(If you’re wondering what the heck the National Maternity Review is, click here for part one in this series).
I don't know about you, but when I was younger, I hated Pride and Prejudice.
I wanted all the women in it to scream and break the china because they were so oppressed. Surely instead of sitting around having tea and waiting to be rescued by a rich man they could DO SOMETHING.
Then I realised it was an early feminist book.
Elizabeth uses what little freedom she has to make sure her choice of husband behaves well. That she had the
balls ovaries to do this in Regency England, and, at first, turned down Mr Darcy (worth $150 million in today's money) is incredible.
Today I have a bit more patience and understanding for those clever and witty women who paved the way before the suffragettes, and Pride and Prejudice is one of my favourite books.
Which brings me on to today's post.
Women in England have more freedom than ever before - it's nowhere near a done deal, but their choices are respected in law and culture.
Childbearing is, however, one area where there's still lots of work to do.
I'm therefore excited by the National Maternity Review's emphasis on improving individualised care for childbearing women.
In this post, I'm excited to take you through the proposed changes and what the review is aiming to change on the front line. In a fun way. As we do on Midwife Diaries 🙂
Why Things Need Improving
Most women have a positive experience having their babies in England, which is amazing considering the pressure on the service, and is entirely down to committed staff.
But there are two big exceptions where women aren't as happy.
- Many feel they don't have much or any choice in where they give birth
- Many feel postnatal care is lacking
To talk more about the choice issue:
In the review women talked about midwives and obstetricians displaying:
'A lack of awareness of risk and a reluctance to discuss it honestly'
This is an issue most midwives I know have been identifying for years, so it's great to see in a government report. There's a lot of fear of litigation and poor outcomes that make discussions muddy.
Also really interesting --- women do not like being 'classed as high, medium or low risk' - and fair enough too, it makes them sound like reheated paella. Women felt the labels took their individualised care away.
25% of women said they weren't given all 4 choices on where to give birth (these are: at home, at a standalone birth centre, at a midwife-led birth centre near a labour ward or on labour ward).
As many women and professionals see choice of birthplace as a human right, this is not brilliant.
And of course, women can only make choices like a stand alone birth centre if there are any in the area - and this isn't always the case.
To talk more about the postnatal care issue:
Many women were unhappy with the number of different midwives they saw. Not many women I know want to be making new friends right after having a baby, they just want support from someone they know and trust.
90% of women stopped breastfeeding before they wanted which is pretty rubbish, and women felt they had a lot of conflicting advice on how to breastfeed.
Many women's partners felt excluded, both antenatally and postnatally, I mention it here because often partners get a bit of parent leave so we see more of them postnatally. Their support can be more important to women than that of the midwives, so this needs looking into.
Finally, many women felt the 6-week postnatal check was too basic, just ten minutes with the GP.
Often there was no mention of mental/emotional needs, which is weird because if you're not going to ask someone how they're doing 6 weeks after having a baby when are you?!
I can honestly say that every healthcare professional I know believes that just being able to talk to someone can prevent mental illness, or relieve suffering. So something's going wrong somewhere.
The Ideas To Improve Individualised Care...
The review suggests a few absolutely fascinating things:
1. Midwives are to work in case-loading models, in small teams of 4-6, so women get care from the same midwives or small team of midwives. It sounds a bit like New Zealand care, which is world class
2. An extra ten minutes per antenatal check! Sweet music to any student or qualified midwife's ears 😉 (This can be 'spent' any time the midwife thinks is appropriate)
3. More use of voluntary organisations and peer support
4. An idea that's working well in Birmingham is to have Maternity Support Workers undergo extra training so they can assist at homebirths, to up the number of babies born at home
5. The most controversial: The £3000 'NHS Personal Maternity Care Budget'
To get this all working, the review envisioned better multidisciplinary training, as poor relationships between professions can impact badly on care. We all care about women and babies, but disagree on the best way to get things done, funny how human relationships are at the heart of any problem....
I'll also talk about no.5 for a sec here.
The £3000 'NHS Maternity Care Budget' has so much misinformation attached.
I've heard a guy in a pub complain that it's 'women being paid to have babies', as if the money will magically appear in their bank account, and I've also heard my concerned sister saying 'but if they've spent all their money on hypnobirthing, will they be refused a caesarean if they need one?'
Really, the review suggests that women have a 'Personalised Care Plan' which is not so different from women's notes now, except with more emphasis on choice through childbearing.
As part of this, women will make an electronic choice on birthplace and choice of care. So when a woman clicks 'St Mary’s Birth Centre’, the money will end up with that care provider.
It's a way of letting women vote with their feet, and getting the money to follow them.
Will it work? We don’t know until it’s trialled, which may start this year.
The Ideas To Improve Postnatal Care
- ‘Community Hubs’ where antenatal, postnatal, and lots of different professionals work together. If you know anything about ‘Sure Start’ centres, it’s kind of like that. The idea is ‘one stop shops’ for women will improve access to care
- Continuity of care, just like in the antenatal period, will have a massive impact postnatally too
- Just like with antenatal appointments, postnatal care should get an extra 10 minutes per visit too!
- Again, more use of voluntary organisations and peer support
- Better multidisciplinary training
All these sound like amazing plans, but I can almost hear midwives and students shouting BUT HOW?!!
I know, some of this is going to be incredibly difficult to achieve, especially as the numbers of midwives and other staff aren't set to be increased by much. It's a reshuffle, rather than a restock.
The answer seems to be: we'll achieve this through very careful strategic planning.
I'm going to round off on the most interesting quote from the review, on individualised care:
Choices being made available to all woman in terms of antenatal care and postnatal care; and of the type and place of birth (i.e. homebirth; in a midwifery unit; or in an obstetric unit in hospital) even if it means crossing traditional boundaries.
This involves low-risk units being flexible about having women with more complicated identified medical stuff going on. Fascinating, and surely a 'moment' for women's rights?
Now I would love to hear from you. Leave me a comment, it makes my day 😉
Do you think the Maternity Care Budget is a good thing for women, or is it a step towards the NHS being privatised?
Do you think the caseload model is an amazing suggestion, or do you think it's unachievable?
We'd love to hear your wisdom.
Thanks so much for reading, I think each and every one of you is the bomb for being here and caring so much for women and babies. I hope you had an amazing Easter, and your chocolate stash reflected your brilliance.
Have a wonderful week, much love,