#TheatreChallenge was a project @ Royal Derby Hospital run by the Birth Outside the Box Team. During the week of the 9th – 15th October 2017 we arranged for staff to be able to lie on the table in our labour ward operating theatre in order to gain insight into how it feels to be a woman transferred to theatre and to generate discussion of ways we can improve the birth experience for these women. This blog entry is about my part in this project and how it has changed me as a midwife and as a person.
Why is a birth centre midwife talking about theatre experience?
Our @DerbyBOTB team had facilitated several projects including changing the way beds were set up on labour ward and a new aromatherapy training day and guideline. The aim of the forum is to bring midwives, doctors and other team members together with the common goal of increasing rates of physiological birth and improving patient experience for all births regardless of mode of birth or where they occur. We now wanted a project which would appeal beyond the midwifery team so we could involve obstetricians, anaesthetists etc in our work.
We realised that theatre patients represented the group of women as far removed from pysiological birth as you can get and when we looked into our unit’s statistics we realised that well over 1/3 of all our women went to theatre in 2016. That was a lot of women! I tried to think of a good way to engage staff in an activity that would encourage us to think of ways we could improve the birth experience for these women, and inspired by #MatExp and their #LithotomyChallenge project it occurred to me that lying on the bed in theatre would be a really simple way to get people participating and thinking.
So I started talking to people about my idea – only to be met with blank looks. People couldn’t really see how this would change anything. Even people who listened to me couldn’t see how it could ever happen – how on earth would I get permission to use theatre? how would we fit in round unit activity? Why would we even want to do this? Undeterred I kept rabbiting on and looking back I can see how key this is to bringing about change. Unless you are a really public figure, no matter how good your idea is, people will generally smile sweetly and move on when you first start talking. The key thing is that you persist.
Then I got lucky. I found someone who “got” my idea. And suddenly I wasn’t just rabbiting on anymore – I was having a conversation! I saw a tweet recently “Conversations are the smallest unit of change”. This is so true! I started having conversations with my buddy on our BOTB WhatsApp group and the other members of our group gradually got sucked in by our enthusiasm. And suddenly it wasn’t just a conversation between 2 people anymore – it was a project!
“Conversations are the smallest unit of change”
We wanted to get across the key message that the woman’s pespective is very different to ours so we made a simple little film by attaching a gopro to someone’s head and pushing her round to theatre on a bed. You can watch the film here – its amazing how powerful the effect is!
We posted the film on our unit’s private facebook page to start conversations with staff. We had a HUGE response. We divided the posts into 8 themes and created a display around each one which included information, references to local and national guidelines, images and quotes from the group.
- Skin to skin in theatre
- Optimal cord clamping
- Babies that go to NICU
- Theatre Birth Plans
- Keeping families together
- Theatre Environment
You can view the 8 mini films here:However we wanted to include ideas from beyond our unit so we created a twitter account @DerbyBOTB and posted on twitter too. Within days our little film had been viewed thousands of times. Aware we needed to keep the momentum going we created 8 mini-films around the themes and posted these as well. By the time we got to #TheatreChallenge week our own unit and units across the country were buzzing with discussion. The reach was amazing!
#TheatreChallenge week became #TheatreChallenge MONTH as so many people wanted to take part and it was challenging utilizing an active theatre space around unit activity. However we felt it was really important not to exclude anyone who was keen to participate. We had all sorts of people on the table:
…….. our housekeeper,
…….. even some hospital governors!
We continued to post photos of participants on Twitter and Facebook along with thought provoking comments from our participants. The impact was HUGE! All sorts of ideas were put forward for things we could change – from dimming the lights and playing music to moving the resucitaire and keeping families together for return to theatre events. Not everyone agreed about the things we should do and not all of the changes will ever come into practice but the crucial point was that we started the conversations!
The following week our unit was hosting its own “Progressive Birth Conference – #ProgBirth17” and somehow I found myself as one of the speakers. This was nerve-wracking – I’d never done anything like this before – however #TheatreChallenge had been so important in our unit that it felt important that someone should talk about it at our conference so that someone ended up being me!
I got such an amazing reception. It was incredibly empowering and moving to see my own colleagues so full of passion. I spoke about #TheatreChallenge and presented the film I’d put together to show what we had achieved:
However I also tried to make the point that we are all responsible for change. No matter how small and insignificant we feel, change has to start somewhere and remember – Conversations are the smallest unit of change!
We quickly realized during #TheatreChallenge that change has to be a team effort. If you want to facilitate skin to skin in theate then you need the anaesthetist on board to position the stickers for monitoring out of the way. If you want to facilitate optimal cord clamping then you need the theatre team to cover the baby with a sterile towel so it doesn’t get cold. We therefore made including the whole team one of our priorities with the tag line 1 woman = 1 team.
I passionately believe that staff need to believe that they can bring about change and that one of the most effective things any unit can do is to empower their staff to facilitate change. Innovation is a huge driver and the NHS claims to be passionate about change with specific departments focused on innovation and leadership. But on the shop floor it can feel very different. Midwives often feel they have little power to bring about change so they often don’t try. Students bursting with enthusiasm seem to fade into subdued practitioners very quickly. I am constantly being told that “Women need to drive change” not midwives. But midwives are meant to be advocates for the women we care for and midwives are women too.
I am not special. I don’t posssess any superpowers which mean that I can bring about change when others can’t. The reaction of my colleagues at our local conference demonstrated that they share my passion and enthusiasm. And the reaction on twitter shows this passion is shared far and wide. I do attend conferences as a way to rekindle my enthusiasm when my mojo has been under fire and I do find twitter an excellent resource for evidence to support my ideas and as a means of sharing my passion. But every single midwife and student midwife out there has the power to do the same. You just have to believe in yourself and your idea.
I feel that #TheatreChallenge has changed me as a midwife and as a person.
#TheatreChallenge demonstrated that I (and YOU) have the power to create ripples and that my ideas (and YOUR ideas) are just as valid as those put forward by public figures and institutions. I have always been full of passion but I think I have been “quietly passionate” – I’ve never been the one to put my hand up in meetings or try to out-talk my adversaries. But I have discovered that social media is a great tool to get your message out there without having to shout. In an age when so many practitioners feel they are not heard, twitter especially is a great way of speaking out. And with so many women out there telling us that birth experience is just as important as patient safety we need to start speaking up on their behalf.
However once you discover that you do have the power to make people listen you will start to gain confidence. Suddenly I find myself feeling positive about speaking at scary meetings or presenting in public spaces. I am still daunted by this don’t get me wrong but I am fueled by a deep inner passion which is carrying me beyond nervousness and shyness. #TheatreChallenge has helped me to find my voice. I hope you can find yours!
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