Putting women in the centre: person-centred practices as tools to improve #MatExp

It’s been a fantastic year, following the growth of the #MatExp project, from conception through to birth and now slowly becoming a self-sustaining project.  Sounds rather like another kind of life cycle that I know!  Continuing in my series of blog posts about person-centred practices in maternity services, in this post I’ll be exploring how they can be used as a tool to improve the experience of women using maternity services, by looking at a few specific and key areas.

Individualised care

Individualised care is central to a positive maternity experience.  In a recent post on Sheena Byrom’s blog, Helen Calvert says,

The current feeling is that there a “boxes” pregnant women are forced into, and once you are in a “box” your care is structured accordingly, with little thought to your individual circumstances, personality, fears and wishes.

Person-centred tools such as the use of One Page Profiles can enable a culture of individualised care through the identification of what’s important to/for women, how they can best be supported, and having meaningful conversations around these.

Multi-disciplinary working

Women get the best from maternity services when the multi-disciplinary team works well together.  I’ve had glimpses into great multi-disciplinary working, in which each professional respects the expertise of the other, working together for safe and positive experiences for women.  Working Together for Change is a multi-dicsiplinary approach to person-centred practices, that in the context of #MatExp would lead to a collaborative approach to improving the maternity experience.

Supported staff

I am a firm believer in women getting the best experience when their carers are cared for.  It was great that HSA’s very own Michelle Livesely was asked to speak about One Page Profiles at the ‘Caring for the Carers’ conference earlier this month.

One Page Profile’s can be used not only as a tool to support the provision of individualised care for women, but also for midwives supporting each other, creating person centred orgniasations..

Great maternity experiences are all about putting each individual woman in the centre of her care, but are provided in the context of organisations that truly practice person-centred care.

Advertisements

Creating a One Page Profile: a guide for Midwives

Last month, I wrote a post about the use of One Page Profiles in maternity services.  In the fourth of the series of posts about using person-centred practices in maternity services, I’ll be writing about how to create a One Page Profile.

So, just to rec-cap, One Page Profiles gather information under 3 main headings, to provide a quick and easy-to-read summary about that person (me or you) which someone else can read to quickly get to know about us :WeMidwivesOPP

  1. What people like about me
  2. What’s important to me
  3. How best to support me

An easy first step in creating a One Page Profile is to download a template, or for the more creative, make your own using the 3 main headings.  The fantastic @WeMidwives template pictured to the right can be downloaded here: WeMidwives OPP template.  Insert a photo of yourself into the template, and you’re ready to start writing!

The next step is to think about what people like, appreciate and admire about you and write down three or four of these qualities.  In our culture, we often find this dfink cards for OPPsdifficult.  If you get really stuck with this, ask close friends and family to help you.  I love the fact that writing a One Page Profile starts off on such a positive note – we all have good attributes.

 

 

Moving on, the next step is to think about what’s important to us.  This can be anything at all, but a starting point can be to consider:

  • Who is important to me?
  • How you like to spend your time, including hobbies and interests
  • What motivates you, energises you and things you are passionate about

Finally, we complete the section about how best we can be supported. Here are some questions that might help:

  • Is there any information about your health that other people need to know to support you?
  • How do you like to communicate?
  • If you feel stressed or overwhelmed at work, what would you like other people to do? What would you like them to know?
  • What would other people need to know or do to help you keep your stress low?

This section is really important in understand each other and can really help to create a supportive team environment.

And here’s a great one that @JennytheM made earlier:

Have you got a One Page Profile?  If so, share it with us @HSAUK using #OnePP


On Wednesday 4th February at 8pm, Michelle and Esther will be hosting a 45 minute webinar for midwives on how to create a One Page Profile.

More details to follow.

 

 

 

Co-creating excellent maternity services: Working Together for Change

Written by Esther Sharma

There’s no doubt about it – change is in the air.  With the recent launch of The Edge, a fantastically inspiring hub for health activists, there’s more reason now than ever before for each and every one of us to play our part in bringing about transformational change.  And at the same time, there’s growing momentum (with campaigns such as the 6C’s) to improve the engagement and experience of those who are using services.  What exciting times we are in!

Photo credit: Feggy Art, Flickr Creative Commons

Photo credit: Feggy Art, Flickr Creative Commons

So, how to bring together these two drivers to put women firmly at the centre of their maternity care?

I recently came across the Working Together for Change (WTfC) process which struck me as a fantastic way to co-create maternity services.

“Working Together for Change is an approach which puts people’s needs at the centre of service development, commissioning and provision.”

WTfC – the second tool we’re looking at in this series on person-centred practices for maternity services – is an eight stage process which identifies priorities for change.  It asks “what is working?” and “what is not working?”, involves service users, makes better use of scarce resources and ultimately leads to better outcomes.  originally designed and used for adult social care services, its applicability in wider contexts is self-evident.  In the context of maternity services, it has the potential to be used to bring about the changes needed to develop true woman-centred services.

Imagine what antenatal classes might look like if we midwives sat down with a group of expectant mothers, representative of our local communities and asked them ‘what’s working?’ and ‘what’s not working?’ and ‘what needs to be changed?’?  I’m sure we would be challenged to think again about the way we provide antenatal education.  Or what if members of the midwifery, obstetric and neonatal teams along with new parents sat down together to talk about the care on our postnatal wards?  How might it re-shape postnatal care?

Briefly, the eight stages of the WTfC approach are:
  1. PREPARE for using the Working Together for Change approach – how when and where?
  2. COLLECT the person-centred information and capture things that are working well and not working well and most important things for the future.
  3. THEME by clustering the information into agreed themes – this happens during the course of a full-day workshop and includes naming each cluster with a first-person statement to best describe the theme of the information.
  4. UNDERSTAND the possible root causes for things that aren’t working and why this might be the case.
  5. IDENTIFY SUCCESS by thinking about what success would look like if the root causes were addressed and changed.
  6. PLAN – different stakeholders plan what they will do differently to move change forwards.
  7. IMPLEMENT by identifying where are we now and how will we know when we’ve been successful .
  8. REVIEW by evaluating progress against success criteria.

The process should be conducted cyclically – perhaps annually, so that the impact of previous action is understood and further actions can be taken to change the things that are not working.

There’s no doubt that it would take courage and humility to go through a process like this.

But surely it’s well worth it in order to provide the kind of service that puts women at the heart of their care.


 

Discover more about the Working Together for Change programme here.

 

 

 

 

Using One Page Profiles in Maternity Services

Written by Esther Sharma

Today, we explore part 2 of our series, in which we are considering how to use person-centred practices in maternity services and we will be looking at One Page Profiles.

Image from @WeMidwives

Image from @WeMidwives

 

What is a One Page Profile?

A One Page Profile is a person-centred thinking tool which what is important to and for someone, and how that person can be best supported.  It is a way of very quickly getting to know someone and also ensures that the person receives consistent support.  One Page Profiles are typically divided into three sections:

  • Things that people like about me
  • What is important to me
  • How to support me

You can read more about One Page Profiles here.

What are the benefits of using One Page Profiles in the provision of maternity services?

One Page Profiles are a fantastic tool which women can use to think about what is important for them on their journey of pregnancy, birth and motherhood, putting them firmly in the centre of the care they receive.  Are they simply another kind of birth plan?  To some extent maybe, but I would suggest that they can be used to complement a birth plan.  They focus more on the woman – who she is, how to support her and what is important to her, rather than on the preferences for how a woman would like during her labour and birth.

In this post, Amy describes how the process of writing a One Page Profile empowered her around the time of her birth, helped her partner to know how best to support her as well as providing a tool to process and think through what was truly important to her at the time of giving birth to Matilda.

Encouraging women to complete a One Page Profile can be a useful component of an antenatal workshop:

Earlier this year, @WeMidwives hosted a Twitter chat about One Page Profiles, generating a lot of discussion around the benefits of using this powerful tool to promote person-centred care in maternity services.  As a result of this Twitter chat, a number of midwives created their own One Page Profile:

Tools such as this, allow midwives and wider maternity services teams to understand and support each other, as well as enhancing the partnership of Supervisor of Midwives and midwives, creating person-centred organisations.

There’s no doubt that for most maternity services, working towards becoming a person-centred department providing person-centred care will require a significant mindset shift, and reorganisation of service delivery, but this is absolutely necessary in order to provide excellent care for women at one of the most important times of their life.

Person-centred practices in Maternity Services

Written by Esther Sharma

As a midwife ‘woman-centred care’ was drummed into me in my student days and continues to form the basis of my philosophy of midwifery. I was fortunate to work in a one-to-one caseloading team which enabled me to provide true woman-centred care, but this model if working is not available to all. And yet, in the midst of the all the pressures facing midwifery services, it still remains as important as ever.

So I’m delighted to be starting a six-part series of blog posts over the coming months, focussing on how we can provide personalised care and continue to put women and families at the heart of the services they receive, through using person-centred practices. This has never been so pertinent, and dovetails with the 6C’s initiative and all the wonderful work being done to improve the experience of service users.

What are person-centred practices?

“Person Centred Practices are ways of commissioning, providing and organising services rooted in listening to what people want…”

In the context of maternity services, person-centred practices have many benefits.

  • Supports personalisation through the co-creation of maternity services that puts women at the centre of their care
  • Person’s perspective is listened to and honoured
  • Regularly look at people’s lives to see what is working and not working
  • Employees know their roles and responsibilities in supporting people

I’ve been reflecting on why we should not change the term ‘person-centred practice’ to ‘woman [i.e. the women in our care]-centred practice’ in the context of maternity care. But then I realised that person-centred practices are not only greatly beneficial for pregnant women and new mothers, but also for midwives themselves. Person-centred practices play a really valuable role in enhancing team working. Indeed, we could even extend person-centred practices to the care of newborns also.

Now that we’ve taken a whistle-stop tour of the concept of person-centred practices, we’ll go on to look at some specific person-centred practices and how they can be applied.

Next up, One Page Profiles.

Featured image credit: Selbe <3, Flickr Creative Commons

Amy’s birth to Matilda and their person-centred birth plan

Twenty-seven year old Amy blogged for us whilst pregnant with her second daughter Matilda who is now one year old. She and her husband, Jay, took part in the person-centred antenatal classes run by Midwife Karina and Helen Sanderson of Helen Sanderson Associates. Amy shares her journey to create a person-centred birthing plan and talks about how it was used in labour.

Written by Amy Louise Longson

Amy's Birth Plan

Amy’s Birth Plan

I created a person-centred birth plan when I was pregnant with my youngest daughter Matilda. The idea came from a five week Person-centred Antenatal Course which I attended in my local area. It was a pilot run by a qualified midwife and Helen Sanderson. My vision for my birth plan was that it would help to communicate my wishes about delivering Matilda, and help aid communication with the midwifes and my husband, Jay.

I used advice from professionals involved in my pregnancy, my previous experience of birth and the experiences of others attending the course to draw up my birth plan. I would come away from each class, and discuss it with my husband.  Once completed I shared it in full with Jay and encouraged him to it read well in advance of my due date!

I kept a copy with my maternity notes, keeping the plan at the front of my notes so they were not missed by the midwife.  As I went into hospital to give birth I let the midwife know that I had written the plan. I wanted her to read it once we’d arrived but my labour was so quick there wasn’t any time. The great thing was that it didn’t matter; my husband was so in-tune with what I had written and what my wishes were that he was able to advocate on my behalf.

Having my completed birth plan in my midwifery notes helped me to feel more relaxed about going into labour. I knew my views and wishes were clearly recorded and I didn’t have to worry about ‘forgetting to tell them’ anything. I guess one of the main outcomes was it really helped me to feel in control at an anxious time and for the kind of person I am, that was really very important..

As well as assisting in how we felt going into the actual birth, my plan was a wonderful communication tool for me and my husband during pregnancy. It helped us to reflect on my first labour, and discuss what went well/not well for us. We were able to use these experiences and incorporate what we’d learned into our new plan.   Using the birth plan helped Jay to be clear about how to support me during the beginning of labour as well as advocate the important information for me after labour; our decisions about injections and holding our baby.

Although my midwife didn’t read my person-centred birth plan before I delivered Matilder I still feel that it was a big success. After all, it wasn’t just for the medical team; it was for me and my husband as well!

Ofsted, health and safety reports – How do we decide on the nursery that best suits our baby?

One year on since Scarlett was born and mum Rowan reflects on her decision making when finding the right nursery and how this formed the beginnings of Scarlett’s one-page profile.

Written by Rowan

Scarlett's one-page profile at eight months

Scarlett’s one-page profile at eight months

This time last year I was holding my brand new daughter in my arms as I stared into her wide blinking eyes, wondering if this precious little girl knew how loved she was already. Scarlett is one year old today and it has been the most incredible year of my life. I look back at photos of those first few hours and can’t quite believe how far we have come.

For the first two weeks I didn’t put her down. She looked too small and fragile to be out of my arms and I had an overpowering urge to keep her close to me so that she could hear my heart beat, smell my skin next to hers, find her milk, know that she wasn’t alone in this strange new world. I was encouraged by friends to move from the living room into the bedroom to get some rest after a fortnight but I can’t even remember feeling tired. All I wanted to do was to look after her. It was early August and the Olympics were on the TV 24 hours a day. Together Scarlett and I watched as Jessica Ennis from our hometown of Sheffield won the gold medal in the heptathlon, Mo Farah became the first Briton to win Olympic 10000m gold and Gemma Gibbons looked to the sky and called her Mum’s name as she took home silver in the Judo. I’ll never forget those moments – I’m teary now as I write. There I was watching people fulfill their life long ambitions, realising their dreams, whilst I held my greatest achievement so far in my arms.

When Scarlett was eight months old it was time for me to go back to work. I’d been worrying about this and wasn’t feeling comfortable about the amount of time I would be away from her each day. There was also quite a lot of uncertainly about whether I could do the part-time hours I wanted in my old job and I decided that the best option for my family was to go freelance and be based at home. Through my work with Helen on this blog I started writing about person-centred practices, something I felt very passionate about after experiencing the results myself in pregnancy and birth. As well as doing something I loved, my new role meant that I could manage my own time and not leave Scarlett for long periods.

I still had the task of finding the right nursery though; somewhere that I knew Scarlett would feel safe and happy without me. As is typical for me, I did a lot of research and made a lot of visits. But part way through the process I realised that I was struggling to compare the different options. They were all so similar in many ways and there were positives and negatives to each. Part of the problem was that I wasn’t comparing the nurseries against my own criteria but against theirs. I’d come away from each visit with a pile of information; Ofsted reports, health and safety certificates, routines. The Nursery Managers were sharing with me what they thought I needed to know in order to make a decision but the emphasis was all wrong. I needed to think about what was important to and for Scarlett and then make my decision based on her as an individual.

I wrote a list. I didn’t realise it at the time but this was actually the start of Scarlett’s one-page profile. I was thinking about what she needed to be supported well and wanted to use this list to work through our options. I came up with the following criteria: Kindness and attitude of staff, quality of the food, time spent outdoors, approach to play, safety and proximity to home (and me of course!).

Scarlett’s nursery is across the road. They have a cook serving fresh, unprocessed food daily. They have three separate outdoor areas and Scarlett’s key worker is loving and kind to her. I wrote up the rest of her one-page profile and took this across on her first day. I feel confident that they understand what she needs and can support her well, not just because they have a copy of her profile but because when looking at nurseries, I thought long and hard about what was important to and for her as an individual and then found the best match.

For her birthday Scarlett had a wonderful party in the park with 27 of her little friends. She clapped furiously as we sang happy birthday and squealed with delight when opening her presents. More beautiful memories for a special little girl.

Well? Did it work? Rowan’s person-centred birth plan…what happened next

kissAt thirty-one I was in a new relationship and pregnant with my first child, struggling with feeling tired and unwell whilst trying to soldier on at work, moving house, missing my friendships and worrying about the impending birth of my daughter. I found pregnancy hard. I know a lot of women feel amazing when pregnant; healthy, beautiful, virile! I didn’t. At five weeks pregnant (days after my first test) I bled. Jon and I had just got our heads around our new future and suddenly it felt like it was going to be ripped away from us. I bled for six days in total and had to wait another week after that before going for an early scan to see if I was still pregnant. I spent the time in the lead up to this scan checking myself in the toilet, taking pregnancy tests and scowering Google for what the bleed could mean. According to some sites, the blood was nothing to worry about if it was dark brown and thick. Other sites disagreed and stated the harmless blood was bright red in colour and watery. There were women on forums that had bled during every healthy pregnancy and others that had miscarried with symptoms similar to mine. Anyone who has turned to Google for reassurance before will agree with me when I say that it has the exact opposite effect. My doctor said there was nothing I could do but wait and see what the scan showed up.

On reflection, this fortnight of uncertainty set the tone for the rest of my pregnancy. The early scan showed a strong heartbeat and I was progressing well at both the 12 and 20 week scans. I know how lucky I was but instead of treasuring the remaining time, I was fretful and felt unwell up until 33 weeks. I attribute a lot of how I felt to the fear of something bad happening and the utter lack of control I felt in preventing this. I felt the responsibility of the baby inside me acutely. I know women that say the first few weeks after their baby was born were the hardest – that the enormity of what this meant suddenly hit them and that they felt scared by the overwhelming dependency and power this little life had over them. I actually know more women that felt like this in the early weeks of motherhood than not – so I know that it is perfectly normal. I didn’t feel like this. But I’d already experienced, addressed and talked through many of these emotions during pregnancy. I did this using person-centred thinking tools and crucially a one-page profile that I believe helped me regain control and direct my own support so that I wasn’t overwhelmed by the labour or those first weeks as a new mum. Quite the opposite in fact, I embraced them. I knew what I was doing and the person closest to me knew what support I needed. I felt calm, empowered and confident.

My labour was supposed to be at home in a birthing pool. Instead it was in hospital with forceps. It didn’t matter. My one-page profile birthing plan had a contingency for a hospital birth and it followed me there and was read and respected by the midwives on the ward.

After an hour and a half of pushing I was told that my baby was stuck and that I needed an assisted delivery. Her heartbeat was dropping and a flurry of activity ensued. They prepped me for theatre. I signed some papers saying they could take my womb out if something went wrong and was whisked into a bright white room, my legs hoisted up in the air, a blanket dividing by body into two parts and what seemed like dozens of people in masks and hats stood by my open legs. If ever there was a time to feel fragile or a little powerless, it was then. Instead, as the surgeon cut my perineum and pulled my baby down the birth canal, I reminded him to wait until her umbilical cord had stopped pulsating before he removed it. I’d just realised that in the urgency he may not have read and digested my birthing plan. In retrospect of course, the umbilical cord was of little importance, my baby was born safely and delivered straight into my arms, but it is evidence that despite all the elements against me, I was still directing my own support. Proof, if ever more was needed, that I was empowered by one-page profile birth plan.

It is true that I am typically an outspoken person and would always speak up on behalf of myself and others if I believed it was important, but the fear I’d experienced during pregnancy would have rendered me silent on a surgeon’s table had I not planned and prepared using person-centred thinking tools.

I have to apologise for the lateness of this post. Scarlett is 11 months old now and a whole world of things have happened since her birth, breastfeeding, first foods, first teeth, crawling, starting nursery… and so the journey continues. I really wanted to share my birthing experience though, especially with those of you that read and followed my blogs in pregnancy. Addressing my hopes and fears in pregnancy and in particular using the person-centred thinking tools to talk through my emotions with my partner was really good for us – and for Scarlett aka Scamp who is the most amazing little person I’ve ever met!

Person-centred antenatal classes empowered Dawn to give birth to her third child in the way she wanted

Dawn was diagnosed with breast cancer whilst pregnant with her second child. Although the pregnancy was straightforward, her physical health was not. By the time her baby was born, eight weeks early, Dawn had had two doses of chemotherapy. “I felt as if my body had had enough,” she said.
Getting pregnant with her third child was a shock and it produced a strong emotional reaction. Dawn decided that whatever the health advice, she wanted a home birth. “I’d spent a lot of time in the last three years going in and out of hospital. I didn’t want to disappear into hospital again and worry the children. We wanted to all be together for the birth and for it to be healing,” said Dawn.
Information is power
Dawn had attended an NHS antenatal class during her first pregnancy – but this time round she was looking for a class that was, as she says, less dictatorial and more designed to help expectant parents make decisions that were right for them. Dawn said, “Karina’s person-centred antenatal class was fantastic. The biggest thing for us was to be given all the information and options… where, who, how, pain relief, alternative therapies, massage. You don’t get that information at an NHS class but for us it was fundamental to get the knowledge and then make a decision.
“The information we received empowered us to say that despite the cancer-related health complications of my last pregnancy, I was not a high risk, that this pregnancy was straightforward and that I should be entitled to a home birth.” In the end, the doctor agreed that if Dawn could carry her baby until 37 weeks, she could have a home birth.
Michael’s job description
Dawn reports that working with her husband, Michael, on his job description was very straightforward. She said, “Michael knows me so well that I was happy for him to be my spokesperson during the labour. If someone was trying to do something he knew I wouldn’t like, I wanted him to say ‘no’. The plan was that he would be my advocate, bodyguard and protector.”
There was also a medical rationale for this. Dawn has lymphoedema in her left arm and cannot have a blood pressure band or any form of monitoring cuff attached. Michael needed to ensure medical staff were aware of this.
Dawn’s one-page profile
When you have a complex medical history, you can spend a lot of time repeating your story to healthcare professionals and Dawn and Michael found that both frustrating and traumatic. Dawn said, “We had had a lot of emotions going on and it was not very nice having to go back over it all again and again.”
Dawn found the creation of her one-page profile, a document that lists what is important to her and how she likes to be supported, invaluable. She put it in her maternity notes and asked midwives, healthcare assistants and doctors to refer to it. She said, “The profile said it all. This is me, this is my story – please don’t ask me to repeat it every time you see me.” Dawn also included a line on her profile about the fact that she wanted a home birth.
Dawn’s conclusions
At 37 weeks and two days, Dawn’s third baby – a boy called George – was born, at home, in a birthing pool. The couple describe the labour as quiet, peaceful and chilled. The whole family was in the room and it gave them all the healing experience that they needed. Within an hour, Dawn was propped up in bed eating a bacon butty and feeding George.
“Karina gave us the confidence to fight for what we believed was right for us. Knowledge is power and she gave us the knowledge. She helped us look at the pros and cons, the good and the bad, and let us make up our own minds. She was also a calming influence and very nurturing. I would highly recommend her class,” said Dawn.

Catherine’s story: “I definitely had the birth I wanted”

Catherine’s first delivery did not go according to plan. But then again, there had never really been a plan anyway. Catherine said, “My entire birth plan was about where to have the baby. We were moving house, so I wanted to have it in Manchester, our new location, rather than Cumbria. When it came to the detail, I thought to myself what will be, will be.”
Fate was a little unkind. Catherine was induced at 42 weeks and the labour took a very long time. Looking back, she wishes she had spent more time labouring at home. “It wasn’t really the labour and birth I would have wanted,” she said.
Catherine runs a baby sensory class and it was through this that she heard about Karina and her person-centred antenatal classes. She wanted to meet other mums in her new area and this seemed like a good opportunity to develop a social circle and take a more proactive approach to her next birth. “Once you’ve done it once, you have more of an idea of how things could be,” she said.
Catherine’s birth plan
“When I was induced with my first baby at 42 weeks, he wasn’t remotely ready to come out, so I wanted the option to let nature take its course, if possible,” said Catherine. Her birth plan also specified that she wanted the opportunity to go home if an induction was taking a long time. If surgery was required, she wanted her husband to be with her.
Catherine said that as a result of Karina’s detailed approach to developing her birth plan, she felt comfortable and prepared for the impending birth. “I felt well informed and prepared to ask questions of the medical team. And rather than saying, ‘Ooh, it would be nice to have a water birth,’ I knew why I wanted it. I also knew which drugs I didn’t want and why.”
The approach used to develop the birth plan was very person-centred. There were no right or wrong answers, just the feeling that what was right for one person may not work for someone else. Catherine said, “I wanted my husband to decide whether I was ready to be handed the baby after the birth. After my first delivery I was so exhausted that I wasn’t ready to take the baby. Some people in the class may have thought it was a strange decision, but the atmosphere wasn’t like that – it was about accepting everyone’s rights to be unique.”
Catherine’s favourite person-centred tools
The relationship circle was one of Catherine’s favourite person-centred tools. With her first baby she hadn’t wanted to tell anyone she was going into labour. This time, there was a toddler involved, so a plan was required to map out who would care for him. The relationship circle also helped Catherine map out who would help her in the weeks following the birth – and even after she returned to work.
The good day/bad day exercise helped too. It enabled Catherine to recognise the things that were making her life difficult. She realised she needed help when her husband was working away, so she employed a dog walker and enlisted her parents’ help with childminding.

Catherine’s conclusions

“This class was one of the best things I’ve done,” said Catherine. “It was really worthwhile. I met other mums, felt much more prepared and definitely had the birth I wanted.”
Catherine laboured at home with a Tens machine, then spent two hours in a birthing pool – and that was it. “I delivered in the water, had skin to skin with my new baby and felt very relaxed. This birth seemed like an everyday thing – the first one had felt like a trauma.”