Kathryn has worked with childbearing women for the past 25 years. During that time she has supported maternity services and women as both a psychotherapist and midwife. She is currently involved in the Pregnancy Psychological Wellbeing Clinic at Sandwell & West Birmingham Hospitals NHS Trust, which supports anxious and fearful childbearing women.
Earlier this year, Kathryn won an RCM Annual Midwifery Award for promoting normal birth in recognition of her involvement in the development of the Serenity and Halcyon Birth Centres at Sandwell and West Birmingham Hospitals NHS Trust.
MIDIRS: Hello Kathryn. You’ve had an interesting and varied career in midwifery, so could you tell us about your background and what led you to become a midwife.
Kathryn: I initially trained as an Enrolled Nurse in 1974 and then went on to do a further year’s training to be a State Registered Nurse. Always in my mind was I planning to be a midwife, since I had been brought up by my mother believing in babies being born at home. I finally got my chance to train as a midwife in the 1980s and even though initially I worked on a neonatal unit it brought me closer to mothers and babies. In 1991 I got appointed to my dream job in the community and was absolutely delighted to work in an area where home birth and domino births were the norm. I worked in a team that completely supported women’s choices and that was the main priority for us.
MIDIRS: How long have you been in the maternity field?
Kathryn: I have worked in maternity now for over 34 years and have never lost interest or passion for this work with women.
MIDIRS: Which areas of maternity care or research interest you the most?
Kathryn: I would say that I am most interested in women’s psychological adjustment to pregnancy, birth and motherhood. I know that many women have had difficult lives and do not realise how this transition is complicated by their past life experiences. I trained as a psychotherapist and achieved an MSc in Counselling and Psychotherapy and it changed my whole approach to midwifery and maternity care. I believe if the woman’s psychological well-being is supported and understood she can achieve a normal outcome.
MIDIRS: Can you tell us a little bit more about your involvement in the Pregnancy Psychological Wellbeing Clinic (PPWC)?
Kathryn: This clinic is a hybrid of many years listening and working with women who have some element of psychological or mental difficulty during childbearing. The clinic is midwifery-led and has been embedded at this Trust as part of the specialist clinic service and supports other clinics such as Perinatal Liaison Psychiatry, Vulnerable Women and other services. The majority of referrals come from community midwives; however obstetricians, anaesthetists and GPs also make referrals. Women are offered an initial assessment and then allowed to explain why they have come for the meeting. Each appointment is around 30 minutes to allow women to share their worries and anxieties. Latterly women who are requesting a caesarean section have been added to the referral criteria and they have the chance to talk through their worries. The clinic works very well and the majority of referrals are women who have a high degree of anxiety or worry. My PhD at Bournemouth University is focussing on women who express worry, anxiety and fear of childbearing so I will be recruiting to this study shortly.
MIDIRS: Earlier this year you were presented with the RCM Award for promoting normal birth. This is a fantastic achievement and must mean a lot to both yourself and your colleagues. Can you tell us how the Serenity and Halcyon birth centres came about and what was involved in the development of the birth centres?
Kathryn: This award was so special to us at the Trust and none more so than our Head of Midwifery, Elaine Newell, who was so passionate about embedding a culture of normality at our unit. The history of how Serenity and Halcyon Birth Centres (Serenity BC & Halcyon BC) came about is due to a high midwife staff vacancy rate when I joined the Trust. Despite many varied approaches to advertising it was sold to the executive team as a solution if we had a beautiful birth centre to attract both midwives and women. We had a positive response in a very short period of time and a vacated neonatal unit was identified as the most appropriate location and had potential for our needs. We secured £850k funding and another amount of monetary support to put midwives into this area with their own team. Serenity BC was immediately successful despite our very poor demographics and population and we soon had midwives from across the country requesting jobs. Halcyon BC was part of the reconfiguration work when we closed our sister unit at Sandwell to relocate and integrate 2800 births per annum onto one site. We knew we couldn’t cope if all the women gave birth on delivery suite and fortunately the Health Oversee Scrutiny Committee recommended a birthing facility in the Black Country locality. Halcyon BC was developed mainly because of these changes but also because the PCT and acute Trust had a high degree of confidence in the clinical outcomes and model of care.
We have now had both birth centres operational for about 3 ½ years and our outcomes are reassuring, our feedback from our families supportive and relationships with other local providers increasing. We believe very strongly that we are a force to be reckoned with.
MIDIRS: How do you see your work progressing in this area in future, and what is your long-term vision for normal birth?
Kathryn: I am very hopeful that if the government continues its current support of midwife led facilities that midwives will not be disheartened and will have a fundamental part of the future. I am certain that the media has a part to play in influencing women’s hearts and minds and I feel we could use our relationships with them much more so we can reach women and find dynamic ways of informing them. I would like to see many more midwives leading services and being part of the quality measures that will disincentive interventions that have been allowed to creep upwards at an alarming rate. Giving midwives more strategic roles and the ability to decision make is fundamental to the future of maternity care and its long term effects upon women.
Advocacy is another key issue; it saddens me that women have to ‘shop around’ for a package of care that ‘allows’ them to make decisions for their births. Midwives need to remember that we are there to advise and support whatever the woman has decided – we are not there to coerce and make her compliant with the care on offer. Women should be respected at all times – as Mary Cronk states ‘We are public Servants’ – we would do well to remember this.
MIDIRS: Which of MIDIRS services do you find of most benefit in your role of midwife?
Kathryn: I love reading the journal and would like to see more British midwives contributing to the publications. I also think the website has a plethora of useful material which student midwives in particular find very useful.
MIDIRS: When you are away from work, how do you spend your time relaxing?
Kathryn: Well time is my precious gift and I do try to use it wisely for myself and family. I love spending time with my daughter and her two boys; they are a real blessing to me. My daughter had a kidney transplant two years ago and although she still deals with her diabetes on a daily level the difference this has made to her life and ours is wonderful. My husband takes me away in the countryside on a regular basis – I do love our country and the beautiful scenery we have so close. I am a creative person so will knit and sew when I can, read and paint watercolours if inspired, I also write poetry which has always been a secret gift that comes out now and again. I enjoy working for others so at my church I will try to give a little back to those of my friends who support me so well.
MIDIRS: And finally, if you could give one word of advice to newly graduated midwives, what would it be?
Kathryn: Be inspired, be passionate, be creative at all times. Even when midwifery seems too hard or painful there will be lessons to be learnt and add to your toolkit of resources that will help you through. Keep as an ideal in your head a birth that moved you; examine why that was and then endeavour to achieve at all your births some tenet of that one. Finally always strive to create a good memory for women – many mothers take their birth memories to their grave, you wouldn’t want to be a part of a bad one would you? I know I wouldn’t.
About the Serenity and Halcyon Birth Centres
Serenity and Halcyon Birth Centres (Serenity BC & Halcyon BC) have developed and established within the Sandwell and West Birmingham Hospitals NHS Trust (SWBH) and the West Midlands region since the very first clinical outcomes report for midwifery-led care was published (Ref: Gutteridge 2011). The first year of clinical activity for Serenity in 2010-2011 demonstrated a shift in low-risk women from the main delivery suite at City Hospital to Serenity BC. The benefit for maternity was – improved outcomes for women, better environments for women and their families and ultimately a clearer pathway of care for all women regardless of risk status.
The first report demonstrated that even within 11 months of operation a clinical difference could be confirmed in a low-risk population whose outcomes from previous years were collectively poor and indiscernible from high-risk pregnant women (Gutteridge 2011). At the same time in that year there was joint consensus from the Trust board and the PCT executive board to close Sandwell Maternity Unit and relocate all staff, services and women to City Maternity. There was appropriate consultation and monitoring by an appointed Gateway Review Team to ensure that all processes, governance and objectives were appropriate. One of the recommendations from the Gateway Review Team and Health Overview Scrutiny Committee was to provide maternity provision for intrapartum care within the Sandwell area – namely a midwife-led facility.
Although public opinion is usually perceived to be negative with any maternity closure, a full consultation process was engaged and undertaken by the clinical director and head of midwifery. During this consultation phase, opinion was sought and considered with action plans developed to mitigate public concerns. Throughout the public consultation a body of work was also commenced with staff both within the hospital and community, this was an enormous change for staff, particularly those based at Sandwell Maternity Unit.
The final closure of Sandwell Maternity Unit was managed with expert care. No women presented at Sandwell Maternity in labour on the day of closure which proved the campaign of raising awareness and writing to all of the pregnant population about the changes had been worthwhile. Halcyon BC had been opened two months prior to this so the final schedule of the plan was completed and the last part of the reorganisation had taken place.
At this current stage more than 4000 births have occurred in both birth centres and we have an intrapartum transfer rate of less than 14%. Staff work across the two birth centres with the support of community midwives who are working towards an integrated model of care which resembles the domino model. Satisfaction levels are high and complaints for the service are negligible as families and women are treated as a untied entity. Women birth and go home in around 2-6 hours which increases the normality of their experiences; midwives are trained in neonatal examination so the journey is supported by midwifery care.
A progress report which has just been published for the Trust board shows a high degree of confidence in the model of care and also continuing confidence in clinical outcomes for a demographically challenged area. We believe we have a transferable model of care that can be adopted to suit any population and are working with other units who wish to progress as we have done. We are incredibly proud to have been successful and are learning more and more about how to change and support maternity care for the future.
The 3 year clinical outcomes report is available from Kathryn.firstname.lastname@example.org
Gutteridge, K (2011) Sandwell & West Birmingham Hospitals NHS Trust Serenity Midwife Led Birth Centre – Annual Report of Clinical Outcomes 2010-2011. Author Kathryn Gutteridge Consultant Midwife & Clinical Lead for Low Risk Care. (Published data for Trust Board, Local and Regional Commissioners).