Category Archives: Maternity

Surveys of members of the British Association of Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA) provide new evidence of pressure on over stretched sexual health services and a sector at ‘breaking point’

 

Access to sexual health and HIV services has been dramatically reduced as a result of changes to the funding and organisation of sexual health services since 2013, according to the medical professionals providing care. Over half (54%) of respondents to a survey of members of the British Association of Sexual Health and HIV (BASHH) reported decreases in the overall level of service access to patients over the past year, with a further 16 per cent saying that access had significantly decreased. In a parallel survey of members of the British HIV Association (BHIVA), three quarters (76%) of respondents said that care delivered to patients in their HIV service had worsened.

With Public Health England (PHE) data showing a 13 per cent increase in attendance of sexual health services between 2013 and 2017 (PHE, June 2018,) it is not surprising that nearly 80 per cent of BASHH respondents (79%) said that they had seen an increased demand for services in the past 12 months. Budgetary pressure means that this demand cannot always be met: more patients are now either turned away or redirected to other parts of the health system.  Six in ten (63%) per cent of BASHH respondents said that they had to turn away patients each week, with 19 per cent saying that they were having to turn away more than 50 patients on a weekly basis. While most were offered the next available appointment, 13 per cent said that patients were referred to another sexual health provider and four per cent that they were redirected to primary care. Clinicians responding to the survey report that many of the patients who are being turned away have symptoms of potential infection.

 

Reduction in prevention, cytology and mental health services

Both surveys revealed significant reductions in services such as the delivery of HIV prevention activities, outreach to vulnerable populations, cervical cytology and psychosexual health services. Three quarters of BHIVA members (75%) said that there had been an impact on access to HIV prevention advice and condoms, with 63 per cent saying access had been reduced; 44 per cent of BASHH members said that HIV prevention services had decreased. Almost half (47%) of BASHH members reported reductions in the provision of cervical cytology functions, reflected by BHIVA members, who also said that cervical screening had been halved (reduced access reported by 49.5%).  This is of particular concern in the context of a fall in national cervical screening coverage and the higher risk of HPV related cancer in women with HIV.

More than 40 per cent (42%) of BASHH respondents reported reduced provision of psychosexual health care, mirrored by a similar number (41%) of BHIVA members, who said that access to psychology input for HIV related mental health problems had been reduced. This is despite the higher risk of mental health issues the HIV population faces. Nearly half of BASHH members (47%) also said that care for vulnerable populations had reduced.

 

STI screening and HIV testing

More than 40 per cent (41%) of BHIVA members said that access to sexual health screening had been reduced, despite HIV positive people being at greater overall risk of sexually transmitted infections.  BASHH members gave a mixed response, with 29 per cent of respondents reporting reductions in STI testing in the past year and 27 per cent increased testing.  The BASHH response regarding HIV testing was similarly mixed, with 21 per cent saying there was a decrease and 26 per cent an increase.

The BHIVA survey showed that it is becoming more difficult for people to test for HIV, with 35 per cent of respondents reporting that there is now reduced access to testing in their own location.  Although 58 per cent of services offered outreach testing, with a quarter of respondents (26%) saying that it was offered locally in another service, more than half (52%) said access to testing in outreach settings was also reduced.  Almost half (47%) of BASHH respondents reported increases in access to online testing in the last 12 months, but it is not yet available in all locations. Although some respondents were optimistic about its role in helping to manage the growing demand for services, others expressed concerns about poor implementation, and suggested it was taking the focus away from face-to-face services.

Funding cuts have also drastically reduced the output of third sector organisations, such as charities and community groups, who have traditionally helped to plug gaps in services with HIV testing, advice and peer support. Nearly 40 per cent of BHIVA respondents said that peer support was no longer offered by their service, with 28 per cent of those that still do saying access to it had been reduced. 70 per cent said that overall the remaining third sector support had worsened, with services stripped back to basics or simply closed down completely.

 

PrEP availability and reproductive health

The roll-out of the PrEP programme through the IMPACT trial has led to increased availability.   Over 70 per cent (71%) of BHIVA respondents said that PrEP is now either available from their service or offered locally by another service (17%) and over 70 per cent (74%) of BASHH respondents reported increased delivery. However, provision remains mixed with 28 per cent of BHIVA respondents saying access is improving, 25 per cent saying it had been reduced, and 11 per cent saying PrEP was not currently on offer locally.

At the same time almost a third (32%) of BASHH respondents reported decreased provision of reproductive health and contraception and a similar percentage (34%) of BHIVA respondents also reported reduced access to these services.

 

Impact of separation of HIV and GUM on staff and services

Changes since 2013 have in many areas led to previously fully integrated clinics that were able to provide a range of services from a single location now being divided between differently funded suppliers.  Patients, particularly people living with HIV, may not be willing or able to travel elsewhere and staff may not be able to access records from other services.

Funding cuts have led to staff not being replaced with a knock-on effect to those remaining and to the level of service they can offer. For example, the loss of Health Advisers and nursing staff can limit support for patients.  More than a quarter (27%) of BHIVA respondents reported that access to partner notification has been affected, yet this is a key method of increasing testing of people at a higher risk of HIV transmission.  Although the majority of services (64%) still maintain counselling for the newly diagnosed, close to 30 per cent said that access is reduced.

Staff morale has been affected, with more than 80 per cent (81%) of BASHH survey respondents saying that staff morale had decreased in the last year, with almost half (49%) reporting it had greatly decreased.  Respondents to both surveys cited the damaging impact sustained budget cuts were having on staff, as well as the pressures and stresses experienced by retendering, restructuring and the loss of experienced colleagues. Some describe the situation as being “at breaking point” and nearly all are worried about the future:  more than 90 per cent (92%) of BASHH respondents said that they were worried, or extremely worried, about the future delivery of sexual health care in England.

 

Commented BASHH President, Dr Olwen Williams: “Providing high-quality free and open-access care for all those that need it has been the bedrock of sexual health in this country for over a century. Whilst we are doing our utmost to maintain standards in the face of record demand and dramatic increases in infections, such as syphilis and gonorrhoea in recent years, these surveys clearly show that continued cuts to funding are taking their toll. Current levels of sexual health funding are quite simply not sustainable and the pressures they are generating are having a seriously detrimental impact on the morale and wellbeing of staff. Without increased support to match the huge growth in demand, the consequences will likely be disastrous for individuals and our public health as a whole.”

Added BHIVA Chair, Professor Chloe Orkin:“Despite the stated ambition of policy makers to reduce health inequalities this will not be possible without robustly funded, sustainable services. Our survey results provide clear evidence that we need to upgrade, not reduce, services if we are to support and protect vulnerable populations. We have made huge strides in the control of HIV, so it is particularly worrying to see that important aspects of HIV care, such as access to prevention services, testing and mental health support, have been reduced. Public Health England (PHE) figures show a 17 per cent fall in new diagnoses, which it attributes to large increases in HIV testing (PHE, September 2018.) It therefore makes no sense to make it more difficult for people to test, as shown by the reduced access to testing in clinics and outreach locations our members report.”

ENDS

Editor’s notes:

  1. Survey responses: The BASHH and BHIVA surveys were both conducted in August and September 2018. BASHH received 291 responses in total, of which 264 respondents were based in England. This press release summarises the responses provided by those members based in England.  BHIVA received 98 responses to the survey, 97 of which were from respondents based in England, which are summarised in this press release.
  2. The British Association for Sexual Health and HIV (BASHH)is the lead professional representative body for those managing sexually transmitted infections (STIs) and HIV in the UK. It has a prime role in education and training, in determining, monitoring and maintaining standards of governance in sexual health and HIV care. BASHH also works to further the advancement of public health in relation to STIs, HIV and other sexual health problems and acts as a champion in promoting good sexual health and providing education to the public.
  3. The British HIV Association (BHIVA)is the leading UK association representing professionals in HIV care. Since 1995, it has been committed to providing excellent care for people living with and affected by HIV. BHIVA is a national advisory body on all aspects of HIV care and provides a national platform for HIV care issues. Its representatives contribute to international, national and local committees dealing with HIV care. It promotes undergraduate, postgraduate and continuing medical education within HIV care.

For further information, please contact either: Simon Whalley, BASHH on 07506 723 324 or simon.whalley@mandfhealth.com or Jo Josh, BHIVA, on 07787 530 922 or jo@commsbiz.com.

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I can’t recommend this film – which focuses mainly on older political activists campaigning for the NHS – too highly.
(Statement of competing interests: I feature briefly in the film)

Pensioners United

Directors: Phil Maxwell, Hazuan Hashim

Country: UK

Running Time: 75′

Year: 2018

A potent account of a passionate group of pensioners who unite together to fight for a better life for themselves and those who will follow them. Starring Jeremy Corbyn, Harry Leslie Smith, the late Tony Benn, and thousands of inspirational pensioners from across the UK.
~ Allyson Pollock

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For everyone who couldn’t make the Conference, here is Alison Scouller’s ( Vice Chair ) speech. An audio file is also posted.

Jean Hardiman Smith

Hello Alison Scouller here, sorry I can’t be with you. These are my thoughts to accompany the SHA discussion document before you. We decided to write this policy as part of our wider policy work, as we had no statement of the SHA’s perspective on maternity care.
I’m a retired midwife who worked in hospital, community and latterly as a midwifery lecturer in South Wales. To devise a policy I took inspiration from the Save Liverpool Women’s Hospital campaign’s manifesto for maternity and worked initially with two Welsh members, Billie Hunter, Professor of Midwifery and Gill Boden who is a campaigner for AIMS, and another Midwifery Professor Mavis Kirkham from Sheffield as well as liaising with our secretary Jean Hardiman Smith. Since then we have revised the policy considerably, following suggestions and contributions from Central Council members.
We have taken on board the particular concerns of the Liverpool campaigners in the context of the creeping privatization of the English NHS, but in writing this policy we had to have a policy which is applicable across the UK. Therefore the first paragraph sets this out. .
We decided that the right to access contraception and abortion that should form part of another document about reproductive rights, including fertility treatment, and that here we should focus on care for pregnancy.
As you can see in point 1) we put the importance of addressing poverty centre stage, and the overarching importance of good nutrition from pre to post pregnancy, in fact throughout everyone’s life! We decided not to be too specific on particular public health measures, as our policy has to be applicable in different versions of the NHS and the wider context. We also included the issue of other forms of stress and their detrimental effect on pregnancy outcomes, both in terms of women and babies.
The next 2 points emphasize the importance of those at the centre of maternity care needing to be listened to, whether it’s about their own individual situation or in terms of general observations about how care should be. Planning for care should of course reflect diversity in all communities. In order to address inequalities in society, whilst all should receive the same level of care, extra provision should be there for some, as was recognized by previous Labour Governments in projects such as Sure Start.
We went on to identify issues related to specific stages in pregnancy itself, having covered the pre pregnancy period. In point 6) Antenatal care is clearly crucial to ensure that women are aware of as many aspects of their health as possible, such as family history, normal physiological changes of pregnancy, Body Mass Index , any pathological conditions already present or precipitated by pregnancy, and how these may impact on their pregnancy outcomes. It needs to be accessible as early in pregnancy as needed. It should be as local to women as possible and include at least one home visit, unless the woman does not wish for this, with her named midwife.
When we talk about antenatal education this does not mean in a formal, school type environment but can range from physically meeting in a group setting with a midwife to having education available on CDs, online and via social media. It’s not just about being given information for example about how labour may progress but also learning practical skills to cope with it, such as exercise and relaxation. It’s also about what happens after the birth and coping strategies for parents. The social and support aspects of women and family members meeting with others going through a similar experience are usually the most valued by those enjoying group education. Of course specific needs have to be catered for, so that some women may prefer to attend women only groups and prefer less formal settings.
The evidence for the effects of adverse childhood experiences on people’s ability to be good parents is now quite compelling, hence point 7)
In relation to point 8) We know from research and experience that women’s wishes in relation to place of birth are determined by many factors, and these are very varied. Health care professionals must strive to provide as much evidence based information to enable women and their families to make the right choices for them. All places of birth carry some risks, with home birth and stand alone birth centres there are always concerns about access to ‘back up’ in emergencies. On the other hand there are risks associated with unnecessary intervention (mistimed, inappropriate and even dangerous) in childbirth, both in terms of mortality but also morbidity of mothers and babies I think Lesley page coined the phrase ‘too much too soon, too little too late’ to summarise the problems unfortunately still occurring. The other thing to bear in mind is the importance of antenatal care and education in ensuring safe outcomes. If that care is as it should be, then women at risk of complications are less likely to have poor outcomes because care will have been tailored to mitigate those complications.
Moving on to point 9) we identify the importance of continuity of care. This can be difficult to achieve in cash strapped services but has been consistently shown in research and other feedback to be a key concern for women and promotes positive outcomes.
Finally we put in relation to after birth, points 10) and 11). Physical, emotional and mental health are equally important here. Increasing breastfeeding rates would make a huge difference to children’s health, yet initiation and continuation of breastfeeding rates in the UK remain low. Once again peer support has been shown to be critical to breastfeeding success, as well as support from midwives and health visitors.
In the past, care of women’s mental health has lacked coordination between midwives, health visitors, GPs and community mental health nurses. Equally where babies have been compromised by maternal complications before or during birth and/or being born preterm then neonatal special and intensive care cots should to be available as needed.

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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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This policy statement is intended to apply to all parts of the UK. The SHA wants adequate NHS, fully funded, woman-centred maternity care, for all women and their family/support networks, from pre-conception to 6 weeks after birth and beyond. Care needs to focus on long term outcomes. It needs to avoid the ‘business’ approach that concentrates on short term targets. The first 1000 days of life are crucial for the long term health and wellbeing of families and society in general. To achieve this, the following is necessary:

Overall principles

  1. To address maternal and child poverty to improve outcomes and to relieve stress related damage, with good nutrition accessible to all, before, during and after pregnancy.
  2. The voice of the woman should be heard and listened to at all stages of planning and evaluation of maternity services.
  3. There should be high quality physical and mental health care appropriate in a diverse society.
  4. Pre-conception care must be available to all to achieve the healthiest pregnancy possible. It should cover harmful factors in the wider and personal environment, such as air and industrial pollution, tobacco, alcohol and substance misuse and domestic abuse.

Specific stages of care

  1. Antenatal care and education should be accessible to women from all backgrounds and cultures.
  2. All care should aim for a safe and positive birth experience. Women should have a real choice of place of birth (home, midwifery or obstetric unit) having been fully informed about how these will meet their individual medical and personal needs. To achieve this home birth should be backed up when there is an emergency with adequate pre hospital care (provided by community-based midwives and paramedics specifically educated on maternity care). Such pre hospital care should enable safe, timely and appropriate transfer to hospital obstetric and neonatal paediatric services. Midwife –led units should be available to women, and hospital based care should allow women’s decisions to be respected.
  3. Continuity of care from midwives (and other relevant health care professionals) is crucial. All women should have a named midwife, who works as part of a community-based team of midwives, and who coordinates care with others, such as obstetricians, as necessary. Ideally there should be continuity of carer throughout the antenatal, intrapartum and postnatal periods. All women should have one to one care during established labour.
  4. Women and their families should be supported emotionally and physically in the early days after birth. There needs to be adequate and realistic help with breast feeding, including midwifery, health visitor and peer support. Community based psychiatric services need to be available to support women as needed, as well as sufficient mother and baby in patient psychiatric provision.
  5. There should be full funding of neonatal special and intensive (levels 2 and 3) care.

Staffing

  1. More staff should be recruited to end the use of agency staff. This includes keeping staff from EU countries and making them very welcome. NHS staff should be actively supported and valued in order to relieve work-related stress and burnout and prevent attrition, so that in turn they are able to give the best quality care. The culture of risk, fear and blame should be resolved.

Research and education

  1. Funding for research into maternity care, preterm birth, still birth, neonatal and perinatal mortality and birth injuries should be increased.
  2. Investment is required in the education of healthcare professional students involved in maternity care. These students should receive non means tested NHS bursaries while being educated. Where appropriate there should be joint education between students such as midwives, paramedics and doctors (potential future GPs and obstetricians) both before and after qualification.

 

 

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As part of a Women’s Season of programmes, Yeti Television are making a documentary for BBC Wales about Abortion and the 1967 Abortion Act. ‘Beyond the Backstreet’ will tell the story of how the fight for safe & legal abortion was won in the 1960s and explore the desperate measures women were forced into before the act was passed. We also envisage bringing the story up to date and looking at how attitudes have changed – or not – in the past fifty years.

No return to backstreet abortion demo

We are currently researching and developing the documentary and looking to talk to women who would be willing to talk to us in confidence. At this stage, we are not asking people to appear on camera, but simply to have a chat with us about their experiences as part of our research. 

In particular we are keen to talk to women of all ages who have had an abortion; been involved in campaigning around the issues; or have stories about this subject from the 1960s right through to the present day. We are especially keen to talk to women who had experiences of, or stories about, back-street abortion prior to 1967.

We are also more than happy to talk to men with stories about this as well. I can assure everyone that we are treating this subject with the sensitivity it deserves and are passionate about telling the vitally important story about the 1967 Act and its ramifications to date.

All contact will be in the strictest confidence and can be anonymous if preferred.

If you are able to help please email women@yetitelevision.com or phone 07595449940 and ask for Jacqueline Lee.

 

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A MANIFESTO FOR MOTHERS AND BABIES IN THE NHS

  1. Increase the maternity tariff. The existing maternity tariff, the money the government allocates for each birth does not pay for sufficient midwives for safe births, let alone for happy births
  2. Bring back bursaries for midwives and nurses
  3. Make full maternity care available to all mothers, no exceptions
  4. Ditch the sweet talking Maternity Review. No personal budgets. No loss of beds. We want a fully funded NHS maternity system, not a choice of private providers.
  5. Respect women’s choices in labour. Listen to the mother.
  6. Home birth, midwife unit or hospital birth, they all need to be in in the NHS with NHS staff fully supervised and in the training loop.
  7. Make obstetric care available in our local hospitals. No four hour journeys for women in labour.
  8. No pressure to give birth at home. Home birth must be a free choice, with full hospital back up available
  9. Full NHS insurance for all NHS home births. No handing over responsibility. No home births on the cheap.
  10. Give women more time with their midwives. More midwives per mother.
  11. No cuts in maternity beds
  12. No woman to be left alone in labour
  13. Help women with breast feeding. Mums need support after birth too. Breast feeding is far too low in UK, yet women want to breast feed for their babies.
  14. Support mums in the early days with baby.
  15. Invest in the start of life
  16. Support maternal mental health
  17. Train more paediatric doctors and nurses.
  18. Research reasons for premature birth
  19. Improve pediatic intensive care
  20. Staff our labour wards so no forced emergency closures. Plan staffing 8 months in advance. It’s kinda natural
  21. Nationalise the private maternity companies taking NHS contracts
  22. Fund research into still births, and birth injuries
  23. Improve procedures for induction of labour
  24. Fully fund neo natal intensive care
  25. Recruit more midwives, nurses and doctors,neo natal intensive care nurses and related staff.
  26. Ditch the STPs and their cuts
  27. Keep all our EU staff and make them very welcome
  28. Fund improved ambulance services and train all staff including dispatchers around birth issues.
  29. Fight maternal and child poverty

For our babies, for our mothers, for our sisters, for our lovers

By Save Liverpool Women’s Hospital

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The historic 1967 Abortion Act is 50 years old this month, yet this fundamental part of women’s health care continues to be a fiercely contested issue. There are still politicians who want to turn back the clock and win support for complete opposition to all abortions in any circumstances. Tory MP Jacob Rees Mogg declared this as his view only last month, although his position was swiftly undermined by revelations that he profits from shares in a pharmaceutical company that produces abortion pills.

Rees Mogg’s desire to deny women any rights to legal abortion is a minority one in Britain. Here a clear majority, 70 percent in the most recent British Attitudes Survey, support a woman’s right to choose. But there is no room for complacency when women in one part of the UK, Northern Ireland, have no right to abortion unless they travel to Britain. The 1967 Act was never extended to Northern Ireland and thousands of women needing an abortion have had to cross the Irish Sea to access a legal termination. As an added injustice, until recently they also had to pay for it. This was only overturned in June after the snap general election when the Tories courted the anti abortion Democratic Unionist Party for support to win the Queens Speech. The ensuing outcry forced Theresa May to ditch the requirement for women from Northern Ireland to pay for terminations.

Today the increasing vocal pro-choice side is highlighting the plight of women living in countries where abortion is banned, including on both sides of the Irish border. In the Republic of Ireland more than 40,000 people poured through the streets of Dublin on Saturday for the sixth annual March for Choice to demand a repeal of the eighth amendment to Ireland’s constitution. This amendment deems the rights of an embryo equal to those of the woman carrying it, at any stage of the pregnancy. This law against abortion doesn’t stop abortions happening, it simply exports them. Thousands of women are forced to travel to England to enable them to take control their own fertility. Over 200,000 women have travelled to Britain from Ireland to have an abortion since the 8th amendment was enacted in 1983.

After last year’s March for Choice, the Irish government handed the issue to a Citizens’ Assembly to examine and debate. The Assembly came out with a clear call for a change in the law, showing just how much attitudes are changing in Ireland. Last week the government finally announced it would hold a referendum on the question in 2018. This provides opportunity to overturn more than a century of anti-abortion legislation in the country, which up to 2013 included the 1861 Offences Against the Person act. This archaic law is still in place in Britain and it makes having or carrying out an abortion a criminal act punishable by life imprisonment. The 1967 Abortion Act did not replace this act, instead it created exceptions to allow legal abortions when certain conditions are fulfilled.

Even 50 years ago these conditions were restrictive, now when the majority of abortions are carried out by taking pills they are an oppressive anachronism. The website Women on Web reported that they receive requests from women living in Britain for abortion pills because access to abortion services is limited by the requirements of the law. The reasons women gave for contacting the website included the distance from a clinic providing abortion care, long waiting times, childcare responsibilities and the difficulty of getting time off work. But any woman in Britain who uses pills bought online potentially risks a prison sentence because of the strict controls over how abortion services are provided.

This is a situation that cannot hold. The Royal College of Obstetricians and Gynaecologists joined the British Medical Association and the Royal College of Midwives last week in calling for abortion in Britain to finally be removed from criminal law and be treated as simply a medical issue.

Repressive laws and attitudes to women’s rights to control their own bodies are being challenged across the globe. While online access to sites such as Women on Web saves lives, millions have no access even to this service. The World Health Organisation estimates that 25 million abortions globally are unsafe, that’s almost a half of all terminations.

In Britain the fight is on to defend the rights won by past generations but to also extend those rights to allow genuine reproductive choices. Whatever the utterances of anti abortion campaigners such as Rees Mogg, pro-choice activists are on the march and determined to win the long-running abortion wars.

First published on the Policy Press blog

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When you’re preparing for parenthood, it’s understandable to fear the sleepless nights that emerge once your baby arrives. However what some may forget, is that sleepless night can occur before your baby is even born! Sleeping during pregnancy can be very tough, and at times can make you feel nocturnal. The extra weight you’re carrying can make you ache and will leave you struggling when it comes to finding a comfortable position to sleep at night.

In the latter stages of pregnancy, the amount of time you sleep could become even more limited due to your bump expanding, your joints beginning to ache and or your legs cramping. Other side effects such as indigestion and heartburn can also add to a terrible night’s sleep. But it’s not all doom and gloom, we have some great tips which can help make you more comfortable at night when your pregnant, so you can get the best sleep possible.

  1. Sleep on your left side

Considered the best way to sleep while pregnant by doctors and midwives, sleeping on your left side ensures that blood circulation to the placenta will not be restricted. This ensures that nutrients will continue to be received by your baby which will aid their development, which becomes more difficult in other sleeping positions.

Other positives of this position are that there’ll be less pressure on the liver and, according to studies, sleeping on your left side will reduce the chances of a still birth.

Sleeping on your back is considered much less safe than sleeping on your side when pregnant. This is because sleeping on your back can put a lot of pressure on your growing uterus, and your unborn baby can also put pressure on the main vein that carries blood back to your heart from your lower body, which is known as a vena cava.

Sleeping on your front is considered safe during the first 15 weeks of your pregnancy, but it’s important to stop attempting this position once the size of your bump increases.

  1. Use Sleeping Aids

One of the best ways to make yourself comfortable whilst sleeping is by either placing a pillow between your legs or sleeping with a body-length special pregnancy pillow, as they can allow you to get a well-needed rest.

During your 40-week pregnancy, you’ll struggle to cope on an old, uncomfortable mattress. By purchasing a soft, comfortable mattress you’re going to limit the back pain you’re bound to suffer in the lead up to giving birth.

  1. Create a nice sleep setting

During your pregnancy, it’s key to note how important being relaxed is for both you and your baby’s health.

To help yourself relax in the evening there are a few things you could do to create a nice sleeping environment. Candles are a good start as they are very therapeutic, but if you’re too panicked about the effect the scents and chemicals will have on your body, then music could be a good alternative.

Music can relieve any prenatal stress and nausea feelings you are having. Avoiding stress is pivotal to decreasing your risks of premature births, behavioural problems in your child and low birth weights.

  1. Block out light

By keeping your bedroom in a dark setting, you’re going to avoid having your sleep affected by both artificial and natural lights.

If you sleep close to your alarm clock, smartphone or tablet device, make sure that any light that comes from these electrical items isn’t going to come into you eyeline. To do this, make sure the brightness on all devices is turned down, or off all together, or cover them with a non-see through sheet.

It’s been claimed that artificial lights can cause havoc on your sleeping pattern as it can affect your body with a hormone called melatonin which is known for disrupting sleeping patterns.

By taking these tips on board you’re going to limit the sleepless nights you are more prone to during pregnancy. However, if your insomnia persists, go and visit your doctor as soon as possible, as maintaining a good sleep cycle during pregnancy is crucial to the health of both you and your baby.

When you start thinking about what you will need for your new baby Parentinn might be a good place to start

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Pregnancy can simultaneously be the most beautiful and confusing time in a woman’s life. Emotions, hope and anxiety- all rush through at the same time. We suggest you enjoy your pregnancy, and give in to those food cravings, but don’t give up on your fitness routine, just because there’s a bun in the oven.

A healthy lifestyle is crucial for a healthy pregnancy. You need to eat right and stay active, so that you can recover quickly after child birth.

That is why you should ensure that your body is getting adequate nutrition, exercise and enough rest.

Light work outs are a must during pregnancy. Exercising boosts energy levels and helps prepare your body for labor. Exercise releases endorphins and can help you fight fatigue. It also helps improve your overall health and wellness. Even if you have never worked out, you can start with gentle exercises. But before starting on any form of exercise, it is recommended that you consult your OB-GYN

Here are 7 must have health and fitness products for a pregnant woman-

  1. Fitness Balls

Fitness balls are a fun and easy way to stay fit and stress free. They help in strengthening your legs, back and core muscles. A fitness ball will also make labor easier for you, and you can use it to try birth positions.

Women often experience back ache in the last few months of pregnancy; something the fitness ball can help you with. You can find several options available like the 2000 lbs Static Strength Exercise Stability ball, which comes with a pump. It is available in 3 colors.

  1. Yoga

Yoga is the safest and most recommended form of exercise during pregnancy. It helps improve flexibility and overall fitness. Also, Yoga has a calming effect on both mind and body, which is good for you and for the baby. It can help reduce discomfort during pregnancy and prepare you for birth. You could go for the Essentials Yoga kit, which includes a sturdy yoga mat, a bag, a yoga brick and a strap.

  1. Treadmill

A treadmill is one of the safest exercise equipment for pregnant women. Walk or jog, depending on what you’re comfortable with, and keep the speed in control. It is a great cardio vascular exercise and a full body workout.

Just be extra careful and hold on the rails, so as to maintain your balance. Take extra care while getting on or off the treadmill. Also, monitor your body heat during workout.

You could opt for the Proform Cardio Tracker, Pro Ifit treadmill and other various exercise equipments.

  1. Stationary Bike

Biking is one of the exercises recommended by the American Pregnancy Association, mainly due to its low risk factor. It is a great cardio vascular exercise and helps improve circulation.

However, over-exerting yourself is not advised.

You could go for the Kettler Axos stationary cycle, which has a seat with back support for added comfort. It has 12 workout programs and an LCD screen which displays important information like time, distance, speed and heart rate.

  1. Maternity support belt

A maternity support belt or a baby belt, gives support to your back and your baby bump during pregnancy. It is especially beneficial if you plan to work out as it provides extra support. Additionally, it helps provide relief from back ache. It comes in a variety of colors and sizes. The Gabriella Elastic Maternity Support belt is definitely a great option. You will get various vouchers and discounts on VoucherBin for health fitness products.

  1. Prenatal Vitamins

Your nutritional needs increase when you conceive and your body requires more iron, folic acid and calcium than it did earlier. Although prenatal vitamins cannot replace a healthy diet, but they can help fill any nutritional gaps. They also help in the growth and development of your baby,

We recommend the Rainbow Light Prenatal Daily Duo Multivitamins, $24.99, available on Target. They are gluten free, sugar free, dairy free and yeast free and do not contain any preservatives.

  1. Maternity Active Wear

Comfort is extremely important throughout your pregnancy, and if you’ll be exercising, you need the right clothes for it. The active expecting mum needs to keep it simple and stylish for her prenatal workouts. Several brands cater to the fitness apparel requirements of pregnant women. Look for something stretchy that’ll last you through the entire course of pregnancy.

Our recommendation is the BeMaternity by Ingrid and Isabel active pant with a crossover panel. It will provide support and coverage.

Finally, listen to your body and don’t stress. Embrace the changes in your body and learn to love your bump! Enjoy this beautiful phase of your life and plan for your baby’s arrival. Congratulations and Good luck!

And then you will have to choose the right baby bassinet!

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A new study of people attending abortion clinics finds that the presence of anti-abortion activists outside these clinics represents a significant source of distress for women seeking an abortion – even where the conduct of anti-abortion activists is itself peaceful and polite.

The study, carried out by Dr Graeme Hayes and Dr Pam Lowe of Aston University, analyses comments made to the British Pregnancy Advisory Service (BPAS) by patients of their clinics between 2011 and April this year. It concludes that even where activists are peaceful and polite, the impact this has on those attending the clinics is significant.

The study included analysis of more than two hundred separate user comments, across eleven clinics, and the findings were clear: a quarter of users made direct reference to the site of protests, and the same number said they felt clinic entrances were an inappropriate place for such actions.

Dr Lowe, Senior Lecturer in Sociology at Aston University, commented:

“It’s clear from the comments BPAS has received that some women find the decision to seek an abortion hard enough as it is, without the added stress of anti-abortion activists present outside clinics. The location of activists was a common theme in the responses we analysed, more so than the conduct of the activists themselves. The women felt that this was an unwarranted intrusion into a private decision and they were uncertain about the intentions of the anti-abortion activists.

The study found users were conscious of the right of anti-abortion activists to express their views, but believed these rights ought to be balanced with the intimidating nature of their presence outside clinics – with presence rather than conduct the key factor for them. Even when perfectly lawful, the presence of anti-abortion activists can still cause alarm and distress.”

Dr Hayes, Reader in Political Sociology at Aston University, added:

“The rights to free assembly and free speech are a vital part of our society, and as we report in our study, the comments made by BPAS clinic users show that they are keenly aware of this. However, at the same time, they also feel their own rights to privacy and confidentiality in their healthcare decisions must be protected.

“Actions outside clinics draw a great deal of public attention to what is a private healthcare decision. For individual women seeking to use clinic services, this is in itself a significant cause of emotional distress. As our report shows, many feel harassed. More widely, these actions put additional pressures on the delivery of public services. Our findings clearly illustrate the issue needs revisiting to ensure a fair balance is struck between competing rights.”

In November 2014, BPAS launched the Back Off campaign to prohibit anti-abortion actions directly outside clinics. The campaign aims to reduce the distress of service users, uphold the right of healthcare privacy, and reduce the costs associated with the public policing of abortion clinics.

A full copy of the study is available on the Aston University website: http://www.aston.ac.uk/lss/research/research-centres/ccisc/social-movements-and-social-change/adps/sept-2015-report/​

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Over the last two years I have been part of a small team of maternity professionals contacting and visiting pregnant women who were being held in Yarl’s Wood Immigration Detention Centre in Bedford. We volunteer for a charity called Medical Justice, which aims to defend and promote the health rights, and associated legal rights, of immigration detainees in the UK. Medical Justice advocates for many vulnerable patients but, as midwives, we were assessing and providing medical reports just for pregnant women.

Being a midwife is a huge part of my identity, my purpose and passion in life. I have worked for the NHS, volunteered for midwifery and mother’s groups and worked as a midwife in Malawi for a while. The stories of the women I met in Yarl’s Wood had the most profound effect on me. To offer what expertise and support 1 could was immensely rewarding, but the circumstances in which they were put were without a doubt the most shocking thing I have seen in my career,. All the more shocking is that this is happening in the UK, here, within our own health service.

The Centre is very like a prison, with tough security, locked door after locked door, isolation rooms and control over access to food and other basics of life. Because of their histories, most of the mothers we met were very vulnerable even before their detention. Sometimes the reasons they came to the UK (fleeing gender based violence for instance) made their pregnancies more fragile and worsened their mental health. Others had pre-existing health problems and complicated obstetric histories. 1 performed a review of cases for a nine-month period in 2013/2014, which comprised of all 21 pregnant women seen by Medical Justice during that period. There is no official record of how many pregnant women are detained, so we do not know what proportion of the total number of detained pregnant women that this review contained.

I estimated that, compared to the urban multi-ethnic trust population in which I worked, the women seen by Medical Justice in immigration detention in the above review were around seven times more likely to have  ‘high risk’ pregnancies – that is pregnancies that we would typically refer for obstetric led care and multi-professional support (such as psychiatric assessment). Additionally, of course, disruption in antenatal care and being an asylum seeker in the first place would promote most of us to seek further specialist support for these women. The NICE (2010) guidelines clearly state that ‘Recent arrival in the UK’ ,’asylum seeker or refugee status’ and ‘difficulty speaking or understanding English’ are examples of ‘complex social factors’ which require more intensive support and care. Furthermore, the CMACE Report of 201 I finds that continuity of care is particularly important in asylum seeking women, due to their increased vulnerability.

In short, these women were extremely vulnerable and often unwell. They showed remarkable courage and strength in the face of extreme adversity, but there is no doubt in my mind that the health, both mental and physical, of the women I met was worsened by detention.

Immigration detention was created to be a short term ‘holding’ place for people who were to be immediately deported. In the review of cases above, I found that the mean length of detention of the pregnant women seen by Medical Justice was 50 days. The range was 10-122 days. All of the women in the review were eventually released by about 30 week; of pregnancy and none were deported until after the birth of their babies, or were not subsequently deported at all as their asylum claims were eventually accepted. Many of them were ‘not fit to fly’ which means that they did not meet the standard international aviation criteria for health and would not be allowed to board a plane during their pregnancies. Furthermore, it is not now legal for immigration personnel to use physical force to make a woman leave the Centre and board the plane, so if a woman refuses to go, there is no way of making her do so.

Yarl’s Wood has a small health care unit, staffed 24 hours by nurses (not midwives) and managers, with a GP in attendance on most working days. The unit is run by a private healthcare company, but of course all of the clinical staff are registered with the relevant professional bodies. Sometimes the pregnant women I met with would be given kind and compassionate care. However, all too often a culture of disbelief seemed to prevail which, coupled with a lack of midwifery/ obstetric specialism, led to many worrying symptoms and alarming risk factors being dismissed by the staff. For example, I saw a case in which it seemed not to be recognised that the limits of normal blood pressure are different in pregnancy than in the non-pregnant woman.

My major concern for these women was the denial of emergency assessment and treatment and delays in allowing women access to acute obstetric care. Cases that you or I would have immediately referred into hospital were left for days, sometimes weeks, with worrying symptoms ignored, or attributed to ‘attention seeking’. Once, a woman I was very concerned about, called herself an ambulance, as she was afraid for her health and for her baby, after several weeks of increasingly severe symptoms. The ambulance was cancelled by the health care staff, without her consent.

The mothers I met told me of the extreme discomfort of being in the Detention Centre whilst pregnant. Most did not find the food palatable and the restrictions on when and what they were able to eat worsened pregnancy related sickness for many of them. Several also told me how frightened they were by the guards, and by a lack of privacy in the Detention Centre leading to sometimes feeling exposed and ashamed.

As above, we do not know how many pregnant women are in Yarl’s Wood Immigration Detention Centre, though we suspect, from very rough estimates based on what women inside are able to tell us, that it is not a very large number. The pregnant women that we saw were not deported during their pregnancies due to health concerns, and were released without deportation making their detention pointless. In addition, the immense physical and mental stress of being in a detention centre had a negative impact on many of their pregnancies, not least because of the disruption to their pregnancy care and lack of access to emergency assessment and treatment. Detention is damaging for these mothers. It doesn’t really matter what you think about immigration. Perhaps you are in favour of tougher screening for asylum seekers and further limits in the number of migrants given permission to stay in the UK, or perhaps you have more lenient views. Either way you would realise that there will always be a process to follow to assess claims for asylum and immigration. Most people would be of the opinion that such a process should be fair (everyone gets treated the same), reliable (we are able to usually tell who is genuinely in need of asylum) and humane.

Most people would also add that it should be efficient – at the lowest possible cost to the taxpayer.

The detention of pregnant women is none of these things. The cost to their wellbeing is disproportionate because of their greater health needs .Their ability to cope is reduced by the normal but difficult symptoms of pregnancy and further by their higher risk of serious pregnancy complications; they are vulnerable. Furthermore, as deportation is more difficult when a woman is pregnant, because of airlines’ health related restrictions and because the immigration personnel are not allowed to use physical force on a pregnant mother, it becomes pointless. The high cost of keeping a woman in detention, potentially causing her and her baby to suffer, only to release her without deportation, is to needlessly spend money.

I am first and foremost a midwife. My commitment to the NMC Code of Conduct (2015), as the bedrock of my professional integrity, is true no matter where a woman comes from, no matter where she is living or who is master of her. Whilst these vulnerable women are in the UK, their care must be held to the same standard that we pride ourselves on in our daily practices. I have reported my concerns through our supervisory system but since the women are almost ‘outside’ of midwifery, and can’t access midwifery care by themselves, it is hard to see what can change whilst they are still detained. The NMC Code states that we must:

  • Make the care of people your first concern, treating them as individuals and respecting their dignity
  • Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community
  • Provide a high standard of practice and care at all times

(NMC Code 2015)

This is demonstrably not always the case for the women we have met in Yarl’s Wood, and this has to change.

How you can help

  • Become a midwife-volunteer for Medical Justice (see below or contact me)

Donate to Medical Justice

  • Write to or email your MP with your concerns

References and Links

Centre for Maternal and Child Enquiries (CMACE) Saving Mother’s Lives: 2006-08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom.BJOG, I 18 (suppl. I) 1-203.

National Institute of Clinical Excellence (2010) Pregnancy and Complex Social Factors. London, NICE Guidelines.

Nursing and Midwifery Council (2015) The Code. HMSO, London.

Public Health England (2013) Guidelines for Malaria Prevention in Travellers from the UK. PHE publications gateway number: 2013054. London, HMSO.

Medical Justice www.medicaljustice.org.The APPG 2015 report on detention and Expecting Change can also be found on their website.

Tsangarides, N.,Jane Grant, J. (2013) Expecting Change, the case for ending the detention of pregnant women. Medical Justice, London.

First published in Midwifery Matters ISSUE 145 Summer 2015

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