Holy daffodils, it’s the middle of March, and I haven’t yet got my National Maternity Review post out till now.
If you’re thinking, What the hell the is the National Maternity Review and should I have heard of it? Panic not, it’s the government’s big look at the maternity services, in response to substandard care - and you probably have heard of it, even if you've not had time to look closely at it yet.
It’s the report suggesting the controversial £3000 ‘Maternity Care Budget’, so women can choose what they want, but there’s way more to it than that, and loads of misinformation around.
The National Maternity Review is important because it aims to save lives, and improve outcomes, and also address the environment midwives and other professionals work within.
It’s pretty much essential reading for anyone interested in maternity care.
Here's the thing, though.
Most midwives I know are devoted to women. They make it their life’s work to provide gentle, respectful, safe care. But then they have ‘real life’, too….they often have tremendous personal responsibility, in terms of commitment to their children, parents, friends, etc. Because that’s what caring people are like.
This means that however important a report is – and this one is important, politically, and because of proposed changes – it doesn’t mean you have time to read it right this second, cover to cover.
So I’ve read, and re-read, with lots of coffee. I’ve summarised my thinking for you and I'll be releasing a few posts on it, so it's easy for you to keep abreast.
Also, I want to share what the ideas mean, taking them from a dense 126-page document, out of the abstract, and into what it might mean in reality.
In this first post, I want to share with you what my first impressions are, and who the team who produced it are. So let’s get cracking!
We're at such a fascinating time in midwifery care because we have these two massive, conflicting challenges.
1) The maternity services need to provide individualised care, as it’s safer, and what women want - they are more educated and empowered than ever before
2) The maternity services need to have a savvy financial model that will help save the NHS from the post credit crunch economy
The report offers ways to make these two things happen, which is pretty amazing, as individualised care is usually expensive; so there's a lot about the review to like.
For starters, the writing is charged with concern for mothers and babies. Sentences like…
Services should wrap around women.
The money must follow the woman and her baby.
These moments are so precious and so important
..suggest the team 'get it', which can only be a good thing.
I’m also a big fan of the basic, waffle-free way they’ve chosen to write: it makes it fairly accessible for women and busy staff, who will need to work in partnership to achieve any of the goals.
The challenges to maternity care in England at the moment are many.
Key ones in the report include: 1) more women having children at an older age 2) more women having complex health needs that affect their pregnancies, who can experience pretty bewildering care from lots of different teams 3) women feeling like they didn’t have proper choice in where to have their baby, and that postnatal care being not up to scratch.
On top of this, midwives are some of the most stressed professionals in the NHS, and I’m so thankful this is being recognised in a formal government report.
The one other thing that deserves a big hand is how many times the report picked up on ‘listening’ to women.
I went through and counted at least ten instances of the report finding women needing to be listened to – and I’m sorry if I sound like Captain Obvious here, but is it SO IMPORTANT, and actually quite a difficult skill involving restraint, time and patience.
As it says in The Roar Behind The Silence, listening is helping. If Shena Byrom, et al, think it’s worth mentioning, it’s worth mentioning. And it’s something everyone from aspiring, to student, to qualified midwives with extensive careers can improve upon.
Overall, the report seems to have a ‘shoot for the moon, even if we miss we’ll land in the stars’ kind of approach.
I guess this is a good thing - midwives and women always knew it was going to be hard to change anything, but backing away from the challenge is not an option, and so positivity is key.
But also, the logistics can’t be underestimated. With just 2000 consultant obstetricians, and 21 ½ thousand midwives in England, and no plans to up these numbers by much (see page 96), getting changes to happen is going to be tricky.
Overall, my first impressions are it was a hugely difficult report to put together, I have mixed opinions on how achievable some areas are going to be, but I'm very hopeful for times ahead.
The review was led by Baroness Julia Cumberledge – the same conservative politician who led Changing Childbirth, back in 1993.
Changing Childbirth was supposed to be the start of a revolution in UK maternity care. There were changes, many positive, but not everything was achieved.
Baroness Cumberledge has said in the past that the NHS is ‘a marvellously pure ideology, the ideal socialist dream. We all have to have dreams, but this one does not work’, which isn't all that encouraging. But she seems to have put her all into the task of improving maternity care, and she has considerable experience behind her, which is great.
Other team members were from child charity Best Beginnings, SANDS (Stillbirth and Neonatal Death charity), Mumsnet, The Royal College of Nursing, James Titcombe (who's son died in tragic circumstances during the failures at Morecambe Bay), and Dr Bill Kirkup (Chair of the Morecambe Bay Investigation).
It did concern me a little that there only seemed to be 3 midwives, out of 18 contributors. These were independent midwife Anne Francis, homebirth consultant midwife Sarah Noble, and Cathy Warwick from the RCM.
It's for you to draw your own conclusions - but I think overall there's a lot of good experience and advice that's gone into this report.
There's work to do, but it's amazing that so much effort, time, money and meaningful research goes into choosing care and getting it right for women and babies in England.
It's easy to be cynical and say 'it's just for political reasons', or 'it's not practical', but for today, I'm going to remain optimistic at the choice our society is making to try and get things as good as possible for women and families.
Do let me know how you feel via the comments:
What do you feel about the National Maternity Review? Scary, or inspiring? Please do leave as much detail as possible so we can work out what women and midwives think.
In future posts, I’ll go on to the most important ideas in the report, which include:
- Individualised Care For Women
- Better Care For Staff
- Digital Suggestions
- Complex Care Needs
- Litigation/Improving Sad Outcomes.
If you found this post helpful and would like to be informed of future articles, please do consider subscribing to Midwife Diaries, I'd love to keep you updated.
Thank you from the bottom of my heart for following this blog and being interested in the well-being of women and families in the UK,
Much Love, Ellie xx