Creative Practice as Mutual Recovery - Birth Shock!

This application for Follow-on Funding for Impact and Engagement relates to an Arts and Humanities Research Council project called The Birth Project, part of the Creative Practice as Mutual Recovery consortium (grant ref. AH/K003364/1). The Birth Project has been particularly interested to explore women's subjective experience of birth and the transition to motherhood using the arts, within a participatory arts framework (Hogan 2017). The project has also explored how artistic practices, conducted in social settings, may promote mental health recovery, and guard against compassion fatigue for birthing professionals. As an outcome of the Birth Project, the multiple discourses and perspectives surrounding birth were revealed and captured in a series of short and engaging films. The aim of this follow on project is to use the original films as part of an educational resource to be developed and used in the formal training of health and medical professionals in order to enhance training, especially with respect to encouraging reflective and empathetic thinking on the part of trainees. Additionally, the proposal is to target new non-academic audiences by showing the films at film festivals to their attendees. Further, the project will promote the films internationally via appropriate digital platforms.

This project aims to enhance the impact of the Birth Project and to increase its capacity for engagement. There is a clear need to extend the original remit of the project because during its implementation considerations for new audiences emerged. The original intention was to explore how creative approaches could help articulate the experience and trauma of childbirth and how art can mediate the recovery of the persons involved in it and explore mutuality in recovery processes. Engagement with the resulting visual outputs from our project challenged assumptions that medical and health professionals held about childbirth and its impact. Evidence then showed that this change in perception led to a resolution on their part to change the ways they practice in order to prevent or mitigate emotional and other trauma.

Specifically, piloted thematic analysis of self-report data showed that the professionals who were exposed to mothers' perspectives from the film showed an increased understanding of the complexity of pre and postnatal care including increased appreciation of the patient's point of view. Medical students pointed out that hearing women's stories made the experience of childbirth 'seem very real and not at all as clinical and mechanical as we are taught'. Other comments reflected an understanding of the 'lasting effect' that childbirth can have on women's lives and a newfound 'empathy' and appreciation of the 'thoughts and emotions' of labouring women. Significantly, there was an increased capacity to go beyond patient relatedness and become aware of patient personhood.

The majority of the project data pointed to a need for increased audience engagement with the project films. Indeed, the health professionals who were involved in the study often identify themselves the need for the mothers' perspective to inform practice. They often recommend in their comments that the film becomes part of their training to inform practice (and the films have been adopted by King's College where they were piloted). Responding to this need we seek the council's support to employ a researcher who will be solely dedicated to this follow-up project. This person will be responsible for making contact with relevant health and medical schools across the UK, arranging and setting up film viewings and discussion and analysis sessions. She or he will also enter the film into relevant festivals and be available for public discussion along with the principal investigator. The researcher will synthesise the results of the proposed impact analysis and write a summary of the collated results. We anticipate that the position will last a year

The beneficiaries of this project will be:

- Women childbearing in hospitals and midwifery units in general. Women will be the ultimate beneficiaries through receiving enhanced compassionate care.

- Health professionals: Health professionals will be beneficiaries on two levels. First they will benefit from having high-quality training resources made available to them, with direct instruction and aid as to their use in training contexts. The majority of the films focus on the women's perspective of childbirth and new motherhood to enlighten health professionals and change practice. One of the films explicitly explores childbirth from the professionals' point of view, so can be used in training or CPD contexts to enable discussion of issues: temporal pressures, compassion fatigue and also the use of the arts in health. The films will significantly enhance the training of medical students, who may have a specialised understanding of the physiological processes of birth but lack an appreciation of the felt experience of it. Data from our completed project has shown that following engagement with our material, professionals become aware of the fact that emotional trauma can occur even in cases where the progression of the birthing process itself was normal and uncomplicated. They also became attuned to the fact that medical or hospital experiences that are peripheral to the birth itself - such as attitude towards the birthing mother, correct communication and consent practices - can either contribute to, or alleviate, distress.

- The general public: Through programming the films at film festivals new non-academic audiences will be reached and knowledge of birthing perspectives and the role of the arts in health enhanced.

- Students: Trainees will benefit from exposure to the films and associated educational materials. First they will be able to 'see' the childbirth experience from the mothers' point of view, both through testimony and the images and other art works, to develop more effective communication and caring practices. Secondly, future generations of students will develop enhanced awareness of the potential roles for the arts in healthcare.

- Policy Makers: Proposed impact activities will reach a range of audiences and will present analysis of the project's findings in a persuasive and accessible way, using quantitative data as well as testimony from participants.

The Birth Project used the arts to enable women (and others, such as birthing professionals) to explore their experience of childbirth and the transition to motherhood. The films explore these artistic journeys and answer the project's research questions, through careful editing. The films are an excellent resource for stimulating thinking about the birth experience and the stresses of new motherhood from a myriad of perspectives. This proposal consists of an extensive tour of a suite of high-quality films and proposed new supporting materials which will enable enhanced training of health-care professionals who deal with childbirth (or its aftermath) such as medics, midwives and health visitors, or counsellors and therapists who may later work with new mothers who are depressed or traumatised. An extensive tour across the UK is proposed to share the material, and to train potential users in the way it can be used (with the additional supporting material). Impact will also be collated via a self-report qualitative questionnaire (including a Likert scale and open text box section) to explore changed attitudes and behaviours that have occurred as a result of exposure to the project resources. Film festivals are also targeted as a way of reaching additional audiences. This project specifies a program of activity to take place over a one-year period. It also culminates in an event and exhibition.