Pregnancy is natural human process. Every baby comes into this world that way.
“No decisions about me without me” This is the slogan that is used to describe what should happen in maternity care.
Some pregnant mothers will be really well informed and experienced about pregnancy and child birth, about care for babies and looking after themselves during and after birth. Other women, especially first timers, have virtually no experience and are dependent on support from other mothers, midwives, GPs and obstetricians. The family support is also important.
However, pregnancy and birth are not without risk to mother and baby. All midwifery services are intended to assist and support the mother, to make conception, pregnancy, birth, post- natal times, all as safe and happy as possible and to provided help if things become complicated
When a mother goes to a midwife for a first appointment she wants to hear that all is well. The mother wants to be told all the relevant information about what will happen in the course of the pregnancy. She wants to know what she should expect. Many pregnant women read loads about pregnancy.
If there is a problem, the mother wants access to world class support for a good outcome. for mother and baby.
Ideally all will go smoothly but, if at a scan or a blood test, problems arise, she wants access to best available care, and within reasonable distance. Travelling across the country is not accessible for many mothers.
When labour starts, mothers want a good midwife to be available to her at home or in hospital. Ideally, mothers want to give birth helped by someone they know.
If the labour proceeds without problem, the mother just wants encouragement, reassurance and people to share the joy. If there is a problem for mother and baby, then the mother wants timely access to best possible support for herself and the baby.
Methods of delivering maternity care
Childbirth has gone through many fashions from the heavily medicalised model of the 60s and 70s to the much more empowering methods of today. A wonderful bank of experience has been developed and researched, making childbirth far safer than in earlier times. This has not happened in other countries without universal health care.
It is commonly agreed that women want respect and choice in how and where they deliver their babies. Having a baby is the single largest reason for admission to hospital.The Cochran report describes how having an informed support with mothers throughout the active labour, helps all outcomes.One in four mothers describe being left alone for some time in labour when they wanted support
In 2013, the NHS mandate stated, that maternity services must
“ensure that every woman has a named midwife who will make sure she has personalised, one to one care throughout pregnancy, childbirth and during the postnatal period, including additional support for those who have a maternal health concern.”
This is an aim we can all support. However, each midwife has to also eat, sleep, rest, learn and live her life. Even if she had only one patient she would still need assistance to care for that patient. There is a national shortage of midwives
It is also agreed that excellent back up care is needed in case of complications. Having a baby at home is great if all goes well but in case of complications all women need access to an excellent maternity hospital.
This government has floated an idea in The Maternity Review that women get £3000 for their individual maternity to care to spend how they wish. This though is fools’ gold. What happens if you need treatment costing tens of thousands? What happens if you think you have nearly spent up and need that last minute help?
Personal Maternity Care Budgets are central to the plans around our hospital. Cheshire & Merseyside appear to be one of 7 national vanguards driving this.
Home births are not, and should not be seen as, a cheap alternative.
Maternity care is interdependent on primary care, specialist services and early years’ services. Yet the papers produced by the National bodies about commissioning maternity care make a significant call for midwife lead care as cheaper, and therefore desirable. If we are to use the midwife led model it muts be because it is proven to be the best, the safest,not as a cheap money saver
NHS England describe maternity quite bluntly in terms of money.
Every potential caesarean section that is enabled to be a normal birth saves £1200 in tariff price alone. Women experiencing a normal birth are more likely to breastfeed and will require less postnatal care and are less likely to visit their GP with postnatal complications. https://www.england.nhs.uk/wp-content/uploads/2012/07/comm-maternity-services.pdf
“The new commissioning arrangements provide an opportunity to redress this imbalance by making midwifery-led services the default option for pregnant women.
It is also important that commissioners recognise the time that it takes – usually between one and two years – for midwife-led and home birth services to achieve sustainable activity levels and to deliver improved health and wellbeing outcomes for women and babies. It may therefore make sense to adopt a transitional investment strategy of pump priming midwife-led services.
Remember the ninja teams looking for privatisation opportunities? Well, Maternity appears to be on their hit list, and we live in a Vanguard area.
More in the next post