Wild Card - Whose Shoes?

11. Professor Lesley Page, talking about today’s #MarchWithMidwives

November 21, 2021 Gill Phillips @WhoseShoes
Wild Card - Whose Shoes?
11. Professor Lesley Page, talking about today’s #MarchWithMidwives
Show Notes Transcript Chapter Markers

Today I am talking to  Professor Lesley Page, CBE, an internationally respected voice of  midwifery!

As co-founder of #MatExp, the social movement to improve maternity experience, improving maternity is very close to my heart.  It's well known that there's a growing problem at the moment around the shortage of midwives, and other pressures. A #MarchWithMidwives has been arranged to raise awareness of the issues around the country. I'm looking forward to joining my local event in Coventry. I wanted to talk to someone who I really respect and who will be able to speak freely about this important topic. Only one person came to mind. And I'm delighted that she immediately said "yes", it's my enormous pleasure to introduce this week's podcast guest, the legendary Lesley Page, CBE.

Lemon lightbulbs with Lesley 🍋💡🍋

  • The power of walking in other people’s shoes, seeing different perspectives
  • Humanising birth, humanising  health care, what could be controversial about that?
  • Core values shared across specialties
  • Personalised care, dignity and respect, choice and control
  • We need to support midwives (and sll healthcare professionals) to be the best they can be, so they can look after others
  • We are all born. This is the start of human life. There can be nothing more important.
  • Learning and understanding internationally, as well as in the UK
  • Childbirth is so much more than a medical event. It is the foundation of the future of the family, the future of society
  • Continuity of carer brings relationships and trust and supports women to have choice and control
  • Strong advocacy and support can help reduce health inequalities 
  • It is only by having open, honest, respectful conversations between people with different viewpoints that real progress can be made
  • The ‘shorthand of friendship’ makes everything work so much better
  • Being on the other side of the fence is a shock when it comes to navigating complex systems! 
  • You need mental space to be able to make systems change; too difficult when fire-fighting
  • There is a gap between theory and practice -  needs to be doable within resources available 
  • The power of connections
  • Creating the conditions for open and honest conversations is key
  • Everyone wants to feel listened to
  • We have to be able to recruit and retain staff, and keep them happy, before we can provide a top quality service 
  • If you make things right for the staff, you will make things right for the people they serve
  • We need to support staff to be the best they can be
  •  Baroness Cumberlege is awesome!
  • Hearing from women and families about good care and less good care, and what matters to them, is energising
  • Good childbirth and maternity experience is about the next generation – the ability to form positive human relationships
  • The importance of early years  - #First1001Days - and supporting new families
  • People want to go the extra mile! People who are burnt out are not able to do this!The small things are the big things 
  • If you have the right intention, things will not go too far awry
  • Whose Shoes can make a difference to patient safety internationally (Alice Ladur’s PhD work in Uganda)
  • Opening new conversations that need to happen, breaking taboos
  • People need a safe space to talk
  • We need to get people talking across the divide – to prevent things forking in completely different directions

Gill Phillips  00:00

My name is Gill Phillips and I'm the creator of Whose Shoes, a popular approach to co- production. I was named as an #HSJ100 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

So who am I talking to today? Today's episode of the podcast is a little bit different. We're talking mainly about a specific topic, and one which, as co-founder of #MatExp, the social movement to improve maternity experience is very close to my heart.  It's well known that there's a growing problem at the moment around the shortage of midwives, and other pressures. And a #MarchWithMidwives has been arranged to raise awareness of the issues around the country. I'm looking forward to joining my local event in Coventry. I wanted to talk to someone who I really respect and who will be able to speak freely about this important topic. Only one person came to mind. And I'm delighted that she immediately said "yes", it's my enormous pleasure to introduce this week's podcast guest, the legendary Lesley Page, CBE. Lesley has so many awards and achievements, it would probably take me to the end of the podcast to try and mention them all. So I'm just going to pick out one or two things that have resonated with me personally. I first met Lesley through Twitter, and then in person back in 2015. At the time, she was President of the Royal College of Midwives. Lesley struck me as someone who was open to innovative ideas. She seemed to 'get' Whose Shoes from the beginning, the power of walking in other people's shoes, seeing different perspectives, and working together to address challenges. I was privileged to attend Lesley's Zepherina lecture in Oxford in 2017. To mark the end of her five years as president of the Royal College, we passed a pinnard around the room, which felt like a wonderful act of inclusion, before it was passed on to the new president. Kathryn Gutteridge. I would describe Lesley as a lovely blend of steely gentleness, which is how I describe my mum. So that's intended as a BIG compliment. So welcome to 'Wild Card - Whose Shoes' Lesley, and I'm really looking forward to chatting with you and hearing your views on this important topic.


Lesley Page  04:26

Well, thank you very much Gill and lovely being put  in the same kind of phrase as your Mum and Flo and people who are trying to make the world a better place. And wonderful, I think to talk about humanising childbirth, and on Sunday, we're going to be meeting around the country in a series of vigils or March with midwives. And what's really important about that, I think, is that it's been instigated by a group of people who are users or other birth workers in the maternity services. So it isn't just about professionals. It's about being with midwives. And when I was asked for a quotation about what's happening on Sunday, what I said was a thank you for marching with us as midwives, marching with us, so that we can give the best skilled, compassionate, knowledgeable midwifery care to every ounce of our ability, so that we have the resources and the ability to do that. And the sub-phrase to that is we're all born and this is the start of human life. And there can't be anything more important. This critical phase of human life which is sensitive to human care. I started life as a midwife in 1965, qualified and 66. And although I had some time out for being mother to my own children, for most of my time, I've been involved as a midwife in the National Health Service and in Canada, where I actually helped establish regulated midwifery. And I've moved from being very practice-focused, very focused on midwifery. And because of my work as President of the Royal College of Midwives, where I travelled around the world meeting women, families, babies, midwives, doctors, birth workers, everybody involved in maternity care, I developed a much broader vision. And I first became involved in this movement to humanise birth in Brazil, in the year 2000, when I was in one of the early humanisation of childbirth conferences. And I kept thinking about humanisation, being right for South America for some of the countries where we saw the most brutal childbirth and highest caesarean section rates. And a lot of people think it's only appropriate for low income countries. But as the science has developed, I've become aware that it's relevant everywhere in the world. Because around the world, we have two common parallel problems. It's not the only problem, but it's a kind of unifying problem. One is that there are some women who don't get the right care, who don't have access to medical care. Some have no professional care at all, or they have inadequate care, inadequate resources, and others experience over-intervention, overuse of caesarean sections, epidural, induction of labour and so on. And these are two parallel problems in the world. And they're often seen in the same area in the same country and between countries. But we also then have the problem of dehumanised even abusive care lack of human rights and lack of respect. And it seemed to me that humanisation of birth, and I've now started to talk about humanising childbirth, I'll tell you why that is in a moment, was a way of getting away from the polemics of the polarisation. And in the UK, we've got a huge problem at the moment with polarisation, you know, we've been told that we shouldn't use the term 'normal birth'. I don't think it's a matter of language. I think that there are elements of that that are very worrying. But humanising birth gets away from this polarisation. And what it focuses on is every woman, baby, other parent, actually having the care that is best for them. But importantly, recognising that childbirth is significant. It's much more than a medical event. It's the start of life for the baby. And this sensitive critical period can make all the difference in the world. But it's also the woman being born as mother and I'm using the term woman here, advisedly, and the family being formed. And within this mix, there is a physiological, a biological basis, and a psychological basis to the growth of love the attachment between the mother and the baby and the baby and the rest of the family, the baby and the other parent or the father. And that is absolutely fundamental to human life. It's a basis to human health and wellbeing to the parents being able to care for the child capably until adulthood. And as I know, because I've got three adult children, you know, for the rest of your life as a parent, you're the parent and you take responsibility


Gill Phillips  10:09



Lesley Page  10:11

But it's also about this link, this connection, this contact, the bond between the mother and the baby. And so many of our interventions and so many of our health services actually disturb the formation of that bond. And humanising childbirth, and this is a double edged phrase, humanising childbirth refers to birth itself, being transformative. It is the experience and the treatment, and the environment and the culture, that actually supports health and wellbeing in the long term as well as the short term, but also supports this capability in the mother and the parents, but also the bond of love. So humanising childbirth is about that experience being transformative to the human being born, who will in their turn, contribute to a more humane human society. But it's also about changing our maternity services. So we humanise them. It's about developing systems of care, taking the sciences, bringing all the sciences into play, providing respectful care, optimising interventions, so women  have access to caesarean sections, for example, when they need them, but they can avoid unnecessary caesarean sections or interventions. So it's about a whole change in our world view. And at the moment, what we're seeing, and we're seeing a big change happening in the United Kingdom, I'm going to talk about a little bit in a moment, what we're talking about is a changed world view. So rather than increasing emphasis on risk, and increasing fear, we're looking at aiming for health and wellbeing, for the woman, the baby and the family over the long term into next generations, because the impact of care around birth is intergenerational. So we're looking at this big systems change. And what I would like to do is to start with the idea that the baby, the woman being pregnant, and there is an assumption here, that the woman actually has the right to choose when to become pregnant, when to give birth to the next generation, that that is a time of hope for the future. Not just the parents who are thinking, hoping for their baby for health and wellbeing. And also the possibility of joy around the birth of the next generation, but hope for society. Because if we can look after the woman and her baby and family, to the best of our extent, then that actually gives us hope for the next generation, you know, these well connected families. And it isn't the only thing. But it's a really important link in the chain. So I've talked for a long time, and I've brought out a lot of ideas. It's wonderful to be able to talk about it. But I don't know if it sounds clear to you, Gill,


Gill Phillips  13:46

I think it's fascinating because to me, you know, I'm not a jargon person. And you get all these terms that are thrown around but 'humanising' something. I can't see what could possibly be wrong with that insofar as, 'let's make things more human'. That's how I'm hearing it. Is that what's meant by it?


Lesley Page  14:07

That's absolutely right. And you know, if you think about, let's take the maternity services in the United Kingdom, because our march on Sunday, #MarchWithMidwives is about the United Kingdom. What we're thinking about, is moving away from dehumanised services. So the fragmented care that we have at the moment in much of the maternity services. So for example, one of the things we're doing in all parts of the United Kingdom, and there's special emphasis in England, is developing 'Continuity of care'. 


Gill Phillips  14:42

Yes, we've done a lot of work around that, too. 


Lesley Page  14:45

Yes, it's been a mainstream of my work. And you've been very involved in it, a system in which the woman can get to know her main midwife who coordinates the care. And that midwife works with a small group of other midwives, so that the woman is the centre of the care. And over time, she can develop a trusting relationship, a trusting relationship between the woman and her midwife and small group of other midwives they get to know and trust each other. And this is two-way, the woman gets to know and trust her midwives and they can talk in a kind of shorthand of friendship, really. But also, the midwife gets to know and trust the woman. And it's a reciprocal relationship, and it allows midwives to provide evidence-based care through human relationship. And so to give you a very, very practical example, The midwife who knows the woman that she's working with, can bring into the conversations, the evidence and the information that the woman needs to understand to make decisions about her care, can take into account the medical background of the woman, you know, the current health of her baby and herself and the family, bring those all into play, and support the woman in making her own decision. And then afterwards, they can talk through what happened, you know, other things that could have been done differently. I call it the five steps of evidence-based midwifery. And that's actually, the only way in today's complex world with these huge systems, hugely fragmented systems very complicated, that midwives can actually be a companion to the woman, supporting her, being her advocate, guiding her, minding the gaps, avoiding the gaps in the health services. And that's particularly true for women who might have more problems. For example, women from black, Asian and minority ethnic groups, women experiencing economic and social disadvantage women with more vulnerable or chaotic lives, women living in areas of deprivation, it's particularly important, but it's important for every woman when she's having a baby. So that's one example about how we can make the NHS, which is one of the most wonderful systems in the world, I have to say I treasure it greatly. But how we can make that huge system that has to work through standardisation, you know, NICE guidelines, how we can actually help the woman choose what is the best for her and her baby, it's the only way we can provide personalised care. So we've got this huge system that can become like a factory, can become dysfunctional, but we're making it more human through the relationships. That also applies to the relationships between professionals and other birth workers. respect for each other, understanding the difference that each of us brings to care, being able to talk about it honestly and openly and debate it. But working in positive, respectful relationships with each other. So being more human, actually requires that we have positive, productive human relationships with each other. And in England, in particular, the Maternity Voices Partnerships, having women who are users of the service, co-producing, designing new services, monitoring new services, having opinions about it, which is being reflected in March with midwives. That is hugely important. And it's kind of like a grand relationship between users and professionals. And we've got, we've got a fork in the path, particularly in England at the moment. We have some of the most progressive policy in maternity services. We've got Better Births in England, we've got Best Start in Scotland, we've got similarly woman-centred services in Northern Ireland and in Wales. But we're also going down another path in which we're seeing the impact of the pandemic exacerbating and showing up the limited sustainability of current services, inadequate resources shortages of staff combined with increasing complexity. The rapidly rising intervention rate adds to this complexity. There are inequalities in outcomes related to ethnicity and deprivation. Reviews of particular services have revealed preventable deaths and trauma for some women and babies. Midwives are experiencing moral distress and burn out. So we're at this fork in the path. And I would like to see us go down the humanising childbirth path, which gets us away from the arguing, the polarisation, the oppression of language, and helps us to talk openly about all the science, all the knowledge that we've got, in a respectful way.


Gill Phillips  20:28

That to me makes so much sense. And I think that idea... I haven't seen it quite like that ... And  that's why I love these conversations in terms of ... I suppose what I try and pick out from these conversations, we've got a thing about collecting lemon light bulbs, and I'm thinking, Is there anything controversial in terms of relationships? Nope, I think most people will want to talk to someone that they know and that someone who knows them, and it is subtle things as well, isn't it? Do you trust someone ultimately to tell them perhaps about domestic violence or an addiction or whatever it might be and those things won't come out through any kind of tick box approach to an appointment. And by seeing somebody different at the next appointment when you were perhaps hoping to see that nice person you saw last time. So we've got relationships, and then trust. I liked your expression, 'the shorthand of friendship', I know exactly what you mean by that, that you can just start in a particular place. And it's the non-verbal signs. It's all of those things, isn't it that you know that person, you know that perhaps that day, things aren't quite right or there's perhaps something more than they're actually saying with their words. Some of the work that we've done around Whose Shoes and the #MindNBody project we did around perinatal mental health. There's an extraordinary pair of poems called "I'm fine". And one of them is written by the mother. They're real people. This is Leanne Howlett, and one of them is written by Kirsty her psychologist who was on the other side of the door, and it's called "I'm fine". So, the overt story is, "how are you?" "I'm fine". And the subtle work that we've done with Whose Shoes in terms of perhaps digging behind that, that perhaps the midwife didn't feel trained enough, knowing that someone clearly wasn't fine. But being under pressure in terms of the length of the appointment, possibly feeling, oh, my goodness, if I start to open this can of worms, and somebody actually tells me how they really feel. And I don't know this woman very well. So that trust and relationship and that shorthand could cut through so much of that, because that's when the real discussions are going to come out. And then I can feel with you the fantastic NHS, but how unwieldy things can be. And another big, big theme of our Whose Shoes work and I mean, this isn't maternity specific at all, is that people who've actually worked in a service, perhaps dementia care or anything, you know, whatever it might be, and then suddenly, they or their own relative, and I hear this expression over and over, are on the other side of the fence, and even they don't know the way to navigate it. So yeah, I think I'm understanding what you're saying, Lesley and humanising to me seems to be, with all the kind of politics and I think that probably is the word in midwifery care sometimes, that humanising should be something that we can all unite behind.


Lesley Page  23:23

Yes, it's interesting, isn't it? Because it can be a bit like motherhood and apple pie. So, you know, people will say, "Yes, of course, we should humanise". But it's interesting, because there is resistance. You know, at the moment, NHS England has one of the most ambitious programmes in the world, to roll out continuity of care. We want continuity of care to be the default for most women in the maternity services by 2023. And there are resources being put behind it. And there are resources at the moment supporting people, but still, there is resistance by some midwives. And I think that one of the difficulties is that actually forming relationships requires fundamental change, it actually requires quite complicated organisational change. And I know because I've led change in a number of large services. And however much midwives and doctors want to complain, it can seem easier to go on the way you are, and think it can be fixed. But actually, it can't be fixed if we go on in the same way. And also, at the moment, after the pandemic, we're in more crisis in the maternity services. There aren't enough midwives. The resources are short, the complexity of the work is mind boggling. If you read some of the accounts of midwives on Twitter, about their day on shift, you wonder how they can ever manage it. There are midwives thinking about leaving this wonderful profession. 


Gill Phillips  25:02

In worrying numbers.


Lesley Page  25:04

And we're having we're having more difficulty recruiting to programmes. So I think you need the mental space because actually you have to reorganise maternity services quite a lot to get continuity of care. And I do remember, because I've been director of midwifery of four big services. And in all of these services, they were dysfunctional when I first took on the post. And I do remember, I felt I had no mental space, no mental energy beyond fixing the budget, the staffing, the getting midwives on breaks, you know, that kind of fundamental. And so directors of midwifery, as I was, need somebody to help them to set up something like continuity of care. Because when you're in crisis, as we are in the maternity services at the moment, you actually need the mental space to be able to think about not only how do I get enough resources, but how do I use them more effectively, which requires reform or fundamental change. And a key strand, the mainstay of that fundamental change, is developing continuity of care, or systems of care in which women have midwives they can get to know and trust from early in pregnancy, through labour and birth and after birth. And we know from the evidence that the benefits of continuity of carer for women and babies and midwives who wish to work in this way ,are considerable, it would be unethical not to implement this approach.. And this continuity of care can wrap the woman around with care, but make sure that she is connected to all of the right people. And you know, there are 25 or so different people, psychiatrists, mental health workers, social workers, domestic abuse, support people, there are many, many avenues, pathways that the woman might need to go  down. So I love this phrase, of the midwife, the named midwife, and the team of midwives, or the caseload of midwives, 'wrapping the woman around' with care, but also supporting her in being referred to an obstetrician, mental health nurse, mental health midwife, and so on.


Gill Phillips  27:40

That last bit feels as if, because that's something that I perhaps haven't totally understood, And in terms of the connections I've got, the different work we've done. So I was very privileged to have Trixie McAree joining us a couple of workshops we've done around continuity of care, talking to her in depth and hearing the kind of 'pure' model if you like, and then talking to some of my friends more 'on the ground', and people who really 'get' it and want it to happen. But then the reality of the pressures. And I think all of these things in terms of ... you mentioned, I think continuity of care is the default in the NHS. I'm involved in a group, which is around coproduction being the default in the NHS, there's so much aspiration, and so much change that could be embraced. And then it's against a background of, as you've said, you know, as a past director of Midwifery, the pressures that  people are under, the resources, just the mechanics and logistics of who's actually covering a shift today, and reports to get in or whatever it might be. And I suppose what fascinates me with Whose Shoes is how you sensibly work through these complex challenges. For example, one of the things that I found fascinating was through our work, obviously, a big part of what we do is trying to connect people in with social media with the workshops. And you might say to people, in different teams, that they're under perhaps very similar situations. And you say, Well, are you talking to each other? Oh, yes, yes, yes. But perhaps it's the directors of midwifery who are talking to each other. And what we've tried to do and found incredibly powerful sometimes is the continuity of carer leads, who it can be quite a lonely role. And they might go along to events where they're all told together, but to specifically try and link them up. And it's like you were saying about relationships for the women and what we were talking about earlier in the conversation. They can become friends, they can ... "how do you find it when you have" this challenge or that challenge? And I mean, for example, bereavement midwives, we find fantastic individuals and think "you'll get on with so and so". And the pledges that we have in terms of individuals taking responsibility and actually being able to DO something, the small things add up. So I suppose I'm saying the big system and the directives from NHS England and the pressure of the papers and the documents and the guidelines, and the fact that for me, you've got so many people and people come into midwifery because they care. They're almost a particular kind of gang of people who are feisty, and they want to be advocates for women and they want to be with women. And you can sort of feel them sometimes being crushed by both sides of this system. That's why I'm finding these podcast conversations and the work we do through the workshops, just SO interesting in terms of how you can simplify and find ... to get from A to B, how do you do it?


Lesley Page  30:36

It's really interesting, isn't it? Because I think it's bringing back to human scale. So one of the things that happens in continuity of care is, you know, you'll have groups of perhaps six midwives working together, six whole-time equivalents. But you've also, you've got in your podcasts, and your Whose Shoes workshops, actually an authentic conversation. And we can in very, very busy services get through, we kind of manage through pseudo teamwork. So we actually don't talk honestly to each other, and identify real problems and work through them. It's being nice to each other. And I think that that authentic conversation, moving beyond the pseudo team, to the team that can actually work functionally, with an aim in mind and the aim is the health and wellbeing of the woman and her baby and her family into the long term and into the next generation. So we've got a massive target, we've got a massive aspiration and this huge system, and I think breaking down to human scale and then working through human relationship is the key to it all. But you know, I would like to humanise politics. My next life. I'll stick with talking about humanising childbirth.


Gill Phillips  32:13

This This feels difficult enough, I think, we'll leave the 'humanising politics'. Yeah, very, very big aspiration, that one. So I guess I'm feeling ... I talked a bit about this. I did a 'reflections' podcast last week in terms of just some of the lemon lightbulbs and the discussions we've had so far. And I talked about working with our graphic artists and the way that they very authentically capture the conversations. And sometimes some of those things that are written down are really not what those teams want to see or want to hear. So it takes a certain kind of honesty and willingness in a way to open a can of worms, to have a Whose Shoes workshop. And I get all sorts of alarm bells in terms of perhaps someone who wants to have this 'coproduction by default' workshop to achieve a particular end, which obviously isn't what coproduction is about. It's about finding out what end we're working to by, you know, what the people actually want to happen. But I really must set up a session with Anna, and so our main graphic artist, because she doesn't just do Whose Shoes work, she does graphic recording work with all sorts of different people in all sorts of different organisations. And we're a bit like, I guess, sort of fly on the wall in that we seem to create the conditions for people to speak openly and honestly. And I said in the podcast last week, the reflections one, that that's, it feels so different from, say the CQC or the inspectors coming in where everybody's kind of pulling together to, to paper over the cracks and not let the cracks be seen. Whereas somehow we seem to make it that people, this seems to be the kind of bit of magic in a way, if you can make it that people are willing to find out what the cracks are. And then the lights that you see in people's eyes, you know, whether it's staff or whether it's women and families or different topics, that someone is listening to me, someone's realising my perspective and continuity of care might be ideal, but it's difficult. And I love the phrase that you used, the 'pseudo teamwork', because I think in these sort of magic moments, you can see that falls away. And people actually start being open and honest and talking with each other, whether it's within a team or speaking with the people that use your services. And they're all on the same page in a way. You know, most of these people, people certainly come into healthcare wanting to do a good job. They're caring people. They don't want things to be all difficult. But I suppose another thing with Whose Shoes is people think it's about listening to the women and families which obviously it is, but for me unless the staff ... and this really comes back to the march with midwives, unless they're fired up to want to go in that profession, stay in that profession, enjoy that profession, go home fulfilled, it's not really going to happen. So you've got to listen to all the different perspectives and then work your way of of making it workable somehow.


Lesley Page  35:11

Yes. And you know, a lot of people think about humanising childbirth is for women and babies and families. But actually, it's about the staff because we know at the moment that there are a number of staff developing PTSD, working in moral distress. And this moral distress is really hard to manage. Because it means that you can't give the kind of care that women and their babies and families need and deserve. And every day you go away knowing that you haven't been able to give of your best. And for me, the vigil or the march with midwives on Sunday, is about supporting midwives to always be able to give their best, to have the values, circumstances, the resources, or the respect that allows them to give of their very best for most of the time, otherwise, you're going to have midwives who are staying in the profession are unhappy, they're burned out, they can't form relationships, and it affects relationships within their family, eventually, you know, if you're burned out, it affects every part of your life, if you've got PTSD, it affects every part of your life. So Sunday is about enabling every midwife, every student midwife, every birth worker in the maternity services, to be able to give their very best to the last ounce of their skill and knowledge, and compassion and love of their work, really. And it's wonderful because we do have Maternity Voices Partnerships, we've got coproduction in the UK and in England, in particular, because of Baroness Cumberlege


Gill Phillips  37:02

She is amazing. 


Lesley Page  37:03

Yeah, oh, you know, we have a genuine coproduction. And I've just been to the Association of Radical Midwives' conference, where the women using maternity services fired us all up, you know, you just felt this energy from hearing about their experiences, and what felt like good care to them and what didn't feel like good care, and how important it was to them. So I think it's about us all working together. And what I have noticed, is every country that has the most safe, effective, high quality maternity services, it's been driven by the public, by users, by not just women, partners of women, members of the public. And you know, in the early 1990s, the Winterton committee started its report, that the time around birth, is of the utmost importance to every one of us. So this is about woman-centred care, care focused on the woman and her baby and family. But it's also about the next generation, the next generation that will be there to form human relationships, to love and respect each other, to be altruistic to love our Earth, to protect the world's resources and protect the Earth. So we're actually there to give birth to the next generation,


Gill Phillips  38:39

which is the biggest responsibility you could have. It really is. 


Lesley Page  38:43

Yeah, I can't imagine anything more important. And I think that the government needs to know that. I know, it's difficult to find the resources, our NHS is probably one of the most effective services in the world. But to know that this is much more than a medical event, and the profound impact it will have not just on individuals, but generations to come. I think that that might fire up politicians actually. To understand.


Gill Phillips  39:15  

They're human too, or at least in theory.


Lesley Page  38:48

 Yes, yes. They are.


Gill Phillips  39:20  

And they've all been born haven't they, at some point. 


Lesley Page  39:22

Yes exactly.


Gill Phillips  39:24

So, we're finding common ground. So just reflecting back about one or two things you've said, and we're doing some work at the moment with one trust around the first 1001 days. 


Lesley Page  39:34

Oh, yes. 


Gill Phillips  39:35

And then somebody else is taking it forward and hoping it's going to be like, preschool, and joining up some of these initiatives so that it's not just about childbirth, and you know, get back home within six hours, but you're at the beginning of a family that needs nurturing. And some of the things like through coproduction that genuinely come through. So we did a whole series of workshops across the South-west. And probably the number one theme that came through, which hadn't been like pre-selected and because it was genuine coproduction, was better support for partners. 


Lesley Page  40:08

Mmm, yes. 


Gill Phillips  40:09

And then I think another thing that you said, which resonated with me in terms of what's happened on the last couple of weeks, podcasts, if you like, is the joy in a way of linking up all together. So the women in the families, but not just the midwives, other professionals. And if you get people who aren't burnt out and they can go the extra mile because that's what they want to do. So, I've spoken to Rachael Grimaldi recently and she's a lovely anaesthetist. And she was talking about how she's set up - and didn't get in trouble for - some fairy lights in theatre. And, you know, I suggested to her that might be like the next best thing like Jenny, the midwife's #SkinToSkin challenge. Or Flo's #Lithotomychallenge. Yeah, the the fairy lights challenge, but that's humanising birth isn't that. 


Lesley Page  40:55

And I think I  t's really important because often the things we think of as small things, because we aren't all going to create big changes, you know, I like to think that we're going to humanise childbirth in the next decade. But it's difficult to do. And it's often the small changes. And I think, basically, it's understanding the impact of what we do. And for student midwives, I often say to them, if you're intimidated by say, an emergency situation, stand next to the woman and talk to the woman and see if you can help her because it's actually the small things, these minute interactions, which will help, the fairy lights in theatre. I love that idea.


Gill Phillips  41:42

And it's not a theory she did it, she did. And she didn't get told off for it.


Lesley Page  41:47

I told you that I was involved in Canada in setting up midwifery as a regulated profession, because I had no midwifery. And we were prepared for a meeting with government by a top coach, a top ranked ranking coach. And he said to us," Don't worry about your words. There's magic in the intention". 


Gill Phillips  42:05

Yes, I love that.


Lesley Page  42:06

And I think that if we have an idea about what it is we want to achieve, and we've seen good practice, we know the evidence, we've seen examples of good care, then having that intention, even if we make mistakes, even if we use the wrong words, even if we rub somebody up the wrong way, somehow, it works out. So us all having a clear vision. And on Sunday, what I would love is for people to have an example of good practice, a clear vision about what good, effective, high quality, safe maternity care is.


Gill Phillips  42:41

Something I wanted to mention to you. You were talking earlier, obviously about your fantastic international work. I don't know whether you know this Lesley, but I'm actually super dead proud of this. So I met a fantastic PhD student, at the beginning of her planning her project really, down at Bournemouth University, and the very short version of the story, and I'm hoping that she's going to be a podcast guest soon ... So Dr. Alice Ladur has used Whose Shoes with men specifically in Uganda to try and ... all the things that we've talked about in terms of understanding why good maternity care is important. That kind of holistic approach in terms of health and nutrition and why antenatal care is important. But she's used the board game with men in Uganda. And the stories around that are quite extraordinary, as you can imagine, but she's completed her PhD now. So she's Dr. Alice Ladur. There's a published article about it. And she's just a couple of weeks ago, won the Vice Chancellors prize for her work. 


Lesley Page  43:44

Oh, how wonderful. That is a really wonderful story. So you're actually bringing from my kind of example and maternity services, you're bringing out all of these ideas, speaking authentically, with people, real genuine coproduction, but also bringing out the problems, which is like opening Pandora's box really, bringing out the problems and you know, the endless problems that have to be solved and, and dealt with.


Gill Phillips  44:21

Having conversations that just didn't happen before. So apparently men in Uganda didn't talk about childbirth and didn't necessarily understand why the women went to hospital if they weren't ill. Yes, but so I won't spoil it, because it's Alice's story. But it's some of those, just opening conversations that need to happen between whoever it is, and making them feel safe and able to have like open and honest conversations, and just seeing where it goes.


Lesley Page  44:50

I think that that's really important. And I think at the moment, one of the things that midwives need is the ability to have a debate, that it's a safe space for them to be able to talk without being accused of pushing normal birth at any cost, and you know, all of the kind of ...


Gill Phillips  45:09

Or any agenda.


Lesley Page  45:10

Or any agenda. And to recognise that what midwives are doing is trying to bring into play this sort of broader vision that midwives have developed over the last few decades and the new evidence that's coming out. So this whole idea of a safe space, which I think you create, through Whose Shoes and through these podcasts, a safe space to talk openly. And honestly, and opening the can of worms. The phrase I was trying to think of,


Gill Phillips  45:45

But unless we open it, then, you know, people stay in their silos, you know, we've got to get people talking across these different divides. I liked your fork, you know, we need to bring that fork back together into something that works for people.


Lesley Page  45:59

Yes, exactly.


Gill Phillips  46:01

I think, I think Lesley, so to hang on to our march with midwives, I loved the way that you summarised it. And I really do like it when things are simple, because I think that's what people need. So I heard "to support midwives to always give their best". 


Lesley Page  46:15

That's absolutely right. And if we can support midwives to always give their best and giving of their best means working with other people as well, then we will have achieved a huge amount on Sunday.


Gill Phillips  46:29

So thank you very much, Lesley. I think that's come to the piece that we wanted to get to, in terms of let's support our midwives on Sunday. And let's hope that they can be and that we can all be the best that we can be.


Lesley Page  46:41

Thank you so much, Gill. It's been wonderful talking with you. Thank you.


Gill Phillips  46:45

I've loved it. Thank you.


Gill Phillips  46:46

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 @WhoseShoes, thank you for being on this journey with me. And let's hope that together we can make a difference.

Introducing the legendary Lesley Page, CBE and the #MarchWithMidwives
Humanising birth, humanising health care
Sharing core values across specialities - dignity and respect, choice and control
MarchWITHmidwives so they can be the best they can be the best
The start of human life – what can be more important?
A long and dedicated career in midwifery
Learning about humanising birth, initially in Brazil
Humanising gets away from polarisation to bring people together
Childbirth, and the bond between the baby and the parents, is the foundation of future generations
Humanising maternity services, optimising interventions
A changed world view: health and well-being now and in the long-term; hope for the future
Moving away from fragmented services; the power of Continuity Of Carer
Relationships, trust and friendship
The role of the midwife
Reducing health inequalities
Create personalisation within the NHS – a wonderful but huge and complicated system
Building trust and understanding within maternity teams
Maternity Voices Partnerships and coproduction
We are at a fork – which way will we go? The need for open honest, respectful conversations
The ‘humanisation route’ seems to make a lot of sense??
‘The power of getting to know each other, so you can use the shorthand of friendship’ to find out what matters to people
The NHS can be unwieldy and difficult to navigate
Continuity of care as the default - but it’s not easy
Pressures on midwives and midwifery services
‘Wrapping the women around with care’
The gap between theory and practice – and how to make it happen!
The power of connections to make things a little bit more doable
Whose Shoes approach cuts through ‘pseudo teamwork’ and starts to work at human scale
True coproduction. Our visual recorders capture the true story! Authentic- we don’t paper over the cracks!
Hallelujah. Someone is listening!
We have to be able to recruit and retain staff, and keep them happy, before we can provide a top quality service
Humanising childbirth is about making things right for the staff as well as the women and families
#MarchWithWidwives is about supporting midwives to give of their very best
Hearing from the experiences of women and families – good care and less good care – is energising!
This is about the next generation – and how they form positive human relationships!
The government needs to know this!
#The First1001Days - indeed joining things up for families with preschool children
We need more support for partners
Going the extra mile – if you are not burnt out!
The small things are the big things
If you have the right intention, things will not go too far awry
Gill is super proud of Dr Alice Ladur – using Whose Shoes with men in Uganda to improve safety
Whose Shoes brings out the problems – so that people can discuss them authentically and work together for solutions
The changes in Uganda - opening conversations that need to happen
Midwives need a safe space to talk
Let’s open that can of worms! Let’s bring people together – not forking in completely different directions
So, let’s support midwives to always give of their best!