Research methodologies: circuit of entanglement. Practice as Research in the Arts and Beyond. Principles, Process, Contexts, Achievements 2nd Edition. Robin Nelson 2022.
Natural Science is a branch of science concerned with understanding, describing and predicting of natural phenomena, based on evidence from observation and
Philosophy Physics - which I assume is the same of the philosophy of physics is concerned with the philosophical speculation of time and space. The deepest theories of modern physics- quantum theory, relativity, symmetry and thermal physics. The central questions of this study concern what qualifies as science, the reliability of scientific theories, and the ultimate purpose of science.
Big data can be categorised as unstruc tured or structured. Structured data consists of information already managed by the organisation in databases and spreadsheets; it is frequently numeric in nature. Unstructured data is information that is unorganised and does not fall into a predetermined model or format. It includes data gathered from social media sources, which help institutions gather information on customer needs.
Quantitative Research is the process of collecting and analysing numerical data. A process of finding averages, patterns, to make predictions and to generalise results so that are available to wider audiences. It is the opposite of qualitative research, which is the analysing of non-numerical data. Examples of quantitative use is in psychology, economics, sociology and marketing. It can be gathered through questions, surveys, focus groups through questionnaires and historical records.
and not mass data. It relates to the gathering and measuring of non- numerical or descriptive data so to ascertain of individuals social attitudes, reality, beliefs and motivation. This type of research is far more in-depth and used to explore complex material on experiences, beliefs, perspectives on a particular topic or experience. Qualitative research is particularly useful when researchers want to understand the meaning that people attach to their experiences or when they want to uncover the underlying reasons for people’s behaviour. It is informed by several strands of philosophical thought and examines aspects of human life, including culture, expression, beliefs, morality, life stress, and imagination.
Here, I have managed to make up a new category called Performative Physics. Let’s scrap that and stick to methods that actually exist.
Performance philosophy is the study of how philosophers and philosophical ideas have been staged in performance or how ideas and images of performance have figured in philosophy. The application of philosophy to the analysis of performance: the philosophy of performance and / or the performance of philosophy. I don’t quite understand this- It is also an international network of researchers, scholars, activists and practitioners.
www.performancephilosophy.org
Auto ethnography uses a researcher’s personal experience to describe and critique cultural beliefs, practices, and experiences; acknowledges and values a researcher’s relationships with others. Using deep and careful self-reflection— typically referred to as ‘reflexivity”—to name and interrogate the intersections between self and society, the particular and the general, the personal and the political. It shows people in the process of figuring out what to do, how to live, and the meaning of their struggles balancing intellectual and methodological rigour, emotion, and creativity striving for social justice and to make life better.
Performative research is research that can be produced, analysed and presented in and through several different modes and materialities for creation. Using only verbal and/or written modes of expression might reduce the meaning-making as well as the affect in producing capacities of the research. The performative research paradigm assumes that there are multiple realities that can be understood in multiple ways. In a research project, researchers create new, unknown spaces, which they investigate. Through research, an ever-higher degree of objectivity is obtained in testing and receiving rounds of feedback, in which the researcher listens to the created world’s feedback and adapts their research models accordingly. These can include reflective practice, participant observation, performance ethnography, biographical/ autobiographical/ narrative inquiry, and the inquiry cycle from action research
Practice Research or practice as research. is the incorporation of methodology in the research output. There are rare a variety of models of practice research. Where the practice serves as a research purpose, or into practice, such a s observing the work of others. Bruce Archer’s statement from 1995’ There are circumstances where the best or only way to shed light on a proposition, a principle, a material, a process or a function is to attempt to construct something, or to enact something, calculated to explore, embody or test it.’
*Arthur, B (1995) the Nature of Research
To book- Hannah has sent link on 19.02.23
Ethics clearancePriscilla Harries as contact. Principle of drawing home birth experiences has been agreed by the midwives at KMU home birth team.
Visiting and drawing the pregnancy models at the Wellcome Trust Collection
Previous experience: grants for documentary drawing practice. Work as a well established freelance Illustrator. Teaching experience: socially conscience design interests.
Drawing - Blood test visual explanation as the patient, showing their perspective and experience.
Dea Gravida - Latin for ‘Pregnant Goddess.’
These votive figures typically show a pregnant female goddesses or woman either seated or standing, often with a hand resting on her abdomen. These figures were made exclusively from terracotta and are typically small in scale.‘Votive’ figures were commonly used to appease the gods in rituals. The figures were produced in Europe - statues have been found throughout the Mediterranean. These figures differ from ‘korotrophic’ figures, who hold babies and are not visibly pregnant. Their exact role is unclear. They are believed to bring good luck and to protect a woman during her pregnancy. These examples have been illustrated from the examples held at the Wellcome Collection, London..
I started my degree at Kingston in 1992. The first year had a large component of location drawing. We would visit collections contained in many of the London museums, select objects or curated themes to develop as our developing drawing practice. This example of an ‘Obstetric Teaching Model’ was housed in the Science Museum. I drew it four times during the course of my degree. I was fascinated by the quality of craft in it’s design and production.
The fact that it was created in the 1700’s. It was made to enable the understanding of a natural and a medical process. This model had a profound effect on the direction the last year of B.A and then my M.A would take. In asking how can illustration practice help people understand aspects of their health both physically and in the changes or the physical transitions the body can take over a time period.
Tokyo - known as Edo in the 18th & 19th Century. Carnivals were very popular with side shows known as ‘misemono.’ These were a form of entertainment for the sophisticated residents. These shows featured curious collections of educational and entertaining attractions designed to evoke a sense of wonder and satisfy a thoughtfulness for the mysteries of life. One popular attraction were a range of pregnancy dolls. It is believed that these dolls were created, primarily to teach midwives on how to deliver babies.
Evidence suggests they were also for entertainment purposes. For example, records from 1864 describe a popular show in Tokyo’s Asakusa entertainment district that educated audiences about the human body. The show featured a pregnant doll whose abdomen could be opened to reveal foetal models depicting various stages of prenatal development.
[Source: Geijutsu Shincho magazine, July 2001] via PinkTentacle.
Project background and context
The work I developed during my third year explored four differing views of anorexia. The view from the family’s perspective, the societal view of ‘girls who aren’t really ill, but seeking attention?’ As why on earth would you choose to stop eating if you still can? The view of the clinician. You are a body with no identity and just a patient using up very pressured resources, which could perhaps be directed to more worthy patients? Finally, the view of the anorectic. An onion peeling of conflicting emotional pulls, guilt and secrecy. These four model were life sized calico models.
This body of work took me onto my M.A.
At Central Saint Martins I continued to develop work, utilising a soft, sculptural often wearable media with the intention to communicate about the body in both healthy and in a diseased state. Some of these prototypes were bought by units and used in occupational therapy to explain and to communicate to younger audiences, to seek to explain how body physiology presents.
*A wearable model which visually shows the layers of tissues, structures, calls and nodes. This was designed and prototyped to explain breast cancer in a medical occupational therapy environment.Soft Pregnancy -made 1997
This project communicates the stages of a pregnancy through soft models. Fertilisation, the union of the egg (gamete) and cells splitting and dividing, the forming blastocyst, it’s implantation and development into an embryo, foetus and a baby. This model series was purchased by a Surrey maternity unit as a piece of hospital art. Rather than in the intention of the models as communication design. The disparity of the embryonic stages and the baby at mid and full term are an issue as they are not creatively representative as an accurate scale
9th March 2023
Hello, I’m having a conversation with Phoebe, who I believe is 26 weeks pregnant?
Hello! Oh 27 on Friday well, tomorrow? Yes, yeah. Wow. They really fly by in the weeks. Another week gone!
So how are you feeling about everything? how do you feel about the kind of care that you’ve had in terms of being looked after, what hospital are you under?
I’m at King’s College Hospital and yeah my first, it’s been really mixed actually, the first meeting I had was like a booking appointment and just felt like really rushed, I wasn’t really listened to, I had loads of questions and their attitude was, ‘we don’t want to put down that you’ve had anxiety before or anything because it’ll be that it’ll make problems for you later and that kind of thing. This isn’t the support that I imagined you might get. But then I saw my sister-in-law’s a midwife and worked in London for a while and said that the King’s home birth team is really good and even if you don’t go ahead with a home birth you just get all your appointments at home and with the same midwife every time. So, since then since I’ve been with that team it’s just been so much better -amazing amount better. I just feel like I’m getting to know this midwife and she’s really nice and there’s time to sort of talk around things. It’s a bit of a shame because I’ll be moving hopefully to Lewisham, out of the borough so I’ll not have a home birth with that team. I think since pandemic there’s a 2% chance of home birth in Lewisham which sounds tiny but actually the home birth in um Southwark and Lambeth where Kings is it is only 4% and they’re supposed to be the best in the country.
Wow! That seems very low. How have you, in terms of how, have you wanted to know everything about your pregnancy?
Yeah, I’ve just been like gobbling up the information, like listening to loads of audio books and my, yeah, my sister-in-law gave me like a pile of books the length of my arm to read. So, I think I just wanted to like get my head around it and now I’m taking a break and- I’ll just digest that for a bit and like not engage with it all the time.
Do you have a plan of how you would see your baby being born?
I have vague ideas of my preferences, I haven’t made the ‘plan’ yet but I intend to do that.
How do you think you will feel if that plan is different from what you prepare from?
I think I’m prepared for it to be like these are just a list of preferences in every situation and then I think I’m quite aware that there’s so many things that can go not wrong, but like different to how you imagine. So I’m kind of trying to see it, not even as a plan, but as like a ‘Presence.’ Almost like one of those books created as a flow diagram - if this happens, then this… If you have to have a caesarian, I’d like, still have skin to skin, all those kind of things.- Yeah. I’m trying to get my head around actually how you put that all on a page? So it actually gets listened to. Feels like a design challenge!
Very true! Is there anything that’s on your mind in terms of- as you just mentioned anxiety. How you feel about the lead up to the birth itself, and then that time when you go home and your life is a different shape? Is there any aspect that I’m worried about?
Yeah, all of the above. I guess there’s just so much unknown and so much that you can’t plan for, just you can’t even imagine experiencing it. I’m a bit scared of like not having enough sleep and just being like isolated. It’s my main fear that because I’m moving to somewhere new and I don’t really know anyone around that like little area. So it’s more the kind of social side of it that is worrying me and just being awake at all hours with a tiny screaming baby that’s somewhat freaking me out. I think I can deal with knowing what could happen in the birth and in the run-up, we’ve kind of, it was stressful like figuring out the financial side of it, like, how do you just not work for a year?
Yes, especially being a freelance person, someone who’s in control of your own as creative career.
Yeah, exactly.
I think there’s never a right time to have a baby though, is there?
It doesn’t feel like it. What other things would I...Do you think that people...I don’t really quite know what I’m trying to say.
Do you feel pressured in any way to kind of approach being pregnant approach leading up to a birth in any particular way whether that be through societal or the clinical care that you’ve had?
Yeah I went into it with like a fear of it I’d say because my mum has always been like it’s the worst thing ever it’s horrendous but it’s something you get through and then you get the baby. So, but having my sister-in-law as a midwife, has been good for trying to re-frame that and just like, even pointing that out that my mum has this like attitude to it. I was like, oh, I just thought that that’s what everyone thinks about birth. So I’ve been more aware of like, more like positive birth, like stuff.
Did your mum have difficult births?
I think she had very nineties births, like very medicalised and it wasn’t an option to think about home birth or not have interventions and stuff.
What are your thoughts on interventions? Are you happy for interventions? Are you welcoming of pain relief?
I think, again, going back to the preferences thing, in an ideal world yeah I’ve been using an app tool for breathing, and I do meditation as part of my life already so I like to think I could breathe through it but I’m not closed to the idea that like yeah I might need something stronger and on the day like if I need it, I need it. I think it’s maybe trying to re-frame pain and like take that fear away is great. Because how, I think how we label things? Obviously this affects how we then experienced it. But at the same time, like, but yeah, I mean, I take painkillers for period pain, for all these other things that you go through.
Do you feel there’s any kind of competition? If so, where is that from? You’ve just said that’s really interesting. ‘I take painkillers for when I have period pain.’
I’ve got headache at the moment wishing I can take some painkillers! With the whole thing with birth -it seems why are we expected to do what isn’t totally natural? I think these labels is kind of kind of interesting. it’s not like you’re doing something that’s outside of being an animal at the end of the day- it’s just like it is what it is. Yeah I wonder where... well I think there’s like a fear that it will affect the baby in some way that you’re like taking opioides as pain relief. Which obviously have an effect have some effect on the baby and I would avoid taking opioides in other situations. I say, would take drugs for other things? but I’ve had codeine? That is like, beginners opioides for back pain. I didn’t recognise its the same family as it feels so different. I guess there’s this wanting to be witness to this thing that’s happening that isn’t necessarily like, something that you need to have painkillers for. It seems odd that we take painkillers in our normal lives and there seems different rules for childbirth? Yes, I heard an interesting podcast with, do you know, Ina Mae Gaskin, the woman who led the natural birth movement in the 70s. She was saying how misinterpreted her teaching has been and that maybe there’s this like natural movement that talks about like oh it’s just fear and you should not feel fear and then you won’t need painkillers but she was trying to say like no fear is a totally perfectly normal reaction to something that’s really intense and that it is just a part of birth and so she’s trying to re-frame it and trying like it’s difficult when there’s a movement around it and there is quite a lot of judgement I think in the natural birth or hypno-birthing movement but yes I think some the better people have been listening to reading and like the no judgment is just about trying to learn what what’s your instincts are.
Interview with Phoebe Halstead.
It’s medically the only time where the people that are looking after you are actually looking after two people, sometimes three, sometimes four.
True.
Any other thoughts, can you be on your 27th week of your pregnancy journey?
I’m not sure where these are, but I guess one thing I found that I was surprised at was just how much conflicting advice there is everywhere and how overwhelming it can be. Obviously there isn’t just one right way to do it or to do any of this, in pregnancy or birth or anything. For example, I am vegan and the contradictory advice about whether that is safe. The NHS think says -it’s fine, like just take folic acid, but then there’s more up-to-date research. It appears there’s some things that you actually need like a week or three and all this stuff that you can’t get from a plant-based diet. I was just surprised, you know that like the NHS aren’t necessarily up-to-date with the most modern research but it’s those things where it’s like oh it’s very specific and very like it that was 30 years ago that they proved this thing and it’s still not the not but I’m sure vegan products and vegan alternatives are now totally different than they were 30 years ago.
True.
With with the explosion of veganism. Yes- what do you call it? Fortified. Yeah, absolutely. A bit more of that. So yeah, anyway.
Do you feel that you are ‘everyones’ and everyone’s just very ready to give you their advice?
Yeah, big time. Yeah - touching your tummy. Feeling that it is absolutely ok to touch your tummy.
I wondered if that’s changed. I just find that really strange the whole thing, in that suddenly your body is public property -like if you’re sort of a bouncy castle. It’s all very strange.
It does change your identity I think in so many ways and just when people ask how you are they like really mean it! They are how are you doing? What? They really seem to care. It’s -wow I’ve already seen, can people really care so much about parents? It’s quite sweet, I guess because people know that it’s a special time. It is a special time, And I think some people really hate being pregnant and just feel really ill through the whole thing. And like every pregnancy is different, every birth is a story like you just said. It is, that whole thing is like it feels like everyone’s got a vested stake in you and it’s harder to go under any kind of radar.
Definitely.
Yes, it’s hard not to let all the advice in. It feels you can spend your whole life trying to do what’s right. Or, that can never not… There’s a conflicting way to be in. It’s easy to see if that becomes even more heightened with the judgement of when you’re taking care of a new person.
I think it doesn’t stop.
I don’t think that will ever stop after you have a baby.
It’s fascinating have you been looking at week by week? Baby now has eyebrows and such? Oh, what the baby’s up to.
Yes- Yeah, I’ve got like an app with like a little model floating baby thing. It can now open its eyes, it can see things, it can like recognise voices. I went to a gig the other week and it was like kicking along in time with the music, which was unbelievably cool. It was like, oh, babies got rhythm already!
That’s great
Yeah, it’s quite easy to get detached from it and just go around your day and then you’re like, oh my God, there’s, I don’t know. You’re growing some eyeballs that can now open and close! Wow, just from those cells. Thinking about like, that we were at that at some point, it’s quite mind blowing. My mum was like, “You were such a good baby. “I hope you get a baby like you were.” Cause I just, I guess I was really quiet. I didn’t scream too much.
Which one did you order? Did you tick the box for the good baby?
Yeah, I think I ticked the good baby box. Excellent.
Thank you Phoebe so I’m really excited can we catch up just before your due date in June? then, after baby arrives?
Of course.
Thank you Phoebe, speak soon
The Stitch-Up: How Medical Misogyny Harms Women 2024
Dr Andrzej Harris and Emma Szewczak
This book is presented and described as ‘a powerful and urgent exploration of how institutionalised misogyny through research and medicine has “betrayed half the world’s population”
Invisible Women Exposing Data Bias In A World Designed For Men 2019
As women we live in a world where many of the things we interact with and put into our bodies are designed fir men. This book is terrifying in that still medication testing is ‘advised’ to be tested on half of the world’s population, mind bogglingly it remains not a be a legal requirement. How can this be ok, when you may weigh half as much as another male patient? Our phones are too big, seatbelts are designed for us to die 47% higher in a serious road accident. Drugs are tested on people potentially twice your weight and size. Data bias is the cause for this as it largely excludes women from studies. Surely, it’s time for this to change. This book highlights the system of discrimination faces by and the effect this has on their daily lives. Author Caroline Criado Perez is an award winning activist and campaigner for women’s rights. This book will make you very angry and disappointed in the ingrained societal misogyny that exists surprisingly in the Western developed world and how it affects us daily. It is presented as case studies. Illustrating how we work countless hours for free, are undervalued and in some cases in danger. On top of that we have to birth babies with heads too big for our pelvis’.
Unwell Women A Journey Through Medicine and Myth in a Man Made World Elinor
Leghorn 2021
This book is not dissimilar to Invisible Women, in highlighting the truth behind women being ignored and abused. In this case by the misogyny in Western medicine. Based in America and the U.K, Cleghorn’s research and book goes back 2000 years of history from Hippocrates to 21st Century medicine. The book chronicles her journey of being diagnosed with Lupus developed from her second pregnancy and taking 10 years to gain that diagnosis, gave her the momentum to research Lupus in the 19th Century. The book has eighteen chapters and three parts. Women’s pain and mistreatment over centuries is featured in stories of individuals experiences. Women being forced to have syphillis tests before marriage, enduring botched abortions and being held to the economics and the pain of menstruation. This book is fascinating and enraging. Women being controlled and crazed by wondering wombs, lack of sexual freedom and the dismissal of pain as being hysterical, unexplained and psychogenic. After waiting 9 years for a hysterectomy and being fobbed off, this book comes as no surprise. I think many women will see themselves the pages.
The Mommy Myth
The Idealisation of Motherhood and How is Has Under mined Women
Susan J. Douglas 2004
Susan J.Douglas wrote this book in 2004, and it is still spot on, or in fact, feels more relevant now than perhaps 19 years ago. I wish I knew of her writing when I became a mother. Her acerbic wit and observation of the conflicting messages we are all fed are all in the chapters. If you don’t want to be a mum, you’re bad; if you don’t enjoy every single second with your kids and yearn for more, you’re bad; if you don’t find each snot-stained and paint-smeared second of motherhood the most richly rewarding experience of your entire life, you’re worse. This book exposes the myth and tells us all to be real people, not desperate carbon copies of fetishis-ed ‘celeb’ perceptions. This book is written from an American perspective and from reviews it seems that this book is well received by women wishing to navigate the pros and cons in child-free living. This book is geared around exploring how society’s ideas and fickle nature have created problems for Mothers, but also how a space can be reclaimed and a reminder that your life and that of your dependants are yours, and you have advocacy in he way you choose to navigate the landscape. She fantastic referencing for her book from pre- 2004.
The Myths of Motherhood How Culture Reinvents the Good Mother
Shari L. Thurer 1994
This book is dedicated to all good Mothers and her daughter, beginning with the quote from The Tempest- ‘Good wombs have bourne bad sons.’ I am half way through this book. It is rich with content fro a psychologist’s point of view. The introduction navigates how as mothers we feel our behaviour or feelings damage our children, how it’s difficult to take pride in our competence. Judgement, anxiety, frustration, neurosis - I am only only the third page of the introduction! This book is dense and complex. The chapters include mothering- The Old Fashioned Way, History begins and ends, The sublime and the ridiculous- The classical Mother. Sacred and profane callings: The Medieval Mother, Father knows best: Early modern Mom. The Exaltation of Mother: 18th & 19th Century Mother. The final chapter named Fall from Grace: 20th Century Mother. This will be my summer reading as it appears to be such a key text. Again, a great resource of further reading pre1990’s. I’ll be back with this book and the benefits and relevance of its content.
Regretting Motherhood.
Astudey Orna Donath 2017
Someone not only said this out loud, but wrote a book on it and it was published and it’s available to read. In a society where motherhood is fetishised and glamourised through media, social media and advertising I found this fascinating. The book published in America and written by an Israeli- Jewish writer. The book derives from a sociological study for her doctorate. The book is made up of unflinching interviews of women’s experiences of politics of regret, reproduction and motherhood. Regretting Motherhood by no the children and the conflicting emotions that brings. The fear of then children finding out. Feeling obligated to care, fantasies of vanishing and living with an illicit emotion. How these women have reached out to other Mothers to find a space and community to talk about these complex emotions. How women have found numerous mechanisms to cope with the feelings including humour and glibness. The endnotes of further reading for the project are excellent: Including ‘Qualitative Interviewing’ in Handbook of Interview Research: Context and Methods ads. J. F. Gubrium & J. A. Holstein. Susan Maushart, The Mask of Motherhood: How Becoming a Mother Changes Everythingand Why We Pretend It Doesn’t. (New York: Penguin Books 1999.
Tuesday 18th April 2023- BBC News
End racial disparities in maternal deaths
- MPs By Philippa Roxby Health reporter
An MPs’ report is calling for faster progress to tackle “appalling” higher death rates for black women and those from poorer areas in childbirth.
The Women and Equalities Committee report says racism has played a key role in creating health disparities. But the many complex causes are “still not fully understood” and more funding and maternity staff are also needed. The NHS in England said it was committed to making maternity care safer for all women. The government said it had invested £165m in the maternity workforce and was promoting careers in midwifery, with an extra 3,650 training places a year.
‘Frankly shameful’
Black women are nearly four times more likely than white women to die within six weeks of giving birth, with Asian women 1.8 times more likely, according to UK figures for 2018-20.
And women from the poorest areas of the country, where a higher proportion of babies belonging to ethnic minorities are born, the report says, are two and a half times more likely to die than those from the richest. Caroline Nokes, who chairs the committee, said births on the NHS “are among the safest in the world” but black women’s raised risk was “shocking” and improvements in disparities between different groups were too slow. ‘It is frankly shameful that we have known about these disparities for at least 20 years - it cannot take another 20 to resolve,’she added. Sandra Igwe set up her own pressure group to campaign for better care for black mothers, after the traumatic births of her two daughters. On both occasions, she says, she was not listened to. “I felt they had stereotyped me,” Sandra says. “They weren’t really kind or caring - they ignored my pain and they dismissed me when I cried and begged for pain relief. “They actually didn’t believe I was in pain.”
Sandra complained about the way she had been treated, saying the system had been “working against me”. Tinuke Awe, who co-founded an organisation called Five X More after her own experience giving birth to her son, said her pain was “actively dismissed” which led to her needing a forceps delivery. ”There is a stereotype of black women not feeling pain, and
being quite aggressive and loud, very strong, so we’re able to take more pain,” she told BBC Radio Four’s Today programme. “I was dismissed and not believed I was in labour - maybe I wasn’t shouting enough,” she said. Black and Asian women are dying from the same causes as other women but more frequently. The most common include heart problems, blood clots, sepsis and suicide.
Out of more than two million women having babies in 2018-20, 229 died in childbirth. That equates to 10.47 in every 100,000 - up from 8.79 in 2017-19, although lower than rates 15 years ago. But death rates vary according to ethnicity:
* 34 per 100,000 for black women
* 16 per 100,000 for Asian women
* nine per 100,000 for white women
* eight per 100,000 for Chinese women
The committee’s report was compiled following two days of interviews with medical specialists, charities, experts and government ministers. It says a shortage of staff in maternity care is the biggest concern. But women belonging to ethnic minorities also feel they are not listened to or understood during pregnancy and childbirth. And the report stresses the government and NHS have underestimated racism’s key role in creating inequalities in care. Ms Awe from Five X More told the committee more than 42% of women surveyed by the charity had felt discriminated against during their maternity care.
Amy Gibbs, from the Birthrights charity, said black and Asian women felt unsafe because of a lack of choice around their maternity-care options.
The vast majority of women who die, across all ethnicities, had multiple and complex health problems, the committee heard - but their risks were not always communicated to relevant staff.
* NHS to tackle ‘unfair’ maternity outcomes
* Miscarriage 40% higher in black women, study shows More money to expand the workforce is needed to deliver safe, personalised care to pregnant women, the report says, as well as a clear crossgovernment strategy and target for improvement. Collecting more information on the ethnicity of women giving birth and ensuring black women are better represented in research is also recommended. Professor Marian Knight, who leads a team that investigates every maternal death in the UK, said there was “nothing inherently different about black and brown women’s bodies that is leading to this disparity”.
Training midwives
But, she told BBC’s Today programme there was some evidence of racial stereotyping and different treatment, including “black women being assumed to have lower pain thresholds” and black and ethnic minority women being less likely to get different forms of pain relief. ”Women are dying by and large from medical and mental health conditions so we need to ensure we are not only raising awareness and training midwives and maternity
professionals, but also thinking about doctors who are caring for women before pregnancy and after pregnancy,” she said. Donna Ockenden, who has conducted a number of independent reviews into maternity service failings, echoed Prof Knight’s views that extra training was needed for GPs and anaesthetists, as well as midwives.
“We’ve got to work towards better inclusive care, where black and Asian women are listened to, they’re heard, and we act upon what they are telling us,” she told BBC’s Today.
“There’s no lack of information, but the lack of action - the slow progress - is no longer acceptable.”
An NHS England official said it was committed to ensuring “all women receive high-quality care before, during and after their pregnancy” and it had provided £6.8m to help local health systems reduce inequalities.
“Despite improvements to maternity services in England over the past decade, we know there is more to be done - and we will review the committee’s recommendations as we continue to take action to make maternity care safer, more personalised and more equitable for all women, babies, and families,” the official said.
A Department of Health and Social Care official said the NHS was already one of the safest places to give birth in the world but the department was “absolutely clear that we must ensure maternity care is of the same high standard, regardless of race”.
The government said the Maternity Disparities Taskforce - made up of mothers, clinicians and key organisations - was focusing on how to eradicate disparities and improve maternity outcomes for all mothers.
Maternity payouts cost NHS twice the price of care itself
Matilda Davies, Georgia Lambert Saturday April 15 2023,The cost of compensating mothers and their families for harm caused by NHS maternity services is more than double what the health service spends on such care each year, analysis shows.
The total cost of harm from clinical negligence was £13.6 billion in the 2021-22 reporting year, according to an annual report from NHS Resolution, the arm of the Department of Health and Social Care that handles litigation. Sixty per cent of the cost of harm was for maternity claims, amounting to £8.2 billion for the year. NHS England spends £3 billion annually on maternity and neonatal services, a board paper published in March confirmed. The cost of harm, which is defined as the current value of the estimated cost of claims expected or received from incidents in the financial year, includes an estimate of the lump sum owed for claims, future periodic payments and legal costs.
“We spend more on the cost of harm, when we could be spending more on prevention,” said James Titcombe, a bereaved father and campaigner at the Baby Lifeline charity.
Analysis by the Times Health Commission, following independent research by the charity Baby Lifeline, found that there were more than 10,000 clinical negligence claims brought against the NHS in 202122, with a total value of over £6 billion. Of those claims, 12 per cent were for obstetrics, accounting for 62 per cent of the total value, or £3.74 billion. These figures did not surprise Titcombe, who became a central figure in the Morecambe Bay investigation after he lost his newborn son Joshua in 2008 due to significant failures in the maternity unit of the Furness General Hospital in Cumbria. Instead of a culture of learning, Joshua’s death led to a trust-wide cover-up, the extent of which was revealed in the 2015 report of the independent inquiry. It concluded that 11 babies and a mother had died avoidably at the Cumbria trust between 2004 and 2013. “There was basically a cover-up, medical records went missing, and there were huge discrepancies between what my wife and I knew happened and what the staff had reported as happening,” Titcombe said. “That process damaged me greatly and meant the trust didn’t learn.” Now on the Times Health Commission, Titcombe has worked closely with Jeremy Hunt and the charity Patient Safety Watch to drive systemic change. Last year NHS England was faced with record maternity litigation costs. Titcombe says that continual testing against national patient-safety frameworks is key to preventing a culture of denial that is still prevalent in trusts. Referring to an independent investigation of the maternity and neonatal services in East Kent, which was published last October, Titcombe was struck by the similarity
to the findings to the Morecambe Bay inquiry.
Failures at the Queen Elizabeth The Queen Mother Hospital in Margate and the William Harvey Hospital in Ashford between 2009 and 2020 included suboptimal care that led to significant harm, failure to listen to families and actions that made the experience of families distressingly poor. According to the report, the problems could have been tackled at eight separate opportunities. Had care been given to the nationally recognised standards, the outcome could have been different in 45 of the 65 baby deaths.
The UK has a compensatory system in obstetric cases in which the claimant must prove negligence. However, countries such as Japan and Sweden have introduced a no-fault compensation model where proof of negligence is not required.
Litigation claims against the NHS often take years to settle, leaving the NHS with significant financial liabilities as claims add up over time.
“For the families affected, the last thing on their mind is litigation,” Titcombe said. “They want the organisation to learn and they want to heal. They don’t want to be dragged through legal processes that re-traumatise them for years and years.”
In 2021-22, the health service’s financial liabilities for obstetrics claims reached £41.5 billion — £36.8 billion of which was for claims of negligence causing cerebral palsy or brain damage.
Sara Ledger, head of research at Baby Lifeline, said: “For the rest of their lives, these babies will need medical care and specialist equipment — years of payments to families for the necessary ongoing care of severely disabled children and adults.” She said there were gaps in prevention strategies and “massive” workforce shortages that, if tackled, would save lives. “In
our own research into the training that maternity healthcare professionals receive year-on-year, we found that maternity staff were often not being trained in key topics shown to be the main causes of harm and death in maternity in 2020-21,” she said.
“One of the main barriers to providing this training was lack of resource and funding.”
The NHS said: “Over the last decade, the NHS has made improvements to maternity services in England — with many fewer stillbirths and neonatal deaths — but we know further extensive action is needed to improve the experiences of women and their families across the country.
“The NHS is investing £165 million annually to grow our workforce, strengthen leadership and improve culture in order to do this. We will continue to work with NHS trusts, the government and our partners to make necessary changes and implement the recommendations from recent maternity reviews.”
NHS Resolution said it “aims to resolve claims quickly and fairly and where possible to keep cases out of costly and distressing court proceedings”.
It added: “Year-on-year the number of cases going to court has reduced and currently a record 77 per cent of cases are resolved without going anywhere near a court, with only a tiny proportion going to trial.
“Doing all that we can to improve the safety of maternity care is a priority for NHS Resolution. As a National Health Service body which is not a regulator but has a relationship with every provider of maternity services in England, we are uniquely placed to bring together patients and healthcare providers to help improve safety, sharing what works well, as well as the insights we have on what can improve.”
Drawing for communication of the process of blood being taken by a health professional to a patient. I have documented this process from the perspective of the patient as it was my blood being taken. Midwives at KMU report that there are many concerns by patients of the process and the amount of blood that is taken in the ‘booking in’ appointment. Some women think the needle is much bigger and the process is longer more complex or daunting. I am looking at the nature of the drawn image so that it is appropriate to animate digitally using Photoshop or TV Paint. I am quite conscious that I want the organic nature of my visual language to remain within the research generated from this project. I don’t want the imagery to look slick or digital. The way I create still illustration is too complicated and time consuming for the amount of frames for an animated interpretation. I am exploring a hand drawn key line with a background fill. The loves coloured blue top right have a appearance of being ‘speckled’ I do not want this to communicate any kind of ‘rash’ or ‘contamination. The bottom right pair has a depth and works with the blue key line. A black line feels too harsh and not organic. The right page has experiments of a non ethnic skin tone, and the clenching of a hand to pump a vein as a set of key frames.
I created a range of washes five years ago which I regularly use in commissioned illustration work as ‘visual crackle’ so the image has a tone behind a drawing. The grey wash which has a sound tonal range. This colour palette originates from the grey one on the bottom right corner. As the original is grey, it can easily changed to a whole spectrum of colours through changing the colour balance in Photoshop. I will use these as a palette, which can sit behind key line drawings for the animation, which will require less drawn iterations, but will remain feeling hand drawn and organic.
The drawings from the previous double page spread and this spread show the development from key line drawings drawn from the process of blood being taken. The line imagery is then placed on top of the digitally coloured marks. I am trying to avoid using a black key line, As with food illustration a darker outline lack visual appeal. In echoing the colour of the background the imagery avoids a feel ‘of being coloured in.’ I am striving to create imagery that has a life and an organic quality, so it feels natural.
The layered elements make this method of image making appropriate for animating. The opacity of the illustrations can be changed with subtlety, and to show a graduation in the movement. The verso page shows how the illustrations can build upon each other in the layers to show the blood travelling from the butterfly into the tubing and filling the vial.
diaLOGUES 2 10X10
Illustration Practice Research exchange
Hannah Rollings and I have been paired to discuss the PhD projects we are undertaking. Hannah is at the latter stages of her research journey. I am at the other end. The process of asking the above questions was helpful in considering my methodology and questions.
During the next time frame of my research I will continue reading, I am awaiting the book Birth Figures - Early Modern Prints and the Pregnant Body. This book studies how different kinds of people understood childbirth and engaged with midwifery manuals, from learned physicians to midwives to illiterate listeners. I will using this with the digital midwifery and medical collection received at Christmas. The Wellcome Trust also has a huge amount of material in their library. I want to look at how the creative processes have developed with print and technological communication methods.
I have being in dialogue with a doula who has worked predominantly in Mexico. She is currently studying her M.A. in Midwifery at Kingston. She has been an introduction to the staff who run and deliver the courses at Kingston Hill. Claire McKellowCourse Director and PhD researcher and Suzanne Achilleos, an S.L. on the Midwifery B.A. and M.A. We will be meeting up to discuss links for this project during the summer. This will be a great opportunity for design and IP to collaborate with health and science departments in the university.
After a quick corridor tutorial with Geoff we discussed making the following questions in the project clearer.
*What is the problem?
*What does a better/ more appropriate visual form look like?
*What appears friendly/ open/ clear and why?
So looking at and considering modes of visual data- what does quality data to this particular audience look like?
What is problem - it has two views. The health professionals perspective. What needs clarity in the journey of a pregnancy and birth? Every birth story is different, so what are the key stages. What is the information that everyone needs to be aware of. What are the specialist stages? For example if there is a medical anomaly or issue. The perspective of the patient carrying the baby. What is the most pertinent information, avoiding Googling to find out medical information. There is a plethora of information in the public arena. Books, publication, websites, apps, social media platforms. Margarida the doula made me aware of tik-tok supplying information about birth and pregnancy. The regulation of the visual information being medically correct and endorsed by the staff in the Maternity Unit is essential. The interview with Phoebe covered her feelings of being judged and bombarded with information that can feel conflicting and confusing.
I will continue to develop the visual language, the journey of getting NHS ethics clearance. Animation and IP, making imagery move using Photoshop and TV Paint, also procreate, without it looking like the visual language of procreate.
If have just attended the two day conference ‘Visceral Bodies.’ This Technē conferences focus was on sexuality, motherhood and social reproduction: a transdisciplinary symposium on representing the visceral body in theory & creative practice. how do we navigate the ‘horror’ or embarrassment of these subjects through writing and theoretical reflection? How do we share real and even brutal experiences without them becoming sensational or shocking in a way that negates their complexity? What kind of literary forms, what kinds of language, do we turn to in our attempts? I recorded the speakers research practice through drawn representations of their presentations, which will feature in reader no.3.
