Hatty Christmas!

🎵With your hats and my hats and my hats and your hats the more we get together the hattier we'll be🎵

Attention, all neurotypes: This is your friendly neighbourhood reminder that it's OK and a good idea to do Christmas however it works best for you. Introvert, extrovert, lonely, content, anxious, peaceful, grieving, joyful, scared, however you're feeling.

This song has been going round and round and round and round in my head since it invented itself when Lil' Peggy brought me our hats for a walk yesterday. In case you didn't sing it in your head or don't know the original song, it is a truer and more inclusive version of the song "For my friends are your friends and your friends are my friends. The more we get together the happier we'll be"

Of course the original song is a lovely sentiment and probably designed to promote inclusion. And it's a pleasing rolling tune that's easy to pick up, fun to sing and sticks on your head. I like it. But it's always irked me that it's just not true! For me at least!

Other people's friends aren't always my friends. Although we may share friends or their friends may become my friends, occasionally we really don't get on. Certainly I may not have met them yet, in which case they absolutely aren't my friends even if they may be one day.

And I have a definite social battery, so "the more we get together the happier we'll be" just ain't it! I do actually like people and need to enjoy spending time with them, a discovery I was pleased to make a few years ago, but the quantity and frequency of my socialising needs to be a lot less than for many others. I need down time to recharge alone and space for regulating activities. More does not infinitely equal happier!

But with my hats and your hats, we will definitely be more hatty the more we're together (if hattiness = nHATS x tHATS, where n=number and t=time in presence of).

Some great adaptations I've made to Christmas the past couple of years have been to allow myself time out where needed (this builds itself in naturally with a small breastfed child, but I had planned for it before the child came along too, although I didn't get a chance to implement because of covid), and to only spend a few days at a time with people if going away. We do go and stay with people a few times a year either as a family or me and the smol, but I now know my limits and tend to keep it to about three days at a time because I know that this is about my capacity before the balance between benefit and difficulty starts to tip.

Knowing what is going to happen and what to expect helps me a lot and my Peggies-in-law are amazing at this - before we go to stay with them they send a suggested itinerary and meal plan. This is fantastic because it means we can make any necessary changes or flag up things they need to be aware of (Little Peggy can't have cow's milk so when buying things like pies from farm shops they need checking) and I know what is happening and what is available. I can also look at menus in advance so I'm not under decision pressure at the time, and I can decide how I spend my time depending on what will be happening (eg. if I know we'll be out all afternoon and evening I might spend more time in the morning away from the family to minimise overload). Even little things like deciding what to wear (inside/outside/formality of occasion) are helped by understanding what will happen when. It just helps my brain relax because I am often thinking about what is coming up in my day or week so I can be prepared for it, and if I don't know then that thought keeps buzzing round taking up brainspace because it's unresolved.

So. If you know something that will help you at Christmas (or any other time!), to quote (slightly out of context) a very wise Peggy who has helped me a lot "it's OK to say it."

Note: saying it explicitly may be more uncomfortable but may in the long run be more helpful because then others are aware and can help to make sure the adjustments that help you cope are kept to, or can show more understanding of any struggles or make different accommodations if they are not kept to.

And last but definitely not least, if you have been brave enough to say it and others have disregarded or forgotten about what you have said, that DOES NOT automatically mean you were wrong for saying it. It does not mean you shouldn't have said it, or that you are a bad person or that you don't deserve whatever adjustment you were hoping to make (or are still going to make, but are now probably feeling guilty about making). 

Sometimes things need saying a few times. Sometimes they need explaining a different way. Sometimes there's a compromise that will still meet your needs. Sometimes people will not understand. Sometimes understanding grows over time.

Stating that doing something differently would help you is not a character flaw or a crime! It might even help others too - inclusivity often benefits everyone not just the person it's "designed for." Or it might make others glad that they know they are maximising your enjoyment and wellbeing by accommodating your needs or preferences.

I hope you have whatever kind of Christmas time you need this year.

Continuity of Care: Inclusive Midwifery

I'd like to rave for a few minutes and sing the praises of my midwifery service. 

By a fortunate set of circumstances I ended up under a different service from the one that I should be under geographically. Because I am still registered with a GP in the city rather than the town near where I live (easier for me to access from work), I was assigned a midwife from the new pilot continuity of care team in our city. 

It has only been running a year and the hope is to expand this model of care across the city in future, returning to a more "Call the Midwife" type of scenario where the same small team of people look after women and their babies from the early days of pregnancy through the birth and the early days of baby's life. Each mother has a named midwife but there are opportunities to meet the other members of the team so that even if your midwife isn't in on the day you give birth you are likely to have somebody familiar come to the hospital or your home to support you. They have a weekly online Coffee and Chat where they cover all kinds of antenatal, birth and postnatal topics, signpost resources and facilitate getting to know other Mums and members of the team.

To begin with I was happy with the care and support I was receiving but I didn't completely realise how grateful I was until later in my pregnancy when I had appointments with people from outside the team (eg. my consultant) whom I had not got to know. 

It turns out I had struck gold with my midwife and her team. From the very first contact she listened to me and my needs, accommodating in every way possible and checking in regularly whether they were getting things right for me. She never failed to check whether I had any questions or worries written down and always asked verbally before we finished appointments too. She kept me on the caseload though I'm out of area because she recognised how important the continuity of care could be for me. Once she knew me a little she showed insight into what I might need and what might be difficult, taking care to communicate in ways that work for me.  She proactively liaised with my mental health team, making sure nothing fell through the cracks. She made sure I had regular in-person appointments at a slightly higher frequency than standard. She repeatedly reiterated to get in touch with any questions or concerns or to ask for help - so much so that I actually could do that if and when I needed to (something I tend to find difficult). She took me on visits to the hospital step by step and completely at my pace so that I could desensitise myself a bit to going there and so I could know what to expect. When I was in labour she stayed to personally take us from the induction room to labour ward and gave a really good handover to the midwife looking after us for the night, who after that also took great care and attention to meet my communication and physical needs. She continued this support after birth, taking nothing for granted, being clear with me and I with her, checking things out and making sure things were right for me. She always let me know who was on shift when, and introduced me personally to as many of the people I might come across as possible.

This approach made me feel safe and functional. It gave me confidence to voice my needs and worries and have these addressed. I never felt as though I were too much work, or awkward, or needy, or an inconvenience, and neither did I feel belittled or patronised despite the extra support I received; rather I felt respected and enabled in my journey towards parenthood. My pregnancy passed with as little drama as possible and with me feeling as stress-free as possible. My birth was a positive experience, despite being in the hospital. I carry no unprocessed difficulty from any of it - an increase in confidence and calmness if anything - and Baby Peggy and I are both as well or better physically and emotionally as we can expect to be.

The times I went in to see the consultant and the registrar without anybody I knew, I didn't really feel able to ask questions, I felt as though I might be judged and I did not feel safe or confident. This is nothing to do with the skill or manner of these professionals; simply that for me, the relationship built over time where I feel assured that I won't be misunderstood, is paramount to my effective engagement and therefore the outcomes of my care.

So thank you, continuity of care team and especially my wonderful named midwife, for your stellar example of best practice in patient-centred care. I hope to see continuity of care teams spread across the city and round the country.