This has been written as a response to Baroness Julia Cumberlege’s Better Births in England: a Five Year Forward View for maternity care.  Baroness Cumberlege recently opened a ‘pop –up’ birthing centre in Seacombe , Wirral.

As a health campaigner, although the centre appeared very good in many ways, it appeared to fall far short of providing the safest place for a baby to be born.  This centre is part of a trial of 3 centres in England, 2 of which are to be in some of the most deprived areas of Merseyside.   Wirral CCG was emailed about safety issues such as the maximum time that would be guaranteed to transport a mother, whose baby became distressed during labour to hospital, for an emergency caesarean  section, and what statistically were the chances of a ‘low risk’ mother needing an emergency  caesarean  section.  Their replies contained warm words about the ambulance service, but no answer to that vital question of a guaranteed maximum time. The second question had been passed on to the Midwife run unit, who replied in writing that the statistic was not known.  It is difficult to understand how the mother-to-be can make an informed choice without being told both those pieces of information along with consequences of the failure to carry out an emergency caesarean  section when needed. This situation needs investigating as does the Better Births programme.

The rhetoric of the phrases such ‘patient centred care’, ‘the  local solution’, ‘listening to women’ , ‘choice’ , and ‘personalised care’are concepts with which it is difficult to argue: this is by design.  However the rhetoric needs to be unpicked.   In Seacombe the local solution, a ‘pop-up’ centre  for this deprived area does not appear to be to be the best place for either mothers to give birth, babies to be born or midwives to manage births as there is no guarantee of a timely transfer to hospital if an emergency  caesarean  section is needed.

The Better Births plan does stress safety considerations, but these considerations appear to get lost in other considerations.   Quoting from Summary of the report of the National Maternity Review ‘Better Births: Improving outcomes of maternity services in England’: Women should be able to choose the provider of their antenatal, intrapartum and postnatal care and be in control of exercising these choices through their own NHS Personal Maternity Care Budget.  Women are able to fully discuss the benefits and risks associated with the different options for place and type of birth.  CCGs make available maternity services that offer the options of birth at home, in a midwifery unit or at hospital.

The NHS is at present starved of funds and is unable to ensure that home births and ‘pop-up’ centres can be made as safe as hospital births because the ambulance service cannot guarantee to ferry a woman giving birth and her  baby in time to avoid catastrophic results.  The priority in these times of austerity should be the safest birth for baby and mother, which must be in a place where emergency caesarean sections can be carried out .  We are losing hospital beds and I fear when some women chose to give birth in an obstetrics hospital unit they will be told that choice is no longer available to them. When parents were given more choice about which schools their children would attend,  many found there were not enough places in the’good’ school they had chosen.

It is the responsibility of our NHS at the point of birth to ensure the safest possible outcome for both mother and baby.

This is of paramount importance.  All mothers- to- be would surely agree and choose that safest option for their child. It seems almost too obvious to state. It is catastrophic for a baby to be deprived of oxygen during labour:  to quote Professor Marianne Thoresen “Perinatal asphyxia can be devastating, putting babies’ lives in immediate danger,” “Babies who survive are at serious risk of developing life-long problems, such as cerebral palsy and learning disabilities. Some are so badly affected they cannot move, speak or care for themselves.”

Although childbirth is a natural process, nature is not always benign. Statistics show this, as does the insurance the NHS pays out when things go wrong. The Furness scandal illustrates what can happen. It seems that giving birth on Merseyside in the C21st . the local solution is not as safe as when I gave birth in Liverpool in the C20th.

The shortage of nurses and midwives should be addressed immediately by re-instating bursaries.

Jessica Ormerod’s ‘Rhetoric v. Reality – Can the new models of maternity care deliver a safe service?’ is essential reading.

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One Comment

  1. I agree that it seems counterintuitive to think that birth could be as safe outside hospital, but the 2011 Birthplace Study published in the BMJ showed that, with the sole exception of low risk first time mothers choosing to give birth at home, birth is indeed as safe for the baby under midwifery led care. That study showed that mothers are far more likely to sustain injuries from surgical intervention in hospital.
    First time mothers wanting to avoid damage to themselves could well be advised to choose a midwifery unit, whether attached to a hospital or a stand-alone birth centre.
    Midwifery care is also less expensive both financially and in terms of birth trauma to the mother. So which is better for the NHS? I would say that society owes it to families to provide the care that gives babies the best possible start in life at the least cost to the NHS. Yes, care should be safe for babies but it should also be safe for mothers. Emergency caesareans or forceps deliveries inflict physical and psychological damage on mothers. We can aspire to more than just avoiding death, we should aim at a smooth transition to motherhood, unmarred by birth trauma.

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