RCM Annual Conference

Programme

The RCM Annual Conference 2018 main and student programme strands can be viewed below.

Keep checking back for regular programme and speaker updates!

Please note: the student conference is only running on 4 October

 

Day One - 4th October

Click here to view Day Two ↓

MAIN PROGRAMME

  • MAIN

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    REGISTRATION

  • MAIN

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    RCM chief executive Gill Walton in conversation with Susan Bookbinder

    • Come and listen to the RCM’s chief executive Gill Walton, one year on from taking up the role, ‘in conversation’ with renowned journalist Susan Bookbinder.
    • Hear the latest on ‘The Big Conversation’ member engagement programme. What key issues has it raised? How will it steer the future of the RCM and the profession?
    • Don’t forget to tweet your questions, to be put to Gill during the session.

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    Systems design and patient safety – learning from our mistakes

    Chair: Susan Bookbinder, newsreader, TV presenter, Zamar International
    Speaker: Dr Suzette Woodward, national clinical director, Sign up to Safety

    • This is a chance to listen to a leading safety expert and highly regarded speaker share her insights into the latest thinking on patient safety.
    • Hear Suzette speak about the challenges teams face, and how the design of systems has a crucial impact on patient safety.
    • If you want to know more about how developing positive cultures in maternity services makes it easier to keep women and babies safe, then this is the talk for you.

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    Stillbirth: death by another name

    Chair: Susan Bookbinder, newsreader, TV presenter, Zamar International
    Speaker: David Monteith, founder, Grace in Action

    During this session, David will share the stunningly moving, heartbreaking, yet ultimately inspirational story of his daughter Grace and his family’s experience of stillbirth. He shares what life is like for a father of a stillborn child and the type of care and support he believes bereaved parents need going forward. In order to offer more support to bereaved parents, David, with his wife Siobhan, founded the charity Grace in Action.

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    Perinatal mental health: from the personal to the big picture

    Chair: Susan Bookbinder, newsreader, TV presenter, Zamar International
    Speakers: Jane Fisher, mental health nurse, Theresa Nixon, director of assurance, The Regulation and Quality Improvement Authority (RQIA), Northern Ireland, formerly director of mental health and learning disability and social work and Louise Nunn, specialist midwife – perinatal mental health, co-chair North West London (NWL) Perinatal Mental Health Clinical Network, education/evaluation lead for the Health Education England NWL Partnerships for Innovative Education Project

    • If you are concerned about how maternity services can better support women with mental health needs, this multi-perspective deep dive is a must see.
    • Hear from a service user, who herself is a mental health nurse, a practitioner and expert, and a regulator tasked with supporting systemic improvement.
    • From the personal to the big picture perspective, this is a key session for anyone who wants to broaden their understanding of perinatal mental health issues.

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    Challenging inequality, sexism and discrimination

    Chair: Susan Bookbinder, newsreader, TV presenter, Zamar International
    Speakers: Alice Hood, equalities lead, TUC, Helen Pankhurst, activist and author, Advisor CARE International and Leyla Hussein, psychotherapist, activist and founder of the Dahlia Project and co-founder of Daughters of Eve

    • Have you ever wanted to challenge the inequality, sexism and discrimination you see around you? Then prepared to be inspired by the powerful testimonies of three women who are doing just that.
    • Let them throw light on the challenges women face in the workplace and society, and share their strategies for overcoming them.
    • Don’t miss an opportunity to hear from these highly-knowledgeable and passionate speakers as they share their personal experiences and broader perspectives on an issue that impacts everyone.

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    The Scummy Mummies

    Chair: Susan Bookbinder, newsreader, TV presenter, Zamar International
    Speakers: Ellie Gibson and Helen Thorn

    The Scummy Mummies are a comedy duo made up of Ellie Gibson and Helen Thorn. They host a fortnightly chat show via podcast for ‘less-than-perfect parents’ and they also perform live shows around the UK. Ellie is a wife, mother, videogames journalist and stand-up comedian. Helen is also a stand-up comedian and wife and mother of two.

STUDENT PROGRAMME

  • STUDENT MIDWIVES

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    Welcome address from RCM president Kathryn Gutteridge

    Chair: SMF members, RCM
    • Receive a warm welcome from the RCM’s president, Kathryn Gutteridge.
    • Hear about what she has learned within her first year in office.
    • Learn more about the future plans and ambitions of the RCM.

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    Growing a baby by a mother of daughters

    Chairs: Charlene Cole and Lydia Marklew-Adams, SMF members, RCM
    Speaker: Clemmie Hooper, midwife, mother, author

    • Have you thought your communication skills are pretty good, but would like to improve on them?
    • Would you like to understand the core skills needed in networking successful? Clemmie will provide some insight into this.
    • Maybe you would like to know what life is like for this midwife, mum, author and social media expert? This is a session not to be missed.

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    Stillbirth: caring and coping, preparing and understanding

    Chairs: Alice Kersey and Deirbhile Murphy, SMF members, RCM
    Speakers: David Monteith, founder, Grace in Action and Samantha Collinge, maternity bereavement service manager, University Hospitals Coventry and Warwickshire NHS Trust

    • Stillbirth is devastating for a family, and can be one of the most difficult moments in a midwife’s career – do you want to feel more prepared?
    • How does it feel to go through it? What do you need at that moment, and in the aftermath? David’s moving testimony will help you understand the experience of baby loss and what you can say and do to support a family.
    • If you’d also benefit from some practical skills and professional insights into how to approach stillbirth in your practice, then Sam has some invaluable advice. Make sure you come along and equip yourself with understanding which could make all the difference to bereaved families you might care for in your career.

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    Meet the experts

    Chairs: Louise Webster, Deirbhile Murphy, Lydia Marklew–Adamsand Jenny Pope, SMF members, RCM

    1. Mary Symington, head of midwifery, Central Manchester University Hospitals NHS Foundation Trust

    After almost a decade in nursing, Mary qualified as a midwife in 1998, working at Salford Royal Hospital, where she became the postnatal ward manager in 2005, then matron for inpatients, community and the birth centre, before taking up the role of matron at Pennine Acute Hospitals NHS Trust. She joined Central Manchester University Hospitals NHS Foundation Trust in 2015 in the role of lead midwife for inpatient and antenatal services at Saint Mary’s Hospital, before becoming deputy HoM in 2017 and HoM the following year, a role where she continues to demonstrate her passion for midwifery and to strive for a high-quality, safe maternity for all staff, women and their families.

    2. Lesley Wood, regional officer for the north-west, RCM

    Lesley has been a midwife for 34 years, spending the majority of her career at Princess Anne Maternity Unit at the Royal Bolton Hospital. She has worked for the RCM for 15 years, leaving clinical practice to take up a full-time role in 2009. Lesley has a broad knowledge of the regional and national drivers affecting midwifery services and a wealth of experience representing midwives and MSWs through employment and professional issues. She represents the RCM within the local maternity systems across the North West, and sits on the Greater Manchester Health and Social Care Workforce Engagement Board. Her work sees her bring to bear influence at a regional national and strategic level, and help lead on transformation changes across maternity services.

    3. Dame Tina Lavender, professor of midwifery and director of the Centre for Global Women’s Health, University of Manchester.

    Dame Tina Lavender is one the most respected midwifery researchers in the world. Professor of midwifery and director of the Centre for Global Women’s Health at the University of Manchester, she also holds an honorary contract at St Mary’s Hospital, Manchester and a visiting professorship at the University of Nairobi. She is co-editor in chief of the British Journal of Midwifery, associate editor of the African Journal of Midwifery and Women’s Health, editor of the Pregnancy and Childbirth Group of the Cochrane Collaboration, and is on the editorial team of BJOG. Dame Tina is an honorary fellow of the RCM and European Academy of Nurse Science, and an advisor to the WHO.

    4. Jude Jones, birth centre midwife, Warrington and Halton Hospitals NHS Foundation Trust.

    Jude Jones is a former member of the RCM’s Student Midwives Forum and the founding member of the Salford Midwifery Society. She was named Student Midwife of the Year at the 2014 MaMa conference, and awarded the Cavell Nurses’ Trust Outstanding Student Midwife Award the same year. Now a birth centre midwife at Warrington and Halton Hospitals NHS Foundation Trust, she is passionate about individualised care for women and families, and finding digital solutions to enhance midwifery care. She is also a trustee of Mummy’s Star, a charity which supports women and families affected by cancer during pregnancy or the first 12 months after birth.

    5. Kathryn Gutteridge, president, RCM.

    RCM president Kathryn Gutteridge is an established consultant midwife with a long history of clinical care in the NHS, currently working at Sandwell and West Birmingham Hospitals NHS trust. She has a reputation for representing women’s psychological and mental wellbeing. She founded Sanctum Midwives; an organisation that educates, represents and challenges stigma around sexual abuse and its impact during motherhood. An experienced author and presenter with an international profile, she specialises in emotional wellbeing during childbirth and women maintaining control over their choices. She is also an expert adviser, helping to steer national policy and develop clinical excellence.

    6. Alison Brindle, midwifery student, University of Central Lancashire.

    University of Central Lancashire (UCLan) final-year student Alison Brindle was nominated in the RCM Annual Midwifery Awards 2018 for the Pregnacare Award for Student Midwife of the Year, which recognises a student who makes an outstanding contribution to their future profession and acts as an advocate and role model for their fellow students. She was shortlisted for her work as chair of the UCLan Midwifery Society, which saw her organise monthly study days and three large-scale midwifery conferences. She is also the brains behind social media campaigns such as #ZeroSeparation and #TheatreCapChallenge helping to change practice across NHS trusts.

  • STUDENT MIDWIVES

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    The wilderness: succeeding in your second year

    Chairs: Jenny Pope, Louise Webster and Elizabeth Barilli, SMF members, RCM
    Speakers: Professor John Clark, director and dean of education and quality – Health Education England (HEE) South, senior responsible officer for HEE’s RePAIR Project.Lauren O’Neill, student midwife, University of the West of Scotland and Hilary Patrick, lead midwife for education at the University of the West of Scotland

    • Are you worried about the challenges you’ll face as a second year undergraduate midwifery student? Or have you made it through the ‘wilderness year’, but seen others fall by the wayside? Then why not attend this enlightening session?
    • Maybe you’d like to understand more about why the drop-out rate peaks in year two? Or get an educators\\\' perspective on what makes the second year tough?
    • Or if you want a personal account from a student who faced the challenges head on, then Lauren has the insights you’re looking for. Don’t miss a chance to learn more and put your own questions to the panel.

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    Expectations and challenges of life as an NQM

    Chairs: Jenny Pope and Vince Rosales, SMF members, RCM
    Speakers: Anna Merrick, midwife, Imperial College Healthcare NHS Trust, Nerys Kirtley, midwifery mentorship facilitator, Cardiff and Vale UHB and Lynne Galvin, regional officer, RCM

    • Are you curious about what life is really like for a newly qualified midwife? Then make sure you hear from Anna, who will be sharing some of her experiences.
    • Would you like to know more about what to expect from midwifery preceptorship? What your responsibilities might be? What challenges you might come across, and the support in place to help you? Then come along and learn more.
    • Whether you’re just starting out, or almost at the end of your midwifery training, you won’t want to miss this chance to prepare yourself for the next steps post qualification.

  • STUDENT MIDWIVES

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    #stmwideas

    Chair: SMF members, RCM
    Speakers: Gill Walton, chief executive, RCM, Melissa Tweddle, student midwife, Hull University, Lynsey Hodgkinson, student midwife, University of Central Lancashire and Laura Flint, student midwife, University of Nottingham

    #stmwideas - a social media campaign, ran earlier in the year encouraging Student midwives to raise their voice and tweet their best practice ideas and innovations for improving maternity services. During this session you will hear from three student midwives who will share their ideas and receive feedback from both the audience and Gill Walton, chief executive, RCM. The winning # stmwideas, as voted for you, the audience, will receive a £100 voucher of their choice. Plus, the two runners-up will receive £25 voucher of their choice.

ABSTRACT PROGRAMME

  • ABSTRACTS

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    ABSTRACT SESSION 1 - PARTNERSHIP

    Chair: Michelle Beacock, board member, RCM

    Early pregnancy assessment suite (EPAS): an outpatient management care bundle to improve care and experience for women suffering with hyperemesis gravidarum
    Elaine Pirrie, senior charge midwife, Ayrshire & Arran Health Board

    The aim of the project was to introduce a standardised regime and outpatient management care bundle to support women suffering with hyperemesis gravidarum (HG), with early access to EPAS for accurate assessment, diagnosis and treatment; reduce HG symptoms; reduce the number of women requiring an overnight stay; promote women-centred care by provision of accurate and appropriate information on discharge from EPAS. We developed a telephone triage flowchart; provided EPAS staff with effective triage training, including community midwives and the maternity outpatient department; and developed clear guidelines for outpatient management of women with HG. An innovative and revolutionary outpatient service has been set up, dramatically improving care. A hyperemesis team has been formed to ensure guidelines are followed; we text message women weekly for ongoing support; women are connected with a support group; and all GPs have been emailed information about the outpatient care bundle and treatment. There has been a significant reduction of women requiring an overnight stay, and standardised practice for treatment of HG as an outpatient has ensured women receive high-quality care without requiring hospital admission, improving patient experience and psychological wellbeing. We saw a 70% reduction in inpatient stays, improving bed availability.

    A mixed methods exploration of the experiences of women living with inflammatory bowel disease during pregnancy
    Helen Janiszewski, midwife researcher, Coventry University & Nottingham University Hospitals

    Inflammatory bowel disease (IBD) is a chronic condition affecting the gastrointestinal system and is an umbrella term for ulcerative colitis and Crohn’s disease, affecting one in 250 people. Management of IBD prior to and during pregnancy is key, with active IBD disease activity increasing the risk of maternal gestational diabetes, preterm birth and low birthweight (Getahun et al, 2014). Literature about IBD and pregnancy is dominated by medicinal safety, with few articles centred on women. The aim of this study was to gain insight into the experiences of women with IBD during pregnancy. An anonymous survey, using closed-ended questions, open-ended questions and agreement scales, was distributed on Crohn’s & Colitis UK’s website and social media platforms. Women self-selected as fulfilling the eligibility criteria, and the potential number of eligible women was calculated using the fertility rate and number of female members of childbearing age. The quantitative data was analysed using descriptive statistics, and template analysis was used for the qualitative data. The survey is closed and final analysis is under way. Findings will offer an opportunity to hear the voices of women with IBD and to interpret their views into further maternity care planning.

    Outpatient induction of labour using a cervical ripening balloon project: review and co-design care with women and their families to improve experience and outcomes
    Elita Mazzocchi, quality improvement and assurance midwife, Barking,Havering & Redbridge University Hospital Trust

    In September 2017, we decided to work on improving women’s experience of induction of labour (IOL) by reviewing and co-designing existing outpatient arrangements. The service at the time involved administration of prostaglandins, which restricted birth location as well as affecting the workload and costing of inpatient services. The aim was to increase the outpatient IOL rate to 5%. The project involved an extensive training programme, which allowed the IOL service to be midwife-led, expanding the midwifery scope of practice and the outpatient IOL criteria to include women requiring low- to intermediate-risk care. This enabled women to have the full induction process at home, and meant they could now deliver at a birth centre. It also allowed staff to provide high-risk care for women without ‘distractions’ in inpatient settings. The project also involved a review of literature available and development of guidelines and a competency pack, information leaflets, etc. The results of the project are excellent: higher vaginal delivery rate (>80%) compared to previously used medical agents for induction (65%), significant reduction in length of stay resulting in 50% cost reduction (saving of >£12,000 per month), increased utilisation of birth centres (>20%), good maternal and neonatal outcomes.

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    ABSTRACT SESSION 2 - SAFETY

    Chair: Julie Richards, chair, RCM board

    Factors influencing the utilisation of freestanding and alongside midwifery units in England: a mixed methods research study
    Denis Walsh, retired associate professor in midwifery, University of Nottingham

    Midwifery units (MUs) are recommended for low-risk births by NICE because they lower rates for CS and other interventions, while maintaining outcomes comparable with obstetric units (OUs). However, they are not available in a quarter of trusts in England and are used by only a minority of low-risk women. This study explores why, using mixed methods to map MU access and utilisation; undertaking case studies in six sites to explore barriers and facilitators; and developing interventions to address these. Ethical approval was gained for the case study component. We found that births in MUs have nearly tripled since 2011 to 15% of all births. However, this increase is almost exclusively in alongside units, whose numbers have doubled. Births in freestanding units have stayed the same, and these are susceptible to closure. Most trust managers, midwifery managers and obstetricians do not regard MU provision as being as important as OU provision, so it does not get embedded as an equal component. Provision and utilisation is influenced by a complex range of factors, including medicalisation, financial constraints and institutional norms, and strategies are required at commissioner and provider level to install MU provision as an essential component of English maternity services.

    Why can’t we all just get along? A critical realist review of how to facilitate positive intraprofessional relationships between alongside midwifery units and obstetric units
    Alison Corr, teaching associate, University of Nottingham

    Alongside midwifery units (AMUs) provide midwife-led care to low-risk women and are situated next to consultant-led obstetric units (OUs). Research indicates a significant problem with intraprofessional, cross-boundary relationships between AMU and OU midwives (McCourt et al, 2016; 2014), resulting in damaging working environments and affecting women transferring between units. A critical realist review was undertaken to explore evidence and uncover macro causal mechanisms relevant to a wide frame of reference. Relevant papers were identified by searching electronic databases. Included papers were read and continuously compared to extract reoccurring results, identified as codes. Similarities and differences between the codes were developed into overarching themes. These were explored using different schools of thought to identify potential causal mechanisms that facilitate or hinder AMU/OU partnerships. Eleven peer-reviewed, primary research articles were included in the review. Themes extracted included: midwives’ identity, medical dominance and surveillance of midwives. Recommendations for practice include identifying and valuing the importance of AMU midwifery skills; rotating midwives between all intrapartum care settings to develop an understanding of each unit’s/midwife’s role; ensuring that all intrapartum care settings are appropriately resourced so that maternity care professionals do not develop a defensive need to protect resources.

    Development of a programme for the prevention of post-traumatic stress disorder in midwifery: preliminary effectiveness and feasibility learning
    Helen Spiby, professor in midwifery, University of Nottingham and Professor Pauline Slade, professor of clinical psychology, University of Liverpool

    Midwives can experience events they perceive as traumatic when providing care and develop post-traumatic stress disorder (PTSD). A national survey with the RCM estimated that at least one in 20 experience clinical levels of PTSD (Sheen et al, 2015). PTSD is distressing and potentially enduring without appropriate psychological intervention. It may also affect quality of care. Strategies to prevent PTSD and support midwives are required. We developed a stepped programme of resources, including universal prevention in the form of a workshop, a peer support system with specifically trained midwives, and access to a clinical psychologist. The programme was implemented to identify feasibility, acceptability and potential utility. Questionnaires measuring trauma exposure, knowledge and confidence of managing trauma responses, professional impacts, PTSD symptoms, burnout and job satisfaction were completed prior to training and approximately six months later. After implementation, midwives’ confidence in recognising and managing early responses to trauma in themselves and colleagues significantly increased. Potential improvements to mental health were detected via reduction in sub-diagnostic levels of PTSD. Significantly higher levels of job satisfaction were reported, with lower levels of depersonalisation and positive implications for the quality of care. There was also reduced service disruption.

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    ABSTRACT SESSION 3 - LEADERSHIP

    Chair: Helene Marshall, board member, RCM

    ‘I thought they were going to handle me like a queen but they didn\'t’: the impact of supportive leadership on the quality of care that women receive and midwives provide at the time of birth
    Jaki Lambert, head of midwifery/consultant midwife, NHS Highland

    ‘Technically competent care’ is not enough to improve the quality of care for women giving birth (de Souza et al, 2014). But the relationships and culture central to care provision are often given less priority as they are harder to monitor and therefore more challenging to improve (Bohren et al, 2015; Freedman and Kruk, 2014). We explored the maternity care experience to inform how quality of care from the woman and care provider’s perspectives can be monitored and improved by identifying key barriers and facilitators. A descriptive phenomenological approach was used, with a total of 63 interviews including in-depth interviews, focus group discussions and key informant interviews with women who had given birth in the preceding 12 weeks, healthcare providers, managers and policymakers. Following verbatim transcription, thematic framework analysis was used to describe lived experience. Ethical approval was granted. The strongest theme identified was that both women and healthcare providers largely felt alone and unsupported. Visible supportive clinical leadership and a companion whenever women wanted one were the strongest mitigating factors. This was triangulated between women, midwives and key informants. We concluded that supportive visible clinical leadership had the greatest impact on the culture and behaviours in a maternity hospital.

    Your birth, we care: women tell us what we know, so what are we going to do about it?
    Sarah Fox, consultant midwife, Abertawe Bro Morgannwg University Health Board and Abi Holmes, consultant midwife, Cardiff and Vale University Health Board.

    In a survey of 4583 women who gave birth in 2017, four key messages emerged: Models of care – women wanted to understand which professional was responsible for their care but frequently did not. They perceived a lack of birthplace choice, and half were not aware of all four options. Most women wanted to birth outside an obstetric unit (OU), but more birthed in an OU than planned. Antenatal information – clinic appointments were a missed opportunity to discuss birth options, rushed appointments affected ability to build up a relationship with the midwife, but NHS antenatal classes were useful. Information around birth was considered leading. Continuity of carer – respondents linked continuity of carer with good-quality care. Having a ‘good or bad’ midwife had a direct impact on decision-making and choice. Enabling choice – women occasionally had their choice to birth in a midwife-led unit taken away when acuity was high. Respondents believed the OU was the default option for birth. Women valued the opportunity for a birthplace discussion and believed it could contribute to reducing unnecessary intervention. Women’s voices from this survey will provide the backbone of future maternity strategy and ensure the safest care that can meet the needs of women.

    Supporting and developing midwifery leaders: a challenge and an opportunity for the profession
    Dr Bernie Divall, lecturer in leadership and management, Northumbria University


    There has been recognition of the central role for clinical leaders in the NHS and the importance of developing clinicians into formal leadership roles. However, many clinicians do not aspire to such roles. Within midwifery, leadership has been identified as a key priority in the implementation of maternity care policy. There is rising concern about the ageing senior workforce, and recognition of the importance of developing the next generation of leaders has led to a number of initiatives. This study explored the challenge of addressing concerns around leadership and management roles. A qualitative, exploratory design was used, involving narrative interviews with midwifery leaders and internet-mediated discussion with clinical midwives. Topics related to career narratives, clinical leadership roles and career aspirations. While the career narratives of midwifery leaders described their desire to make a difference and demonstrated a clear understanding of the hybrid nature of their role, clinical midwives painted a far more negative picture of leadership. Clinical leaders were perceived as \\\'managers\\\', and there was a lack of attraction to midwifery roles considered as managerial. The findings demonstrate the importance of developing a clear understanding of the many clinical leadership roles available if midwives are to influence maternity care policy.

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    ABSTRACT SESSION 4 - SAFETY

    Chair: Birte Harlev-Lam, board member, RCM

    Baby skincare – sharing evidence with new parents to ensure safe and effective best practice
    Alison Cooke, lecturer in midwifery, The University of Manchester

    There is a rising prevalence of childhood atopic eczema in the UK (Flohr and Mann, 2014), and a number of factors may be contributing to this, including lack of guidance about best baby skincare owing to misunderstandings about evidence and uncertainties about effective and safe baby skincare practices. To develop appropriate, evidence-based guidance, a mixed methods study using concurrent triangulation was undertaken. The study comprised a quantitative survey of 42 lead midwives for education (LMEs), a UK survey of 96 parents, and an exploratory qualitative study using focus groups and interviews with 10 parents, 13 health professionals, five LMEs and four student midwives. A stakeholder group was convened to monitor and inform progress. A lack of awareness among all audiences of the evidence on baby skincare was clear; health professionals who were aware of some of the evidence did not share it with parents in case it violated their professional code; many health professionals adhered to NICE guidance (2015), which doesn’t reflect the current evidence base; parents felt they received conflicting advice; and participants felt that where there was no evidence then the best expert opinion should be given. A clear and simple consistent message on current evidence is needed.

    Quantitative fibronectin to help decision-making in women with symptoms of preterm labour: determining decisional requirements (QUIDS qualitative)
    Helen White, lecturer/researcher, The University of Manchester

    Reducing the detrimental impact of preterm birth relies on timely interventions. However, for those who do not have a preterm birth, interventions are not necessarily benign. Accurate prediction of preterm birth is a challenging clinical priority. The QUIDS study aims to develop a decision-support tool to be used with fetal fibronectin testing. This was a qualitative study, with data collected via focus groups, face-to-face or telephone interviews. Nine clinicians experienced in threatened preterm labour and 12 women with personal experience of, or risk factors for, preterm birth were recruited from three NHS tertiary-referral centres. Interviews were audio recorded, transcribed verbatim and analysed by three researchers, using a framework approach. Ethical approval was granted. Analysis revealed four themes: decision-making, communication, accessing and negotiating care, and impact. Women and clinicians welcomed the ability to predict preterm birth accurately, using fetal fibronectin testing and the decision-support tool. Women wanted to be involved in decision-making to varying extents. Some felt they could make wrong decisions owing to their vulnerability and competing family priorities. Where women trusted clinicians to keep their babies safe, they handed over control. High-quality communication can positively influence women’s experiences of care and trust.

    Quality assurance improvement- reducing the avoidable repeat newborn blood spot screening rates- NBSS
    Rachel McLean, neonatal screening specialist midwife, University Hospitals of Derby and Burton


    In 2015, national guidelines changed on standards for accepting good-quality newborn blood spot samples (NBSSs). Subsequently, our trust had a significant rise in ‘avoidable’ repeat NBSSs (10.8%). But with intervention from the neonatal screening midwife and management support, there has been a steady decline in rejected NBSSs. Staff have received direct individual support from the neonatal screening midwife, and, through collaborative working with line managers, the trust is now considered an example of good practice. The neonatal screening midwife and managers organised ‘fresh eyes’ exercises once a month for four months to quality control NBSSs. Members of staff who had more than three avoidable NBSSs per quarter were given one-to-one training in obtaining good-quality samples. Staff also visited the hospital where the samples are analysed to gain a better understanding of why good-quality NBSSs are important and the potential devastating effects if treatment for the nine serious metabolic conditions is delayed. Since last year, the trust has introduced daily ‘fresh eyes’ in the hospital and community, which has had a significant effect on reducing the number of errors. For the last three quarters of 2017-18, we have achieved NHS England targets and have been asked to showcase our hard work.

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    ABSTRACT SESSION 5 - LEADERSHIP

    Chair: Kate Evans, board member, RCM board

    One giant leap for NQMs! Does it have to be?
    Nerys Kirtley, midwifery mentorship facilitator, Cardiff and Vale University Health Board

    NQMs struggle when they start employment without the support of mentors (Hughes and Fraser, 2011), and resilience and retention is low (DH, 2010). Data collected through anonymous questionnaires showed our NQMs did not feel supported to fulfil their roles and morale was low, leading to a preceptorship programme, called ‘Prep for Practice’, whereby a team of midwives committed to supporting NQMs. Members were allocated as link midwives to give NQMs access to senior midwives in clinical areas. NQMs’ first clinical areas in employment were matched to their final placements, and placement mentors then became their preceptors. Third-year students shadowed our Band 7 coordinators on delivery suite, developing teamworking, caseloading and prioritising skills but also strengthening relationships. We also created learning opportunities for identified gaps in the curriculum, such as recordkeeping. The programme offered support and guidance through WhatsApp groups, meet, greet and orientation days, supernumerary status and development of a manual, allowing our new midwives to feel part of the team and develop their competencies to gain a Band 6. Results have been fantastic so far. When asked ‘Were you supported during the preceptorship programme?’, 100% either strongly agreed or agreed, compared with 45% last year.

    Implementing a succession planning programme to assist midwives to develop their own career pathway within maternity services
    Brigid McKeown, lead midwife for community midwifery and public health, NHSCT

    The State of maternity services report (RCM, 2016) reveals that two in every five midwives (40%) in this region are aged over 50. More worrying, 53.57% of Band 7 midwives are aged over 50 years. Concern is growing about the impact of such a large proportion of our midwifery workforce approaching retirement age. We recognise the need to motivate, enthuse and nurture future midwifery leaders, but fully understand the barriers for midwives with busy lives when contemplating more senior roles. Within our trust, midwifery leaders have worked together to introduce a new and exciting way to inspire and develop Band 6 and 7 midwives. The aim of the succession-planning programme is to assist midwives to develop their own career pathway within the maternity services. This innovative programme is offered to any midwives who meet the set criteria. We were delighted with the response, as almost 20 midwives self-nominated with support from their line managers to participate. The programme covers networking, shadowing and masterclasses and runs over 10 months, with pre/post questionnaires and regular evaluation. It will enable midwives to develop coping and resilience skills, communicate more effectively, build useful networks, motivate teams, plan projects and work collaboratively.

    Pressure area care in maternity
    Alison Jones, midwife, Cardiff and Vale University Health Board


    Pressure ulcers or bedsores occur when an area is placed under pressure, reducing bloodflow and risking the skin breaking down and injury occurring. Following a number of pressure ulcers being sustained by women during a 12-month period, we reviewed midwifery practice. Two main themes were identified: risk assessments for intrapartum pressure area care were not being completed, and appropriate care plans were not being put in place for epidural anaesthesia. We needed a programme of collective learning to improve practice, but a literature review found few maternity-specific documents. Advice was sought from the tissue viability team within the health board and a workbook tailored to midwifery practice was developed. This has been used as part of a presentation for student midwives in their first year of training and the session is now part of the curriculum. Lunch-and-learn sessions have been provided using the workbook, and it is also accessible on the health board clinical portal. Midwives are now able to demonstrate knowledge, skills and competence relevant to their role in caring for those at risk of pressure ulcers, including identification and referral to specialist services, and to promote best practices in the prevention and management of pressure ulcers.

FRINGE PROGRAMME

  • FRINGE DAY 1

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    SPONSORED BREAKFAST SESSION
    A new era in the management of nausea and vomiting of pregnancy


    Speaker: Dr Catherine McParlin, senior research midwife, Newcastle University

    Presentation of disease background - Introduction of the condition ‘Nausea and Vomiting of pregnancy’ (NVP), prevalence, incidence, disease aetiology and pathophysiology
    Clinical needs- Describes the current clinical unmet needs of women suffering NVP and impact to the patient
    Current Management of NVP – Current national guidelines and treatment pathways for managing NVP
    How the new medicine fits in – Where the new licensed drug sits in the treatment pathway of NVP


  • FRINGE DAY 1

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    Cervical screening; what you need to know
    Chair: Kathryn Manning, facilitator, Redactive
    Speaker: Saimah Anwar, public health engagement coordinator, Jo\\\'s Cervical Cancer Trust

    In this presentation there will be an overview of cervical screening and its importance, addressing common myths around causes of cervical cancer, abnormal results and looking out for signs and symptoms of cervical cancer. Delegates will have the opportunity to work in groups to discuss barriers to cervical screening and increasing its uptake.

  • FRINGE DAY 1

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    SPONSORED SESSION
    Natural vs evidence based: what is best for baby’s skin?
    Chair: Louise Silverton, former director for Midwifery, RCM
    Speakers: Dr Alison Cooke, PhD, MRes, BMidwif (Hons), RM, lecturer in midwifery and David Mays, senior director, global scientific engagement, Johnson & Johnson Consumer

    Many believe ‘natural’ baby skincare products are best for baby, and with this trend come a few myths:
    • Chemical ingredients are synthetic or man-made
    • Natural ingredients are not chemicals
    • Natural ingredients are better than chemical/synthetic ones

    Our panel of experts will discuss the science of baby skin; and why an evidenced based approach to baby skincare is so important, addressing common myths around natural vs chemical ingredients. Join us to be part of this exciting debate.

  • FRINGE DAY 1

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    Multidisciplinary teamworking: it’s more than a buzz phrase
    Chair: Kathryn Manning, facilitator, Redactive
    Speaker: Wendy Randall, consultant midwife, Oxford University Hospitals NHS Foundation Trust


    The term ‘multidisciplinary teamworking’ is one delegates can’t fail to be familiar with – but what does it really mean? This is a chance to dig beneath the buzzwords and explore what effective multidisciplinary teamworking actually looks like from the perspective of a real team who will share their journey to better working relationships. The session includes a short film, made by the maternity team at Oxford University Hospitals NHS Foundation Trust followed by a presentation about the challenges they faced, the choices they made, and how they have maintained the changes.

  • FRINGE DAY 1

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    YOUR RCM: new RCM membership publications which give you information, knowledge and evidence to be the best you can be!

    Chair: Suzanne Tyler, director of services to members, RCM
    Speakers: Gill Adgie, regional head - north, RCM, Alice Sorby, employment relations advisor, RCM, Lyndsey Wheeler, senior organiser and engagements project officer, RCM and Dr Mary Ross-Davie, director Scotland, RCM

    The RCM produces dozens of publications every year for its members to help in their careers, whether in workforce planning, supporting women or to take a stance on important issues. In this session, delegates will hear from RCM staff about different publications that will put knowledge and advice at their fingertips – just go to the RCM stand to pick up a copy. Included in this session are publications covering baby boxes, flexible working, working-related stress and making the most of the MSW role.

    Learning outcomes
    By the end of this session delegates will
    • Know how publications are a key RCM benefit for members that can help them with many facets of their working lives as a midwife
    • Understand how to make the most of publications – using them as how-to guides, to take a stance on an issue and expand knowledge
    • Be aware of all the resources on the RCM stand they can go pick up and tell their friends to too.
    • Gain specific knowledge and advice on the issues of infant feeding, baby boxes, MSW roles and responsibilities, lone working, flexible working and workplace stress.


  • FRINGE DAY 1

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    They used to be so good
    Chair: Kathryn Manning, facilitator, Redactive
    Speakers: Gill Adgie, regional head - north, RCM and Alice Sorby, employment relations advisor, RCM


    This session will explore an issue which affects 75-80% of the workforce; it is a silent issue for many organisations. The ‘M’ word is a taboo subject for many. We want to raise awareness about the issues affecting members and support those who may be suffering with the symptoms of the menopause. 75% of women suffer a range of symptoms with 25% or 1:4 suffering severe symptoms. Good work is good for you, and women in good work environments report less symptoms. The NHS is sitting on a demographic time bomb in regards to its aging workforce, this is one area where we need more understanding and support.

  • FRINGE DAY 1

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    Perineal trauma and Obstetric Anal Sphincter Injury (OUSI): what you need to know
    Chair: Kathryn Manning, facilitator, Redactive
    Speakers: Sara Webb, specialist perineal midwife, mothers with anal sphincter injuries in childbirth (MASIC) , Posy Bidwell, research fellow, midwife, RCOG and Geeta Daniel MASIC mother

    This session will highlight the plight of women who suffer from childbirth related perineal trauma; the consequences of trauma, how to manage care effectively and appropriately and the need to improve education and training in this area. You will also hear about the OASIS Care Bundle; which is a quality improvement project which was implemented in 16 maternity units across England, Scotland and Wales to reduce severe perineal trauma, or obstetric anal sphincter injuries (OASI). The project looked to scale up the care bundle and was vigorously evaluated to determine clinical as well as implementation outcomes, including feasibility and acceptability to clinicians and women. Finally, you will also hear a compelling account from a mother living with the condition and the effect that it has on her everyday life.

Day Two - 5th October

Click here to view Day One ↑

MAIN DAY 2

  • Main Day 2

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    Putting policy into practice

    Chair: Susan Bookbinder, newsreader, TV presenter, Zamar International
    Speakers: Deb Jackson, head of midwifery and associate director of nursing family and therapies, Aneurin Bevan University Health Board, Justine Craig, head of midwifery, NHS Tayside and Ann Remmers, midwife and clinical director, the South West Maternity and Children’s Strategic Clinical Network

    • Have you ever felt overwhelmed by all the transformation and change that is enveloping maternity services? Then you need to hear from three midwifery leaders who are putting policy into practice on the front line.
    • This panel will share how they are trying to make maternity transformation a reality; what the challenges are, and how they keep going in the face of organisational, cultural and financial constraints.
    • If you want an insight into how maternity policy is changing services in reality, this session is one you won’t want to miss.

  • Main Day 2

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    The top, the middle and the bottom: leadership at every level

    Chair: Susan Bookbinder, newsreader, TV presenter, Zamar International
    Speakers: Karyn McCluskey, chief executive officer, Community Justice Scotland, Dame Tina Lavender, professor of midwifery and director of the Centre for Global Women’s Health at the University of Manchester and Mhairi McLellan, student midwife, Robert Gordon University

    • Do you want to be more of a leader among your colleagues? Or have you ever wondered how the leaders around you got to the top? Then this panel session is definitely for you.
    • Whether you are just starting out, climbing the career ladder, or a senior leader yourself, these speakers will help you reflect on the nature of leadership – what makes a great leader? Can you be a leader at the ‘bottom’ of an organisation? And is there such a thing a good follower as well as good leader?
    • If you would like to explore leadership at every level with some truly inspirational women, then make sure you attend.

  • Main Day 2

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    Partnership and professional leadership: what do the most influential women in healthcare have to say?

    Chair: Susan Bookbinder, newsreader, TV presenter, Zamar International
    Speakers: Gill Walton, chief executive, RCM, Professor Lesley Regan, president, Royal College of Obstetricians and Gynaecologists, Dr Asha Kasliwal, president, Faculty of Reproductive and Sexual Health and Karen Middleton, chief executive, Chartered Society of Physiotherapy

    • Did you know there has been a shift in gender representation in professional leadership, and there are now an unprecedented number of women in chair, president and chief executive positions across the royal colleges of health? If that fact piques your interest, then you should come along and find out what it might mean for your profession.
    • If you’d like to see the professions work more closely to improve women’s health then why not listen to a conversation between four professional leaders, which could open the doors on that future.
    • If you would like to hear from some of the most influential women in healthcare, and put your questions directly to them, then you will not want to miss this.

  • Main Day 2

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    On the margins: improving outcomes for vulnerable women

    Chair: Susan Bookbinder, newsreader, TV presenter, Zamar International
    Speakers: Memuna Sowe, midwife, Croydon Health Services NHS Trust’s Rainbow Health Centre, Faye Macrory, retired consultant midwife and Hilary Alba, charge midwife. Greater Glasgow and Clyde

    • Do want to know how to provide the best support for vulnerable women and families in your care? These exemplary midwives have the knowledge and experience to help.
    • Have you have ever felt concerned about going the extra mile, while also staying within boundaries? Would you like some guidance on how you can be a better advocate for vulnerable women? Are you passionate about improving outcomes for women and babies on the margins? Then you will want to hear what these speakers have to say.
    • If you want to come away from conference with fresh insight into how midwives can adapt their practice to help the most vulnerable women and families in their care, then make sure you don’t miss what promises to be a compelling session.

  • Main Day 2

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    100 years of suffrage – 150 years of the TUC - celebrating the role of women

    Chair: Susan Bookbinder, newsreader, TV presenter, Zamar International
    Speaker: Lynn Collins FRSA, regional secretary, TUC North West

    This presentation will spotlight and celebrate to role of women throughout the history of the TUC and aims to inspire with tales of collectivism and campaigning showing how women were at the heart of changing the world of work for good.


RCM STRAND DAY 2

  • RCM STRAND

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    Leadership

    Chair: Kathryn Gutteridge, president, RCM
    Speakers: Gail Johnson, professional advisor for education, RCM Helen Rogers, director, RCM Wales and Dr Laura Abbott FRCM, senior lecturer in midwifery, Department of Allied Health and Midwifery University of Hertfordshire

    This session will provide delegates with an opportunity to hear about the leadership initiatives currently available to midwives and maternity staff and how the RCM continues with its commitment to developing leadership skills at all levels

    Learning outcomes
    By the end of this session delegates will
    • Have an appreciation of the importance and value of leadership at all levels
    • Be aware of leadership education opportunities available to members
    • Hear about specific leadership activities in each of the four UK countries
    • Hear how RCM Fellows showcase leadership
    • Know where to seek further advice and guidance on their careers
    • Appreciate how i-learn and i-folio can support development at all levels

  • RCM STRAND

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    YOUR RCM: new RCM membership publications which give you information, knowledge and evidence to be the best you can be!

    Chair: Kathryn Gutteridge, president, RCM
    Speakers: Gill Adgie, regional head - north, RCM, Alice Sorby, employment relations advisor, RCM, Lyndsey Wheeler, senior organiser and engagements project officer, RCM and Dr Mary Ross-Davie, director Scotland, RCM

    The RCM produces dozens of publications every year for its members to help in their careers, whether in workforce planning, supporting women or to take a stance on important issues. In this session, delegates will hear from RCM staff about different publications that will put knowledge and advice at their fingertips – just go to the RCM stand to pick up a copy. Included in this session are publications covering baby boxes, flexible working, working-related stress and making the most of the MSW role.

    Learning outcomes
    By the end of this session delegates will
    • Know how publications are a key RCM benefit for members that can help them with many facets of their working lives as a midwife
    • Understand how to make the most of publications – using them as how-to guides, to take a stance on an issue and expand knowledge
    • Be aware of all the resources on the RCM stand they can go pick up and tell their friends to too.
    • Gain specific knowledge and advice on the issues of infant feeding, baby boxes, MSW roles and responsibilities, lone working, flexible working and workplace stress.


  • RCM STRAND

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    Quality Improvement in maternity services

    Chair: Kathryn Gutteridge, president, RCM
    Facilitator: Mandy Forrester, head of quality and standards, RCM
    Speakers: Cheryl Clark, Angela Cunningham, MCQIC (Scotland) and Vivienne Novis, OASI

    This session will give participants an overview of the quality improvement programme currently ongoing across the country. A short panel discussion will be followed by examples of projects undertaken as part of the programmes to explore how learning care be shared.

    Learning outcomes
    Participants will
    • gain an understanding of national maternity quality improvement programmes
    • appreciate the value of quality improvement in maternity services
    • hear lessons learned from members who have been involved in projects

  • RCM STRAND

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    ‘Can continuity work for us?’

    Chair: Kathryn Gutteridge, president, RCM
    Speakers:Dr Mary Ross-Davie, director for Scotland, RCM and Lia Brigante, quality and standards advisor, RCM

    This session will share with attendees a wealth of resources to support them when thinking about implementing continuity models of care in practice. The RCM supports the principal that midwifery continuity of carer should become the central model of maternity care in the UK, as there is now such a wealth of good quality evidence to demonstrate the positive impact on a range of outcomes. However, implementing this model represents a very significant change in the way that maternity services are organised and that many midwives work. The RCM is committed to providing our members – both managers and clinical midwives and maternity support workers, with resources to support them in implementing continuity models successfully and sustainably.

    Learning outcomes:
    1. Will be aware of the new RCM ‘continuity counts’ game, revised position statement, I learn module and ‘Nuts and Bolts’ resource.
    2. Will understand how they can access RCM support around the issue of continuity of carer implementation
    3. Will know how to access key information about the evidence around continuity of carer
    4. Will feel confident that they have resources to share with colleagues back in their places of work to support positive, sustainable implementation

  • RCM STRAND

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    National maternity and perinatal audit

    Chair: Kathryn Gutteridge, president, RCM
    Speakers: Mandy Forrester, head of quality and standards, RCM and Dr Tina Harris, senior clinical lead (midwifery) national maternity and perinatal audit

    This session will give participants an overview of the National and Maternal Perinatal Audit. We will explore the relevance of the audit to clinical practice and look at how findings can be applied to improve the quality of care provided to women and babies.

    Learning outcomes
    Participants will
    • gain an understanding of the National and Maternal Perinatal Audit
    • learn how to relate findings to their own trust/board
    • learn how to apply audit outcomes to clinical practice

ABSTRACTS DAY 2

  • ABSTRACTS DAY 2

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    ABSTRACT SESSION 6 - PARTNERSHIP

    Chair: Julie Richards, chair, RCM board

    Multiples matter: a multidisciplinary team approach to personalised care
    Kathryn Harper, multiple births midwife, Leeds Teaching Hospital Trust

    Multiple pregnancy is associated with higher risks for the mother and babies, including miscarriage, anaemia, hypertensive disorders, haemorrhage, operative delivery, mental health problems and postnatal illness. Maternal mortality is 2.5 times higher than in singleton births; the stillbirth rate is higher; and the risk of preterm birth is higher, occurring in 50% of twin pregnancies. NICE guidance (2011) recommends specialist teams care for multiple pregnancies, however, only a small percentage of units have specialist midwives (18%) and sonographers (28%), and 30% of multiple mothers do not have care from a specialist consultant (Tamba/NCT Maternity Report, 2015). In our unit, women were seen in a consultant-led twin clinic but received most of their care from their local midwife at their GP practice. In May 2014 we developed a multidisciplinary team multiples service, providing expert advice and specialist, personalised care consistent between the hospital and community setting and working collaboratively with fetal medicine, outreach and neonatal staff, children’s centres, Tamba, social media and external agencies such as Home-Start. An external audit by Tamba in 2017 identified lower than average stillbirth and emergency intrapartum CS rates. Feedback from patients has been overwhelmingly positive.

    The development and feasibility testing of a midwife-facilitated intervention to support women with mild to moderate anxiety in pregnancy
    Kerry Evans, clinical academic midwife, University of Nottingham, School of Health Sciences

    Many women experience symptoms of anxiety during pregnancy. Severe anxiety is associated with negative health outcomes for women and babies, and psychological interventions may be beneficial for pregnant women with mild to moderate symptoms. The aim of the study was to develop an intervention that could be facilitated by midwives. An intervention was developed according to the Medical Research Council theoretical and modelling phases for developing complex interventions, and delivered in three components: a one-to-one pre-group meeting with the midwife; four group sessions facilitated by the midwife and MSW; and self-help materials to be accessed between group sessions. All nulliparous women in two study locations who were 16-25 weeks pregnant between April and May 2016 were invited to participate. The GAD-2 (generalised anxiety disorder) scale was administered by the community midwife to assess eligibility. Data collection comprised baseline and post-intervention self-report anxiety measures and semi-structured interviews to determine feasibility and acceptability post-intervention. Data analysis used descriptive statistics for quantitative data and template analysis for qualitative data. This study established the feasibility of providing an intervention for pregnant women with mild to moderate anxiety, facilitated by midwives, that is acceptable to women, with no negative impacts.

    The parents study: parental involvement in the perinatal review process following the loss of their baby
    Mary Lynch, midwife, North Bristol NHS Trust

    There are approximately 4500 stillbirths and neonatal deaths at age under seven days (perinatal mortality) in the UK each year. This equates to around seven in every 1000 births. The perinatal mortality review meeting (PNMR) that takes place post-death can provide answers to parents and vital lessons on improving care for women and their families. Unfortunately, evidence suggests that parents are unaware of this formal review, and many would welcome the opportunity to participate. We considered that parental involvement in the PNMR would have potential to improve patient satisfaction, drive improvements in patient safety, and promote an open culture. Women and their partners were invited to participate in the study if they experienced a perinatal death within a six-month pilot period. They were asked to complete a PNMR parent feedback form, developed from a consensus meeting of national experts, during a home visit from the research midwife. This allowed them to submit questions, comments or views that are then discussed in a standardised format at the PNMR, with each feedback comment addressed and any salient learning points clearly documented. Results to date are encouraging, although the full suite of follow-up measures is not yet complete.

    Effective partnership: how collaborative working improves care of women with perinatal mental health disorders
    Daisy Kelly, specialist midwife for perinatal mental health, Kings College NHS Foundation Trust

    Deaths from psychiatric causes remain the leading cause of maternal death in the year following birth (MBRRACE, 2014), unchanged over 21 years. There is clear evidence to demonstrate the significant morbidity associated with poor perinatal mental health, largely experienced by the infant and thereby affecting our future society. Effective mental healthcare must be holistic, especially in the perinatal period, when a woman’s life inevitably becomes more complex. Professionals must liaise regularly to ensure seamless care. In our large and diverse borough, we have achieved this. There is a weekly meeting attended by a minimum of five different organisations, all working towards a shared goal of improving perinatal mental health. The woman and family are kept central in all discussions, and partnership with housing, the Child and Adolescent Mental health Services and family support workers ensure that social needs are also attended to. A weekly multidisciplinary clinic is held, staffed by a specialist midwife, perinatal nurse, perinatal pharmacist, perinatal psychiatrist and consultant obstetrician. More recently, the multidisciplinary team has offered a perinatal training day. The success of the team has been rewarded with an award for ‘Best mental health team’ across three large boroughs. This was largely as a result of outstanding feedback from service users.

  • ABSTRACTS DAY 2

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    SPONSOR SESSION
    Reflection on the NIPT roll out in NHS Wales
    Speaker: Sarah Anderson,all Wales genetic service, Institute of Medical Genetics, University of Wales

    NHS Wales rolled out Non-Invasive Prenatal Testing (NIPT) in April this year as part of their national screening programme. The first presentation by Sarah Anderson, from the genetics lab in Cardiff and Wales University hospital, reflects on the first 6-months of implementation in Wales and discusses the importance of working with a multi-disciplinary team, involving the lab performing the assay, the local genetics team, the midwives, the screening co-ordinators and the obstetricians. It will highlight NIPT uptake in Wales and the initial results so far.

    NIPT perspectives from the voice of the genetic counsellor
    Speaker: Christin Coffeen, senior genetic counsellor, Illumina Inc

    In the second part of the workshop, you will hear from Christin Coffeen, currently a genetic counsellor at Illumina and a former clinical prenatal genetic counsellor. Christin will reflect on important counselling considerations as health care professionals speak with patients about NIPT. It will highlight an educational tool available for health professionals to share with their patients.

  • ABSTRACTS DAY 2

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    ABSTRACT SESSION 7 - LEADERSHIP

    Chair: Pauline Twigg, board member, RCM

    Collaborative learning in practice models: the dynamic learning and care environment
    Elizabeth Crisp, midwife & midwifery lecturer, Staffordshire University and
    Susan Jackson, midwife & midwifery lecturer, Staffordshire University.

    Education for healthcare professionals has undergone significant changes over the past three decades, while safe learning and care environments remain a consistent requirement; increases in patient dissatisfaction, waiting times and staff attrition must be addressed in the further evolution of education for healthcare provision (Health Education England, 2015). In this current climate of staff shortages, increasing workloads and financial pressure, the collaborative learning in practice model can improve both student and staff experience. Lord Francis (2013) is often referred to by proponents as a key driver for the implementation of the collaborative learning model. However, a strong link to the Francis Inquiry is difficult to identify; other than to recognise that the past 35 years of development of nurse education has been in the absence of primary consideration of service users, which arguably has resulted in a unsatisfactory culture within care provision. Students’ pre-registration journey is not without challenges, which can directly influence their practice learning experiences and the practice-learning environment. Contemporary challenges, such as the removal of student bursaries resulting in self-funding of tuition fees, have the potential to impact on recruitment to health professional courses, consequently resulting in staff workforce shortages in specific healthcare fields.

    Rethinking inductions of labour
    Sally Goodwin, lead midwife for inductions, Sherwood Forest Hospitals Foundation Trust and Susie Al-Samarrai, consultant obstetrician, Sherwood Forest Hospitals Foundation Trust

    In 2016, we were challenged to question if women were being induced appropriately (induction of labour (IOL) rate >35%). We had formal and informal complaints about patient experience, length of process and delays. And staff and patients were frustrated by daily firefighting to triage/prioritise the most appropriate inductions. A concept was developed to review all IOL requests centrally, allowing prioritisation of urgent cases and consensus opinion on more challenging cases. A year’s secondment was introduced for a Band 6 midwife to develop, introduce and embed a new pathway for inductions. New guidelines were produced, along with patient information leaflets and a referral form. IOL slots were changed from PM to AM to ensure inductions were part of the ward round. There was also a focus on optimising chances of labour, including relaxation, aromatherapy, mobilisation and use of water. Women now feel ‘more cared for’ and ‘more involved in decision-making’, while staff no longer feel pressured in clinic or on the labour ward to accept and book inductions. Service flow improved and more women are birthing less than 24 hours after administration of Propess®, and there is a reduction in the use of a second Propess®, as well as oxytocin infusions and epidurals.

    Multiprofessional human factors training within maternity improves safety culture
    Malissa Rayfield, simulation fellow and clinical midwife, Norfolk & Norwich University Hospital

    Human factor training within maternity is now identified as a major area for development and has been recommended by several major reports, including MBRRACE (2017) and the RCOG\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\'s (2015) Each Baby Counts. Human factors is a broad term, exploring why an event happened as opposed to simply what happened. For example, why did this midwife incorrectly interpret a CTG, as opposed to simply what was wrong with her interpretation. This concept allows midwives and the whole maternity team to unpick why many of our errors happen, and, with this knowledge, we are training our team on how to prevent them. We have trained a team of 17 faculty members to support the implementation of human factors teaching to all maternity staff. We have embraced the recommendations of MBRRACE and Each Baby Counts and have developed a national film explaining how to improve situational awareness. We run weekly in-situ simulations to embed human factor knowledge and are rolling out a monthly two-hour teaching session in which we embrace formal teaching, forum theatre and storytelling to highlight how human factors affect safety. All of our 350 maternity staff will be trained in human factors by December 2018.

  • ABSTRACTS DAY 2

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    ABSTRACT SESSION 8 - SAFETY

    Chair: Kate Evans, board member, RCM

    I\\\'m in labour. I\\\'m telling you I am in labour.’ What is the experience of being a pregnant woman in prison? Findings of an ethnographic study
    Dr Laura Abbott, senior lecturer, University of Hertfordshire

    The UK has the highest incarceration rate in Western Europe, with pregnant women making up around 6% of the female prison population. There are limited qualitative studies published that document the experiences of pregnancy while serving a prison sentence. My doctoral study presents a qualitative, ethnographic interpretation of pregnancy experience in English prisons. The study took place during 2015-16 and involved semi-structured interviews with 28 female prisoners who were pregnant or had recently given birth, 10 members of staff, and 10 months of non-participant observation. This presentation focuses on how ‘institutional thoughtlessness’ in a patriarchal system can lead to dangers for perinatal women. From missed medication and a lack of basic provisions to inappropriate diagnosis of women in labour – my talk will bring this groundbreaking research to RCM members through the voices of women. The main frustration that was articulated by all participants was not receiving basic rights and entitlements, with inconsistencies across prisons, often dependent on individual staff knowledge. This research has given voice to pregnant imprisoned women and highlighted gaps in existing policy guidelines. In this sense, the study has the potential to springboard future inquiry and to be a vehicle for positive reform.

    Fetal movements matter: using forum theatre in the co-production of a care pathway for women who experience reduced fetal movements
    Dr Helen Baston, consultant midwife: public health, Sheffield Teaching Hospitals NHS Foundation Trust

    This project focuses on the care of pregnant women with reduced fetal movements (RFM). Fetal activity is used by midwives and mothers as a sign of wellbeing, and a reduction in movements is often associated with fetal compromise and stillbirth (Stacey et al, 2011). We know from analysis of local data that 42% of the women who experienced stillbirth in our unit identified a preceding change in the pattern of fetal movements. Of the women who ring our antenatal contact centre, the fourth highest reason is RFM. Inconsistent advice can lead to a delay in the reporting of RFM and consequently a delay in its management. Women seek and receive information from a range of sources, however, advice regarding what to do if they notice a difference in their baby’s activity is variable and confusing (Warland and Glover, 2016). As a large, tertiary maternity unit that employs over 300 midwives, ensuring that all professionals provide consistent, evidence-based advice was our challenge. We used the ‘forum theatre’ methodology to identify facilitators and barriers to undertaking and embedding practice change (Kontos and Poland, 2009), and will share excerpts from the production to demonstrate how this can lead to workable solutions.

    The Warm Bundle: reducing hypothermia in term and near-term newborn infants
    Chistina Smith, charge midwife, Greater Glasgow and Clyde

    Neonatal hypothermia is widely recognised as a contributor to newborn morbidity and mortality. The neonatal period is crucial in the mother/baby bonding process and separation should be minimised. A retrospective review of unplanned admissions to the neonatal unit (NNU) within this service highlighted a significant problem with admissions of term and near-term (35-42 weeks’ gestation) newborn babies with hypothermia (temperature <36.5⁰C) and related morbidities. The project aimed to reduce admissions of newborns with hypothermia by 30% in 12 months. A cross-speciality, multidisciplinary team was set up, and the Warm Bundle educational package was developed to standardise and enhance processes for thermal care. This included a poster teaching the WHO warm chain, and introduction of a standardised process checklist for every delivery. Quality improvement methodology was used, with monthly measurement of process and outcomes over three years. Although process compliance was achieved, outcome data demonstrated the need for additional environmental interventions, including raising the temperature of delivery rooms and introducing warm cots and warm linen supplies. The project was a huge success, with a 58% reduction in the annual number of hypothermia-associated NNU admissions, and the Warm Bundle has been adopted in several hospitals in the UK.

  • ABSTRACTS DAY 2

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    ABSTRACT SESSION 9 - PARTNERSHIP

    Chair: Kate Evans, board member, RCM

    Partnership in practice, baby steps towards big changes?
    Sonia Wilson, midwife/baby steps health practitioner, Leeds Teaching Hospital and Victoria Ward-Joel, baby steps implementation manager, NSPCC

    This evidence-based perinatal education programme for families experiencing adversity or vulnerability was developed in partnership with the NSPCC in response to gaps in antenatal education in the perinatal period (McMillan et al, 2009). It builds on the Preparation for birth and beyond framework, incorporating the latest findings from research into infant mental health, strengthening relationships and improving outcomes. The NSPCC has been working with early adopter partners to introduce the programme within mainstream public services, and we became an early adopter in 2014. The overall aim is to optimise parents’ and babies’ health and wellbeing and promote sensitive parenting and secure attachment. We run nine sessions throughout the antenatal and postnatal periods, and visit the parents at home beforehand. Following the baby’s arrival, practitioners film the interaction between parent and baby. We encourage fathers and partners to attend the programme, while encouraging single mothers to bring a friend or family member to the group. The programme is facilitated by a midwife or health visitor and a family support practitioner. The same two co-facilitators deliver all the home visits and weekly sessions, bringing skills and expertise that can help parents through both the physical and emotional aspects of becoming a parent.

    Together we are more than the sum of our parts: perspectives on partnership in practice – a collaborative journey to implement the recommendations in Better births
    Helen Maric, midwife transformation project manager, North West London Local Maternity System and Nicky Wilkins, consultant midwife, North West London Local Maternity Team

    We work across eight clinical commissioning groups, four hospital trusts, six maternity units, 40 community clinics and employ more than 1000 midwives to improve maternity services for 30,000 women and families. We have been working to establish partnership networks to enable us to achieve increased continuity of carer, improved postnatal care and improved consistency of information. Our achievements include: • Developing four new models of care, tested across sectors in a variety of approaches • Recruiting to and launching two new caseloading teams for midwife-led pregnancies and for women with previous gestational diabetes. Two further teams for women with multiple pregnancies and women with social complex needs are to be launched • Expanding existing caseloading teams for women with social complex needs • Designing and delivering new models of caseloading out of birth centres • Reconfiguring community midwifery services to improve continuity • Co-producing information packs and discharge letters to ensure a sector-wide approach • Introducing and standardising a personalised postnatal care plan for all women • Producing a cross-sector maternity app; facilitating choice and rich in content • Working towards harmonising MSW job roles • Nurturing supportive links with maternity transformation programmes • Sharing our learning at midwifery forums across the country • Invigorating and embedding all Maternity Voices Partnerships.

    Neonatal transitional care education programme for midwives
    Joanna Greenock, practice development midwife, Greater Glasgow and Clyde and Tom McEwan, lecturere in midwifery, University of the West of Scotland

    Minimising separation of mothers and babies underpins The best start – a five-year forward plan for maternity and neonatal care in Scotland. The availability of neonatal transitional care (NTC), which supports a resident carer, usually the mother, to care for a baby with requirements in excess of normal newborn care but not requiring neonatal admission is pivotal in achieving this aim. In October 2017, we set out a plan for how NTC could be provided to families across this health board. One of the needs identified was midwifery staff education. An NTC education group was convened to plan, deliver and evaluate a programme to ensure that midwives understood the benefits of caring for babies within NTC settings, were confident in delivering, and supported a family-centred approach to care, and were responsive to emerging family needs. The NTC concept was then promoted locally and 14 places on a pilot programme were offered to midwives interested in working in this setting. Participants indicated a marked increase in perceived ability, and we concluded that high-quality education is essential to ensure consistent delivery of high-quality NTC. This pilot has enabled NTC education for midwives to be developed, delivered, tested and amended for further implementation.

  • ABSTRACTS DAY 2

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    ABSTRACT SESSION 10 - SAFETY

    Chair: Tracy Miller, board member, RCM

    #TheatreCapChallenge: improving safety and creating better birthing experiences for women in theatre
    Alison Brindle, student midwife, Lancashire Teaching Hospitals Trust and Emma Gornall, delivery suite manager, Lancashire Teaching Hospitals Trust

    Medical error is reported to be the third leading cause of death in the US. The World Health Organization (2000) report An organisation with a memory estimated 850,000 adverse events per year were happening within NHS hospitals, equivalent to 10% of hospital admissions. Human factors are considered to be one of the main causes behind medical errors, and 50% to 70.2% of harm can be prevented through comprehensive, systematic approaches to patient safety (WHO, 2018). One area where improvement needs to be made is within the maternity theatre setting, where, often, women do not recognise their own midwife among the sea of blue scrubs and theatre caps. This can make women feel vulnerable, but improving patient safety while improving their experience is difficult. We discovered a way to tackle both issues with the simple act of writing names and roles on theatre caps. This improves women’s birthing experiences in theatre but also helps to overcome communication barriers across the team. To raise awareness, we launched the #TheatreCapChallenge campaign across social media. Many healthcare workers and theatre teams are now adopting this simple idea, not only in the UK but also in countries such as Australia, Spain and the US.

    Service redesign for women at risk of Gestational Diabetes Mellitus (GDM)
    Noreen Dunnachie, lead midwife for diabetes, NHS Ayrshire and Aran

    The number of women diagnosed with gestational diabetes mellitus (GDM) has increased threefold, from 7% in 2010 to 22% in 2016, peaking at 25% in 2015. This has resulted in an unsustainable service with heavily oversubscribed clinics, and infrequent, inconsistent specialised care. Part of the first-stage service improvements focused on improving women’s satisfaction with their care. Plan, Do, Study, Act cycles were used to collect data and feedback. Following a diagnosis of GDM, each woman attended a one-hour meter demonstration and education appointment, providing one-to-one tailored advice. Introduction of a telephone clinic allowed weekly diary reviews of blood glucose levels, facilitating dietary changes without attending hospital and enabling women to retain community-led midwifery care. This has significantly reduced the number of clinic appointments and medical input. Consequently, the number of women able to manage their diabetes with diet control alone has significantly increased. In addition, our data has shown a reduction in the mean birthweight of babies born to women with GDM. Women’s satisfaction has improved significantly. A new designated OGTT clinic was also set up, using the two-hour wait between blood samples to provide expert education on diet and lifestyle choices for all women, not just those with an impaired result.

    Information behaviour: an ethnographic exploration of midwives accessing and using information for practice in the labour ward
    Elinor Jenkins, midwife, Isle of Wight NHS Trust

    As maternity care becomes more complex, midwives need to use information at the point of care on the labour ward. Understanding how midwives use information could improve the information environment. This was a qualitative study using the principles of ethnography. Twenty-one purposively sampled midwives were observed providing high-risk care to women in the labour ward of an English tertiary referral hospital with a delivery rate of 6000+ births per annum. Ten of the observed midwives were purposively sampled for interview. Data was collected and analysed between October 2011 and November 2014. Ethical approval was obtained from the National Research Ethics Service. Thematic analysis using open and focused coding revealed that midwives identified information needs when they recognised limitations in their knowledge. Information sources used by midwives were usually verbal or documented and included maternity notes, guidelines, equipment, computers, colleagues, women and the environment. Accessibility, usability and approachability were key. As information for care can change relatively quickly, it is essential that midwives are able to seek and use information successfully. Educating midwives about information excellence, creating more user-friendly guidelines and improving search techniques for electronic information could support improved information access and improve safety and quality of clinical care.

FRINGE PROGRAMME DAY 2

  • FRINGE DAY 2

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    Fear of birth a spectrum
    Chair: Kathryn Manning, facilitator, Redactive
    Speaker: Dr Yana Richens OBE, deputy head of maternity services – Nursing Directorate, Professional Midwifery Advocate

    Come along to this session to hear from a leading expert on the fear of birth with a specific focus on Tokophobia.

  • FRINGE DAY 2

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    Surrogacy; a midwife\'s perspective
    Chair: Kathryn Manning, facilitator, Redactive
    Speaker: Sarah Spencer, senior midwifery manager, Cardiff and Vale University Health Board and Spencer Clarke, lawyer, Law Commission

    Surrogacy is an ever evolving, more prominent part of a midwives role. Come along to this session to hear from RCM Award winner, Sarah Spencer, on her first surrogacy case involving twins. Sarah will cover the intricacies of this complex case and how, as a senior midwife, she worked with multidisciplinary teams to ensure the process was smooth for everyone involved.
    You will also hear from the Law Commission who will run through the current guidelines and the future of surrogacy.

  • FRINGE DAY 2

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    Massage for mother and midwife
    Chair: Kathryn Manning, facilitator, Redactive
    Speaker: Claire Nutt, founding director & massage therapist, The Birth & Wellbeing Partnership

    In this interactive session led by midwife and massage therapist Claire Nutt, you will learn the benefits of massage for both midwives and women in your care. The session will deliver practical, proven insights in an interactive format giving you the tools to aid you in your role and assist you in the workplace.

  • FRINGE DAY 2

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    Pilates: the benefits for you and the women in your care
    Chair: Kathryn Manning, facilitator, Redactive
    Speaker: Nikki Kelham, physio-led pilates instructor, Complete Pilates

    Pilates is hugely important in ante and post natal care, this session will equip you to share those benefits with the women you see every day. Led by Chartered Physiotherapist Nikki Kelham, the session will deliver practical, proven insights in an interactive format. You will learn the basics of pilates for yourself, including abdominal, breathing and postural work and you will be given tools to aid you in your role. You may even have some fun too!!