Denise was privileged to be invited to attend a webinar yesterday morning on the future of technology in the NHS post Covid 19. Although she attended this in her role as a local borough councillor, the event was apolitical. Denise comments:
Over 200 invited guests attended a webinar presentation with the Secretary of State for Health and Social Care, Matt Hancock, Tara Donnelly from NHSX, a government unit with responsibility for setting policy and developing best practice for NHS technology and other speakers from the commercial sector.
The presenters explored the huge impact that Covid 19 has had on the use of technology in the NHS, the increased use of telemedicine in primary care and the need to extend this across secondary care, as well as the need to continue to improve technology across all areas of the health and care sectors. Necessary cultural changes in respect of both NHS staff and patient approach to the use of technology in healthcare should be facilitated. Other issues discussed included the importance of data protection and confidentiality for all concerned and the essential change management processes to enable hard-pressed staff to embed technological changes into care. An interesting resource that is now available on:
This gives advice to people on how to have a virtual consultation with your GP. One speaker made the point that whilst Covid 19 has been the biggest challenge the NHS has seen since its inception, we face an even greater challenge in the next 20 years as we increase the use of technology in healthcare. All in all, a very interesting webinar.
As Denise prepares to start work on her sixth revision of the world-famous Bailliere’s Midwives’ Dictionary for the 14th edition, she has been pondering the current challenges to language, particularly in maternity care. Language constantly evolves, some words change or become obsolete and new words enter common usage. But, she asks, is the current trend a step too far? Denise says:
“Since becoming a midwife in the late 1970s, the language of midwifery has been forever changing to accommodate contemporary developments, to remove those words no longer used and to add new terminology. One term which midwives will understand being removed from the next edition of the Dictionary will be “supervisor of midwives” to be replaced with “professional midwifery advocate” – but when did you last use the word “funis” to describe the umbilical cord or “albuminuria” instead of “proteinuria”?
Some professional language has changed to reflect politically correct trends. When I was first a midwife, we talked about “home confinement” but this was deemed to be too risk-focused and implied – quite literally – restriction on the mother. The 1970s and 1980s saw a movement for change, headed by inspirational midwives such as the wonderful Professor Mavis Kirkham, to re-evaluate our language so that it was more “woman-focused” in line with the 1982/1984 Maternity Care in Action and the 1993 Changing Childbirth reports. Personally, I have never used the word “womb” to describe the uterus and hardly ever talk about “patients” with its inferred control of those receiving maternity care, especially since they are, on the whole, not ill.
The change of attitude from medical control to working in partnership with women and their families can also be seen in changes to phrases such as “expected” to “estimated” date of delivery and, indeed, from “delivery” to “birth”. Some phrases imply a negativity that can be reduced by minor alterations in wording. Example of these include “failure to progress” (in labour) or “incompetent cervix” which suggest the problems are somehow the fault of the “patient”.
However, in the current climate of equality, have we gone too far? Whilst midwives and obstetricians must move with the times and try to use socially inclusive language, professional terminology needs to be clear and unambiguous. Language is a form of communication which must enable those on the receiving end to understand the message of what is being said. This is why midwives and other health professionals are taught to modify their language from professional jargon, including abbreviations, to terms to which expectant parents can relate.
Recently, I have been concerned to see several posts on social media advocating changes to the language of obstetrics and midwifery, including abandoning the names of medical instruments such as Sims’ vaginal speculum. I understand the reasoning behind this particular case – despite being a well-known obstetrician who contributed to medicine in several ways, there is dissent about the fact that Sims experimented on black women for the good of white. In no way mean are my comments here intended to be controversial but if we remove the names of those who have historically contributed to the evolution of the field of obstetrics and midwifery because of some other aspect of their lives and work, do we not risk history being repeated? We risk those in current practice who are influential in their field going unrecognised in the future. Further, in respect of language, we risk confusion through the use of non-specific terminology or the need to use unwieldy phrases to describe what we mean – in this case, using the Wikipedia definition of Sims’ speculum as the “double-bladed surgical instrument used for examining the vagina".
There is also the current laudable trend to unify language so that it is inclusive, to avoid giving offence. One Facebook post included a list of alternative terms which could be used instead of gender-specific terminology. Examples included changing “breastfeeding” to “chest feeding” with little acknowledgement that men actually do have breast tissue. An alternative word for “mother” is suggested as “birthing person”. This is despite the fact that almost all those giving birth are – physiologically – women. To date, less than 100 men around the world have given birth and then only through the wonders of modern science.
Fathers should now be referred to as “non-gestational parents” – but is this meant to include those men who have been pregnant? More worryingly, it is suggested that the phrase, “maternal” health should – incorrectly - be referred to as “perinatal” health, the former denoting the person who carries the pregnancy and the latter referring to the period around the time of birth. We should, according to this post, no longer be using standard medical terms but instead be referring to “internal reproductive organs” and “internal reproductive glands” – but how are we meant to differentiate between “birthing persons” and “non-gestational parents”?
The irony of this particular post is that it was on an American antenatal education page called – wait for it – “Motherboard” – surely that should be “Parent board”?
Today, Denise was busy running an international short course in maternity aromatherapy for a group of 24 excited midwives from Indonesia. Midwives in Indonesia are just beginning to explore the opportunity to include aromatherapy in their care of women, especially in labour, and one of them had even read Denise’s aromatherapy book (in English)!
The session went really well with no technical problems and there were lots of questions and discussion at the end from many of the midwives. one question centred around the use of aromatherapy for women with postnatal depression, which Denise explained could be treated with caution using essential oils. However, one of the popular oils which grows in Indonesia is ylang ylang, which has very sedating effects. Denise explained that ylang ylang can be helpful when used for women with normal postnatal “blues” but should be used with caution for those developing more serious depression, as the sedating effects can suppress the emotions in depression, rather than uplifting the mood.
Another question focused on whether aromatherapy could be used to turn a breech baby to head first. Denise explained that whilst aromatherapy is relaxing, which may help the mother’s muscle tone to relax, allowing more “give” for the baby to turn, it cannot in itself turn a breech baby. Denise, and her colleague Amanda Redford, who was moderating the Zoom session, did however, talk briefly about moxibustion and the midwives expressed interest in learning more about it. Moxibustion is a Chinese medicine technique which involves using heat near an acupuncture point on the feet, to balance the internal energies; it is, on average, 66-70% successful in turning a breech baby to head first. Amanda had only just, the evening before, conducted a webinar for UK midwives and maternity workers on moxibustion. The main area if discussion was that of insurance when working in private practice offering maternity complementary therapies. She explained that unless you are a qualified acupuncturist, midwives should not physically perform moxibustion for women, as it is not possible to obtain indemnity insurance. Instead, midwives and birth workers can teach the parents how to perform the treatment and carry it out at home by themselves.
Expectancy’s Diploma in Midwifery Complementary Therapies includes four days on aromatherapy and a day on moxibustion for breech as well as other options such as reflex zone therapy, a clinical form of reflexology, and hypnosis for childbirth, needle phobia and smoking cessation
The Future of Technology in the NHS
What’s the point of professional language?
An online aromatherapy course
The Expectancy Kit
Denise has had a busy couple of weeks. Here she tells us a bit about what she has been doing:
The next Expectancy online webinar!
Hand in Glove
Ask your pregnant mums!
Working for yourself