Kelly Williams: Termination of Pregnancy Services Midwife, Manager, Researcher, Doctoral Student, and current Lead Midwife at North Thames Genomic Medicine Service Alliance

Kelly Williams is a terrific midwife who has worked in termination of pregnancy services and many other interesting and worthy places. She’s currently working on her doctorate. This interview talks about some very difficult termination pregnancy issues and other hard aspects of health and social care jobs, just so you’re aware.

Remind me what you're up to at the moment what's, what's the job situation?

I'm currently the lead midwife for the NHS North Thames Genomic Medicine Service, I started about a year ago with the completion of the 100,000 Genomes Project. The project aim, which ties in with the NHS Long Term Plan, was to sequence 100,000 genomes of patients with cancer or rare/infectious diseases. It’s about providing data to help with diagnosis, treatment and results. They split England into 7 areas, and for each, there's a Chief Nurse, Chief Pharmacist, and then I'm working as the Lead Midwife for my area, which is North Thames.

I’m two months into an 18-month secondment and I’m working on a project that is about making post mortem results after a miscarriage, termination or stillbirth a bit more straightforward. What we really want is for perinatal pathologists to do a full fetal exome and use their specialist skills to look at far more genetics than is standard right now. Then that result can then be available when parents meet with an obstetrician for a debrief. I'm still learning a lot about screening and genomics. There are also aspects of my role applicable to women having cancer treatments in pregnancy, and babies who are born unwell and who need rapid exome sequencing. I do lots of thinking through what specialist midwives need to know about genomics. In addition, I’m talking to Maternity Voices Partnerships because obviously genomics can open up all kinds of ethical and legal concerns, and there is some information that clients simply might not want.

What were the requirements for your current role?

One of the things you need to know is that a job specification is an employer's wish list. It's not a must-have list. I am especially aware of this having been in the position of hiring people. And this role is about being an expert midwife, knowing about the maternity services and then linking that into genetics, rather than knowing everything about genomics. When I looked at this job, they asked for someone who was doing a PhD. I had just started my professional doctorate and on the face of it that wasn’t enough to apply, but I was like, whatever, I am doing professional doctoral studies! I didn't have that much knowledge on genomics, but I went to the Health Education England site and did all the modules in five days as preparation. And I pitched things as, I have A-Level Biology, so I know about genes. I have a maths degree and postgrad qualification. And I made sure I found and undertook any other online learning I could find. And that worked, I got the job. 

Any advice for interviews? Both for general midwifery roles and more specialist ones?

Before I got my current job, I had three unsuccessful interviews and after each one I just felt so embarrassed. It felt like I was a terrible midwife. But it wasn’t that at all, I was just competing with other people at my level. But it felt very personal, I was asking whether it was because I was a brown person, all of those things. When you don't get a job you need to give yourself a bit of time to grieve, cry, be really upset and then carry on. Because it takes resilience to go on and I know some people try once and then never do it again. It’s too hard. And that’s a shame because not getting a job means absolutely nothing, it’s always about them, or timing, it’s never about you.

It turns out that the interview technique is really important. Especially if you are a female midwife of colour, you have to apply for jobs with confidence, you need to bring that to the interview.

I once mentored someone through the Florence Nightingale Windrush Foundation. It’s a Health Education England Programme that offers nurses and midwives who are descendants of the Windrush generation or are from ethnic minority backgrounds support with their career development. The midwife I mentored had been qualified longer than I had and is older than me. We’ve mentored each other really, she went for a Band 7 position, didn’t get it and got some helpful feedback. It turned out it was just that someone else had a stronger interview technique, they were no more qualified and had no more experience than her. She was able to tell me about small changes to interview technique that she needed to make, and I was able to apply that to my own performance.

Can you tell me a bit more about what you know about midwives from ethnic minority backgrounds going for specialist roles?

Sometimes if you can't see people who look like you in senior roles, you can think ‘that role is not for me’. A lot of the time what gets you a senior role is really good interaction with a senior manager, something like helping out with an audit or a guideline, or covering a role when someone has a holiday. And racially people tend to react better to people who are like themselves. They’re not microaggressions, it’s more unconscious bias, managers just tend to go back to the people they have chosen to help them out before and after a while, the gap just becomes bigger and bigger. It’s difficult for me because I’m aware of my own privilege, as I don’t have a very ethnic-sounding name and if you speak to me on the phone I just have a generic northern Yorkshire sounding accent. I’ve gone to universities within the UK. I’m what some would term the acceptable face of a person of colour and I’m well aware that someone with a name that easily identifies where they are from and a degree from outside the UK and a different accent is going to have a very different experience. I try to go in and do what I can to support other people but also be aware that their journeys are different to mine.

Gloria Rowland is doing a lot to turn the tide, she’s now Chief Nurse in South West London, and was previously Director of Midwifery for the country’s largest maternity service (Barts NHS Trust). She speaks a lot about mentorship, people of colour, and you know, the biases against her of having a thick Nigerian accent and wanting to be a proud Nigerian woman. She's doing some work on how we lift each other up. But I also know that I got my first Band 7 post after two years qualified, I got my first Band 8 when I was less than four years qualified. And people thought it was because of who my friends are, but also that I was just filling some kind of quota. That’s difficult to hear, but know that some people are just jealous. That’s what I’ve learned. It’s easy to get into a senior position and then say, right, I’ve done my work, I’m just going to keep my head down. But you need to extend hands to other people who need that support. 

Yeah. This tallies with what the author Roxane Gay says, she’s a black writer whose work on racism is helpful in understanding what goes on.

Yeah. Well, that's the thing, you want to be able to share your stories about how difficult it is, without putting people off. And, you know, I'm also lucky in some respects that, because when I was newly qualified I was keen and confident and pushy, all of the things that, you know, sometimes we’re told aren’t good traits, especially in women. And I could imagine what I was experiencing was down to me committing to jobs too quickly, or I did too much work, or I was friends with the right people, as opposed to it being a colour issue. I’m aware that a lot of people don’t have that luxury.

I think the other thing that I took from reading Roxane Gay is that she was like, ‘of course, racism is there. But if we think about it all the time, we'll never get anything done’. And I was like, sure, yeah, it's very important to be loud and having conversations about racism, but you don't have to have it in the forefront of your mind all the time to get things done. This is what I do with misogyny, I guess.

Yeah, absolutely.

So tell me about your early career, when you worked in termination of pregnancy services?

I qualified after having trained with the University of Cumbria, which is an amazing, brilliant university, but it is very tiny. There were 15 people in our cohort. I worked at the last obstetric unit that had no epidural service, which was in Carlisle. It was brilliant, but there was no diversity. So I went and got a job at Kings, and at the time there was no preceptorship, you just picked up your uniform and off you went. There were a lot of issues and it was very stressful. And then less than a year later, I was looking around for jobs, and I saw a position at the British Pregnancy Advisory Service (BPAS) for a Ward Manager. They wanted someone with two years of experience and I had my eleven months, and I told them about my management experience from the financial world, which is what I was doing before midwifery. I applied and I was just surprised I even got an interview but made it to the second interview. When then they called me one day, I was on shift at work, and they said I’d got the job. I was gobsmacked. Everybody that I ever give advice to now about jobs, I tell them to wait for the ink to be dry on the contract, wait for everything to go through. But instead, I hung up, and I went to see my Band 7 and said, I quit. And so with that job, again, it was about this is what what you want, this is what I have, and let’s negotiate. 

When I started I had mega imposter syndrome, I was managing nurses and midwives who had all been qualified longer than I was, who'd all been doing the job of scanning and looking after women having terminations for a long time. But somehow it worked. I felt like I couldn’t make any mistakes and that I hadn’t been qualified long but actually we made the culture work very well. The fact I was new was my strength: you have to listen to your staff. 

That management role was about having a level of authenticity and saying, I don’t have those skills but I do have this: I want to learn, I’m keen and I care about people. And that makes up for an awful lot. A manager/midwifery relationship isn’t supposed to be hierarchical, it’s supposed to be supportive. And I never get carried away with titles. I mean, possibly the most important thing I did was approve annual leave and I can definitely do that! Oh, and since then, there have actually been times I haven’t listened to staff which still haunt me, but those examples make really great interview answers at least.

Do you have any advice on working at BPAS or another place that offers termination of pregnancy services?

If you're happy to work in a service that provides termination, then it's a great place to be a midwife. It really is. I've been heartened by caring for so many women and people who are pregnant and carrying them through all the different types of termination. I think the advice would be that it is you have to be very, very pro-choice. If anything, the experience made me slightly less pro-choice. When you see all the things that you see in those roles, it’s so difficult, sometimes it’s just heartbreakingly sad. However, the erosion of women's rights would be worse. The scanning is really interesting and harder than it seems by the way, because of all the complexity. I really liked early pregnancy scanning and dating but the thought of having to do that to find, you know, a ventricular septal defect or echogenic bowel, you know, arg, it makes me want to cry, it’s so hard. But that's just how my brain works, even though I’m very analytical, I'm sometimes a bit cack-handed. But there are midwives who love it,  I worked with a midwife who was on the same course as me at BPAS and she’s now a midwife sonographer and she absolutely loves it. It's just a really technical skill. My love is always going to be about having conversations with women, that's my skill set. 

To work somewhere like BPAS you also have to be really comfortable with the different conversations. You have to be able to support all of it. You might think you’re okay with anything but for instance, if you have a client who comes in who’s in a really horrible domestic abuse situation and is choosing a termination at 23 weeks for a completely healthy baby, that’s so hard. You will need to be there for the physical aspects of termination. Or things like a termination chosen because of a limb defect but no other issues...it’s thinking through how you would deal with those situations. Knowing that whatever a women’s choice is, they will live with the consequences of that decision and you will have your own feelings but you are there to support them regardless. You need to think about your biases and how you’re going to deal with them.

During the pandemic I went through Frontline19 which is a free counselling service for NHS and other workers and this woman, I’ve never met her, we just spoke on the phone a few times every week. And she rescued me from so many mental health problems and I talked to her about all the horrible things, the stuff that happened and the stuff I was thinking about various people. We should be making it easier to get that support because, you know, why would you ever come to your clinical governance manager for a chat about how horrible it is to be a preceptor? Or how you want to develop your career? Or what it's like to be a black midwife within the NHS? 

I agree. Is there anything else you think I should ask you?

It's important to be aware of the difficult side but it's also key to talk about how much I like being a midwife. It is core to my identity, it’s great. But sometimes I feel really guilty for liking being a midwife. I've seen it leave friends and colleagues by the wayside, and it destroys people and all the rest of it. And I feel really guilty sometimes. It’s survivors guilt. But I like being a midwife and I’m doing things to actually improve the service.

Also, when you’re learning a new skill, it’s the same with anything, you have no idea what you’re doing, to begin with. I don’t want to do anyone with a vagina a disservice but the first time you do a vaginal examination, it feels like a sock full of jam. And then all of a sudden, it’s fine, you’re like, oh my god, I can feel fontanelles! It’s like that when you’re learning to suture, and I had no clue when I did my first scan either. It becomes clear.

I have also quoted you in another chapter on advocacy and activism:

Throw It out and Start Again?

Sometimes activists and others tell me ‘the system is broken’. The suggestion is we dismantle the current care model and do something else. My opinion on this is that dismantling the maternity services provided by the NHS or other main providers of healthcare would be very complicated and there is no way of guaranteeing what might replace it. Midwives would be powerful enough to make some big changes if we all made the decision to go independent at once, or something of that nature. But we’re talking about a level of change that would almost certainly come with care being neglected in the short term. I suspect many of us have to work within the system we have, or if we feel it’s a better option, step into activism as a full-time career. Usually, as clinicians, we accept we're in an imperfect system and do the best we can, changing things little by little, and looking for roles in which we can be most useful. 

It’s also worth pointing out that I’m incredibly grateful for the medical community. Many of my friends and family wouldn’t be alive without them. I would remain chronically unwell. My brother, who was born prematurely, might not be here. I once asked a midwife working in a government-funded hospital in Delhi, ‘how do you screen for pre-eclampsia?’ and she answered ‘you can tell when they’re frothing at the mouth’ i.e. it was only identified when clients were fitting. I’m not talking about doing a comparison to developing world countries and then feeling like everything is fine. I’m aware that this is not the kind of care we expect in the UK. To quote midwife Kelly Williams ‘we are trained for a service that provides women or client-centred care and it’s not enough that we have pre-eclampsia rather than eclampsia, and no-one dies’. I agree, the practice/theory gap is jarring and the inequality experienced within the NHS is, at times, horrifying. We are losing staff to burnout and for other unacceptable reasons. But even with all this being true, I can’t believe that privatising care or making a sudden massive overhaul of maternity and perinatal services is the answer when so much of our wellbeing depends on the NHS continuing to function.  

My conversations with Mars Lord, who is one of the most prominent birth activists in the UK, suggests that we are right to be proud of what the NHS achieves (Lord, 2021). It’s paradoxical given everything I know and have experienced but I can imagine myself being an NHS midwife for as long as I’m of working age and I think it’s a huge mistake to throw what we have away.