8th March is International Women’s Day 2018. This year the UN asks us to reflect on the courage of ordinary women and to celebrate activists who are fighting for women’s equality and rights across the world. In their comments on the International Women’s Day page, the UN focus on sustainability, and specifically mentions the activism of women in rural areas working to champion rights for women.
These are big issues – massive issues – violence against women, gender pay gaps, poverty, exploitation, climate change and it is of course, important that we understand the worldwide picture but it sometimes means that we can overlook the issues of importance that women are campaigning for in our own areas. These are the everyday battles that women in our own communities are facing. We have seen the important work that @vvfabs and other Women for Independence members have done in highlighting Period Poverty, the WFI Justice for Women Campaign and tonight I met with women from Caithness Health Action Team (CHAT) who are fighting another battle right here in Scotland.
Caithness is a place in Scotland like no other. Some of you might know that I lived there for several years and loved it – still love it. It has a beauty which is stark and raw but it is beautiful nevertheless. It is however, 110 miles north of Inverness. When I moved there, driving up the road in the late 90s, I thought we were never getting there. What looked fairly doable on a map proved to be a winding, twisting road which went on and on and on – and it was snowing – and it was May – and it took nearly three hours to get there from Inverness.
One of the things I checked out on my first visit to Wick were the medical facilities. I was reassured to see that there was a good hospital and doctors and services which would meet the needs of my growing family. Since then however, the situation has steadily deteriorated with more and more services moving to Inverness. The biggest and most dramatic of these changes have been the changes to Maternity Services which took place in December 2016. Previously, Caithness General had consultant obstetricians (2 and a locum) but no facilities for on-site specialist neonatal paediatric support or adult intensive care. Following a review, NHS Highland changed the Maternity Service from a consultant led service to a Midwife led Community Midwife Unit. These changes were supposed to provide safer, more reassuring care for the women of Caithness. At the time, Professor Hugo van Woerden, NHS Highland’s Director of Public Health and Health Policy, outlined the findings of his report, saying that the CMU was a recognised option and that NHS Highland “know how to make that model work.”
So here we are a year and half later, and it appears to be ABSOLUTELY clear that the model which NHS Highland introduced is ABSOLUTELY not working for the women of Caithness.
The idea is that where mums to be are deemed to have “high risk” pregnancies they would be required to deliver in Raigmore. Seems sensible right? But in the first year 210 babies were born to mums from Caithness and 199 of those were delivered in Raigmore. This suggests that over 90% of pregnancies in Caithness are “high risk”. I wonder how that can possibly be the case but assuming that it might just be so, let us examine what that actually means.
It means some women being in Raigmore Hospital in Inverness for days or weeks. This means they are at least 100 miles away from their home, from their other babies, their husbands, their support and their communities. Oh and let’s not forget, from their visitors. Not everyone knows people in Inverness who can visit if you are admitted for a prolonged period of time. Often days might go by without a pregnant woman having a visitor.
It means women travelling over 100 miles in labour sometimes in an Ambulance but often in their own cars. I have had five children and three miscarriages. Each birth was different – long labour, short labour, waters broken at home, emergency section, elective section. In all of them (except the last one) the trip to the hospital was not pleasant – and I only had a twenty minute journey at the most. Imagine two and half hours in a car, in labour.
Now imagine that journey in the dark without access to a loo, in the driving rain or even – as we saw last week in the snow following a snow plough. There is a bit of footage doing the rounds on twitter just now which was put up by Bear Scotland which shows the snow plough followed by two ambulances and a car. You can see it here.
I understand that one of these ambulances carried a sick baby, one a mum in labour and the car in between another pregnant mum. This is the reality of the experience of women travelling from Wick in labour. Later that same night two women had to travel together in one ambulance with a midwife. Now, there is no doubt that the snow plough driver and the ambulance driver and the dad driving the car in between did a great job. However, expecting pregnant women, at a time when they are at their most vulnerable, to travel those sorts of distances is appalling. It took over four hours to make that journey in the snow. It is not ok to expect a woman in labour to share an ambulance with another woman. It is not ok to ship pregnant women almost wholesale down to a Maternity Unit 110 miles away which, incidentally, is already bursting at the seams.
We know from lots of research that women given privacy, space and a stress free environment during labour need less pain relief and have less complications and yet over 90% of women in Caithness giving birth are subjected to this long and arduous journey.
And there is more.
I heard that some women who have suffered a miscarriage also have to get themselves to Raigmore Hospital. In at least one instance that meant a woman had to drive herself the 110 miles. Again, Ill remind you of the lack of public toilets or any facilities to deal with the sometimes horrific bleeding that can come on during a miscarriage.
I heard about pregnant, labouring women who have had to urinate in a layby or hammer on the door of a closed hotel to use a toilet. The embarrassment and the mortification these women expressed is huge.
I heard the experiences of women whose husbands work off shore having to leave their other children with relatives and neighbours because they have to go suddenly to Inverness – for days.
I heard of the lack of accommodation at Raigmore for partners and families. I heard that often women who are more vulnerable or less assertive than others don’t get the help and support that they need for accommodation when they arrive in Inverness because they are not able to speak out loudly enough.
I heard that Raigmore is at capacity and struggling to cope with the extra caseload.
I heard that people are leaving Caithness because they have no faith in the health services for their families. How do we ensure the sustainability of rural communities if we do not provide good quality health care?
I heard that women are rushing to leave hospital because they need to get back up the road for their other children or their partners and that NHS Highland dismiss that as being “their choice” with no recognition that Hobson’s choice is no choice at all.
I heard that women are deciding to limit the number of children they are having, not because of their own preferences but because the experiences have been so difficult, so traumatising and so awful they cannot face going through all that again.
All this makes me furious, but what makes me just as angry is that I heard that these women feel that their voices are not being heard.
NHS Highland appears to have utterly no interest in addressing the fears and concerns of the women involved. They repeatedly tell CHAT that they can’t speak about the experiences of the women involved. They have failed to share important information with CHAT and they have failed to consult effectively with the wider community, and its not just over Maternity Services, it is happening with other services too. NHS Highland have been patronising and patriarchal in their approach to the changes they have made and in the way they have failed to engage with women. These are women who should be having one of the greatest experiences of their lives and instead, in many cases, are having one of the worst.
Women are feeling silenced. They are scared of speaking out in case they get the lovely midwives in trouble when they know the midwives are doing their best but are hampered by policy decisions made by the NHS Highland Board. Women are silenced and disempowered in the decision making process. They don’t speak out because nothing changes, because no one is listening and because, when you have just given birth, you maybe don’t have the emotional and physical strength to shout about your experiences.
Well, We are listening, because we know that it isn’t just the rest of the world that is failing women, it is happening right here. The Scottish Government plans a “Best Start” for all babies and children in Scotland. They say that “Maternity and Neonatal care should be co-designed with women and families from the outset, and put mother and baby together at the centre of service planning and delivery as one entity”. This is not happening in Caithness and there is no sign that NHS Highland has even read the introduction to the plan let alone thought about how they might try to achieve this in Caithness. The Scottish Government must put pressure on NHS Highland to improve services for women in Caithness and hold NHS Highland to account if they continue to fail to do so.
A Best Start is what we want for pregnant women in Scotland going forward – it is part of the fairer, better society which so many of us are working so hard to achieve. We are however, not only failing the women of Caithness but all women if we do not acknowledge and listen to their experiences of childbirth. NHS Highland need to take urgent action to do exactly that – listen, and then they must find an innovative solution to the issues I have mentioned here. International Women’s Day isn’t just about what’s happening in the rest of the world – it is about our women here too. These are our women and our children and we must do our very best to make sure they are heard and that their concerns are addressed.