Today I am talking to a ‘Fab Obs’.
#FabObs is the hashtag we use in our #MatExp social movement - an obstetrician who ‘gets it’. Listening to what matters to women.
Finding ways to prioritise, obviously, the safety of mother and baby, but really listening to women – and indeed helping them tease out the choices and birth options.
And today that #FabObs is Alison Wright. Alison is the immediate past Vice-president of the RCOG (Royal College of Obstetricians and Gynaecologists) – a big advocate for the RCOG women’s network, embedding women’s voices into every aspect of the college‘s work. Forward-thinking and exciting.
Alison has led the development of ‘I decide’ - a tool enabling women to think through choices and decisions in labour.
As well as being a champion of maternity experience, Alison is also ‘just’ an everyday ‘Obs and gynae’ doctor.
Lemon lightbulbs 🍋💡🍋
We LOVE it when you leave a review!
If you enjoy my podcast and find these conversations useful
please share your thoughts by leaving a review (Apple is easiest to leave a review) and comment on your favourite episodes.
I tweet as @WhoseShoes and @WildCardWS and am on Instagram as @WildCardWS.
Please recommend 'Wild Card - Whose Shoes' to others who enjoy hearing passionate people talk about their experiences of improving health care.
Today I am talking to a ‘Fab Obs’.
#FabObs is the hashtag we use in our #MatExp social movement - an obstetrician who ‘gets it’. Listening to what matters to women.
Finding ways to prioritise, obviously, the safety of mother and baby, but really listening to women – and indeed helping them tease out the choices and birth options.
And today that #FabObs is Alison Wright. Alison is the immediate past Vice-president of the RCOG (Royal College of Obstetricians and Gynaecologists) – a big advocate for the RCOG women’s network, embedding women’s voices into every aspect of the college‘s work. Forward-thinking and exciting.
Alison has led the development of ‘I decide’ - a tool enabling women to think through choices and decisions in labour.
As well as being a champion of maternity experience, Alison is also ‘just’ an everyday ‘Obs and gynae’ doctor.
Lemon lightbulbs 🍋💡🍋
We LOVE it when you leave a review!
If you enjoy my podcast and find these conversations useful
please share your thoughts by leaving a review (Apple is easiest to leave a review) and comment on your favourite episodes.
I tweet as @WhoseShoes and @WildCardWS and am on Instagram as @WildCardWS.
Please recommend 'Wild Card - Whose Shoes' to others who enjoy hearing passionate people talk about their experiences of improving health care.
Gill Phillips 00:10
My name is Gill Phillips and I'm the creator of Whose Shoes, a popular approach to co-production. I was named as an HSJ 100 'Wild Card' and want to help give a voice to others, talking about their ideas and experiences. I'll be chatting with people from all sorts of different perspectives, walking in their shoes, if you are interested in the future of health care, and like to hear what other people think, or perhaps even contribute at some point, Whose Shoes Wild Card is for you.
Gill Phillips 00:46
Today, I'm talking to a #FabObs. #FabObs is the hashtag that we use in our #MatExp (that's maternity experience), social movement to describe an obstetrician who just 'gets it', listening to what matters to women, as in really listening. Finding ways to prioritise, obviously, the safety of mother and baby, but really listening to women, and indeed helping them tease out the choices that are best for them in terms of their birth options. And today, that #FabObs is Alison Wright. Alison is the immediate past Vice-President of theRCOG, that is the Royal College of Obstetricians and Gynaecologists, and a big advocate for the RCOG Women's Network, embedding women's voices into every aspect of the college's work. This is forward-thinking and exciting. Alison has led the development of 'I decide' - a tool aiming to give women the ability to think through choices and decisions in labour. And as well as being a real champion of maternity experience, Alison is also 'just' - and we never use the word 'just' - an everyday Obs & Gynae doctor. So I'm delighted that Alison agreed to chat to me on the podcast today, and tell us a bit more. Welcome, Alison. Thanks for being a #FabObs! Can you tell us a bit more about yourself, and what's important to you?
Alison Wright 02:16
Thanks so much, Gill. I'm delighted to be here. And of course, delighted to be described as one of the #FabObs. So yeah, I'm a consultant in obstetrics and gynaecology at the Royal Free Hospital in London. I'm also working at NHS England and improvement as a specialty advisor, with a particular remit for personalised care. So yeah, as you say, it really matters to me that women and birthing people are listened to throughout their birth journeys and pregnancy. And also that we really strive to provide high quality care. That also means that we have adequate staff numbers, which I know is a real issue for all of us working in maternity services at the moment. So what matters to me is providing the best care, but also to do whatever we can to improve the numbers of staff in maternity, and also to support those staff so that we can keep on giving the quality of care we want to give.
Gill Phillips 03:12
That's a brilliant start, Alison- and I actually gave up my day job 14 years ago, to make a difference around personalised care. But that was with a social care background. What does personalised care mean in the context of maternity?
Alison Wright 03:29
Yeah, it's interesting, isn't it? Yeah. I think personalised care means different things to different people. So for the NHS, long term plan, personalised care is included as one of the five major projects that the NHS wants to provide for patients. I think for us in maternity care, it means that we bring together the clinicians expertise and the patient's expertise, in other words that we, we try and combine, looking at and listening to what matters for that particular woman, as well as giving our professional expertise. Because I think historically, we've not always been good at doing that. So I think, you know, we're good at making a risk assessment. The woman puts together her birthing plan, and kind of never the twain shall meet until we're in labour. And sometimes I've been in a situation where a woman is in labour, and she shows us her birth plan. And, you know, women often say, you know, "so the birth plan has now gone out of the window", which we really try not to, not to do and we always try and respect whatever elements of the birth plan we can. I always say to them, "no, we will do whatever we can to honour your wishes in the birth plan". But what we're trying to do now in NHS England and Improvement is personalised care and support planning, which means that from the very start of the pregnancy journey, that woman or birthing person will share with us - me, the obstetrician or her midwife - what matters to her at that point, and then we can have a conversation about what her background risks might be. So we have a conversation about the risks and what matters to the woman all the way through so that it's not a big surprise, then if I recommend an intervention in labour, or if she wants something particular about her birth - we've had those conversations antenat ally. So I think that's really important. It's difficult because it means we need to have much more of an honest dialogue early on, it means we need to make information more available. It means that we need doctors and midwives to have time in clinics to have those conversations. But I certainly think that that's something that we all need to be striving for, so that women and birthing people are more prepared when they're in labour, and therefore can make informed decisions better.
Gill Phillips 05:52
I love that description - that feels like a real lemon lightbulb in terms of ... I think you said if it doesn't work properly, then never the twain shall meet. So,, and obviously I talked to a lot of women and you've got a birth plan and that expression 'it all went out the window' - it's far too common, isn't it? And that idea of the relationship - I think that's that's what I'm hearing - throughout the antenatal journey, and the trust as well. And actually understanding this is what matters to the women. But hey, we've got these risks, how are we together going to work through that? It's very exciting and very human. And like, why is it so difficult? But then you mentioned the word 'time' and staffing, trying to tease through that reality, isn't it?
Alison Wright 06:40
Yeah. And also, I think it is being honest with our dialogues with women. And I think doctors and midwives have been very well intentioned, sometimes in the past, in not sharing information with women. So for example, a project I was involved in looking at anal sphincter tears, and tears during childbirth. There was a big project that the RCOG and the RCM did together. And women, 57,000 women, were told about the risks that could happen in labour. Previously, people had been quite anxious about sharing those risks. But actually, there are only a handful of women who said that they'd rather not know. And all the others said that they were glad to have that information antenatally. And I think that goes for a lot of the risks of childbirth. Well-intentioned clinicians think that it might scare women, if we tell them what might happen. But actually, the evidence does show that largely women want to know what might happen. And women that I meet in labour, sometimes for the first time, for example, if I'm recommending a forceps birth, some women are really scared about that. And it would have been really helpful to have warned them antenatally that this might be offered. Of course, it would only be done if it was really necessary. All the doctors are trained in this. And just a little bit more about why that might be recommended, I think will be really helpful in the kind of high-pressured situation and labour.
Gill Phillips 08:14
Information is key, isn't it? Because it gives us control, doesn't it? And I think is interesting what you say because people do cope with information differently, don't they. I had a friend with cancer. And basically she didn't want all that information. But she wanted me, as her friend, to be finding it out and just feeding her little bits that might be: Hey, I think you need to know about that. Whereas I'm a bit of an information junkie. I've actually had cancer as well. And I wanted t o know everything. And that helped me feel - well, it's that word isn't it, 'in control'. So we're all you know, again, it's it's personalised, isn't it?
08:52
Yeah, and I'm sorry to hear that Gill, I didn't realise
Gill Phillips 08:54
It's 20 years ago, so ...
Alison Wright 08:58
But yes, we have to be personalised, and some women don't want to know, and that's also fine. But I feel as a clinician, we have to give every opportunity. And of course, like the brilliant work you do with Whose Shoes, you know, we have to make sure that that's accessible. So there is no point in giving a leaflet where the numbers to contact are out of date. Or perhaps if the person doesn't actually read English or doesn't speak English as the first language, we have to, again it comes back to personalised care, we have to check out how that person is going to access the information as well as whether they want it and how much they want. So yeah, exactly. And I think it comes down to not making assumptions about people. We can't assume that nobody wants the information because it will scare them. Similarly, we can't assume everybody wants to know everything. So we just need to get better at checking that out on an individual basis, I think but making sure it's available and accessible for those who want it.
Gill Phillips 09:59
And I think that's where some of these more creative methods come in, like making little videos and things. I've got a friend, Leanne Howlett, who's actually, in a previous guest on the podcast, she does amazing work around perinatal mental health as a result of her own lived experience, wanting to help other women not go through what she's gone through, and she set up a playgroup, basically. So rather than just go to the local mum, or parent and baby group, to set up something to try and support women who've had perinatal mental health problems, so that they can meet and talk to each other. But she made a little video. So this is just ... and I think sometimes the NHS can overthink things, you know ... this was like on her iPhone, "this is me walking into the centre, when you come you might be wondering what it looks like and where you park and how to come in. This is me - Ipark here. You know, I walk in here, this is what it looks like. And we're friendly". And I think there's such a role ... I think there's far more of that kind of thing happening these days than just the formal leaflet telling you about the service.
Alison Wright 11:10
Yeah, exactly. Interestingly, I don't know whether you know, Gill ... other work ... Tim Draycott. He's the vice president of the college now, he's done on the Odon device. That's an alternative to forceps, and ventouse. And as a result of work that he did with service users. Overwhelmingly, people wanted videos rather than leaflets, which I think was really interesting in terms of how we get information out there. So I know that the college and others are working on making more information available by video, because that's what people do nowadays, isn't it?
Gill Phillips 11:45
Yeah, if you want to put a shelf up. You don't read the manual any more. You just watch someone doing it, don't you, or talking about it.
Alison Wright 11:53
Yeah, exactly.
Gill Phillips 11:54
So you mentioned Tim Draycott's tool. So what about 'I decide'? That's the tool that you've been leading on? So tell us about that, Alison.
Alison Wright 12:03
Yeah, this was really as a result of Nadine Montgomery and and her very ... what happened to her son, Sam, very tragically, with a shoulder dystocia which led to her son Sam having a form of cerebral palsy. And the ruling, Nadine Montgomery versus the Lanarkshire Trust Health Board, ruled that really women ought to know the material facts. So as a result of that ruling, the college's NHS England Improvement and Birthrights charity got together to look at what we could do practically, to try and do whatever we could to avoid that situation happening again, so that women are informed, antenatally prepared, which is what we were saying before, really. And which didn't happen in that case, and we're trying to improve the system. And I've been working with Nadine Montgomery, and to her credit, she doesn't blame any of the staff involved. She just wants to work with us to make the system better in the future.
Gill Phillips 13:06
That's fantastic.
Alison Wright 13:07
Yeah, so basically, the 'I decide' framework means that we get better information, accessible information to women antenatally. That we have personalised conversations antenatally. So what this means for a particular woman individual, and then it means that in the intrapartum setting, so when the woman is in labour, 'I decide' is like an acronym, it's a series of letters - so the 'I' is for immediacy, for example, the first I, looking at: 'okay, have we got time to have this conversation now? So women would understand that ... If, for example, there was a cord prolapse and we needed to deliver the baby immediately, that we might not have time to go through the conversation as we would normally.
Gill Phillips 13:52
Absolutely
Alison Wright 13:53
Yeah. But women would be prepared for that antenatally, we would only do that if we absolutely had to. And then you go through the rest of the 'I decide' site. So the D is for detail what's happening, the E would be an exchange of information. So based on personalised care through the antenatal period, then choices. So look at what the choices are, we could either do caesarean now or we could wait longer, and what the implications would be. And then the woman confirms her decision that she agrees to consent. And then there's an evaluation of the process later. So it's basically to try and improve informed consent, which is something that the GMC has set standards on supporting doctors to do this better. And of course, also improving women's autonomy in making their choices. This has been great actually, Gill. It's been a real win-win whenever we talk about it, because obviously it's going to help clinicians and make their job easier, as well as having women better informed and making better informed decisions. So yeah, I'm very excited about it. So we're currently piloting in three trusts around England. So looking at how it's going to work in practice, obviously, we've got the electronic digital aspect of it, getting it embedded into digital electronic records, which is a challenge. But that's that's the way that everything is going in terms of digitalisation.
Alison Wright 13:53
I love it. I really do! Because Florence Wilcock has mentioned ... so Florence Wilcock, my big magic mate, co founder of #MatExp ... has mentioned that Alison Wright is working on the 'I decide' tool, and I knew it was around consent and the information, and that was all I knew. So hearing you describe it there, and the acronym ... so we're a bit against acronyms. And that's a great acronym, because it actually makes sense. And it logically works through in the order. I don't know how you've come up with that. But it doesn't feel as if the words are just fitting into that 'I decide', it feels like really meaningful. So that's exciting. I think.
Alison Wright 16:06
It's really exciting. And, you know, Maternity Voices Partnerships have been involved, we're very excited in it. Also, NHS Resolution, and others from the legal perspective. So it, so far, it really does seem like a win-win. And we're looking at how we can quality improve, obviously, we've got to make sure that it doesn't add a lot of time on to clinicians' busy lives. And also make sure that it works properly for the women in practice. So that's what we're doing at the moment, looking at the actual detail of the implementation.
Gill Phillips 16:37
And in terms of saving time, and I think I'm always fascinated with any of these things like the short-term and the long -term saving of that time, and it might be different health professionals. But if people feel more involved, and their maternity experience is better, and they don't develop trauma, or PTSD, or whatever it might be that obviously, that's a far better outcome for the women and families, but also potentially for the health service as well, if less people are coming back with complaints, or obviously even worse, tragedies if things haven't gone, right, because there wasn't that kind of consultation and relationship.
Alison Wright 17:18
Yeah, completely agree completely agree. Definitely no doubt, long term. And in the wider sense, it's hugely beneficial. I suppose we still, I still need to bear in mind that the maternity services are under huge pressure at the moment. So to bring in something which will ultimately make everything better, we still need to make sure that even in the short term, it's not going to add too much time on. So I think that is really important from the clinicians' point of view that they understandably, will be wary about introducing something. So we've got to make it work. And we've got to make it easy, which currently, it seems like we can do even in the short term without making it any more time consuming.
Gill Phillips 18:00
Brilliant. So, Alison, how about the work that you do with the RCOG Women's Network? Because that's really what sits behind all of this. And you've mentioned working with Maternity Voices, Partnerships, and so on.
Alison Wright 18:14
Yeah, I think this is really important. And as you know, Gill, Florence has also been a big part of the Women's Network.
Gill Phillips 18:20
Absolutely!
Alison Wright 18:22
Yeah. And I think it's just making sure that we get that message that we all want the same thing. So previously, I was a co-chair of a MSLC. So before they became Maternity Voice Partnerships, I used to co-chair an MSLC with an NCT teacher. And that works really, really well actually. Because historically, there have been some perceived tensions between the women's voices and what the women wanted, and what the clinicians wanted. And I think this is still the case, I think there are still pockets of this. But actually, it works really well that we co-chaired the group, the MVP together. And also we had a day, Rosie and I had a day where we shadowed each other, And so I shadowed her as an NCT teacher, which was amazing, actually, I really, really loved it. And she shadowed me on labour ward. So looking at, particularly at some of the high risk situations and why we need to monitor and so on, and it was really, really valuable. And I would - I know obviously Gill all the work you do in Whose Shoes and that kind of does chime a little bit - but I think, I think for anyone to to do that, to shadow another professional in their day-to-day work. It's still an eye opener, no matter how well you know somebody or how much you respect them. To actually to do that day with them was certainly ... for me it was a real eye opener was really, really valuable. And she and I did speak at conferences actually looking at ...
Gill Phillips 19:58
Oh fantastic!
Alison Wright 19:59
Partly to make sure, because I feel very strongly, Gill, that obstetricians need to be at the table for various reasons. Part of which is we haven't been historically as involved with Maternity Voice Partnerships, and maternity services, perhaps as midwives are. And I'm really keen, as you know, are other obstetricians, that we get more involved. Because I think it's really, really important that we, we kind of introduce ourselves both locally and otherwise to women, just making it very clear - we're the woman's advocate as well.
Gill Phillips 20:37
I think that's really interesting, mutual shadowing or just shadowing in general and people perhaps at different levels of the hierarchy or in different worlds, a real eye opener. And I think we couldn't go any further in this without mentioning Florence's 'the Obs Pod', fantastic podcast series that she's been doing, which obviously has been quite instrumental in me se tting up 'Wild Card' that we're talking on here. And Flo says that the most successful, most downloaded episode of the whole work that she's done so far has been around her involvement in home birth.
Alison Wright 21:12
Really.
Gill Phillips 21:13
Yeah. So, that felt similar really, you know - you shadowing an NCT antenatal teacher, and Flo, as an obstetrician, going off to a home birth. And also, I know through the work that we've done together - the work that we did with London Ambulance Service wi th Whose Shoes - Flo took herself out with the paramedics.
Alison Wright 21:34
Really!
Gill Phillips 21:34
And I think these will be the days that really stick with you. She did.
Alison Wright 21:40
I didn't know that!!
Gill Phillips 21:42
Oh, you'll have to listen to her 'Blue Light' episode Alison, where she talks about that. Basically, the London Ambulance Service said to us, "We like the work you've been doing around #MatExp And Whose Shoes, but have you done something around emergency services?" And we hadn't. And as part of the preparation for that - and Flo pretty much led that work and she ran the workshop on the day - she went out in an ambulance to see what happened, you know, not maternity related, just obviously whatever happened on the day. And I think just these things that open your eyes to a different world and inevitably feed in something new into your practice and into your thinking, is very exciting.
Alison Wright 22:26
Absolutely absolutely good for Flo, I have to say!
Gill Phillips 22:28
So, you've got your challenge there, you'll have to be off in the ambulance now! And from my point of view, we had a really successful workshop. So that was obviously building the #MatExp, the maternity experience work, but then London Ambulance LOVED Whose Shoes. So we went back - and obviously developing and crowdsourcing new scenarios, new poems, which is what we do - but we did follow-up workshops with them around mental health. So not maternity related, just mental health, and then End of Life care. So some of these spin offs are interesting, you know, I find with my work ... that I don't plan where it's going, but you kind of go with the energy and it's very organic. And, you know, I never intended to set up a podcast and hey, nor did Flo originally, but now she's just celebrated her 100th episode of the ObsPod. And it's an incredible resource for people, whether it's healthcare professionals, or students or women and families expecting babies, to dip into and perhaps come along to the obstetrician, or come along to the midwife, a little bit more informed ... a few better questions or already knowing some basic information, again, in terms of I think, saving the clinician's time, we could share some of these resources wider, then we can have more informed conversations.
Alison Wright 23:49
Absolutely. And I do tell our staff about the ObsPod, actually, because I think the principle as well as the actual is really important. So what stuck in my mind about the emergency buzzer and why it might go off and what might happen, I think is really important. Yeah, I was talking to our junior doctors about it, actually, because I think that sort of thing really scares women. But if you do say, you know, this is what might happen. And this is the reason, as Flo did in her podcasts. And I think that's really helpful for it just takes the fear out of it. If people are prepared, again, the majority of people want to be, but at least give them the opportunity to be prepared for what might happen. And the - just coming back to the our RCOG women's network ... have been really helpful in kind of facilitating obstetricians and women to speak, so particularly women who may choose to free birth for example, I was really interested why some women preferred not to have any professionals involved in their birthing, but our Women's Network facilitated some conversations to explore that, and I think that's really Important too.
Gill Phillips 25:01
Wow, free birth. That's a whole extra topic. We'll perhaps come back to that one day. But I was just thinking ... picking up on what you said about Flo in the podcast - that buzzer episode was one of the most interesting to me as someone looking into the system, but also in terms of buzzers - something that jumped out at me - so on my podcast, and we're doing some really interesting work with Whose Shoes around Family Integrated Care at the moment, we've got an amazing group of people, clinicians, parents who've had babies on neonatal units, clinical educators coming together. And the two fantastic parents, called Nadia Leake and Rachel Collum, who've done a previous episode on my podcast talking about their experience of neonatal care and their desire to build Family Integrated Care. And Flo listened to that. And she immediately had a lemon light bulb moment. And she thought, 'Oh, my goodness, I didn't realise that parents are having to buzz into the neonatal unit and wait for someone to let them in. And effectively they're locked out from their own baby'. And none of these things are solved overnight. But I think to sow those kind of lemon lightbulbs ... just, you know, walk in somebody else's shoes, and to think well ... it might be that you investigate something like that. And obviously, you've got security, and you've got all sorts of other issues. But I think just having these lemon light bulb moments and having people like Flo and yourself with the will to follow up and see if things could be improved in some way. It's really exciting.
Alison Wright 26:35
Yeah, and I do. I firmly believe that all obstetricians are of that mind. It's just whether we have the opportunity to do that. So I think it's really important that we encourage all obstetricians to be more involved with ... Another example is, that I've done in my own trust: 'Ask the obstetrician', so that women through the Maternity Voices Partnership can join and ask. They can ask anonymously if they want to, or they can do it face-to-face at the time. So we do on Teams to ask ... At the time, we wanted to ask about the vaccine, but we also wanted to cover assisted vaginal birth, why it might be recommended and so on - again, to try and take the fear factor out. Because we do know that these are relatively common things to happen in labour. Yeah, women often don't understand or don't realize that they might be recommended or why they might be recommended. So as much as we can get obstetricians involved in antenatal preparation, I think it's really important.
Gill Phillips 26:35
Oh, I love that, 'Ask the obstetrician'. I do! Brilliant!
Alison Wright 26:40
And our registrar's, were really keen, all of our registrar obstetricians were really keen to get involved. Because they also sometimes have situations where women are, very understandably, very keen to have a completely natural birth without any intervention. But if and when there's an issue arising, and a doctor comes into the room, it's nearly always someone they've never met before. And of course, the first time the woman meets one of us is when we're saying, 'we need to do such and such, we need to recommend an intervention', which she obviously doesn't want. So it's it's a tricky dynamic sometimes and would be made so much better if we could have some kind of introduction, both of what might be recommended and who might be recommending that, you know, friendly, approachable, obstetricians as we are.
Gill Phillips 28:35
Absolutely, you're smiling away. It's lovely. It's lovely talking to Alison, it really is. Yeah. And coming back to what you said before, really with the NCT, it's just a variation on that really, isn't it? We're used to having, you know, as a routine part of antenatal care, particularly for the first baby, some kind of antenatal class - it might be NCT, it might not be - but, from the obstetric point of view, that 'Ask the obstetrician' are the the things that might happen that you wouldn't be bringing up in all the routine antenatal classes run by perhaps the NCT, but which are equally important for people to know. And it takes away that element of surprise and disappointment perhaps when things that - if you'd known about them and perhaps get your head around a little bit more - antenatally that it could happen - and what will we do if it does, just feels much more human and much more reassuring and more likely to have a good maternity experience?
Alison Wright 29:28
Yeah, I think so. Exactly. And that's certainly what we hear from women, that if it's not a big surprise, it's much easier to deal with. And I think sometimes there's a perception that obstetricians intervene. For reasons that I don't know. There's a lack of trust of why an obstetrician might want to recommend, for example, a caesarean or an assisted vaginal birth. So I think it's to get the message out there that we are, we are their advocates too. Interestingly Gill, when I was first a junior doctor, and I was quite vocal, as you can imagine ...
Gill Phillips 30:08
Brilliant!
Alison Wright 30:09
I was with a particular patient and a senior doctor. And I asked to speak to him away from the ward and away from the patient. And at the end of what I had to say, he said, "if you start trying to be the patient's advocate, you will never have a career in medicine". So ...
Gill Phillips 30:27
Oh, boy.
Alison Wright 30:29
And then, you know, 30 odd years on, thankfully, people are much more encouraging us all to be the woman's, the patient's advocate. But I think sometimes a woman doesn't always know that, it's not always as obvious as we'd like it to be, that we are her advocate, and we genuinely are working with her. So I think that's a really important message to get across somehow. And I'm not saying "Trust me, I'm a doctor". I'm saying, "you know, I genuinely have your best interests at heart".
Gill Phillips 31:00
Yeah. And you can feel that ... Okay, so that was not just a lemon lightbulb moment for me. That was a Goosebumps moment. Yeah, that shift in thinking. And I think, for all of us working in this area, to be patient ... you know, that things can't just flip from one day ... you've got so much history in terms of the traditional doctor-patient role. And then this shift of thinking in terms of co-production and shared decision making, just working together for the best outcome, then ... yeah, that was that was amazing. And I'm so glad you didn't listen to that .... senior person 30 years ago. Well done you!! And the other thing I was going to pick up on is ... one of our original Whose Shoes maternity cards, developed with obstetricians, was a card around, 'I only want an episiotomy if strictly necessary'. And, you know, it's like, 'well, what do you think we're gonna do? You know, just give you one for the sake of it', you know, and, and then I think, well, back in my day, actually ... they did! Yeah. So the kind of changing times if you like. And I know one of Flo's favourite Whose Shoes, cards is 'Changing times' where my mom was given castor oil, as a matter of routine. And she told the doctors that it would make her sick, and it did. So. I don't know. It's just quite interesting to think how practice changes over time in anything, isn't it? And to be those leaders, to take it to the place where, you know - the next step really - but it feels forward thinking and, and perhaps innovative, risky, whatever, at the time, but then 10-20 years later, it's like, "Really?? you did that??" you know.
Alison Wright 32:41
Yeah, no, absolutely. Right. No, it's very true. Yeah. And I think, at the same time, we do have to be careful that we don't swing too much to the 'everyone has a choice, and do whatever you like'. And I think, just coming to some of the work I've been doing with the Personalised Care Institute, Alf Collins is a really inspiring ... the lead of personalised care for the whole NHS. And, and he talks about 'dumping', which is something that well-intentioned clinicians do to say, "It's your choice, you decide". And I think we saw a lot of this with pregnancy and the vaccine ... again, very well meaning people would say, "You're pregnant. It's up to you what you do about the vaccine". And what Alf would say, and I would say is that it's, it's still up to us to give a steer as a professional. In our experience, this is the evidence, this is what I would recommend, of course, it's always informed choice. But we also just have to be a little bit careful that we don't go so much to say we're wanting everyone to have a choice that we don't then offer them information. So from the Montgomery ruling, it does not expect us to be neutral, it expects us to facilitate choice that's informed.
Gill Phillips 34:01
Yeah, I think informed choice. And I've never come across ...I've come across the concept, but I've never come across that word 'dumping'. But I think from the patient's (or in terms of maternity, the woman's) point of view, that is such an important thing, because you can think, "I don't know, you know, you're the doctor, you're the expert!" And I know I did mention at the beginning that I had cancer myself and I would say to the oncologist, "What would you do? What would you do if this was your wife?" And it felt a bit like it let us both off the hook a little bit, because that's what I really wanted to know. But I wanted the information around it as well. Yeah. Yeah. Wow. So no dumping, but lots of informed information and working together.
Alison Wright 34:46
Yeah. No dumping. And as I say, I think it's out of good intentions, that people are increasingly wanting to offer choice, but we do have a responsibility to give our experience. From what service users have said to me is, as long as we say, "This is my experience, in my experience, in my opinion ..." we're not saying this is a fact. Unless it really is. We just have to be honest, I think that's, I think that's the bottom line. And we, we have not historically been good at being honest about where there's uncertainty. And there's a lot of uncertainty in the evidence around a lot of maternity care.
Gill Phillips 35:25
Yes, yeah. And that will resolve and there'll be further research and further evidence and things will hopefully become more known. But I think, to embrace that uncertainty and to acknowledge it. And similarly for the patients, for the women and families to respect all the training of the doctors, and the fact that all this research has happened, and you can't hope to get your head around it in nine months of pregnancy or in the shock of having an illness or whatever. So it's trying to tease through that balance, isn't it? I think this has been an amazingly real conversation. Alison, I think it feels that we've teased through some of that stuff. And there aren't simple answers are there but to keep working together and work through and to acknowledge that everyone's doing their best, and there's some fantastic work happening.
Alison Wright 36:19
Yeah,absolutely. And we're all ... we're all on the same side. We all want better, safer, positive outcomes and personalised care for for everybody.
Gill Phillips 36:29
That's been a really, really good conversation. And it's Sunday morning, and the sun is shining. And let's hang on to the good vibe of that. And it's been so exciting to talk to you, Alison. I think what you're doing is amazing, and women and families will work with you and take this forward.
Alison Wright 36:49
Thank you so much, Gill. Yeah, really, really enjoyed talking to you. As always. Thank you.
Gill Phillips 36:55
I hope you have enjoyed this episode. If so, please subscribe now to hear more of these fascinating conversations on your favorite podcast platform. And please leave a review. I tweet as @Whose Shoes. Thank you for being on this journey with me. And let's hope that together, we can make a difference.