Sunday, April 08, 2007

NHS encouraging midwives rather than obstetricians because they are cheaper?

A full range of birthing choices, huh? If only one could simply giggle and chuck the glossy Maternity Matters document in the bin along with Patricia Hewitt. We know the NHS will never be able to provide every mother with her own named midwife to hold her hand throughout what James Naughtie hilariously referred to on the Today programme yesterday as her "confinement" (where do they find these male presenters born so many, many generations ago?).

We know it, because we know about NHS rotas and staff attitudes and the way the patients are made to fit around them. We know pregnant women are not all going to have their own midwife on call, unless that means call back after 9.30am and speak to the answerphone.

Yet we must do more than chuckle, for Maternity Matters is no joke. It is the next stage in a midwife-led campaign to limit the choice available to women giving birth. You only need to read the introduction to see this. "It also emphasises the need for all women to be supported and encouraged to have as normal a pregnancy and birth as possible," writes Ms Hewitt. Her junior "Minister for Care Services", Ivan Lewis, adds: "I believe individualised care offered by a midwife, specialist support provided to those most at risk and normal birth without medical intervention will become a more realistic option for every parent."

A "normal" birth . . . birth without medical intervention: why? Why should we? This is an extraordinary conspiracy against women, a sort of quasi-religious belief in the virtue of pain, which Ms Hewitt is bafflingly encouraging. The more that modern medicine offers, in terms of pain relief and convenience, the more urgent the insistence of this weird sorority that a woman has to give birth "naturally".

Again, why? We are no longer expected these days to die naturally, without the operation that would remove the cancer or the pain relief to help us on our way. We are not expected to have our hips fixed naturally. We are not even expected to endure a mild headache without a paracetamol. Yet somehow the deeply painful and, for some, traumatic experience of giving birth is forced upon woman after woman in the name of some Earth Mother concept.

As a woman interviewed on the radio yesterday said, the worst part of her otherwise excellent treatment on the labour ward was the moment when the midwife gave her "quite a lot of grief" because she chose to have an epidural. She only had the strength to insist upon it because her father, sister and husband were all doctors and she trusted their advice. These midwives trained to help women give birth are for some reason trained only to help them give birth naturally. They are the chief conspirators against us. Please, let us have fewer of them, not more, Ms Hewitt.

I remember when I told my very nice and until then helpful midwife that I was going to have a Caesarean (I, fortunately, had a choice). I might as well have said that after careful thought I had decided I would feed my baby heroin. When she had recovered sufficiently from the shock, Maureen, a large, broad-hipped woman and mother of about eight, suggested I might have been swayed by Posh Spice: "A lot of women want to follow their favourite celebrity." Then she asked whether I was doing it at my husband's request to keep myself perfect for him "down there". There was no way she was going to understand that for me a predictable, pain-free birth (yes, I wanted it in the diary; anything wrong with that?) with a surgeon I had met and trusted, accompanied by lots and lots of drugs, was my choice.

Too many women in their late thirties have too many horror stories of agonising labours followed by emergency Caesareans under general anaesthetic so that, after all that, they miss the actual birth. For the rest of their lives they must live with terrible scars from being slashed wildly across the stomach by the cack-handed doctor on call, and remember the first weeks of their child's life in only a blur of exhausted depression and trauma. Does maternity not "matter" for them, too? Ask a woman who has had a planned Caesarean: awake, calm, pain-free. And no risk of the "down there" issues that Maureen referred to, either.

Yet the whole thrust of government policy is towards making that - the best choice for many - less and less available. They are closing smaller consultant-led maternity units and encouraging women towards natural home births or midwife-led units (no Caesareans), while hoping to use the specialist consultant-led birth centres only for the few expecting complicated births; minimal medical intervention, maximum embrace of the "natural". Ouch!

Perhaps the most insidious effect of these official attitudes is the guilt they can engender in the poor woman who tries and feels she has "failed" to have a "normal" birth as eulogised by NHS midwifery and the equally messianic National Childbirth Trust, progenitors of so many doomed "birth plans". One writer in The Times has been describing the feelings of disappointment and failure she felt after an emergency Caesarean: "Right from the start I felt I had let [the baby, Charlotte] down, not to mention me and my family." So irritated were many "pull yourself together, girl" readers, that she felt compelled to respond, this time less traumatised, a year after the birth (you can see the whole debate on the Alphamummy blog): "In the months leading up to the birth of Charlotte, like any very excited first-time mum, I read lots of books and attended a `natural birthing yoga' class on a weekly basis. In all my teachings I was told over and over again that the best way is the natural drug-free way. I was told that drugs slowed down the labour and could affect the baby. Nowhere was I told the benefits of drugs. I was brainwashed into thinking that natural is right and drugs were wrong."

Quite. It is shocking that a feminist Secretary of State for Health in the 21st century should be colluding with the pious missionaries campaigning to keep women's birth experiences in the 19th. We are modern now. And we are not in the Third World. We do not need to get behind a bush and squat. Let those who want to go natural, choose natural. But let those who don't, choose drugs. Choose a Caesarean. Choose life - any way they want it.


NHS might not even be able to supply a midwife!

Fury at Hewitt's plan to water down promise of one-to-one midwife care for pregnant women

A government pledge to give every mother the right of one-to-one care from a midwife during labour has been watered down to allow hospitals to use lower-paid attendants with fewer skills. Midwives' leaders call the move 'scandalous', arguing that it will increase the risks for those women and babies not supported by a qualified midwife.

The policy shift will be in the government's maternity strategy, due to be announced by Health Secretary Patricia Hewitt this week. The government has come under increasing pressure over the state of maternity wards due to a recent spate of reports showing that standards in Britain are falling, with thousands of women not receiving good antenatal care or enough support during the birth. In its election manifesto in May 2005, Labour promised that by 2009 women would be cared for by a named midwife throughout pregnancy and would receive continuous care throughout the delivery. Instead they could now find themselves in the care of a maternity support worker, a new category of staff without a nursing or midwifery degree who may not be able to deliver a baby safely.

However, Health Minister Ivan Lewis is adamant they would not jeopardise safety. He told The Observer: 'By the end of 2009, we want to see trusts at least giving a commitment to the fact that a skilled professional is present throughout the birth. That could be a midwife or it could be a maternity support worker.' He defended the use of lower-skilled staff: 'What matters is that the mother feels confident that she is well cared for. There are many maternity support workers who are providing an excellent service.'

Lewis also criticised the 'rhetoric and scare-mongering' of recent media reports that have highlighted problems on maternity wards. 'A lot of the media reporting has been very irresponsible because it scares women. There have been two million births over the past three years, and 50 women died in that time due to obstetric complications that could have been dealt with better. One death is too many - but that number doesn't suggest a crisis in terms of safety.'

The Royal College of Midwives is furious that hospital trusts will be able to claim they offer continuous care during labour when they have replaced trained midwives with maternity care assistants, who are paid around 12,000 pounds a year and are not subject to the same regulation. They were originally introduced to help with lighter duties on maternity wards, such as feeding and washing, but many believe hospital trusts see them as a cheap workforce.

RCM adviser Sue Jacob said: 'This change has been quietly slipped in and is nothing short of scandalous. Do we really see childbirth as so unimportant that you de-skill the very people who will be delivering children? Women want nothing less than a midwife by their side when they are in labour. We know from all the research that's been done that continuous care from an experienced professional makes a huge difference to the safety of both the mother and the child.'

Belinda Phipps, chief executive of the National Childbirth Trust, said: 'We would like to see the gold standard being met, which is a qualified midwife being with a woman throughout labour. We know that 10 per cent of women are being left alone during labour, and they don't like it. It's just down to not having enough staff, and the financial situation in the NHS has made that worse.' Phipps pointed out that in Scotland the target of offering continuous care from a midwife is already being met. 'It has to be asked why the rest of the country can't achieve this goal, given that it is so very important for women when they go into labour,' she said.

Under the new strategy, called 'Maternity Matters', from 2009 women will also be offered a choice of whether to receive their antenatal care from a midwife or a GP. They will be able to choose whether to give birth at home, in a midwife-led unit or in a hospital.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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