to save money within many trusts. Although it is fair to say there may be some regional variations, the pictureis resonating throughout most of the country; I liaise closely with consultant midwife colleagues and heads of midwifery. Midwifery establishments continue to be reduced and then further reduced, which I fear is increasing the potential risks for the safety of mothers and babies. In tandem, the profession is losing both experienced andnewly qualified midwives, which is damaging in the short term and poses serious questions for the long term.

It appears to be the same story, maternity services are being used to make savings, as they exist with no specific targets and within acute block contracts. Midwifery numbers are calculated along side nursing establishments in reducing hospitals beds, to the detriment of community activity such as ante and postnatal care, in addition to delivery suite. Locally, my colleagues and I are pioneers in working differently, aswe do not believe the midwife must provide all aspects of care. We have facilitated the expansion of health care assistant roles, and developed mechanisms where local community mothers are providing breast feeding peer support. The latter has been positively recognised within national fora.

But fully qualified midwives are essential for more aspects of care, and given the enormous potential of midwifery services on the future health of the nation, I respectfully offer you my view, expertise and experience in these matters in the hope that these desperately worrying trends can be reversed quickly before it is too late.

With warm regards,

Sheena Byrom

Consultant Midwife

East Lancashire Hospitals NHS Trust

From: <patriciahewitt@dh.gsi.gov.uk>

To: “sheena byrom”

Sent: Thursday, April 26, 2007 9:13 AM

Subject: Re: Clinical sounding board

Dear Sheena

I feel very guilty indeed not to have responded rapidly to your very thoughtful and worrying e-mail. My only plea in mitigation is that I wanted to reflect properly on what you had said, rather than send an immediate response ... and as other things overtook me, I completely failed to do the actual response. Please accept my apologies - you must have thought me very rude.

I share your worries. Indeed, it was because I’d heard at least some cases where midwifery staffing numbers were being squeezed that we decided to include in the Operating Framework for 07/8 the need to plan ahead for the Manifesto commitment on maternity. We will need to look carefully at the workforce survey, which will be published tomorrow, to see what happened in the year to September 2006, and then use the Maternity Action Plan and Operating Framework to focus particularly on those parts of the country where staffing problems are worst.

I was very interested in what you said about using a wider range of professionals - and community mothers - to deliver services. But of course all this has to be led and supervised by qualified midwives, who also have to be available to provide the care that only a midwife can provide.

I do hope this is of some help. Once again, please forgive me for the delay in replying. Do come back to me with further comments (and do feel free to call me Patricia!)

thank you for everything you’re doing, and for being part of the sounding board.

Best wishes, Patricia

Final note - Anna and I believe we must keep focusing on and speaking up for appropriate investment, using the evidence where we have it (such a midwifery continuity of carer) staff wellbeing, leadership support, strengthening family feedback and involvement, learning cultures with no-blame litigation.

What are your thoughts?

I had to write to you because I’m stuck in a place where I’m a bit lost without you. You remember how I used to leave you voice notes to get things off my chest? I find myself listening to advice you’ve given me in the past, on WhatsApp, when you’ve responded to one of my rants when I feel vulnerable or there’s been an injustice. Your carefully thought out nuanced advice. Sensible and compassionate, and fiercely articulate when there was an injustice. We communicated at least twice weekly and yet we didn’t see each other at all for many years.

I missed your funeral Maddie, and that was awful - but I’m still away in our camper van - this is our last week. You knew I was away as weWhatsApp-ed right until the day before you died - sometimes your message was just (not ’just’) a heart. I loved seeing your name flash up on my phone. I heard from your loved ones that the occasion was just beautiful, just as you would’ve wanted. A farewell to you, I still can’t believe it.

I’ve just left Lisbon, Anna met up with us and we’ve been exhibiting and speaking at the 34th Triennial Congress of the International Confederation of Midwives (mouthful, right?) Honestly, you would’ve loved it. 300 midwives from more than 120 countries, and there were doulas too - all with the same passion for birth. I couldn’t take it all in a times, so much love and hugging. Our stand was like the hugging station! Some of the midwives knew you Maddie, there was one older midwife, like me, from Cambridge who was particularly close to you. Just imagine that! I was able to talk about you, and I’m sorry I cried a bit.

I gave a talk about our Midwifery and Maternity Birth Collective, and Anna about continuity of carer. I was SO nervous, in fact in the morning I nearly chickened out. Anna had to give me a firm talking to, and then I did it, and now I feel pleased.

Maddie, I want to tell you about Katie and Becky. Your special friends who have, through their own distress and grief, been so kind to me. I made a mistake recently and caused someone to feel angry with me. It was totally unintended but I understand the impact. You see I was needing someone to talk to - to tell how triggered I’d been about an incident, and it was the wrong thing - I chose the wrong person and it was insensitive of me. Katie has been helping me, like you would’ve done, to understand responsibility and regulation of ourselves and others - about how we show up. I can’t tell you how supportive it’s been for me. I am grateful that through you they are now in my life. Beautiful Nikki and Laura too - and of course dear Kay who feels like she’s always been there.

I will be forever grateful that we got to spend those precious few days together Maddie, in Norfolk. That I was able to share a bedroom with you (what an honour) and you allowed me to give you a gentle, loving massage or two in the early mornings. You see, for me, that was everything. I hadn’t seen you for a decade, yet immediately we could share an intimate sleep space. How lucky am I.

I wrote a blog post about you Maddie for our All4Maternity website. I want the world to know about you and how fabulously clever you were - we’ve made all your articles and blogs open access and added links to your other writing spaces too.

How grateful I am that you took time to write here too, sharing your insightful poetry that will live on and continue to soothe and guide us.

I will keep writing to you my dearest friend and I’ll tell everyone I meet who never had the pleasure of your love, what a legend you are.

My deepest affection - She She ❤️

PS Anna reminded me that you sent me this message f my 70th birthday, last November. I’m going to keep it here then I can be reminded of our special friendship.

As children we were always taught that bragging was a BIG NO. The same for any kind of self-proclamation of success or promotion (ie telling others). I was born in 1955 - my parents were humble and kind and we were brought up as Roman Catholics. Another reason for humility, penance and reaffirming GUILT.

Later in life, as a nurse and then midwife working in the NHS, it was never wise to shine. ‘Who do they think they are?’ was a retort often heard if someone did something well and attracted attention. Jealousy at its finest and learned behaviour. So if you were singled out in a positive way, you sure kept it quiet.

Then came social media, where folks share their achievements and awards of all kinds - and I think it’s liberating. My eldest daughter Anna, who is a midwife and educator, and I, in our talks to midwives and students, encourage delegates to lift up each other. When we see someone excelling, to support and encourage them - stand in their light and feel the glow. I believe it is the antidote to the global turmoil we are in currently, where on social media criticism brings more attention, more ‘likes’ and followers - creating media storms and pile-ons.

Brene Brown talks about this in her books and a podcast episode Strong Back, Soft Front, Wild Heart - have a listen. Brene (talking about social media) says people group together even if they don’t know each other - but they feel close because they hate the same people. She calls it common enemy intimacy. For example ‘I don’t really know that much about you, but we hate the same people, so we must be connected’. Brene says it’s just a counterfeit connection at best. I see it all the time - someone makes a mistake, or does something another person dislikes, and it’s all hell let loose. I find it hurtful and harmful - it’s happened to me on several occasions, and I wrote about it here. For Brene, she received death threats and harm to her children. It’s outrageous.

So if we share love and celebrate positive actions and encourage those who are what Brene calls ‘Standing in the Wilderness’ hopefully we can create a shift, HOPEfully.

Being humbly proud of something is good, but how come I still find it hard sharing it? I do it, but I always imagine people saying ‘who does she think she is?’

This week I received a text informing me I had been awarded a Vision of the Future Award. I couldn’t believe it and had to read it several times. Felling the feels, I only shared it with certain members of my family - the ones I felt sure would be happy for me. The day after I posted about it on Instagram - still doubtful - I did it for several reasons. The main one, I have to admit, is that I felt and still feel proud. Proud although overwhelmed and shocked. It was totally unexpected. I also wanted to spread some good news, to hopefully inspire other midwives to keep going - because even through adversity and vulnerability there can be light.

Here is the award being announced by Paris Tempest of Broughton Sanctuary (see photo). I’m adding it here for my children’s children, in years to come.

What I your thoughts? I know this is a personal thing - we will all feel differently.

Thank you for reading,

Love Sheena ❤️

‘Thumbing it’

Travelling long distances means we talk about all sorts - current affairs and times gone by. We saw a walker on a busy road, hitching a ride. Paul actually travelled this way most of his early and mid youth - in fact he and his older brother Stephen (RIP) hitched rides all the way to France and back when they were 15 and 15 respectively. No money for public transport meant this was the only way to get places. Not a common phenomena these days….have you ever ‘thumbed it?’

It got us talking about the potential dangers of jumping into the car of a complete stranger, especially for women. Is it worse now than then? Or is it that we hear about it more when things go wrong? Are we living in a more risky world?

Babies sleeping, outside?

We started thinking about the other things we used to do that have been completely abandoned in today’s world. In the 1970s and 1980s we would put our babies outside, all weathers, in their prams to sleep. They were big prams where sleeping was comfortable - baby all wrapped up in winter and with a cat net covering the opening. And they slept - all that fresh air! We left them outside shops whilst we purchased goods - never gave it a thought that the baby may be taken - it was a common site to see little ones parked up on the hight street. Perfectly normal. Apparently they still do this on Scandinavia countries, despite the cold. Why do you think it’s not acceptable in England?

So much has changed in our lifetime and we tell our grandchildren the stories as they roll their eyes. Playing outside as young children was just ‘normal’, coming home for meals only, and at bed-time. It was freedom for sure. More updates soon, I want to tell you about my hour live on Instagram with Davina McCall this week, about Paul crashing our camper and our experience with the mechanics, and my online talk next week to midwives in Greece.

Thank you for reading my post - I love writing and appreciate you. Have a great day 🌸

Our first taste of Greek camping was delightful - we’ve started a scoring system based on location, facilities, friendliness of staff and price. This one was an 8/10 for sure. And we met lovely people as a bonus - those you’d like as friends. They, the people we met, are seasoned Greek campers and told us that rustic is the word the facilities. I get that - basic, as outdoor as is reasonably respectful (shower blocks that is) but clean clean. Well, so far, so good…..

The second site was different and here lies a tale. Heading along a country lane following Google maps to the chosen location when we came across a middle aged man on an old Vespa - he was blocking us from progressing where there was a fork in the road. One way to our site, the other to, it turned out, his work place…..

My over active and suspicious mind immediately concluded we were doomed - being ambushed for passports or money or both - until it became apparent he wanted us to follow him to a different camping ground. ‘I’ll give you a good price’ he promised. 25 Euros a night. We weren’t sure whether that was good or bad without seeing the place - and we soon found out. The location was exquisite - right by the sea and we chose a spot to pitch overlooking the turquoise ocean. The facilities, on the other hand, were grim. More than old and unkept it was hard to understand how everyone around us from all parts of Europe seemed to accept the state of the sinks, the many stray cats and total disarray. We decided we’d need to get used to it too - welcome to Greece! Well all went well (apart from the noises in the night, see below) until we were leaving. The same ambush man was behind the desk as we went to pay. PB asked for the bill and when it was presented so was the demand for cash. 50 Euros. But we didn’t have enough cash - so we wanted to pay with cards. This is when this man changed his whole persona and became angry - demanding cash due to the ‘good price’ he had given us. We explained they he hadn’t stipulated that when we arrived - ‘I forgot’ he said. We apologised, and he got even more angry and made a phone call where we could hear more raised voices. It must’ve been his boss, we thought. As we drove away, a bit disappointed with the aggression, we guessed he was on commission for cash bookings and probably in trouble. For us, lesson learned.

Another lesson came our way the night before, when we were woken around 1am with a rhythmic beeping noise - like a smoke detector. It seemed to be a distance away from our camper so we presumed it was someone else’s problem. Not ours. Neither of us could settle back to sleep and when the noise got louder Paul got up and started to look through the cupboards. He emptied them all - and we sleepily scratched our heads. Eventually PB went outside with his phone torch to investigate - when he shone the light on the right ride or the camper the noise stopped. He walked round to the other side and it started again. That’s when we thought it must be a creature and proceeded to quickly close the skylights! I Googled the incident and found out it was a Scops Owl - listen here! Apparently common to Greece, as many other parts of the world. Have you ever heard them?

Last November I celebrated my 70th birthday. My Goddaughter Francesca gave me a journal, a gorgeous yellow book with my name on the cover. This is the third journal given to me and I’d love to boast that I’ve filled them, with the adventures and thoughts I experience. I have good intentions - start - then forget. I guess it’s because I’ve never been disciplined with journalling. Well I brought the yellow journal with me and decided to log our travels - so I can look back and remember. Or maybe my children or grandchildren may find it interesting, or not. I’m sorry to say my handwriting has deteriorated so much…is this because of technology or age? Do I need to write more? I used to pride myself in my handwriting.

I’m sat writing this in the western Peloponnese area tucked in behind a bush next to our van to shelter me from the sea breeze which is wild today. It’s sunny, and there’s a cold beer calling….

...those using maternity services are able to choose a Caesarian birth in the NHS, but not able to have a physiological birth (when they want one).

…that the decades myself and others have fought hard to promote choice in place of birth, ie home and birth centres as well as hospital, are seriously under threat. All those minutes, hours, days, weeks, months, years. Makes me so frustrated.

…that more and more women are so fearful of maternity services that they choose to give birth at home without support (no judgment)

…that England and the UK were renowned globally for their standard of midwifery practice. Now other countries are looking on and asking ‘what’s going on?’

…that there are are individuals who are portraying midwives as the being part of of a ‘normal birth at any cost’ rhetoric which is causing untold harm in so many ways.

…that midwives feel anxious about telling others what job they do 😢

…that student midwives have to pay to be educated and to work, and then there are no jobs for them

…that there would be a mass exodus of midwives…

What do you say?

By the way - I’m not giving up.

Sometimes I feel like the food police, particularly with my family - but I find it mind-blowingly bonkers that there is so much rubbish (not food) being sold in shops and seemingly at every opportunity where people are.

I remember 20 years ago, in my post as consultant midwife in public health, writing a paper to present to the hospitals (Trust) Board highlighting the fact that the snack machines throughout the building were full of sugar and fat laden snacks and drinks. There was even one in the bariatric clinic - directly facing the people waiting to discuss their weight problem. My proposal to my bosses included a switch to healthier options such as fresh fruit and water.

I didn’t know as much then as I do now- I’m interested in both the science of ultra-processed foods and the commercial strategies that drive their development and marketing. I’ve learned loads from books and online content too, and I see there are more and more moves to raise awareness and lobby government.

What happened to my plea to exchange those hospital snack machines full of unhealthy products? It was turned down. A healthy alternative wouldn’t give the same financial return. It beggars belief.

I visited the same hospital last evening and the snack machines are still there - though I did notice some water.

Let’s encourage such people to be sicker even though we don’t have the capacity to treat them.

I know that’s a simplistic viewpoint - but it’s real. It’s a public health issue.

Last week I relented and bought my grandson some BLUE sweets as he was looking at me longingly - and normally I say no. We were in a discount store - and the woman serving told me how she thought all the ‘stuff’ for kids, like what I was buying, should be banned.

She said ‘In 20 years time there will be revelations about the harm this rubbish is causing to us all’.

I agreed, yet I was giving this rubbish to my own family.

OK I’m not perfect and I eat some UPFs too, I love crisps and nuts when socialising and I try not to be too purist. But as I learn more from folks like Chris van Tulliken I feel the constant urge to tell the world. And to eat healthier. I wish I’d known what I know now, during my early parenting days.

I’d love to know your thoughts…

We have a midwife crisis. Imagine putting your life on hold to follow a dream to care for others, that means sacrifices such as having less money to feed your family, working stressful 12 hour shifts whilst studying for a degree - and then no prospects at the finishing line. Just disappointment, disillusionment and debt.

Now imagine one of your family, someone you love dearly is giving birth to a much-wanted child. Imagine she has poor care mainly due to the lack of midwives available to give her the attention she needs. Imagine when she is at her most vulnerable moment, in labour, the midwife has to leave her to attend to another person in her ‘care.’ Your loved one suffers harm, both physical and psychological, imagine that. It would be your worst nightmare, right?

This is reality, right now, for student midwives about to qualify - in fact, for many who are already newly qualified midwives. They are DESPERATELY needed, yet they have no jobs. Please read more about the crisis here - and sign the petition if you can. It is SO important. I protested with the students in London, and I will be with them tomorrow in Manchester. I’m taking two of my grandchildren.

Being an activist is in my blood - campaigning for injustice is always on my mind - so knitting helps me to relax and keeps me grounded! I’ve been an avid knitter since my early parenting days - I made hand knits for my youngsters, always looking for unusual patterns (loved French Phildar). Now I knit plain blankets and dishcloths… this is my latest creation - it’s massive, and I’ve almost finished.

To keep my mind busy, I’m learning new skills - becoming a Weleda advocate (more on that in another post) is exciting and I’m learning Italian with Duolingo. I already speak some French and it would’ve been easier to pick that up - but Italian is my favourite language so I’m keen. We’re off to Italy in our camper van real soon, so I’m looking forward to practising more.

And lastly - I love Wordle. Emma Lee-Potter (a wonderful journalist who I had the pleasure of caring for 20 years ago) gives an overview of the word puzzle in her last post and asks readers what their starter word is. Mine is AUDIO. What yours?

I want to say - thank you for following me here and reading my words. It’s lovely to see your comments and messages, I appreciate every one of them.

Have a great week….

In 2015 The Roar Behind the Silence: why kindness, compassion and respect matter in maternity care was published, edited by Prof Soo Downe and I, bringing together 50 chapter authors. One of the chapters, Not All Obstetricians, written by consultant obstetrician Alison Barrett, is a revealing account of how maternity systems are grounded in patriarchal values, how mothers and babies, and female employees (mostly) are regarded as being at the bottom of the hierarchy. Dr Barratt finishes her chapter by telling the story of being subjected to verbal abuse as she left the hospital after being on call and attending an emergency in the night. In haste and without realising, she had parked her car in the space reserved for a consultant paediatrician, who couldn’t then park his car the following morning making him late for a meeting. As Alison reflected on this incident, later at home, she considered how she must have appeared - her old car, her worn clothes and smudged makeup, and that perhaps The Consultant had treated her this was because he thought she was a midwife. Alison mentions The Birth Wars, a book by Mary Rose McCall -about the conflict between obstetricians and midwives and wonders whether her grandchildren, if reading it, will consider which ‘side’ she was on. Alison didn’t want to be pitted as a ‘bad guy’ of which she says, there are far too many. Due to the patriarchy.

I am writing this blog as a long-form response to the consistent attack on UK midwives - a multi-pronged attack, particularly in England. The negative mainstream press, blaming midwives for all that is wrong in maternity services has been apparent and increasing during the past ten years and more. The ‘Cult of Normal Birth’ where midwives are charged with pursing ‘normal birth at any cost’ are both highly politicised terms - the latter taken from a statement in the Morecambe Bay Report in 2015. Midwives, ‘pushing’ birthing women and people into having a ‘normal’ or ‘natural’ birth appears to be the root of all evil, according to the press and prolific commentators on some social media platforms, notable X. I have never witnessed this in my extensive midwifery practice - and yet if families have suffered I acknowledge that it is beyond unacceptable. If midwives were doing this, it has been highly unsuccessful. Birth interventions are at an all time high, and student midwives are struggling to reach required standards for qualifying due to lack of exposure to physiological births. I am well aware that midwives, doctors and others working in maternity services, for a variety of reasons, make mistakes. When this happens, there must be accountability. But creating a media storm portraying midwives as deliberately coercing women into something they don’t want, when the evidence tells us most women want a physiological birth, is misleading to say the least. The harm this causes and has caused is playing out right now.

Hold this point for a moment. I’d like to now introduce you to something else.

On Instagram, there’s another perspective being deliberated. On this platform, midwives are being labelled as coercing parents into having unnecessary interventions - the opposite ‘side’ it seems, to the narrative elsewhere. Now there may be an element of truth of course, as most NHS midwives are working in extreme conditions - the conditions already highlighted in the various reports of reviews into failing maternity services. Toxic cultures, burnout and moral injury, lack of time and resources and inability to practice midwifery. Most midwives are fearful and constrained in their ability to change the way they deliver care - and they are literally only just surviving. Many, very many, have left. The ones who remain, in my opinion, need support in bucket loads, they deserve to be supported to work in safe environments, to have the time and space to care for their precious charges - new families. What they definitely don’t need is more harassment and blame for what is a political issue - blatant underfunding and dismissal leading to institutional harm. It saddens me to see our colleagues, other birth workers diminishing our profession too - I am a believer in learning to try to understand others points of view. This criticism on social media, on Instagram, will not make the service safer, or help midwives to improve. I am afraid it potentially increases fear and disillusionment. I see midwives responding online, under stably being defensive and saying not all midwives. They are trying to protect themselves, and they are quite right, not all midwives - we are not an homogenous group. My mission is to encourage us to be united, to move together in the same direction. We all, I believe, want to enhance the experience and outcomes for birthing mothers and people, and their babies?

There is much written about this already - this growing unease about the loss of midwives and midwifery in England, and increasingly the UK. Imagine a country where midwives were no longer autonomous, where the choices for women were diminished and our practice was diminished to obstetric nursing. Midwifery in the UK was the envy of the world - seen as gold standard - now our global community is watching with puzzlement, and horror.

Well I’m not finished fighting. I don’t like that term, fighting. There’s too much of it already, for the wrong reasons. Alas I have turned to the notion of fighting for what is right, against the injustice and to hold on to what is ours, midwifery practice.

I would like us to be unified, with families, with our colleagues, obstetricians, doulas, birth educators, maternity support workers, anaesthetists and ALL who strive for better maternity care. I am fighting for that. And for midwives to practice midwifery.

Who’s with me?

This photo is one taken in Norway in 2022, snapped by birth photographer extraordinaire Eva Rose. Paul and I visited her home in our camper and we were enthralled by the majestic mountains.

Climbing to reach this spectacular vista was a struggle - I was (and still am) unfit and I have drop-foot, the consequences of a back injury several years ago. The effort to take each step was made easier by the loving encouragement of Eva Rose, her husband OJ and mine - they held me all the way. They pulled me up at times!

Similar effort has been needed to write my second memoir - I’ve needed so much encouragement and support even though I’ve wanted to do it for years. Latterly, the guidance and mentoring has come from friend and fellow midwife Amity Read - so now I’m on my way and my book proposal has gone to a potentially interested publisher. I am waiting. Yikes.

In the meantime I’m seeing posts from others who are self publishing and it’s got me thinking. Then I need to look into the alternative and explore pros and cons - until then I thought I’d ask you - this wonderful writing to community. What do YOU think?

I’d love to hear from you,

The last post I wrote was in December shortly after my dear sister died suddenly on Christmas Eve. Sue lives, or lived, in the USA. Since then I’ve been in deep grief - with her beautiful family at the funeral, with my others sisters and our partners. Although Sue was terminally ill her death was unexpected. Though she had prepared everything, letters, long discussions- she planned for the void she was leaving which was comforting when we huddled together.

Her three daughters, and husband, participated in her funeral service - their tributes were deeply meaningful and filled our grieving hearts. Here is what Vanessa, the youngest daughter said.

‘After my mom’s cancer diagnosis, she read “The Last Lecture” by Randy Pausch. Randy wrote this to capture his life lessons before he lost his life to cancer at 48. My mom was really inspired by it and started to document her own lessons for my sisters and I, and for our kids.

She never finished her “last lecture”, but she had spent her life teaching us. So today I’ll do my best to represent 3 lessons from mom:

• Focus on the positive

• Do good for others

• Get on with it.’

Vanessa elaborated on each point - and it was heartwarming as well as heartbreaking- Sue was guiding us even in her absence.

On the first lesson - ‘Focus on the positive’, Vanessa said:

‘The most incredible version of this was after mom’s stage 4 cancer diagnosis. She wrote about it at the start of her draft lecture:

“I find self pity very unhelpful, so I started to think of all of the things I would avoid by having this diagnosis:

• Alzheimers

• Nursing homes

• Surgeries

• Root canals

And the list went on. When I finally shared this with my family, we were able to laugh and begin a new way to cope”.

I love these lessons. They’re mine now too and I’ve used them already.

Rest in love Sue. I miss you…❤️

It’s 7am on the 28th December 2025, and we’re just leaving the Netherlands - it’s been special spending some of Christmas with you, in your country. I’ve been thinking about you a lot, and how you were there when I got news of the unexpected death of my dear sister Susan, on Christmas Eve. You heard my cry, my distress, and although you’re not a stranger to bad news like this, it must’ve been hard for you to be next to me at that moment. I didn’t get chance to say goodbye to you, but I lay on the bed in the dark for hours, and when your message lit up my phone, I knew you understood. It meant the world to me and was comforting to think that you cared. Thank you.

I want to tell you about Susan (Sue), my sister. I thought I’d do this by letter - because writing letters is something Sue did to my parents, when she moved away from home in her late teens. No cell phones then, and house calls were hit and miss. How we loved those airmail letters - look them up if you ever get time.

I hope all our grandchildren will read this special letter too, but I’m addressing it to you because of your connection with the news of Sue’s death, as my eldest granddaughter. I really want to pass on some of Sue’s wisdom, her courage and her unique spirit for life, and passion for learning.

So a brief introduction. You probably know I’m the youngest of five girls. My amazing sisters. I’m sat here on the laps of Anne and Lynne, Lynne (on my left) was the eldest and she tragically died in 1983, aged 40. I’ll tell you about Lynne another time - I think she was the gentlest of us all and we miss her every day. Susan is far right, and next to her is Eileen. We have always been close Minnie, like one person really - we are similar yet individual - and the bond we have is like a stitched seam. Our partners/husbands all liked each other which was a bonus.

About Sue. I am eight years younger than her so my early memories of her presence on our home are blurred - I can remember her having the ‘box’ bedroom at home (it was tiny) once the two elder sisters had left, and she was obsessed by the Beatles. Paul McCartney posters adorned her walls and she played the Rubber Soul album (called an LP) continually on a small blue record plater. I still know most of the songs off by heart, they are etched in my musical memory!

Our parents bought a bakers shop when I was nine (we lived there too), and I was left to my own devices most days - but Sue recognised my situation and tried to encourage and influence me. She took notice and was interested which was lovely for me. One of the highlights was when Sue took me to the Bronte Parsonage Museum, in Haworth, Yorkshire. Have you heard of them Minnie? Maybe you recognise the books (and films) Wuthering Heights and Jane Eyre written by the sisters? Check them out if you don’t know them. Sue didn’t just take me there on a bus, she bought me a scrap book and memorabilia such as postcards and supported me to write about the sisters and family - something that sparked my interest in literature at such a young age. This might not seem signifcant to you, given the easy access to knowledge today - but in my time it was remarkable - my parents weren’t well educated - they were busy and hard working, and we didn’t have access to books, novels, never mind encyclopaedias. Education wasn’t a priority in our household, but Sue brought it in. Sue left home when I was 10 , she went to teacher training college in Liverpool, and she never lived with us permanently, again. But during the summer breaks Sue came home and stored some of her teaching aids in a bedroom cupboard - many of the items I’d never seen before, models of coffee beans and exotic vegetables, so she spent time talking to me about them, patiently.

Sue also travelled in Europe hitching lifts and sent us postcards of the places she visited - she took a job as a chambermaid in Windsor Castle and eventually went to work in Bermuda. You may be thinking, so what? I know these things are common place now, but in the 1960s and 70s it was highly unusual for working class families to have adventures like this. Sue wanted something different and she went to find it.

Minnie, my parents, your great-grandparents, had never been abroad, only short holiday breaks in Blackpool, Ireland (where my dad was born) and once in the Isle of Man. Imagine what it was like for them when Sue invited and paid for them to visit Bermuda for a holiday. They took a transatlantic flight (first flight ever) to what they later described as ‘paradise’ - this beautiful island where they were introduced to all-you-could-eat brunches and free flowing cocktails, as well as the unique sounds of steel bands and the waves from turquoise seas. It was life-changing and exciting - Sue and her husband John facilitated all that, opening up a world they never knew existed. That’s what my sister did, she hosted, she shared her life, wherever she lived. After Bermuda Sue and John settled in the USA, and each one of our big family (it’s a lot!) has had the opportunity to spend time in her home and to have had the pleasure of getting to know Sue and John, and their daughters and grandchildren. It came natural to Sue to share the knowledge she had about her current residence, wherever that was.

Sue was my first teacher. and she carried on throughout her life. It was more the way she was than the opinions she had or advice she gave. Even when Sue knew she had a terminal illness, she showed us how to be, role modelling with a positive attitude and acceptance. Minnie, when I visited Sue and John in September this year, Sue talked about dying openly and calmly, encouraging me, and Paul, not to be sad - or at least - no dramas. She told us she wasn’t afraid of death but of dying - she didn’t want a challenging passage - and that wish, to some extent (I think) was granted.

I can’t believe Sue has gone. My steadfast, brave, funny, generous sister. It feels unreal right now to think I can’t send her a message, that she won’t respond in our sisters’ WhatsApp group. ‘Where are you’, I keep asking? I am picturing her with Lynne, and being in our mum’s arms. In the early years of her time living in Bermuda, mum used to cry when Sue left after a visit home - she would play ‘When Will I See You Again’ by The Three Degrees whilst the tears flowed. It helps me to think of her this way.

I wish you’d known my sister, Minnie - and that she’d gotten to know you too. You’d have loved each either other I feel sure. Sue was always interested in hearing about what you were up to, and Quentin, and all our grandchildren - Seamus, Prizma, Betsy, Archie, Myla, William and Paul.

At least now you’ll understand why Sue’s death is leaving a big hole in my life, in all our lives. We loved her so.

And when great souls die,

after a period peace blooms,

slowly and always irregularly.

Spaces fill with a kind of soothing electric vibration.

Our senses, restored, never to be the same,

whisper to us.

They existed. They existed.

We can be. Be and be better.

For they existed.

Maya Angelou

These last photos were taken eight years ago, in Bermuda again…when we went to celebrate Sue’s 70th birthday. We surprised her. Sue is the one with the hat.

Mum often told the story that Nurse Heselton would smoke cigarettes while ‘delivering’ babies, including my siblings. Beyond that, we knew very little. But when a friend recently asked if I had any idea what had happened to her, my curiosity was sparked.

The librarian kindly offered to do some digging and later emailed me with a few leads from Ancestry. One entry by a gentleman called Ray Buck seemed particularly promising he said, and he sent me a link to Ray’s Facebook account. It felt like a long shot but I reached out to Ray on Facebook Messenger and to my surprise and absolute delight, Ray turned out to be Nurse Heselton’s nephew.

Ray seemed warm and generous with his time when he communicated with me, eager to share stories of his Aunt Madge (as he knew her). He also revealed that he still had some of her midwifery birth registers, documents once legally required of midwives (including me) as well as some of her medals.

I told Ray that I, too, had been a community midwife in the same town during the 1990s, supporting women to give birth at home, just as his aunt had done decades earlier. I hoped the connection would mean something to him.

After several exchanges, Ray kindly offered to gift me these precious items. At 84 he was happy that the memorabilia would be valued, cared for, and preserved as part of both local and midwifery history. I couldn’t believe it and was absolutely thrilled.

On 14th August, Ray carefully packed the items and sent them via Royal Mail, tracked, from his home. I waited eagerly for their arrival.

But it’s the 1st September and the package still hasn’t reached me.

Both Ray and I began searching desperately for answers a couple of days after there was no sign of the parcel. We discovered I had given Ray the wrong postcode but only one digit out. Still, the correct address was written clearly, and the tracking system continued to show the parcel was in Preston sorting office.

Trying to get answers from Royal Mail was disheartening. After an hour waiting in a line to speak to someone on the regional helpline an employee unhelpfully told me the parcel would eventually be sent to Belfast, even though Preston is just just 30 minutes from my home. I asked her if I could collect it. No. It had to go to Belfast, and it would take time. Once in Belfast, in time, the parcel would be opened and Ray would have to provide a clear description of the content. ‘How would he know when it was opened?’ I asked. He would need to keep checking the RM website with the tracking number - I was informed.

In desperation, I visited the Preston office myself on the 20th August. By some stroke of luck, I met Fiona, a member of staff who truly cared. Once she heard the story, she went out of her way to try and help, doing all she could to trace the package. Sadly, even her efforts haven’t yet thrown any light on the problem. I have to admit, Fiona is the only person so far who seems bothered about this dilemma.

I shared my plight on social media. On X (Twitter) where I have a significant following, I posted and tagged the Royal Mail account and received a glimmer of hope when someone (Ryan) asked for details - though I was almost scammed at the same time by a fake account. On Instagram, one of our local MPs picked up the story from my stories and contacted Royal Mail’s CEO who got in touch with me. However, On the 29th August he informed me via email:

“We have investigated this as fully as possible and regrettably, we are classing it as lost. It could still turn up or be returned to sender but at this point, that doesn’t seem likely. For that reason I have offered to make a payment as a gesture of our goodwill.”

The compensation offered was £150.

No amount of money can replace what was inside the parcel. These were unique, irreplaceable pieces of midwifery history; documents lovingly preserved by Ray and his wife across decades and house moves. They represented not only a professional legacy but also a deeply personal family story.

For Ray and his wife, the loss is heartbreaking. For me, to say I am disappointed in Royal Mail’s handling of this situation is an understatement. How can a tracked parcel simply vanish without a trace? Someone must know where it is.

I have written this blog post in an attempt to reach out to more people - to share our story far and wide. Perhaps someone, somewhere, will read this and know what happened to the missing parcel. I challenge the Royal Mail to prove that they can do better: to search further, to trace this package, and to show respect for the history it carries.

For Ray, for myself, and for the memory of Nurse Heselton, I hope the items can still find their way to me, or back to Ray. Can you help?

It’s World Breastfeeding Week and as I’m responsible for social media activity for our All4Maternity platforms, I had an idea to share this image - it’s me breastfeeding my first born Anna, on the postnatal ward, in 1979. As a point of interest (I think), Anna is a midwife too, and she is the CEO of our company. So here I am - breastfeeding our CEO 😂

It was so different in 1979, and I’ve been reflecting on what I learned (I was a midwife at this time) and what I practised. Brace yourselves. Remember there was no ‘evidence-based practice’

1. Expectant mothers were encouraged to ‘toughen up’ their nipples using a toothbrush (ouch) - I didn’t do this myself, but shared the advice with others.

2. Babies were offered 60 mls glucose four hours after birth as first ‘feed’.

3. 6 hours after birth, baby offered a breastfeed, and for first two days every six hours 3 mins each side on first day and 5 mins on second day. On the 3rd day babies were ‘put to the breast’ every 3 to 4 hours, but encouraged not to let them feed for longer than 10 minutes each side - ‘he must not be cajoled to feed longer than 20 minutes in case over-feeding occurs’ (Myles 1975).

4. A nipple spray was encouraged - something called ‘Rotersept’ (not sure of spelling. It was expensive.

5. Babies were cared for at night in the nursery, separated from their mothers. Often breastfed babies were given formula milk to ‘allow’ mothers to sleep through the night. This, and restricted feeding, frequently resulted in engorged breasts, which were subsequently ‘bound’ with nappy pins and draw sheets. Sleeping tablets were distributed freely to new mothers.

Where I worked, rooming in of babies and demand feeding was introduced in the late 1980s - and caused a lot of consternation amongst staff and the families we cared for. I was one of the few who welcomed the changes - I’d never let my babies out of sight when they were born (I knew that the babies were left alone in those nurseries!), and I fed them as soon as they cried - so went against guidance!

What are your experiences? I’d love to hear….

Today I sat at the side of a local ‘fun’ pool observing my two granddaughters having fun diving around the fake ‘waves’ and hurling down a huge water slide. It was stuffy and hot and the chlorine filled air made my already itchy eyes, sting.

I couldn’t not see the fact that there were so many obese children. At least half of them - though of course I couldn’t be sure of the numbers. Now I know this absolutely does sound judgy, but it made me sad and also frustrated - the busy cafe just feet away was peddling crap (sorry) ultra-processed foods and there lies the problem. There are tons of studies highlighting the clear link between eating a lot of ultra-processed foods and a higher risk of becoming overweight or obese. These foods are often packed with added sugars and calories, but they’re lacking in important nutrients and fiber. AND they’re intentionally made to taste so good that it’s easy to eat too much without even realising it. Kids love UP foods, and parents too - I have a problem being ‘addicted’ to certain foods, but I’m aware and trying to change.

A big part of the problem is with the food industry itself. I’ve learned (and it’s obvious’ that ultra-processed foods are deliberately designed by manufacturers to be irresistibly tasty, with just the right mix of salt, sugar, and fat to keep people coming back for more. These companies often prioritise profit over health, creating products that are cheap to make, have long shelf lives, and encourage overeating — even though they’re low in real nutritional value. In many ways, the widespread rise in obesity and diet-related diseases is less about personal choice and more about the environment food producers have shaped.

I don’t want to preach here, you will all probably know this. But then you may not. So I’m respectfully offering some tips from what I’ve learned, but I have a long way to go…

To deal with the rise of ultra-processed foods, I try to cook more with real ingredients, I read labels more. I don’t buy anything with ingredients I can’t read, or that I wouldn’t keep in my kitchen cupboard. Here is a brilliant app that helps with making healthier choices, and I follow some informative Instagram accounts that give us healthy alternatives to certain foods. Iv’e read this book too which is so helpful.

And last year I was lucky enough to interview a very interesting and knowledgable nutritionalist Rob Hobson. Have a listen when you have time.

So I try to focus less on blaming individuals and judging and more on highlighting the system that makes unhealthy choices the easiest ones. I also keep sharing information with my family though sometimes it feel like I’m being evangelical…and that’s not attractive.

What are your tips and ideas?

So when I received an email from a worried midwife, one of many before it, pleading with me to help, to do something about the diminishing midwife-led care options (birth centres and home birth) on offer for childbearing women in England and the UK, and the rising rates of induction of labour and Caesarean birth, I contacted Soo, and others, to see if we could come together, to take action, AGAIN. Interestingly, these ‘others’, namely Anna and Claire, had had similar calls for help from midwives.

This is part of the message I received - and the same concerns land in my social media inbox accounts almost daily.

‘……am a homebirth midwife and have been for the last 13 years and am becoming increasingly concerned about our profession and the way IOL, csections and loss of midwifery knowledge are increasing. I’m aware that many midwives have tried changing the system and have been burnt along the way, including you. One of the reflections I’ve had is that we don’t have many conferences for midwifery anymore, conferences that focus on promoting physiological birth and all the nuances’.

Luckily and unusually, some of us were in the same part of the country at the same time and were able to meet, to share thoughts and make plans. Here we are. Soo, Anna Byrom, me, Steph Heys, Claire Feeley and Gill Thomson. We agreed we had to do something, at least try. We also made suggestions on who else needed to be involved, and we made a start.

We called the movement the Midwifery and Maternity (MaM) Birth Collective, and here’s what we eventually agreed as our aim, and what we added to an Expression of Interest Form to share with anyone who wanted support, or to be involved in any way:

In addition to the impact of gender, race and social inequalities on maternity care outcomes, there is another pressing concern. We are a group of midwives, obstetricians, academics, maternity care supporters who are concerned about the current crisis in maternity care, particularly around the reduction of midwife-led services and the rising intervention in labour and birth in the UK. Maternal mortality is rising, while improvements in stillbirth and neonatal outcomes remain frustratingly slow. Rates of birth trauma are increasing, and litigation within maternity services continues to climb. The incidence of freebirth is growing, suggesting a lack of trust in existing care systems. Governance structures appear ineffective, failing to address these escalating concerns. At the same time, women are experiencing reduced access to out-of-hospital birth options and midwife-led care. Meanwhile, medical interventions are rising at a significantly faster rate than in many countries with far better perinatal outcomes. Our aim is to enhance safe, respectful maternity care and are inviting expressions of interest from midwives, obstetricians, academics, and maternity care associates who are keen to join the conversation at this initial stage. This collaborative group will provide a platform to share insights, experiences, and evidence in order to better understand the circumstances and contributing factors behind this trend. Together, we aim to identify challenges, amplify the voices of those impacted, and consider potential strategies to safeguard and support midwife-led care as a vital part of the maternity landscape.

After just one week there are more than 250 completed forms, and we have organised the first seminar. It’s tomorrow evening (7th July 2025), and it should be a great start to the movement. Here is a link to find out more.

We’re planning a newsletter to send out to those who have completed the EoI form, and to organise more events during the year. Please get in touch if you have any ideas, or suggestions for us. Everyone is more than welcome.

The word ‘clique’ doesn’t conjure up positive connotations for me, though I understand that ‘clicking’ with others and ‘finding your tribe’ is a human trait that has enabled human existence. I certainly have my tribe of support who guide and nurture me in my personal and professional life and I encourage others to do the same - especially student midwives and all midwives who seek my advice. There’s a difference and I can explain why.

First, just read this, posted anonymously in a Facebook group for student midwives. My heart sank when I absorbed each sentence, so familiar to me. I reached out to her, asked permission to use her words, and she will be reading this blog post when I send it to her. I promised to do that.

‘Can we talk about the disgusting and toxic culture on CDS (Central Delivery Suite, also known as Labour Ward, or Birth Suite’?!

I don’t know if it the same in most trusts (hospitals in the UK), but that ‘cliquey’, if your face fits and if not then ‘you-can’t-sit-with-us’ culture is gross from full grown women. I’ve just finished with a moody supervisor who I was walking on egg shells with every single day, who wrote me a basic ‘couldn’t really be bothered’ feedback form, but the feedback was good. Then went behind my back to my Practice Assessor and said something completely different. The midwives slag off students in my cohort while I’m in the room, sit there watching and judging other people’s CTG (fetal monitoring during labour and birth) on the centralised board. Talk terribly about one another, often not nicely about the women.

It’s such an awful place and I’d rather put pins in my eyes than do rotations there’.

I have been aware of this toxic behaviour on labour wards, this playground-like bullying, since I entered the midwifery profession in 1977. Sometimes the negative actions are covert such as eye-rolling, intentions and ‘in-jokes’ about others. I was witness to it all, continuously for decades. The sad thing is, when it was all around me, I didn’t do anything about it, except I NEVER joined in. That wasn’t always easy, being the odd one out in a room. I felt unsafe, uncomfortable and afraid, yet I didn’t report it or challenge the perpetrators. Big regret - one I can do something about now. Since I’ve been sharing my experiences and knowledge as a midwife during presentations to midwives and student midwives for the past 15 years, I talk about this phenomena, and offer some words of wisdom. My midwife daughter Anna does the same, too.

How can student midwives and midwives look after themselves (and their colleagues) in these challenging situations? Can they ever influence negative behaviours at individual, shift or departmental level?

Here’s what I suggest.

1. Remember you are not alone - this isn’t your fault or even anything to do with you. It is a symptom of the culture of the department, ward, service, and reflective of the personalities of those you are working with.

2. There are NO excuses. When some say ‘oh well, they mean well but they are under pressure. No. There are no excuses at all.

3. Never ‘fit in’ with negative cultures or the criticism of others - when you are desperately trying to fit in. The image above is a copy of the slide I use to to talk about this. Just remember that the people condemning others will very likely be having an opinion on you too. This behaviour makes services unsafe.

4. Document all incidents you witness and speak to your university lecturers or if you are a qualified midwife, your manager or supervisor, Professional Midwifery Advocate or someone in a senior position who can take action if necessary. You may want to approach your union too.

If you feel able, and you may need support from your peers or trusted supervisors or seniors to do this, respond to any criticism you hear. For example, consider the following phrases:

• ‘Did you really mean to say that’?

• ‘That’s not how I see them’ (the person being criticised)

• ‘Does [name of person being criticised] know you feel this way’?

• ‘How do you think [person being criticised] they would feel if they knew’?

All these phrases are non-confrontational, but none of this is easy. It takes courage to do the right thing, when the pressure to be one of the team is compelling. And it may make you unpopular, but only for a time. Because there will be others who feel like you, who also feel afraid to speak up - and they will be grateful for your leadership. Eventually, like-minded colleagues will want to work with you, they will feel safe with you. If it feels too hard, as I encouraged previously, seek the counsel of others to support you.

5. When you find your tribe, your peer support network, be inclusive. Don’t form another ‘clique’. Keep your circle of support ‘horse-shoe shaped’ so that it’s always open to others, be inclusive. Invite those who seem alone or lost, be the change you want to see.

6. Lastly and most importantly, learn from negative experiences if you can, and influence future care provision by never repeating this toxic behaviour.

I hope this helps. If you are are reading this and you have other suggestions - please add them in the comments! I am always learning and always grateful.

To the student midwife who allowed me to publish your comment, thank you. You speak for hundreds of others and you have enabled the potential to make it easier for others too. Hopefully, and especially, for you. I send you my love and encouragement.

Recommended reading:

Flourish: A Practical and Emotional Guidebook to Thriving in Midwifery by Kate Greenstock

Nurturing Maternity Staff: How to tackle trauma, stress and burnout to create a positive working culture in the NHS by Jan Smith

Love and Midwifery by Diane Menage and Jenny Patterson

And Then There’s Us – The Challenge of Being a Student Midwife. Ellie Durant Series in The Student Midwife journal

I remember the moment vividly. I can actually revisit the experience in my head clearly, which is unusual as I have limited memories of my early childhood. It was before my 9th birthday I know, because we moved house after that. I can visualise the sofa, the black and white TV and a feeling of comfort and joy being allowed to stay up later than usual to watch a particular programme. What a don’t recall is the programme or the scene that made me feel physically sick - deeply traumatised and distressed. Just the intense sickness.

I cry a lot, too. As a child my mum used to tell everyone ‘her bladder is behind her eyes’ - what a weird thing to say, but now everything is falling into place, when I’m almost 70.

When I was training to be a nurse in the 1970’s I couldn’t help but cry with relatives or patients if they did, it was almost impossible and I got in trouble for it from my seniors. ‘It’s not professional’ they’d say, ‘you have to be detached’. Now I don’t agree, but it was a tough call not to disobey!

My first experience of seeing a woman in labour (it was around 1977), in distress with an examination she was having and screaming for the practitioner to ‘stop!’ They didn’t. Now I know this is violating human rights but at the time I was absolutely sickened and appalled. I looked around the room to dead-pan faces of other care givers in the room who seemed unperturbed. This was usual, normal to them and I wrongly thought I needed to be more like them. I was a brand new student midwife and wide-eyed trying to learn. I instinctively knew it was wrong so I left the room, helpless and sat on some stairs with my head between my knees, trying not to vomit.

And so it goes on. From then to now the incidents have been many and varied. I’ve been aware of my hypersensitivity reading books and watching films for example, my reactions to any form of violence is extreme, I can’t watch things that others, my friends and family, are able to enjoy without the same reaction. Sometimes I find it hard to comprehend. For example I once read a book, I was loving it, until the story described a gang-rape. That immediate gut-wrenching feeling came, but it’s the impression it leaves on my mind, never erased, even though it wasn’t involving me. I walk out of cinemas or close my eyes and block out sound if I can’t leave.

It’s confusing! I’m told there’s a label. ‘Highly Sensitive Person’. I know I’m an ‘empath’ but is this different?

On a positive note I find it easy to love, to give love, to try to understand and I’ve learned how not to absorb the distress of others who share their grief or trauma though it’s taken me a lifetime.

Anyone else out there who this resonates with?

A few years ago a MIDWIFE sent me this photo…it’s me, as a student (or newly qualified midwife) holding HER as a newborn, newly born. There I am, cradling a midwife to be. Katie. It was 1978.

Wow. That was a super special surprise - and I actually remembered Katie’s parents and her siblings! What a joy that was..and to think of the connection, the circle of life, for me, was incredible.

Sometimes I have to pinch myself. There have been so many challenging times and events in my career but the immense joy I have experienced, the thrill and the privilege of being a midwife overrides the darker moments.

I shared the photo of Katie in my arms on Instagram here in 2020, so for IDM this year I simply reshared. Because it made me reflect and appreciate my life and my work in my 70th year of being alive.

And in this photograph I want to now imagine me whispering to Katie ‘you are going to be a midwife too’ ❤️

Sending love to you all 🌺