Sheila Kitzinger 2023-24 Programme Projects

after birth: Towards a short film on maternal mental health

The 2021 play after birth was the product of a collaboration between researchers in the National Perinatal Epidemiology Unit, Oxford playwright Zena Forster and charity Action on Postpartum Psychosis. A performance of the play, and post-show discussion with clinicians/academics, and midwifery/medical students, was supported by the Sheila Kitzinger Programme (SKP) in 2022.

Leona Allen, Sally Tatum And George Fletcher In After Birth on stage facing directly to camera.

The play on stage. Photo by @camharlephoto

Evaluation of the play was overwhelmingly positive with the public, health professionals, women with lived experience and researchers. The project was also ‘highly commended’ at the University of Oxford’s Vice-Chancellor’s Innovation and Engagement Awards 2022 as ‘deeply compassionate, innovative, interdisciplinary collaboration and co-production’.

Sheila’s work ranged over many issues touching under-served groups, such as those with mental health problems, and highlighted the complex interplay of physical, psychological and social wellbeing. This is also reflected in the growing research literature exploring the benefits of the use of storytelling and film in educational contexts, to decrease stigma, resulting in increased empathy.

The support of the Sheila Kitzinger Programmed helped start the next phase of work to extend the reach of the play’s key messages. Jo Elliott (a BAFTA winning filmmaker) joined the team to develop a short film based on the play. The programme funded a face-to-face, multi-disciplinary workshop to support the development of this short film and also to explore how we can use the film as an educational intervention for health professionals to promote perinatal mental health.

Zena and Jo have developed a draft screenplay for the film and, with the help of this Sheila Kitzinger Programme award, are developing a short ‘taster’ film to help move the project forward.

Ultimately, the aim of the play, and now the film, is to raise awareness, increase empathy and reduce stigma around perinatal mental health, and ultimately improve care and outcomes for women and their families. This builds on Sheila’s approach and legacy.

Five Indivdiuals Receiving Award In Wood Panelled Room

From left to right: Zena Forster (playwright), Louise Richardson (then-University of Oxford Vice-Chancellor, Rachel Rowe, Fiona Alderdice, Sophia Wilkinson (NDPH PPIE lead)

Motherhood during Covid: A Play with Q&A Panel (30 and 31 May 2024)

With funding from the Sheila Kitzinger Programme, Dr Antonia Mackay (Oxford Brookes) will be leading the production of an original drama exploring the impact of the pandemic on first-time mothers and their experiences of maternal healthcare at the North Wall Theatre. The two-night stage play will be based on Dr Mackay’s research into the effects of digital healthcare during this time, and in consultation with Human Story Theatre, will communicate several women’s lived experiences between 2020 and 2021 to an audience including the public, midwifery students, Brookes Drama students, the Green Templeton community and interested academics. Developed in collaboration with Associate Producer Amelia Thornber (The Old Vic Theatre), Amy Enticknap (co-founder of Human Story Theatre), Jennifer Kirman (PLSE Oxford School of Nursing and Midwifery) and Dr Eleanor Lowe (PL English Literature, Drama and Creative Writing), the play will culminate in an expert panel Q&A on the Friday night. With SKP’s support, the play aims to communicate the up till now invisible experiences of new mothers during the pandemic to a wide audience, and reveal the realities of motherhood in lockdown.

Getting beyond the polarisation of childbirth: Finding common ground

Professor Sue Ziebland and Professor Lesley Page

Background

Discourse around childbirth (including pregnancy, labour, birth and the early life) has become polarised, particularly around spontaneous vaginal birth vs intervention in childbirth. This creates divisiveness and may reduce access to the care that individual women, their babies and families need and prefer. In this case there is the potential for harm to the woman, her baby, and family. Disagreements from the polarities can also divert attention from the complex problems that currently beset UK maternity services.

Process and preparation

With support from the Sheila Kitzinger Programme at Green Templeton, we invited a small group of key people, known to represent divergent views, to meet in a neutral safe space, to discuss where there might be common ground.

A preparatory Zoom meeting was held, with invited experts from user groups, charities, academics, practitioners and opinion leaders, to identify which people of influence to invite and to inform the ambition for the meeting. We concluded it was vital to represent different standpoints, especially if we could bring together people who might not normally share a platform.

Invitations for a half-day meeting chaired by Professor Charles Vincent were sent to a carefully selected group by Sir Michael Dixon, Principal of Green Templeton College Oxford. The invitation letter stated that we were inviting people ‘willing to engage in seeking common ground for care that is higher-quality, safe and just (for users of services and staff) and human rights-based. We may also identify some areas where agreement may not be reached, and perhaps some where either immediate changes can be recommended, or specific research is needed. We want to create a safe space for a conversation on this sensitive topic, in good faith, so that together we can start to draw the debate back from the polarities’

It was decided not to pre-set an agenda and instead to allow the group to decide on priorities for the conversation.

The meeting: Monday 17 July 2023

All invitees were prominent opinion leaders and care was taken to ensure that different perspectives and experiences were included and that a safe space was created to support honest and respectful discussion. The meeting intended to bring people together, recognizing that there are strong views. The main aim was to listen to each other, surface divergence of views and then collectively develop a forward vision.

We collectively agreed that:

  • All attendees had the best interests of mothers, fathers, children and staff at heart
  • Nobody had a fixed ideological position
  • Everyone attended in good faith
  • The meeting would be treated as confidential
  • We would not reveal who attended, nor use social media unless all agreed

Attendees were invited to reflect on the following questions:

  • What do you value about our current approach to childbirth and maternity services?
  • What concerns do you have about our current approach and practice?
  • What changes would you like to see?

The group was invited to identify areas where they might work together, which led to some discussion about the aims of the meeting, which not all had interpreted in the same way. Some saw the intention as being to discuss issues specific to ‘normal birth’. Others wanted to discuss safe birth more broadly. It was clarified that the meeting arose from a perceived need to discuss polarisation about physiological birth, within a broader discussion of safety in maternity care.

Key takeaways

There are important findings from existing inquiries that need to be used to develop policy collaboratively.

An agreement is needed, based on reproductive and birth rights, on the ultimate aims of maternity care and what a safe birth ‘looks like’. Different professions and user groups do not consistently have a shared view on this.

The wider science underlying the physiology of pregnancy and birth should be better recognized, understood and communicated.

Personalisation of care and dynamic consent is vital. Women should be supported to pursue their preferred mode of birth in the context of trusted relationships with service delivery teams, and understanding of: the health of the parent and baby; the values and preferences of the mother and family; the evidence that relates to their specific situation.

Neither ‘normal birth’ nor heavily interventionist birth should be ideological. Instances where a specific approach has been prioritised above women’s care needs, preferences and safety considerations have caused harm.

Multi-disciplinary clinical teams need to work together to bridge professional boundaries throughout the perinatal pathway, re-focusing on the needs of the woman, her baby and family.

Change is needed within policy, organisations, and the professions to enable evidence-based and birth rights-based practice.

Our group could help to articulate the different ways to achieve a ‘good’ birth and contribute to a more joined up conversation nationally by identifying where shared/supportive decision making is done really well (and what factors support this good practice). This would be a positive drive towards better national care.

Our group could be a powerful influence on the national conversation, demonstrating its ability to find common ground and common values. The ability to deal with polarisation is vital, across the country and within Trusts. This group has access to a wide network of different people, and could reach many stakeholders. Improving care requires fundamental organisational change to help achieve the ultimate aims of good maternity care.

We face deeply complex and nuanced issues including differences in viewpoints raised in our meeting. Participants recognised that these are not served well by polarisation and wanted to move beyond these divisions.

Our proposed next steps are:

  • Start with the statements and next steps on which the group agrees and disagrees.
  • Based on these, identify further areas of agreement about the ultimate aims of good maternity care.
  • It was agreed that it was preferable to go one step at a time, achieve something tangible and then build momentum.