From here to (better) maternity: A long road for Britain

The experience of giving birth is getting worse. Mothers need greater choice, not bigger hospitals

In between the tea ceremonies, the cruises and learning to fold kimonos, the wives at the G8 summit in Lake Toya have been campaigning against maternal mortality. It's the perfect choice for the spouses, a subject surely as uncontentious as gazing at waterlilies. No one wants mothers to die in childbirth. Everyone must be shocked that a woman dies every minute giving birth and that there is a global shortage of four million midwives. Yet no one does anything about it.

The British should know. We are increasingly bad at giving birth. In the past ten years spending on maternity services has gone up by a quarter in real terms. Yet the satisfaction rates have plummeted, Britain's maternal death rate is one of the highest in Europe at 7.3 per 100,000 births compared with an average of 6.8, and the free-market think-tank Reform says that maternity care now accounts for more than half of all negligence claims against the NHS.

According to a study into maternal care published by the Healthcare Commission yesterday, most units do not have enough beds or showers and two thirds of trusts still offer no choice of how to deliver baby, leaving women feeling powerless. But the real problem is that the money has been directed at building projects rather than people. The proportion of the NHS workforce represented by midwives has dropped from 2.1 per cent to 1.7 per cent in ten years and some midwives are now in charge of a quarter more births than they were in 2001.

When I had my first child, in 2000, I gave birth in the cramped Queen Charlotte's Hospital in London in the same room where I had been born. The paint was peeling off the radiators, the blinds were stuck in a June heatwave and you had to import your Jaffa cakes from the local garage. Yet the system worked. You had your own midwife who followed your every twinge and came to celebrate your baby's first birthday. “This is not a hotel,” the midwives would say when you asked for more than one piece of toast on the ward, but they had the time to teach mothers how to feed their babies and change their nappies.

When my second baby was born two years later, the hospital had moved to a gleaming new site overlooking Wormwood Scrubs, with cappuccinos in the canteen - but the experience was harrowing. The midwives appeared as exhausted as the patients and rotated faster than the fans. They had to follow a raft of directives rather than their intuition. I got down on my knees just minutes after the birth to clean the floor before my parents arrived because nobody else had time to clear up the mess.

When my fourth child arrived, I brought in a bucket and brush but I didn't need it. The hospital was so overstretched that I was sent home within two hours of giving birth.

The postnatal experience has deteriorated even more rapidly. Terry, my first health visitor, had been looking after new mothers for more than 20 years. While she made us both tea, she was quietly working out whether I was elated or depressed and how many bottles of wine were stacked in the bin. But she had given up by the time I had my second child because she couldn't stand the doubling of her workload. She never saw the same mother twice; instead her job was to collate information on the religion and ethnicity of every baby. Our last health visitor spent an hour filling out forms and never touched our baby, which is presumably why she registered my son as a girl on every document.

Although under Lord Darzi of Denham's plans more money will be spent on building new supersize units, in recent years 41 small maternity units have been closed or are now under threat. Yet Britain already has the biggest maternity units in Europe, and these have shown no improvement on maternal mortality. The bigger the unit, the more impersonal and daunting the service will become. There may be more consultants for emergencies but most women will never see one. The Government has promised it will solve this by returning to one-to-one midwife care but there is already a shortage of 5,000 midwives and there isn't the money to fund such a specialised system.

It's easy to think that pregnant women don't matter: they are not ill (as I was constantly told) and they are not going to come back often. Very few actually die in childbirth or of postnatal complications, so all they need is a building, a nameless face shouting “push” and an ability to cross their legs until they actually make it - sometimes miles away - to their nearest super-hospital.

But for many women this is the first time they have ventured into a hospital since they were born and the weeks after their baby's birth can be crucial in helping them to cope with motherhood. Instead of queueing up to drop their children in supersize baby battery farms, they need to feel that someone cares about this new life. So let women go free-range and choose the type of care they want - whether in smaller units, at home or in a larger hospital with a consultant on hand - and give them a friendly face to guide them through the process.

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Insane medical working hours in Australia: One in three medicos risks patients' lives

ONE in three doctors admits they have put patients at risk by working exhaustive hours to prop up Victoria's ailing health system. And more than 80 per cent say medicos in general work too many hours and are under so much stress that the safety of patients and doctors is being compromised. A Herald Sun survey of Victorian doctors also revealed half had considered quitting due mainly to stress, long hours and excessive workloads.

Almost 90 per cent of doctors said there were not enough of them to adequately care for the health needs of Victorians. "We are dangerously tired, overworked and stressed, and patients are suffering and dying from errors borne of pure exhaustion," one doctor said. Another said: "Hours are ridiculous. Working 12 days straight is idiotic and guarantees serious medical errors with fatal consequences." The findings are based on the responses of 1787 doctors who took part in the Herald Sun poll.

The survey also revealed:

MOST doctors believe hospital emergency departments are in crisis.

MORE than 90 per cent say it is unacceptable that more than 45,000 patients were left waiting on hospital trolleys for more than eight hours during the last six months of 2007.

ABOUT 80 per cent say already swollen hospital waiting lists for elective surgery will get longer before they get shorter.

SEVEN out of 10 doctors say patients are losing faith in the public health system.

MORE than 80 per cent say public hospitals will continue to fail their performance targets unless they receive a massive injection of cash from the Government.

The poll showed 47 per cent of Victorian doctors work more than 50 hours a week and 8 per cent work more than 70 hours. Thirty-one per cent of doctors admit they have compromised the care and safety of patients by working excessive hours. And 47 per cent of doctors who work more than 70 hours a week admit to putting their patients at risk.

The strain drove one doctor to write: "I constantly reconsider my options. You asked whether I have considered leaving the medical profession in the last three years - of course. Daily. And unless things change soon, I most likely will."

About 40 per cent of doctors seeking counselling from the Victorian Doctors Health Program are struggling with issues of stress and fatigue. "When you are fatigued, you can't see the wood for the trees to make decisions," director Dr Kym Jenkins said. "I know a significant proportion of the people I see here who are stressed are worried they might have made a mistake. "When people feel they might be compromising patient care it can be anything from not having done their paperwork before the knock-off, to being worried about a major incident."

Australian Medical Association state president Dr Doug Travis said the Herald Sun survey brought to the public's attention the every-day realities encountered by doctors. "We do not have the capacity in our public health-care system to give Victorians the care they need right now, today. That is beds, nurses, doctors and emergency departments," he said.

Health Minister Daniel Andrews said the Government was negotiating a new enterprise bargaining agreement with the AMA to balance increased doctors' pay while leaving enough money to improve the health system. "We value the feedback of our hospital doctors and recognise the vital work they do in making the state's public health system one of the world's best," he said.

Opposition Leader Ted Baillieu said the Government must confront issues raised by the survey. "The huge pressure on our doctors is further proof that Labor has abandoned Victorian public hospitals," he said.

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