 Thank you Jane. So I have the great honor of introducing actually two speakers for this presentation for session 15 Jill Darlington and Rachel Ward Jill Darlington is midwifery lead for practice development and preceptorship at one-to-one midwives She has been a practicing midwife for over eight years and joined one-to-one midwives in 2014 as a case-loading midwife Jill's passion lies with offering fully informed choices for all families in particular clients requiring complex care planning and That she believes that a holistic approach to maternity care involves empowering not only service users But midwives as well Jill and her husband have three Boys his love for sport keep Jill on her toes as we can imagine Welcome Jill and Rachel her co-presenter is Rachel Ward Rachel Ward is the midwifery lead for screening and immunization She has been a midwife for over six years She joined one-to-one midwives as a case-loading midwife with a path in for informed choice and consent This suits the case loading case loading model of care She is also the mother of a two-year-old and Winnie Who she says delights she and her partner every day so Rachel and Jill I'll hand it over to you welcome Hi Cindy Hello everyone, I hope you can all hear us and Hello, hi Zane up. It'd be lovely if you just all quick put in the public chat that you can hear us Just to give it as a bit of a boost of confidence Rachel is also here. Hello Okay, we will quickly go through this slide This is just our title page and we'll take you to the next one which will show our lovely faces So Cindy very lovely then gave you our background so we can whiz past this slide quite quickly and get to the nitty-gritty of the presentation Thank you very very much for inviting us to be part of the vidm and thank you all for joining us today It is something that needs celebrating every single year Okey-doke, so we work for one-to-one midwives, which is a case loading model of care Meaning that midwives get to spend time with their women and they're named midwife all the way through But why is case loading important? It's very big news at the moment So we've got the likes of better births here in the UK which is supported alongside with the NHS long-term plan Better births came through a few years ago in order to push forward better care for women midwives and their families Continuity care has been a huge push within this Just to be able to go back. I feel it's almost like going back a few decades to the care that midwives used to provide It is very much a social model of care And it is really important the likes of Hannah Darling Jane Sandel so many researchers have pushed for continuity of care and the importance of it for many years now Here at one-to-one we've been able to implement that and keep up with the pace and go above and beyond where we should be according to better births Very simply for various different reasons The social model of midwifery is really important Across the world really because it provides that holistic view for midwives and the the families that they are looking out for regardless of ethnicity race sex gender Income economic status. It really doesn't matter Continuity of care in the social model of midwifery plays a huge role in protecting that sacred space for them We also have some great improved outcomes that we've been able to Audit all the way through the sort of caseloading model of care will go on to those a bit later but the sort of improved outcomes that we haven't got sort of statistics for but that we know is the improved mental health of not only the mother but the father siblings greater wider family and Speaking has been a caseloading midwife. I'm sure Rachel will agree. It actually improves your mental health of midwives as well It is really good. I'm going to let Rachel talk a little bit about the midwife's job satisfaction Well, I think it Improves the way that we work within one-to-one in the autonomy that we give midwives and the whole caseloading model of Getting to know the women that they look after better And we know that it improves how midwives feel about their job I think anecdotally when we speak to students who come out with us or Just people come in to have a look around they there's less moaning heard I guess and and more kind of job satisfaction the midwives enjoy going to work. They enjoy the work that they do and We definitely have less leave for sickness within one-to-one midwives because of the ways that the midwives can manage their own Diaries and and their life and and there is a kind of positive role of self-care garnered within one-to-one midwives as well So I would say yes, definitely with within one-to-one and even for myself I say there's a definite increase in satisfaction It is when you work in this caseloading model of care, your passion is invigorated wherever you come from so I've worked in a trust I trained as a trust in a trust as a student And it as a student it is invigorating empowering and you're exciting and then when you go to work for whichever trust you pick And you can find that your passion and your desire to make things better Even your willingness to do something above and beyond not just for women, but for the organizations Dwindles over time. It didn't take long for me at all Unfortunately, which is why I chose then to work for one-to-one midwives And it is just happened a bit sooner for me Yeah, I came as a newly qualified midwife I was a student and I think at one point in my second year I definitely saw myself as a delivery sweet midwife and then with the Doing continuity of care and doing a caseloading module in my third year and realizing how sometimes working within the bureaucratic structure of well within here in the NHS I was finding that stifle all the the things I wanted to do as a midwife and so The fact that one-to-one was up and running by that point gave me an opportunity to kind of go right if I'm gonna make this jump And I'm gonna do it. I'm gonna do it straight off the bat of Qualifying and coming and doing it and there. Yeah, haven't looked back since. Yeah, I think no student midwife out there today Particularly in the sort of England where we're having now having to pay for our fees That's been taken away from us, which is a huge drawback to increasing that sort of staffing issues across the UK You you wander into this professional you get called to this profession because you want to do it You want to make things better and it's never about the midwife It's always about the woman and her family and if that passion starts to dwindle You've got to be brave enough to take that every day courage and go I've got a step outside of this I've got to redefine myself and find that passion to do something One-to-one midwives very fortunately open their doors to me and I've been a passionate supporter of them since Hence we are here today with you at VIDM, which is great So we'll move on to the next slide so One-to-one midwives for a lot of you is particularly internationally may not know much about us and the lovely lady in your slide there is Joanne Parkington I just seen her on the chat as well. So say hello Joanne Snuck in to see us Very nice that picture has got to go and so Joanne is our CEO. She is our Visionary basically she started this many years ago in 2010 With again a passion for caseload and care for what people call in true midwifery so Joanne was able to get a commissioned pilot study in one of our local areas To be able to prove that continuity works for improved outcomes at this time It was just antinatal and postnatal care. There wasn't Insurance coverage for the intrapartum care, but Joanne with just a couple of midwives Was able to prove Very shortly I'm probably less than the 12 months that she was given that the improved outcomes were Including breastfeeding there was improved outcomes for DNA or did not attend so caseloading you don't have a lot of do not tends because you manage that Relationship that midwife mother relationship And it just had general over prematureity rates went down Absolutely all sorts. It was an outstanding piece of work that Joe Leading these midwives was able to do it began as a social enterprise then with a full-on commission from that area And it is grown Tremendously since then we've sort of gone from two to three midwives to I think there's probably over about 80 to 90 With the majority caseloading obviously the likes of my myself and Rachel and a few others In order to support the organization and the midwives going forward We don't have a caseload now, but we have all come from this caseloading background But we do occasionally take the odd woman on just because they usually previous service users that have been with us before Which is a great great honor can't quite just take myself away from I think we've all got a couple of women still on our caseload We just can't step away because we are that passionate about it brings so much joy to us and the families And the outcomes regardless of what they are always improved particularly for the mental health And the overall birth experience It's we have in the UK something called the family and friends test So this is what all maternity organizations are asked to report on The satisfaction and overall service needs. Yeah, and would you recommend it to a friend is the ultimate Yes, would you recommend it to friends and family and we've got this FFT test, you know Scores range from 97 to 100% positive Scores on that positive feedback. So it shows you that the women are enjoying I think sometimes you can see some skepticism about whether continuity career is that what women really want and And I think that shows that it is what they want and it's what they enjoy So, yeah It is lovely and we provide this test Sort of antinacally post-nacally and post birth So we have three sort of studies at one to one we go above and beyond as always and we asked for this test to be done After their anomaly scan around the 20-week period as well And that is to keep a check on how women are feeling about their scans and again That always comes up with a really positive feedback Obviously caseloading model of care doesn't quite fit the national FFT So sometimes we'll change those and I think generally in the UK They are looking at getting a better response from service users and women to be able to sort of mark how they're doing So our next slide is the core values of one-to-one midwives These were set up from the sort of very very beginning You can probably all read them for those of you are just listening that we will just talk through them The first one is excellence one-to-one has a pioneering and creative spirit that sets us apart We are resolute in our passion to be the best we can be to lead the world in the art and science of midwifery To be synonymous with excellence and innovation Then safety safety is the first and foremost crucial aspect of everything that we do It is embedded in the one-to-one ethos and philosophy of care Our next one is professional at one-to-one we employ only the best Midwives who are dedicated who honor the relationship they have with women Midwife midwives who are privileged to be part of a woman's birthing experience integrity at all times we will act with respect integrity reliability and responsibility We will carry out our role in a responsible and professional manner and the last one is woman-centered We will advocate to support and empower women in our care in a non-judgmental and inclusive manner And that is really at the heart of it at the key of it Being woman-centered is a totally different way from working from other trusts and any NHS in the organization Our care is totally centered around them. We will go to their homes We will take the lead from them as to where they feel they are along their pregnancy journey They may very wish at the booking appointment to talk about absolutely everything. They may want to talk about just birth They may want to talk about the first 12 weeks They may want to talk about their greatest fears and concerns or they may want to talk about the complexities of care They're going to face There's no set agenda at this point We will take the lead from them and often our booking appointment is the Greatest opportunity to start that bond of the midwife mother relationship We will probably spend about two hours with that family and it is often very much a family inclusive event We've got children running around. There are husbands present. We've had mothers at mother-in-laws. We've had nans Friends absolutely everybody and we welcome them all to this one-to-one case loading model of care They are the leaders in their care. So it has to we have to follow them almost The safety aspect is absolutely key. We cannot go away from that We are not an organization that promotes normal birth at all costs We know a lot in the UK recently. There's been some rather bad poor press reported of midwives attempting to Have normal births for women One-to-one midwives. It's normal birth would be great, but it's their outcome that matters their outcomes aren't just based on Did you have a vaginal birth? It's how satisfied were with your whole pregnancy journey? Did you have the right outcome for you? Did you feel involved in the choices that you made? Were you the leader in your care? As midwives we navigate the care, but we should never lead the care It should always be the woman and the family that lead in the care And we will get a lot of women who come to us who Perhaps they felt pigeonholed within norm maternity services and our midwives work Excellently to be able to provide them with the most up-to-date Evidence and help them to interpret that and we expect our midwives to be able to critically analyze all recent research That comes out in order to be able to care for these women who have otherwise Perhaps otherwise would assume normal services and look for free birthing or that kind of stuff. So yeah, we will offer We will offer to the women absolutely every single choice. Okay. We can't actually do Elections at home and things like that But we will provide them with that choice and that opportunity if that is what they are wanting But what we generally find and it increases as time goes by is if women are truly informed About their choices They will usually generally go for a home assessment and a home birth Or a normal birth within a local acute trust and the NHS Our safety measures are paramount. We have a very strong Governance department Who sort of leads the way in the safety measures that we have around midwives and the women and our other staff It is a very positive governance department And that is unique as far as I am concerned within the or outside the NHS in the uk at the moment And it is led by one of our colleagues kelly kelly rouse who she has also caseloaded the one-to-one Model of care and she is supported by sarah hayward in that department as well And they lead a very positive midwife focused Governance departments that spend a lot of time with midwives involved In perhaps incidents or things like that reflecting on it get into the bottom of why it is When we have big incidents in the uk they have to go through what's called an rca a root cause analysis It is a really fantastic approach I think it's actually slightly pinched from the aviation industry But it is a really good in-depth approach. I've seen many of these done in many trusts And for one-to-one midwives one of the key parts of this is to involve the women and the families from the very very beginning And they are present in the room As the leaders of their care amongst the multidisciplinary teams different trusts clinical commissioning groups and they lead that sort of Analysis of their care and that is really positive That is taking women right to the heart of their care even when things don't go as planned Our other safety aspects are a lot of what we call complex care planning. So we know Complexities in women is really really growing at the moment from anything from maternal age bmi epilepsy cardiac is a massive concern in the embrace for uk reports currently And it's about planning right from the very beginning It's about midwives being these navigators of care being able to access the care that they need All the way through and being able to make those choices on all the evidence that we have And I think if we go back, you know to the title of our presentation about reclaiming mid midwifery And that's what we're doing You can't you can't reclaim midwifery for midwives unless you help women reclaim birth and pregnancy for themselves So ultimately that is what we're trying to do it one-to-one Give the the birth and the decisions back to them and and assist them and go back to being Minimize being these sign posters and and and guide us through pregnancy care So this is ultimately where we're getting it from and we're making maternity services better by helping women to to take control It is because we we have our professional integrity to uphold and by that we We're not pressurizing these women. We're not influencing their decision making So we are providing the information in need to make those decisions and it's really and it's truly inspiring watching these families grow And educate themselves and become empowered through all the different services that we offer Um, and it is a true sort of it's empowering for midwives. It's absolutely fantastic to be able to sort of do this Um, and it yeah, you have to take yet. It's really just an inspirational way to work Right, we're going to nip on to the next one now Just So things that we Find help us in in what we're trying to do is we we talk very much to women about What birth is and we help them to ready themselves and prepare? I think a lot of women who put up to be Anxious about birth is it's more of a kind of anxiety of the unknown Um, so we do a lot of work with the women that we look after to teach them about the hormones of pregnancy and labor to understand What their body is actually doing Um, we have started introducing classes on optimal fetal positioning So they actually understand what their baby's doing and what their general day-to-day activities What that impact is on on their birth Teaching them about labor the the lengths of labor one of the things that we have done is Introduce hypno birthing as a kind of standard element of our maternity care So we will offer it to to all ladies. We've trained all midwives or we're aiming to train all midwives in hypno birthing Whether they teach it or not because what we do want is that midwives can help Women who are hypno birthing in their birth whether they teach it or not to be able to What's the word i'm looking for facilitate that uh that experience? I think you can sometimes I mean I remember back as a student seeing a lady come in who was hypno birthing And the staff around have no idea what it was or how to help facilitate that And I don't think that that helped with her birth at all So, you know, I witnessed it within family as well in in different areas. So For us to be able to have midwives you can help with that and then teach these women We can provide extra classes that are dib in For some of them there's a small minimal cost to it or there's a free impart the service Obviously continuity just to explain how continuity works within one to one We have teams of midwives between around six to eight is where we should have it and within those Teams we have buddy pairs. So two to three midwives in a buddy pair Each of those midwives has a caseload of up to 32 women at any one our time give or take You know, sometimes you have those busy months like we did after the world cup. Yes, suddenly everybody's pregnant So you have a case that around 32 and as a as a caseload of midwife You're expected to see those women for all their routine anti-natal care So your bookings You work you have how many weeks off do we give them these days? Currently 63 days is how 63 days of annual leave and it works where you and your buddy cannot be off at the same time You the women get the continuity by seeing that name to midwife But then also knowing that if their midwife is off on annual leave It'll only be one other that you should be seeing or two if they're in a care of three We additionally have um, you can see up there a mamma as a midwife and mother assistant so By any of the name may be known as a healthcare assistant or a midwifery support worker They fulfill a function a number of functions for us, but kind of act for breastfeeding support. They can Go and do babycares. They provide Parental teaching lessons Education lessons. Some of them do teach hypnobirthing as well. So they work in a in a group just to provide that continuum through pregnancy Women may see other other midwives So we have centering sessions and the hypnobirthing might be taught by a midwife they've never met before But overall, um, you know, we're we're achieving 98.9% continuity for women through routine anti-natal appointments and this is The satisfaction that is reflected in the fft scores that we talked about before um The midwives in a in order to be able to manage that caseload of 32 women have Full autonomy over their own diary. We provide them with a diary and that's about as far as we go with it as to To what we want to do. So it's for them to judge how they book those appointments in um We give them some guidance about, you know, a longer appointment We're not asking them to do 10 minutes and see however many women in one day so it's for them to Judge how long you send so some women you'll see for an hour Some you might still be there two and a half hours later some Half an hour you've got to judge that individually with each woman And those midwives can choose to do lots of appointments in one day or a couple appointments spread over seven days But we are expecting them to be on call Um for six of those seven days a week. So they do get a day protected time Just to keep on top of paperwork and have a little bit of a brain breather a little bit of self-care um I think the on call scares a lot of people with the continuity model of case loading But because you're a case loading for your women, you are not called out every single night You are probably called out on average If you have four women due you're going to have four calls out overnight through that case loading model of care You will get the odd triage call But again because we've gone back to the basics of protecting this continuity and we have taught the physiology of pregnancy We have taught the physiology of labour. We have explained a lot of what to expect in the next few months You won't get a lot of those triage called the antenatal education is key to be able to Sort of build that midwife mother relationship and they trust you and you trust them And it is really important people are very afraid of a case loading model of care Because of the call outs and interruptions But it is not sort of part of that Now don't get me wrong case loading sort of becomes part of your life You have to accept that but your triage calls can be any time of the day They are mostly in the day as well because women are also still Sort of observance of your life And observance that they don't want to interrupt you But they will they'll send a text they'll phone and things like that Going back to the physiology. This is how we're protecting the continuity As rachel has said we work in very small groups of two to three Currently the better birth is advocating working in teams of sort of six to eight midwives But for sort of continuity to truly work case loading to truly work It needs to be much smaller on that basis of two to three midwives six to eight midwives I'm sure many will you remember particularly in the uk is going back to where team midwifery was Now we had a big push Before my time as a midwife There was midwifery 2020 changing childbirth all advocating continuity All pushing it forward and it's taken up until better births for a real sort of national driver to be able to do this But what we need to do is protect that continuity so the message doesn't get lost If we're saying that everybody has a named midwife in a team of six to eight Are we really providing continuity because will that woman still see eight different midwives through her pregnancy? It is not in my opinion. I don't rachel may agree with you We agree with me or you all out there listening may agree But we need it to be that sort of two to three midwives and that goes through to the intrapartum care as well um intrapartum cared as we all know birth happens within usually about a five to six week period so um We recently had a lady on virtual international day the midwife who birthed her child at 43 plus two weeks who was Informed empowered and made that decision and was supported by her named midwife Due to annual leave and things like that our midwives don't always make that Intrapartum continuity, but that's when your buddy group comes into action So there is another person and they will meet them even if they've not met them They will have had a telephone conversation with them. They might meet them at centering or hit the birthing It's really important The personalized care part of it is Really really important to that woman taking that lead and feeling in control of her pregnancy The individualized care plans come for planning right from the very beginning So women are assessed as they all go along and have input into their sort of what we call risk assessments They sort of plan the care they choose the care We will be very very blunt and ask that question. Is this what you want to do? What would you like to do here? Our recommendations are this but what do you want to do? When they get to the sort of intrapartum care for those women with complexities They have a very detailed individualized care plan Outlying everything that they need to know. Okay, so that is the good and the bad We are very very honest with this and then they can make that decision and what the true Beauty of our booking visits and our care all the way along is that we don't ask Women and families to make decisions on where they're choosing to birth Until they are in labor because that is when You form that relationship that is when a woman will feel totally different. So we give them that option We can facilitate Home birth we can arrange supporting labor We will support a woman if she wishes to go elsewhere But we don't hang on to that Initial where would you like to have your baby chats right at the very beginning and that is the very start of empowering a woman The other beauty of continuity care and providing mispersonalized care Is that if you're only seeing one midwife all the time you don't have to repeat yourself And what you've seen and there's some research on this is that if women have to keep repeating themselves They start to leave out information And therefore don't end up telling that fourth fifth sixth midwife that they've seen the whole story Which then how can any midwife prepare a proper kind of care plan for ladies not telling you everything Whereas those midwives who've seen that lady appointment after appointment They've got that whole view of that pregnancy and can assist her in making those kind of more personalized plans You know, we're talking about flexible visits and time and length You know, we the the women in the midwives have a mutual respect I think for not always requesting appointments at half past seven on a Friday evening Or nine o'clock on a sunday morning, but you get a little bit of that But you know, there's that mutual respect where they work together to put those appointments in that continuum into a kind of Nice good future there. I think yes Julie Roberts has just made a comment there maternity care providers need to invest in services to ensure continuity of carer And not just pay lip service to the concept. Julie, I couldn't agree more There are a lot of models going along at moment in order to hit the targets laid out by better births in the NHS long-term plan Initially of I think it's 20 to 25 percent and then by 20 20 50 percent continuity this They are going to struggle and they're trying to do it because They need to make that target. Basically, there's been set national by the national drivers But a lot of places are doing it by having elective cesarean section teams Endocrine disorder teams for diabetes and things like that Which is good. These women are of no less value. They are just as important However, what we've got to understand is the better births and is about improving the outcomes for these women Now their outcome of continuity and satisfaction over their birth experiences and birth choices may be increased But where was the maternal outcome? Where was the physical back to the physiology? Where was their improved outcome? Where was the improved outcome for the baby? Where was the improved outcome for the family the case loading model of care? And we are very passionate as i'm sure you can understand is the way forward And that is for all women of all risk factors of all previous birth experiences Case loading model of care needs to be kept at the front and the forefront of better births and the NHS long-term plan Okie doke, so How is this achieved? How where have we come from so far? Partnership working is a really key point to be able to be able to access these resources Um to be able to provide the full care So as lead navigators for the women the partnership working we have to do is obviously with the care quality commission Maternity voice partnerships are current sort of real buzz about them in the uk About getting women involved and things like that the maternity voice partnerships should be led by a service user So these need to be led Constructively with a bit of coaching for that person to be able to sort of manage this and it's about truly listening to the women's voices Um one of the main sort of points here you can see is women and families That's always at the top of our list to listen to our women and our families They provide us with the knowledge and the push and the drive to be able to take the service forward One-to-one we we try to be quite proactive as opposed to reactive So, you know when women are giving us ideas and things that they think could improve our service the nature of one-to-one There's only a few layers of kind of management that we have to go through in order to enact a change So we can make changes really quickly to to suit women and what they're telling us would benefit them in their care I mean we have had to remove ourselves that the whole reason that one-to-one works is that we are commissioned So we're commissioned by clinical commissioning groups, but we are independent We are an independent group who've been commissioned So we have to we have to un like break down midwifery and what it was in maternity care and then put it together in a new way to Solve those problems in maternity care that normal services were struggling with and that's what we've had to do And I would say if we were thinking about the major walls that we come across It is because we are thinking outside of the box with things and we're trying to work in partnership with these people But I will be honest and say that it's not always There are a lot of challenges not always a partnership We are overcoming these challenges bit by bit slowly by slowly slowly building these relationships and overcoming these challenges But it is difficult, but we have that passion behind us equally. We're under a lot of scrutiny because of that I think we've probably been inspected more times than we wish to remember Whereas other services in the local area perhaps haven't been under such an eager eye So yeah, it comes with its challenges But again over time over the years that we've been practicing that is changing now It still is because they are realising that we are a safe service and that we do truly provide midwifery care One of the other sort of groups that we work in partnership with and Listen to a lot is over on this side our midwives Okay, we cannot provide the service without our midwives and we have to listen to them and formulate ongoing innovations and plans with them and they if you listen to the midwives they They have a massive vast amounts of experience and ideas and plans And part of it is about grabbing those midwives and supporting them letting them sort of Feel out their plans and what they need to do and things like that Not everyone the plans work not everyone's already going to be put into place But it's about respecting those midwives for their ideas. We welcome innovation. We welcome new practice We welcome everybody that thinks outside the box to be able to do this um public health england is Obviously one of our governing bodies here and I'm going to leave this to rachel but I have to say rachel has done some fantastic work in the past 12 months by engaging and listening with public health england and being able to Show them what one to one out. Well, they the public health have recently become kind of a Part of the commissioning service previously They were just kind of putting there the the antenatal and newborn programs that Those of you working in the uk will be aware, but now they're part of that commissioning service So they're looking gathers quite closely as to what we we do and and I have to say I think I think they were expecting Not not so good stuff So when I've I've been working with them to show them what we do and how we do it I think they've been quite pleasantly surprised about how continuity of carer and this caseload in community model Can actually improve these um public health initiatives that are that are going out there so, um, it's been quite interesting working with them and and It's not quite the same Overlook that the the ccgs have over us, but they they are looking at us and seeing what we're doing and The the key performance indicators that obviously is that there's any screening coordinators listening You'll know exactly what I'm talking about the submission of those every quarter as to how we are Keeping up with those and if I look at our outcomes compared to local local trust, which I get to see You know, we are beating them in some areas and very close to them in others Um, I think one of the things that does become a little bit of a stick in the mud is because we give women True informed choice over what they're having. We do get a proportion of women who decline and this is a big sticking point and and In some ways they see a decline as that's a missed opportunity But that it should be rectified and I have to sit there and fight for the fact that women can decline things if they wish to And then, you know, we have fully informed them and because they have that Full information about everything that we're offering them. That's why we do get a little bit a few more declines But then others and I think that was the that would be the only area where we we kind of fall down slightly In that number, but it's it's not a falling down It's just a true representation of women having all that information as opposed to stick your arm out and have some blood tests But you don't really know what they are It's going back to reclaiming the midwifery for the midwives And supporting the women to reclaim birth for them And their pregnancy and they do have the right everybody has the right That's why we're all midwives to stand up support and advocate Is the right of a human being to make the decisions about their own care There couldn't be anything more fundamental than that And it is just a fabulous way to work in this case-loving model that is an accepted part of this care The local acute trust that we work with we have had to form relationship with them and they are improving Rapidly from where we started But we have to be quite formidable in our presence there We have to be able to form sort of communication pathways outside of the sort of more National parts of finance and things like that And I'm sure Joe may pop a comment on very quickly about the national tariff Joe is working alongside those to be able to Make the national tariffs suitable for what it actually is Because we all have national tariffs So charging cross boundary working Which is again what better births is saying that that is the sticking point currently is this cross boundary working and partnership working There has to be a greater level of input for financial sort of Challenges basically to be able to do it to value what's the work that is being done Not just by us, but by other people as well But again, it's all down to sort of income and we know that the nhs is massively underfunded But we get paid no more than the nhs We get paid exactly the same for our work So the national tariffs and the standards But it is it's a huge part of it. There needs to be a shake-up across the uk because of this Okay, doc So we do like to celebrate our outcomes and we do like to celebrate our midwives Our sort of private group chat for all of our midwives absolutely promote celebration. So one of the greatest sort of Innovations I suppose was what we call the birth selfie So when midwives have been to a home birth and they they will then group together sometimes involving women The lamp lamp post is very common in them Sometimes it involves a whole family with their consent and they will put on this and it inspires midwives to keep going it is absolutely It's it's nice It's like people are out there supporting you regardless of what you're doing What day of time and night and things like that. So there's a lot of celebration going on within one to one as well I'm sure you can And rachel, I just want to give you a five minute Warning that we're gonna And for those of you who are just listening on your phone and things like that the outcomes for home birth So that's women's start in their home birth journey bills We have an instrumental delivery rate. So that's four sets or vantus of 4.9 percent We have an emergency cesarean section rate of 4.9 percent Our small for gestational age in the uk which is considered below the tenth centile of growth is 0.2 percent Our third degree perineal tears are very low at 1.3 percent and we have a 0 percent fourth degree perineal tear Rachel For all births, you know, our stillbirth rate is is below the national average at 0.2 percent um 2 percent for the fourth degree perineal tears We've got 560 women who've attended hip hip new birthing classes and a 2.2 percent Premature to rate so births below 34 weeks. So, you know, we could we can talk to you all day But I think these numbers are quite They tell you it without needing to talk about it. It is. These are all well below national averages It speaks for itself It speaks for itself even if the women not choosing home birth it speaks for itself And that's what needs to be listened to our continuity rates are great Just under 100 percent for antinatal and postnatal Slightly lower for intrapartum due to annual leave and midwives lives, but even that is fantastic And it is just really really important and normal the general delivery rate Whatever you want to call it is really really high regardless of the outcomes But we're always striving to make it better. We lay down challenges to our midwives to make it better Okay service use of feedback is really really important to us um I'll just read it out for you for those who are just listening on the phone One-to-one offered lots more flexibility. I already had a one-year-old daughter And with a busy work schedule attending hospital appointments would have proved difficult And that was Philip at one of our one-to-one moms And then Kim's passion for hitting a birthing helped to eliminate my fear of giving birth And gave me the confidence to birth our beautiful baby at home for the most perfect start to our life as a little family Another one of our mom So, you know, this is the sort of feedback we get on a regular basis women enjoying what we're doing and Definitely gives us a firing or belly to carry on even in even in the darker hours of which there are some And you know, it's still it's stuff like this and the the cars you get from women and the feedback from women and so Excuse me. Sorry Rachel and Jill I just need to interrupt here. We actually are gonna have to leave this room in two minutes so if you want to just give a couple closing words And I believe if you want to share your information in the public chat if people would like to ask you questions or engage with you um with more input or insight then You can make that public and people can do that out of this session Closing words very very difficult But for midwives everywhere across across the world Remember your passion remember why you came to this remember your calling True midwifery or case loading midwifery continuity of carer is vital to protect midwives for the future Um, we need to hang on to it. We need to advocate for it We need to fight for it not just for ourselves But for women for babies for partners for families for everything We have got to protect us and midwifery in order to protect the people that we care for Rachel, would you like to say anything? I don't think I can top that Jill. I think I'll leave that there Thank you very much. We would like to thank you all very very much for listening We'd like to thank the vidm as well. It is absolutely fantastic We will support it again Next year We hope you will take this and sort of get that fire in your belly and to go off and be midwives again Excellent. Thank you so much lots of great comments And we do hope that you guys will reach out to Rachel and Jill to ask great questions