Friday, 2 March 2007

How far would you go to have your baby?

What is it with the Labour Government that everything Big has to be beautiful? Granted, since Tony Blair has been in post, there have been many great improvements in the health service, not to mention a better pay and career structure for its staff but also an attempt to improve quality of care for patients with many more policies, audits, risk management strategies, to name but a few. Along with these vast changes, which incidentally, have happened so rapidly over the last 10 years, that it leaves one’s head reeling, there have been attempts to close smaller maternity units, accident and emergency units and smaller hospitals. When I say smaller maternity units, for example, I mean units that deliver 3000 babies a year, which is hardly small. On a daily basis this equates to approximately 10-12 births, or more in a 24 hour period. A larger maternity unit can deliver up to 8000 babies per year. These units are already stretched to breaking point; imagine them having to absorb another 3000 deliveries on top of this.

The rationale given for closing the smaller units is the always trite answer that the bigger ‘super units’ will offer superior care to the care given in the ‘humble and lowly’ smaller units, that incidentally give a superb range of care from ‘midwifery led care’ to ‘consultant led care’, offering women more choice and a much better chance of ‘knowing their midwife’ and less intervention thus resulting in a much better chance of achieving a ‘normal labour and birth’. Of course, the real reason for the proposed closure of these units is to save money. It has been proposed that some of the deficit funds of the NHS could be reduced by closing the smaller units.

But these smaller units serve a huge population and are often in or near rural areas so that women already have to travel 20 miles or more to access. If these units are closed, then women would have to travel possibly in excess of 40 miles or more which is no joke when in labour or with some serious problem that needs urgent attention. A recent piece of research showed that the presence of these smaller units has prevented 20 or more women from dying in childbirth every year. This image of women having to travel many miles to access maternity care, is all too familiar to developing and third world countries where women there have to travel many miles to get help and where the maternal and neo-natal mortality rate is high.

What can be done to stop this relentless march to close smaller units? Firstly - Midwives – remember that the battle is still about the struggle for the control of childbirth and that patriarchal forces are still at work i.e. the Government and the Medical Profession, which is still predominately male, to control the way women give birth. David Nicholson, Chief Executive for the NHS was confident recently that support would be won from the public for these closures because the doctors would support the proposals. If these closures are allowed to go ahead – then this would be the beginning of the end for the midwifery profession as we know it with vast numbers of midwives becoming technicians assisting on a conveyor belt style of care with all the attending technology and medicalisation of childbirth that this will bring.
Therefore, think very hard and long about why you became midwives in the first place and make your feelings known to local politicians and fight to keep maternity units open. Make sure that you elect managers and supervisors who have vision and courage to challenge the status quo and don’t forget that the position of midwives mirrors the secondary position of women in society.

Secondly - All women, think about what you really want from the maternity services. Do you want to be looked after by midwives who truly care for you and your family holistically and are passionate about providing women centred care which gives you a good chance of achieving a healthy, normal outcome or do you want to have to travel many miles from your home to be looked after by someone who is a ‘birth technician’?

Birth has become an increasingly Kafkaesque with reductions and centralisation of services seen by managers as ‘progress’. Women and Midwives have to fight together to ensure that a safe and wholesome environment is available not too far from home.

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