Thursday, 19 April 2007

More Musings on the state of the Maternity Services in the UK

I was not going to write any more thoughts on the sad state of the maternity services in this country for a while. However, after reading a post from a student midwife from America on her excellent site Belly Tales, I felt I had to write a response. Midwife to be from America has just been on her hols here (and I hope she had a good rest ready to finish the rest of her education) where she had been reading all the coverage in the media on the statements issued from Mrs. Hewitt, health secretary. These statements being related to the documents being released stating that by the year 2009 all women would have a named certified nurse midwife and the choice of where they could birth their babies, either at home or in a maternity unit of choice. Yes, as I have spouted before, all very fine ideals and ones that have been muted since 1993 when the then Conservative government launched the concept of Changing Childbirth (DOH 1993). I remember being as excited as Midwife to be from America was at this concept and having only just qualified as a midwife myself was fortunate enough to find myself working in a ‘pilot scheme’ to trial team working. I can remember the joy and pleasure I had at this time of being able to book women at the start of their pregnancy, be with them through all the pregnancy, labour and then carry out the post-natal care. This joy was very short lived however, when after only ironically 9 months, the scheme was disbanded because of acute shortage of midwives in the trust. That was my first wake up call to the state of midwifery in this country. There have been countless other calls since.

As Student Midwife to be from America is or should be aware, Changing Childbirth was often quoted and recognised by its familiar mantra. CHOICE, CONTINUITY AND CONTROL. This was, of course for the woman and not, as many have since suggested, for the midwife, although I have to say, it would be good to have some choice, continuity and control of my working life at times and midwife to be from America will come to realise this herself as time goes by after practising as a qualified midwife for a while.

Anyway, I digress. Midwife to be from America appears to be very excited by Mrs. Hewitt’s proposals and suggests that at last, the maternity services are moving in the right direction in the UK. Her post is full of lots of ideas and thoughts, all very plausible and very well known to all the midwives and women in this country. What midwife to be from America fails to realise or understand is that a) we have been here before and it didn’t work because of the fact that were not enough midwives, not enough money and b) the maternity services in the NHS are part of a huge whole service and monies are allocated for all sorts of services including of course, looking after the very ill and dying and research into ground breaking treatments and operations.

Payment by results means that money is generated for each pregnant woman that uses a NHS Trust service but the money does not even make the maternity unit-it is swallowed up by the trust as a whole. Of course, I am totally committed to raising the importance of women centred, midwifery care and strive to do this on a daily basis but my eyes have been opened to the stark reality of midwifery services in the UK and this time last year, I was not even sure that I had a job in the NHS because of the financial situation in the trust where I work.
The budget had to be slashed dangerously low so that even if the unit was short of midwives because of sickness, then agency and bank were not allowed to be employed. This meant running the maternity unit on dangerously low and unsafe levels of care so if a woman was booked for a home birth, then she could not have one because there were no midwives to be spared to go out to her. This situation has not changed since then and I cannot see it improving in the future and certainly not by 2009. So Midwife to be from America, thanks for your enthusiasm and positive thoughts but we have been here before, 14 years ago in fact. It was lies then and it is certainly lies now. I wish it wasn’t. I wish we could provide a gold standard service but how can you on peanuts or as my dear departed Dad would say, Tram tickets!

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