Chose your fancy hat folks. These are the hats. “Choice“, “natural childbirth without Caesarian Sections or epidural“, “birth outside of hospital“,” birth at home“, and fanciest and flimsiest of all the “other providers”.

The fancy hats have been thrown into the ring by a number of different groups who have the ear of this government.Pressure groups have a legitimate role in society, but they cannot claim to speak for a whole section of society, they cannot speak for all women giving birth.

In Liverpool the plan involves setting up a pop up midwife maternity unit outside of the Hospital to see if people want one? Think about that.

In Liverpool we have three of the 4 options advocated by the maternity review. There is the biggest maternity provision in Europe, there is a midwife based unit at the hospital, there is a home birth service. However the maternity review says women should have all these choices. The waste of resources involved in a “pop up” maternity unit is enormous, if it is to be safe. This crazy hat experiment would be from within the existing numbers of midwives.We need more midwives not less.

Many of the pressure groups who are quoted in the maternity review, like the NCT and the Women’s Institute do not directly advocate privatisation or for the use of for profit providers.They do stress the need for more resources. They contributed to the review and agree with recommendations like continuity of care, greater choice, more facilities for mental health and for post natal care.. They have done well in pointing out the impact of poverty.

It is the privatisers, the multi national heath insurance groups, their think tanks and management consultants, who are driving the maternity review. The charities are just useful cover.

Where did the honest bits of this idea come from? (The dishonest bit is to do with cost cutting and privatisation)

Well, in many areas of the country,there is no Women’s Hospital. Women give birth in a unit in a General/ Acute Hospital. Some women want something less clinical, more respectful of women.

Liverpool has this already. Liverpool Women’s Hospital is far from perfect but it is one of the best places in the country to give birth. Fancy a natural childbirth with a pool and aroma therapy? Fancy going home in 4 hours? Fancy having the best obstetrician available if things go off plan? All available at the Liverpool Women’s Hospital. Fancy an elective C section? That is avaialble too.

Another strand in this push for change, is that hospitals, it is said, insist on costly interventions that do not seem to be needed quite as often in midwife led units.

Now some of these interventions are quite common and are chosen by some women; choosing to have a Caesarian or to have an epidural is not reckless or stupid .

It’s hard to tell from reading the research if it is true or not that it is the hospital situations that drives interventions.

It certainly was true in the past, where enemas were given to all mothers arriving at hospital in labour (and yes, it was a foul experience), where women were shaved when they came into hospital in labour and when every woman giving birth was given an episiotomy.These days, thank goodness have gone. Are hospitals more cautious, do they intervene too early? If the intervention is to save the baby’s life or to save the woman pain, whats wrong with the intervention?

A woman who is pretty sure all is well and that birth will probably be straight forward might be more likely to choose a midwife led unit, and might be advised to do so. So they will have fewer interventions. A mother who has an idea that things might be complicated might decide to go to a hospital, and be advised to do so.In this case the interventions will be available close at hand Interventions will be expected. So the figures are not clear. Do hospitals drive the number of interventions up or do those most likely to need interventions go to hospital? For those reader who want to read more here and here.

Choose your fancy hat, but you need shoes and clothes too. The clothes and the shoes here are representing the strong structure of universal, world class, maternity provision.

Judging maternity provision on the basis of numbers of interventions is fundamentally flawed.Survival rates and levels of injury should be the criteria. There is a need to respect all the choices made by women, including those who want a Caesarian, who want epidural and who want natural childbirth. And the choices of those who want a quiet natural birth but to have interventions if things go wrong or if they are worn out by an over long and painful labour.

Women who feel in control of their own life, in control of their own body, are well-informed and confident in the support around them, are likely to have happier deliveries. Life in Austerity Britain does not help make this most women’s experience. Poverty wrecks self-confidence.

Many women from every background still fear giving birth, many have been traumatized by giving birth.

The after effects of natural childbirth are not well supported in this country with incontinence being the least of the problems

We have a shortage of obstetrician and pediatricians, we have a shortage of midwives. The service cannot be improved without significant additional funding. The Junior Doctors contract will penalize young women doctors who are a majority of obstetrician, so we will have more problems in the future.

We support fully funded training for midwives, both as they start their careers and during their career.There should be a career structure not just involving management. We think obstetrician and midwives should share at least some of their training and share good practice. Conflict between to the two professions would be counter productive.

Midwives tend to come from working class back grounds and often train after some life experience. This will be ruled out by the Bursary withdrawal.Being from the community gives them a special positive link with mums.

We do not though think obstetrics should only be available at regional centres, that the role of obstetrician should be restricted and most women be delivered by midwives, simply as a way of saving money

Then, the truly fancy hat, that of private providers: it appears that they the private providers might try to get in on the provision of the maternity review in Liverpool. Please be alert.

Health care in the USA is expensive and not universally available. Maternity care is appalling. Rates for deaths of babies are appalling. Yet it is US firms that are circling our provision like vultures. In the US there is a group of midwives who do home delivery who are not university educated and who have no hospital experience and who are not linked to obstetrician. They do not publish their Maternal of baby survival stats. We want none of that.

Then we have the problem that the Maternity Review is now linked to the Sustainability and Transformation Plans for the 44 areas of the country.They are commonly referred to as Slash Trash and Privatise plans.The care of women and babies is a crucial role for the NHS. We must defend it.

For all our mothers, sisters, daughters, friends and lovers,and for our babies,Save Liverpool Women’s hospital and save the NHS.