Last week a subgroup of the Birmingham and Solihull Maternity Voices Partnership (MVP) went to Birmingham Women’s Hospital to do the Fifteen Steps Challenge, and today they’re feeding back their observations at our first MVP meeting.
What is “Fifteen Steps To Maternity”?
“I can tell what kind of care my daughter is going to get within 15 steps of walking on to every new ward.” This powerful statement, from a mother whose daughter needed frequent inpatient stays, inspired the development of the Fifteen Steps Challenge. The Challenge focuses on seeing care through a patient or carer’s eyes, and exploring their first impressions.
We decided to use the Fifteen Steps For Maternity toolkit to kick off our MVP work because it’s a simple, practical and engaging idea that can have an immediate effect on services.
Our MVP subgroup visited Birmingham Women’s Hospital and looked at three wards — ante-natal, delivery and post-delivery — to make observations and feed back to staff with their first impressions. Over the next few months we hope to be able to do the same thing at the other hospitals in the region. (Next stop Good Hope – let us know if you’d like to take part.)
Watch the videos below to meet some of the team who took the Challenge, and hear some of the examples of the observations they made. As service user Catherine points out, “little things make a huge difference when you’re about to give birth”!
Catherine is a maternity services user
Anne-Marie also gave her views as a service user
Kookie and Sue
Kookie and Sue are midwives at Birmingham Women’s Hospital
The first meeting of BSol MVP is taking place today, Thursday 12th July, but we’re still keen to involve more service users. (And not just mums! Dads, grandparents and other family members are all very welcome too.) If you’ve used maternity services in Birmingham or Solihull over the last few years, give our MVP Co-ordinator Sharon Bartlett a ring on 0121 456 7820 to ask about being part of the MVP.
Do you have recent experience of maternity services in Birmingham or Solihull?
We are putting together Birmingham and Solihull’s Maternity Voices Partnership (MVP): a team of people who provide feedback about their local maternity system. The panel will include maternity professionals (like midwives and doctors) and people with direct personal experience of the service.
If you have recent experience of maternity services in Birmingham or Solihull, we’d like to invite you and your family to get involved. We want as many people as possible to have their voices and opinions heard – not just women, but their partners and other family members, too.
We’ll be collecting your feedback and leading more discussions so that you can share your ideas about how local maternity services could be improved. The idea is to design and develop services with real people in mind.
The first meeting will be in July and we will hold an induction for all volunteers before it takes place, so you’ll be fully prepared. Expenses will be paid, including travel, parking and childcare costs.
If you’re interested in finding out more, please contact your local MVP Co-ordinator Sharon Bartlett at email@example.com or call 0121 456 7820.
If you work with people who have recent experience of local maternity services, or if you’d just like to help us spread the word, you can share this blog post, and there’s even an A5 leaflet you can print and share. Download the A5 leaflet [pdf, 192kb].
Maternity Voices Partnerships are being set up all over the country and we’re excited about going out into our local communities and finding people to take part in ours. Sharon, our Co-ordinator, is a former Pregnancy Outreach Worker so she’s got some great experience and knowledge of local networks.
Since Gateway began in 2006, our tag line has been “Changing Lives, Changing Services”.
To change services, we have to play an influencing and sometimes challenging role, sharing evidence of the need for change. That’s why we have always seen it as part of our responsibility to gather views from service users, ensuring that what they say is heard by decision-makers and other people of influence.
And that’s why we’re delighted to announce that Gateway will be providing Birmingham and Solihull’s Maternity Voices Partnership.
A Maternity Voices Partnership (MVP) is a team of people who work together to review and contribute to the development of their Local Maternity System (LMS). Gateway will be bringing together regular panels of service users (people with experience of maternity services, and their families) and service delivery representatives (like commissioners, midwives and doctors) to ensure that a wide range of voices are heard.
Why Gateway? Well, having run the Pregnancy Outreach Workers Service (POWS) for over a decade, we’re ideally placed to deliver – if you’ll excuse the pun – the Maternity Voices work. We know that there is often a lack of awareness of services in the places where those services are needed the most, so we’re particularly keen to be part of a national programme that wants to build better relationships with hard-to-reach communities, and hear from as many service users, from as many different backgrounds, as possible.
Through POWS, we have already established strong connections within those communities that are known to have a poor take-up of services. We also have strong connections with midwives, Children’s Centres, Social Services, housing providers and other third sector organisations who work with pregnant women – particularly in areas of multiple deprivation. Gateway’s staff are often from these communities themselves, and are experienced in working with and encouraging people who don’t typically come forward.
Gateway’s role will be to form the MVP, finding the right people to be part of it, ensure the quarterly meetings cover topics that are of relevance to service users. Then, we’ll provide the Partnership’s feedback to the LMS Board.
We will soon be advertising for service users to get involved, we’ll be providing training to prepare them for the first meeting in July. If you have recent experience of Birmingham and Solihull’s maternity services, and you’re interested in finding out more, please contact our MVP Co-ordinator Sharon Bartlett at firstname.lastname@example.org.
This MVP will be part of the new Birmingham and Solihull United Maternity and Newborn Partnership (BUMP), which has been set up as a result of the National Maternity Review (Better Births). We’re very much looking forward to being part of project BUMP, giving as many people as possible a voice, and bringing the ambitions of the National Maternity Review to life.
(The photos on this page were all taken by, or of, our Pregnancy Outreach Workers.)
Last week, we ran the first session of training for our Peer Educators: young people who will be going into schools to talk about their experiences of parenthood.
We’re delivering this programme in the West Midlands in partnership with Straight Talking, a London charity that employs teenage mothers and young fathers to educate young people about early parenthood, healthy relationships, child sexual exploitation and sexting, enabling them to make responsible life choices.
Gateway was chosen to deliver the programme in the West Midlands because of our proven successes with services like the Pregnancy Outreach Workers Service (POWS). It’s thanks to networks and experience like this that we’ve been able to recruit young people to the programme very quickly and hit the ground running. You can hear from one of them, Emily, in the video below.
The point of Straight Talking’s Peer Educators scheme is not only to reduce the high rate of teenage pregnancy and child sexual exploitation in the UK, but to support teenage parents themselves to achieve economic wellbeing and quality of life. Because the work is paid, with full training, it offers really good work experience, building confidence and opening the door to potential longer term employment. We love this model of working – employing people with direct, personal knowledge of the issues their clients face, and helping people to help each other – and it fits perfectly with our values, aims and objectives.
Last week’s training was led by representatives from Straight Talking, together with two Peer Educators who have been working with Straight Talking in other areas of the country. It began with some sessions in the training rooms at Gateway, including how to manage a classroom – no easy task! – and how to get pupils talking. The experienced mentors helped the new recruits to learn how to set ground rules and lead ice-breaker activities that will help them to start conversations and debates with pupils.
The next day, the new Peer Educators got to see how it worked for real, as they shadowed their mentors and watched them lead some Straight Talking sessions at Grace Academy in Solihull. Gateway’s Programme Co-ordinator Caroline (pictured at the top of the page with three new recruits) said, “it was really interesting to see how engaged the pupils were and how much they seemed to enjoy learning from the Peer Educators. There were some good debates and the hands-on activities really got the pupils thinking – like deciding how they would prioritise if they were faced with having to budget for a young family. Each session ended with a young person telling their own story of becoming a teen parent, and each time it was really powerful. It clearly makes a big impression on the children.”
In the video below, Emily talks about why she wants to be a Peer Educator, and why going into schools to talk about being a teenage mum is helping her, too.
Ruben from Straight Talking said, “Working with Gateway is going to be important for Straight Talking, simply because they share the same ethos as us, which is working with people to try and get them back into employment, and working with teenage mothers to give them the best health and wellbeing. You can tell straight away with the people that Gateway brought in that it’s going to be a good working relationship.”
We’re really looking forward to finding more young people to become Peer Educators over the next few months. If you became a parent when you were a teenager, you’re still under 25 now, and you’d like to find out more, call Caroline on 0121 456 7820.
Shazia has been a POW since the start of the service in 2007. At the time, she wasn’t sure what she wanted to do – she’d done some teacher training but knew it wasn’t for her. However, as part of teacher training she’d met someone involved in the health sector, and felt immediately that she would be more suited to this sort of work.
Soon afterwards, she saw an advert for the new Pregnancy Outreach Workers Service and liked the idea of it. “I liked the fact that there would be no routine and I would be doing something different every day, and that I’d be in charge of my own caseloads. I always knew I wanted to help people and that’s exactly what I would be doing.”
Shazia puts her ability to engage with people down to her sense of humour. “I’ll make fun of myself if I have to. Helping clients to see the humour in situations breaks down barriers and brings people closer together.”
Shazia’s most memorable clients are those who have had issues with substance misuse. “When I started, my knowledge of drugs wasn’t great – I knew a bit about it but not much – but over the years I’ve learned a lot from my clients. Now, I understand the phrases people use, and the way users think.”
She continued, “the thing about addiction is: there’s no point in patronising someone or telling them they shouldn’t do what they’re doing. They know this already. They feel a terrible amount of guilt. They deserve to be treated nicely.”
She went on, “the pull of addiction is really, really strong. If the only people you know are dealers or addicts themselves, and they all have your number and know where you live, that’s a hard environment to get away from. Most of the addicts I’ve met started using in response to abuse or trauma from a young age – things they’ve never had any real support for – so the problems go very deep.”
Shaz recently bumped into someone she supported six years ago. As they chatted, the woman thanked her, saying, “you were the one who treated me like I mattered, and didn’t look down on me”.
Shazia says, “This person’s journey was special to me because I was the one who communicated with her the most, explaining what was happening and often being the person who had to give her bad news. She had a social worker, who was very good, but she didn’t trust her… So it was me who was her birthing partner, staying three nights in the hospital with her. And then it was me who explained to her that, because she hadn’t had four clean drug tests, it was unlikely her baby would be going home with her.”
When support ends, Shazia says it’s important to close cases properly by ending contact and making sure that clients are self-reliant. “It’s not fair on them if they continue to rely on me afterwards,” she says.
(Shazia went on maternity leave last month. When she returns next year, it will be to a new role within Birmingham’s new Early Years Health and Wellbeing service.)
Jacque came to Gateway at the very start of the POW Service in 2007. For her, it was the ideal job.
“I have a degree in Family Work and before I joined POWS I was working with families as an outreach worker and social therapist. Working one to one with families is ideal for me.
“I love helping people face to face, helping them to find balance and meeting their needs. Sometimes people just need someone to listen to them, and even just a fifteen minute chat can have a big impact. This kind of social support is vital.
“One of the great things about POWS is that we are from the communities we support, so we know what’s out there and can engage at a community level. The women we work with trust us, because there’s a mutual understanding. We can have a real heart-to-heart … it’s mom to mom.
“Over the years the POWs have supported thousands of women between us. The original remit for the service was to support ‘marginalised’ women – those who have experienced domestic abuse; women with mental health issues; families with no recourse to public funds – and over the years the needs have become more acute.
“The women we’re supporting now are more vulnerable than ever. They include refugees and people who have been hit really, really hard by the recession, so we are dealing with a lot of homelessness, and language barriers.
“Although on paper we do a lot of the same things that other support workers do, the difference is that we are more available; more accessible than most. We will come out to see people wherever they need us to, whether that’s at home, at a Children’s Centre or at the shops, and they can call us at any time.
“It’s our job to make sure baby is born healthy, and to reduce inequality. And the way we do that is to make sure mom has support from as early a stage as possible. If she’s smoking or drinking, or if she isn’t eating properly, perhaps because she doesn’t have the finances to support herself – then of course the child will be born into inequality.
“Some of the happiest times with POWS have been seeing people’s excitement at a new house, or seeing women breastfeed happily when they never thought they’d be able to.”
Jahanara has been with Gateway on and off for many years. Like many of our POWs, she originally joined as a Community Family support worker, but as a speaker of different Punjabi dialects, including Mirpuri, she’s also worked as a Gateway Interpreter.
As a POW, Jahanara works with a mix of women, but over the last couple of years has seen more and more women with mental health problems.
Recently she supported a client who has suffered severe depression and mental health issues after being raped. She had never told anyone about it – not even her husband – and it was only when she became pregnant with her husband that she finally started talking about what had happened.
“She’s in such poor health that she hasn’t really been able to look after herself,” says Jahanara. “But it’s my job to make sure that she will be able to look after her baby when it arrives. We have spent a long time talking and her husband now understands that he needs to really look after her at the moment.”
Sometimes it will take a while for women to admit they need help. On one visit to a new client, the pregnant woman told Jahanara everything was fine – but Jahanara noticed that her other children were going barefoot and wearing ill-fitting clothes. So, on the next visit, she took along some items from Gateway’s baby bank, including children’s clothes, baby clothes, toiletries and nappies. “She couldn’t believe it,” says Jahanara. “She said, ‘I only get £90 a week and it goes so quickly. You can’t believe how much you’ve helped me.’ It gave me peace in my heart.”
Often, women will have a number of support workers, but don’t feel like anyone is there to support them, themselves. “Sometimes women just need someone to make them smile, or to pop to the shops with them,” says Jahanara, “and provide a bit of moral support in everyday life. Most support workers are there for the child, but we are there for mum, giving her someone to rely on and a number to call in times of need.”
Sophia has been here since the start of the service in 2006. She says, “it’s completely changed in that time!
“Over the last decade – and the last couple of years especially – it’s gone from simple signposting and accompanying women to appointments, to supporting women with issues around safeguarding and substance misuse, and helping them through court reports and procedures.”
Sophia says she’s learned a lot as a POW, both on the job and from her colleagues. “We’re a good team,” she says. “It’s important for us to be able to offload onto each other, bounce ideas around, and support each other through difficult cases.”
Sophia explains how important it is for POWs to meet women as early as possible during their pregnancy. “POWS is a preventative service. Often, if we meet women in the first few weeks of pregnancy, we can start helping them to begin the routines and habits that will lead to a healthy pregnancy. We can sort out a lot of issues before they get to the point where the woman or her unborn child go into safeguarding.”
Sophia is keen to point out that POWS are there for mum, when everyone else is there to support the child, and that they can prevent safeguarding issues. “The whole reason POWS were brought in was to empower women. If we can support them to make their own healthy choices from the beginning, then we can prevent a lot of issues later on down the line. In many cases we can help to stop babies being removed and going into care.”
Many of Sophia’s clients are women with a number of complex issues. “One woman who always stays in my mind already had a teenage child, and she’d had another baby years ago who’d died. When I met her she was pregnant with her third child, but she was not in a good way at all – she was drinking heavily, smoking cannabis and more. She’d been referred to drug workers and social services, but she needed more help during her pregnancy so she came to us.
“I helped her to focus, really. By taking her out of her environment a bit, and helping her to make sure that her money went onto the things she would need for her baby rather than drugs, I supported her to start new, healthier routines.
“For many women, the only support network they have is an unhealthy one, so we can provide a different outlet – we’re there for her to talk to at the end of the phone, we can meet up with her at home or in the community, and we can support her with all the admin that having a baby brings – filling in forms, shopping for essentials and getting to appointments on time.”
Shaista’s been here for nine years so she’s a relative newbie!
“POWS used to work out of Children’s Centres, which was a bit isolating, so coming together to work out of the Gateway office a few years ago was the best thing. Being able to work as a team, sharing advice and supporting each other is important for us.
“I’ve worked across Birmingham, with all types of new mums, including teenagers and older mums, and in lots of different communities, from Washwood Heath to Handsworth.
“That’s what I love about the job: we’re out in the community, and anything can happen. But that’s also why POWS are good for pregnant women – because we can go to them.
“It’s all very well making an appointment for someone to visit a Children’s Centre, but it’s not always practical to expect a pregnant woman to travel, especially if they have other young children too. If they’re new to the area they may not be able to remember where to go, or how to get there on public transport, and if finances are an issue, then even bus fares can be prohibitive.
“We are also really accessible. We are there from early on in the pregnancy, because early intervention can be vital. The more that services are cut, the more vulnerable women need someone to help them prepare, and to navigate through what is often a very confusing and admin-heavy time.
“Clients have our phone number and they can call us any time. We can visit families in the evenings if necessary, and we can use our own transport to pick people up and take them to appointments. It’s this sort of flexibility that really sets us apart from other health professionals and helps us to build a more genuine, useful relationship with the women we work with. We’re not turning up in a suit with an official-looking badge, we’re just popping over to give them a bit of support.
“One of the things that has really helped us recently is the ability to use more modern technology in our roles. We all have tablets that we take to each appointment and that means we can help people to fill in forms, bid on council properties, and make appointments there and then. This can be really important for people who don’t have internet access at home, have limited phone credit, or find it hard to talk on the phone, perhaps due to language barriers.”
Over the next few months, the dedicated Pregnancy Outreach Workers Service (POWS) will be closing. POWS is to be consumed into Birmingham’s new Early Years Health and Wellbeing service, which is a partnership led by Birmingham Community Healthcare NHS Foundation Trust (BCHC), so our POWs will be transferring to new roles with BCHC’s partners Barnardo’s, Spurgeons Children’s Charity, St Paul’s Community Development Trust and Springfield Project.
But what about the gaps?
We’re pleased our POWs will be able to continue to make use of their extensive knowledge and specialist skills, and that Public Health has recognised that this group of vulnerable women exist and need support. But POWS will no longer be an identifiable service, and I’m worried this will leave gaps.
As yet, there is little information about how exactly mums and mums-to-be who are at risk will be looked after under the broader Early Years service.
Details of the new model of service often refer to “children and families,” but not to pregnant women specifically. Will pregnant women still receive dedicated support from an early stage of pregnancy? And when a child is taken into care, will the mother continue to receive direct, one-to-one support?
We have asked for reassurance, and have received some further comments from Commissioners, but the information is still sparse. In my opinion there is a potential for gaps here which could, over time, become problematic.
At the moment, POWS offers intervention from as soon as a woman knows she’s pregnant. Often, a POW will get involved at 14 or 16 weeks – sometimes as early as ten – and the earlier we get there, the more we can do. Once the POW receives the woman’s contact details, she’ll be in touch within 48 hours.
These early weeks, while the baby is in the initial stages of development, are always vital, but even more so when a woman has complex needs. Amongst many other things, POWs can help women stop drug use or smoking, ensure she’s eating (and eating the right things), identify suitable accommodation, and make sure she is engaging with midwifery services and attending appointments.
Commissioners have told us: “The health visitors within the new service will receive referrals from midwifery in line with need. Where the woman is vulnerable or has additional needs this will be before 26 weeks.”
The earliest time mentioned in the documentation we have seen is 20 weeks, more than halfway through pregnancy.
Dedicated time, responsiveness and intensity of support
The information we have about the new model talks about an initial visit, and then a second visit. We know this isn’t enough for women with complex needs. Much of a POWs’ work is unpredictable and can include a lot of one-to-one crisis management. For example: taking women to appointments, providing phone and text message support at any time, supporting homeless women to ring round the Housing department and hostels, helping women to remove themselves from domestic abuse and taking them to a safe place, and providing support during mental health crises, including out-of-hours chats and accompanying women to get support from the Community Psychiatric team.
When we raised this with Commissioners, we were told: “The new integrated service will be able to meet needs of the type you set out. There will be the integration with other services across the city ensuring that the service responds at the right time and in the right way, especially as you say in situations of homelessness and DV. The single cross service record will provide assurance on the services and level of engagement of an individual which will also assist the service in supporting women through their pregnancies.”
What we’re not clear about is who will be providing this support. We’re not clear if women will have the chance to build a one-to-one relationship with a support worker who can help her to navigate through services, provide a single point of contact with regular phonecalls/texts and visits, and provide moral support.
Women with a safeguarding need make up about 20% (80-90) of the women POWS support annually, with about 50 of these needing intensive support – between half a day and a day a week. Where a woman is facing the removal of her baby, the POW is often pivotal: ensuring mum understands what is being said, and being on hand to make sure she takes the necessary action in relation to the Child Protection Plan.
But, again, we’re not sure who will provide this support in the new model.
Commissioners told us: “The provision of support to enable parents to develop the skills they need to parent well and the provision of step down services for those who are in the social care system are important elements of the new model.
“Within the new model no specific timeframes have been set for support to this group, it is our expectation that support is provided in line with need. This flexibility will help to build upon the approach currently operated within the POWS service.
“The new model is health visitor led with the health visitors identifying and brokering support for children and families in line with need.”
But will it provide intensive support for mum? I would really like to be reassured that women will get the continuity, trust and flexibility that they need in these circumstances.
I feel like Commissioners have given us the opportunity to have our say. I’ve filled in impact assessment forms with input from the POWs, and when I’ve raised my concerns I’ve been invited to say where the gaps are.
But I’m just not convinced we’re being listened to or understood. Although I’ve received responses, they feel flimsy. I don’t feel they’ve been detailed enough to provide me with reassurance, and this leaves me worried.
I really hope the new service will prove me wrong.