I attended a HSJ ( Health Service Journal) seminar on 26th January 2010. It was actually about using or selling a data tool called Interqual (registered trademark) and it was clearly aimed at A&E and acute illness scenarios (heart illness etc). However, applied to maternity services and birth its principles, I think, could be an eye-opener. If it was seriously and rigorously applied to maternity services and birth services I wonder if they would be structured very differently? AS Gary Lane said at the end of his presentation – short term pain for long term gain – restructuring services to give appropriate levels of care at the appropriate time will have long term benefits for patients and Trusts.
The seminar began with a quick overview of the financial situation of the NHS:
• NHS nationally has a shortfall of £20billion. This amounts to a big cash crisis.
• Trusts and PCTs have been informed that they will only receive 30% of 2002 levels ( this needs to be checked as was not on the slide) of the money they received for Acute admissions.
• Just 10% of PCTs have managed to reduce A &E admissions accordingly
• There is a continuing demand for quality assurance through QIPP (Quality, Innovation, Productivity and Prevention) and CQUINN
The Solution
Reduce acute level of care (ie in hospital, in patient care) and providing as much care as possible in patient’s locality and community.
My comment: Surely this is the nub of the issue with regard to how maternity care is structured? The complaint of many women is that their care is inappropriately centralised and clinicalised, and not there at the right time, place and level that they really need. From maternity services point of view women are going into hospital for birth inappropriately – the system is set up for care only to be in this location. So, for example, women turn up to hospital and complain that they keep being returned home in early labour – why not assess women at home and keep them there until they wish to go in or give birth? Homebirth services are provided as optional extras by maternity services rather than being structured into the care pattern for all women as, for instance above. For many women this would be appropriate localised care at an appropriate level, and would reduce acute admissions to hospital – unnecessary acute admissions to hospital.
Postnatally, regular midwifery and social care visits to establish breastfeeding and general wellbeing of Mum and baby dyad in first 2 – 4 weeks post partum could reduce acute admissions (eg for gastroenteritis of baby) and post natal depression. The question being does saving in one departments budget offset the extra spend in another? Ie If investment in low level social care (to establish breastfeeding for instance) has big payoffs in the acute budget ( readmission of babies for instance for preventable illness) will this be acknowledged and supported within the NHS structure?
A case example given was Rotherham – this was not maternity services but hospital acute care generally – however, if read applying to maternity services it is thought provoking.
The key issue to be tackled in Rotherham: Patients in acute beds who do not need to be.
The tool was the Interqual tool.
The objectives:
• Right care, right place, right time
• Admission avoidance ( patients being admitted into hospital that do not need to be)
• Developing Alternative Levels of Care
• Better care with better value (for money)
• Building locally based care
Activity
(Taken from the HSJ Rotherham Case study PDF http://mediazone.brighttalk.com/comm/Emap/12ce4a01b3-16351-3188-12894# )
• Rotherham Partnership began implementing InterQual in February 2009 initially on three wards covering emergency admissions; trauma and orthopaedics; and healthcare for older people. It was also implemented in the community in a purpose built facility for people with chronic obstructive pulmonary disease.
• Case Managers assessed patients both on admission and throughout their hospital stay and where they identified that patients could be cared for more appropriately elsewhere, they worked to facilitate a supported discharge.
• All patients are reviewed against InterQual’s admission criteria and then against the continued stay criteria while they are on a ward using the system. In the first16 weeks (16 February 09 to 8 June 09), 3631 reviews were undertaken on 892 patients.
• .The hospital found that 49% of the admission reviews met the criteria for an acute admission; 45% did not.
• The continued stay [in hospital] reviews show that 15% met the acute criteria and 77% did not.
• This data shows that the 77% of continued stay reviews and the 45% of admission reviews which did not meet the criteria resulted in patients occupying an acute bed. This meant a total of 1574 days, when patients could have been cared for at a sub-acute level if that level of care had been available in Rotherham.
• InterQual has subsequently been rolled out in Rotherham across respiratory medicine, and plans are in place to use the criteria in a modified way on the Stroke Unit and obstetrics and gynaecology in order to undertake retrospective audits.
• Case Managers report numerous examples where experience told them that a patient needed moving to a less acute environment but InterQual provided the evidence-based assessment to confirm this.
Long term objectives (from HSJ seminar)
• Using Interqual data to identify the number and type of patients who are not meeting or requiring acute level of care to inform future commissioning.
• To commission the most appropriate service model location and resource structure to deliver this.
• Changing the culture of the organisation and clinical practices.
• Identifying bottlenecks (eg bed blocking or delivery room blocking)
• Ensuring medical intervention at appropriate times, levels, and places.
• Short term pain for long term – redesigning care system so that they are efficient in the long term so that care is provided when and where it needed says Gary Lane.
Right Care, Right Place, Right Time
For Mums that means: One mother one midwife, at home, for the birth
Tuesday, 26 January 2010
Wednesday, 20 January 2010
Harsh reality and gritten teeth
This week the snow finally cleared. The ice on the windows became condensation. I could get dressed without the heater being on for 40 minutes first! The coldest winter for thirty years and we move into the coldest house in Bradford!
But snow gives a beautiful dressing to everything, ice stops people coming to see you; huddled around the fire you don't venture into the rest of the house to see what needs doing. This week the snow cleared and out of my office window I can now see the builders rubble, the plaster, the discarded cardboard boxes. The over-grown lilac has lost its sparkling dressing and looks leggy and messy. Without the Victorian Christmas look the porch looks less Dickens and more tatty tenement. What will people think as they come to the door I fret? - They won't want to come to a birth resource centre looking like this?
And though the hall has beautiful pannelling it needs touching up and a polish, and as fast as I clear it up another lot of stuff is dumped by the front door on its journey up, down, in or out of the house. The living room needs half a dozen boxes removed and just needs tidying up - and one of those Belgium-sized sofas removed. Could anyone come here and believe this was a place to learn about birth and be nurtured in it?
And the therapy room - the fridge as the family call it - because that is what it is. A gaping doorway into a once lovely Edwardian glass and wood extension makes this the coldest room in the house. And so it has become the repositiory of all boxes and items without a home and not essential for immediate use. And it feels empty and sad and in need of a coat of paint. Could this be a therapy room where women are nurtured and loved, and where healing is offered? Could you see it and believe it?
I believe it, I know it . . .but will others see it and believe it too? People who I need to come to the groups, facilitate the groups, provide the therapies, provide the funding? Can they see it? Could they come to a place with a scruffy garden with daffodils peeping through as scouts for the beautiful garden we will make - could you? Could you come and sit and learn in a big room that is beautiful but not finished - like when you wear a suit and then sturdy boots for the weather? Or your pretty dress has the stripes of a sickly baby? Could people feel comfortable with cosy but not yet posh? Could you?
And could a therapist see a beautiful but cold drab room and believe that this in 4 weeks could look pretty good and feel wonderful and 12 months be perfect? Could they? Could you?
This week I have faltered because the snow has cleared and the harsh reality on a dull wet day is that there is alot to do. The house IS tatty and you can't replace all the windows of a Victorian Edifice for under £10 thousand pounds and we spent that on getting the roof weather proof and the cellar damp proof. And my wild roses won't flower until June and we won't be cutting the trees until later in spring.
And my kind and honest friends - are they being really honest when they share my enthusiasm and say how lovely the house is and capture my vision and say everything will be OK? And that all it needs here is a coat of paint and there a sort out?
Sometimes realising a vision means holding on to your vision with gritten teeth, believing when the reality tells a different story, and just working task by task. Sometimes only your friends can see the progress. Sometimes you need a holiday.
But snow gives a beautiful dressing to everything, ice stops people coming to see you; huddled around the fire you don't venture into the rest of the house to see what needs doing. This week the snow cleared and out of my office window I can now see the builders rubble, the plaster, the discarded cardboard boxes. The over-grown lilac has lost its sparkling dressing and looks leggy and messy. Without the Victorian Christmas look the porch looks less Dickens and more tatty tenement. What will people think as they come to the door I fret? - They won't want to come to a birth resource centre looking like this?
And though the hall has beautiful pannelling it needs touching up and a polish, and as fast as I clear it up another lot of stuff is dumped by the front door on its journey up, down, in or out of the house. The living room needs half a dozen boxes removed and just needs tidying up - and one of those Belgium-sized sofas removed. Could anyone come here and believe this was a place to learn about birth and be nurtured in it?
And the therapy room - the fridge as the family call it - because that is what it is. A gaping doorway into a once lovely Edwardian glass and wood extension makes this the coldest room in the house. And so it has become the repositiory of all boxes and items without a home and not essential for immediate use. And it feels empty and sad and in need of a coat of paint. Could this be a therapy room where women are nurtured and loved, and where healing is offered? Could you see it and believe it?
I believe it, I know it . . .but will others see it and believe it too? People who I need to come to the groups, facilitate the groups, provide the therapies, provide the funding? Can they see it? Could they come to a place with a scruffy garden with daffodils peeping through as scouts for the beautiful garden we will make - could you? Could you come and sit and learn in a big room that is beautiful but not finished - like when you wear a suit and then sturdy boots for the weather? Or your pretty dress has the stripes of a sickly baby? Could people feel comfortable with cosy but not yet posh? Could you?
And could a therapist see a beautiful but cold drab room and believe that this in 4 weeks could look pretty good and feel wonderful and 12 months be perfect? Could they? Could you?
This week I have faltered because the snow has cleared and the harsh reality on a dull wet day is that there is alot to do. The house IS tatty and you can't replace all the windows of a Victorian Edifice for under £10 thousand pounds and we spent that on getting the roof weather proof and the cellar damp proof. And my wild roses won't flower until June and we won't be cutting the trees until later in spring.
And my kind and honest friends - are they being really honest when they share my enthusiasm and say how lovely the house is and capture my vision and say everything will be OK? And that all it needs here is a coat of paint and there a sort out?
Sometimes realising a vision means holding on to your vision with gritten teeth, believing when the reality tells a different story, and just working task by task. Sometimes only your friends can see the progress. Sometimes you need a holiday.
Thursday, 7 January 2010
I am a believer.
"If I count how many steps it would take to climb this mountain I would go no further: I would sit down and cry. But I have decided to be a believer."
I have not blogged for a good while. And I am sorry for that but let me tell you something of why. We had this dream, this plan. It started off as a plan to put work and home together, to simplify our lives so we did not spend 2 hours and 20 miles a day in a car taking children to school and us to work. We wanted a more sustainable lifestyle. But then we looked around some houses homes, premises – all kinds of things, all over the north of England and Wales. Mind you, there seemed to be a theme, as our favourites tended to be old doctors surgeries.
And so another dream began to emerge. “What a lovely big room” we thought. “It could work for classes, courses, training etc. And look at this room! This would be so fab as a therapy room.” Basically, we realised that we might be able to have an office, a pool storage and a Birth Resource Centre. That phrase was given us by a doula moving down from Edinbugh who had worked with Nadine Edward’s set up. She gave me the concept I was looking for: A resource to parents, midwives practitioners for maternity birth and beyond. A place to be informed, nurtured and massaged as well. A network hub for birth.
That was the dream. Now the reality. A large family a small income, a small but expanding business, a credit crunch. After 18 months of arguing with banks (No, the Royal Bank of Scotland does not lend to small businesses any more) and vendors (What? You want to knock another £10 thousand off for the tree in the cellar?”), we finally purchased 89 Bradford Road, known to the children as 89 Zoo Lane ( Do you remember ’64 Zoo Lane' on TV?) and to David as Gormanghast.
Our new home is a gargantuan Victorian edifice with no central heating system. After the TV programme ‘Victorian Farm’, we’re going for the spin off: ‘Victorian House’ complete with real TB. Spread over four floors there is ample opportunity to lose children, ladders, staircases and whole rooms. Visitors and workman have been known to appear in doorways looking puzzled and nonplussed asking “Where have the stairs gone?” “I thought they were around here somewhere”. And so our enchanted house casts its spell.
We got the keys to the focus of our dreams on 30th November. On 1st December the builders moved in to remove the tree from the basement wall, put the stairs back where they need to be for health and safety reasons as well as reaching the fourth floor, and to make other basic repairs – such as restoring the roof and chimney etc.
It was an exciting week when we moved in – and yes it took a week to move the Weston tribe with their goods and chattels plus expanding business into one set of premises – (and yes we do now have a tradesman’s entrance!). Unfortunately as we moved in, the central heating boiler moved out into the skip and we had the white Christmas we would never have contemplated otherwise. Ah the twists and turns of fate! Our children have now learnt that getting ready for bed means putting your pyjamas on top of your day clothes. And no one is allowed out with less than five layers of clothes. Tom says he prefers ‘windy Walney’ (our holiday home) with outside loo because it is warmer there. And it is.
The Scott of the Antarctic Memorial Society are holding their annual re-enactment at 89 Zoo Lane to which all who have the appropriate clothing are invited. Bring a penguin. Placement students from the British Antarctic Survey are also welcome. (None of this is true but its sounds good! - ed)
And so here I sit with large jumper retrieved from case of clothes from my student days and woolley hat (I may look silly but I feel warm!) writing my blog. IN four weeks time I want the embryo Birth Reosurce Centre to be ready for birth – I suspect, like every mother, I will have to learn the art of contented waiting. In the mean time there are boxes to empty, furniture to arrange, walls to paint, workmen to find and organise. And at the same time, meals to cook ( where is that pan it can’t be in a box), washing to do, children to take (or not) to school, customers to deal with, bills to pay.
If I count how many steps it would take to climb this mountain I would go no further: I would sit down and cry. But I have decided to be a believer. So instead I count the steps I have made and look back at how far I have travelled. With the courage this gives me I can turn my face forward.
I know that in three years time we will hardly believe the distance we have covered. I am a believer.
I have not blogged for a good while. And I am sorry for that but let me tell you something of why. We had this dream, this plan. It started off as a plan to put work and home together, to simplify our lives so we did not spend 2 hours and 20 miles a day in a car taking children to school and us to work. We wanted a more sustainable lifestyle. But then we looked around some houses homes, premises – all kinds of things, all over the north of England and Wales. Mind you, there seemed to be a theme, as our favourites tended to be old doctors surgeries.
And so another dream began to emerge. “What a lovely big room” we thought. “It could work for classes, courses, training etc. And look at this room! This would be so fab as a therapy room.” Basically, we realised that we might be able to have an office, a pool storage and a Birth Resource Centre. That phrase was given us by a doula moving down from Edinbugh who had worked with Nadine Edward’s set up. She gave me the concept I was looking for: A resource to parents, midwives practitioners for maternity birth and beyond. A place to be informed, nurtured and massaged as well. A network hub for birth.
That was the dream. Now the reality. A large family a small income, a small but expanding business, a credit crunch. After 18 months of arguing with banks (No, the Royal Bank of Scotland does not lend to small businesses any more) and vendors (What? You want to knock another £10 thousand off for the tree in the cellar?”), we finally purchased 89 Bradford Road, known to the children as 89 Zoo Lane ( Do you remember ’64 Zoo Lane' on TV?) and to David as Gormanghast.
Our new home is a gargantuan Victorian edifice with no central heating system. After the TV programme ‘Victorian Farm’, we’re going for the spin off: ‘Victorian House’ complete with real TB. Spread over four floors there is ample opportunity to lose children, ladders, staircases and whole rooms. Visitors and workman have been known to appear in doorways looking puzzled and nonplussed asking “Where have the stairs gone?” “I thought they were around here somewhere”. And so our enchanted house casts its spell.
We got the keys to the focus of our dreams on 30th November. On 1st December the builders moved in to remove the tree from the basement wall, put the stairs back where they need to be for health and safety reasons as well as reaching the fourth floor, and to make other basic repairs – such as restoring the roof and chimney etc.
It was an exciting week when we moved in – and yes it took a week to move the Weston tribe with their goods and chattels plus expanding business into one set of premises – (and yes we do now have a tradesman’s entrance!). Unfortunately as we moved in, the central heating boiler moved out into the skip and we had the white Christmas we would never have contemplated otherwise. Ah the twists and turns of fate! Our children have now learnt that getting ready for bed means putting your pyjamas on top of your day clothes. And no one is allowed out with less than five layers of clothes. Tom says he prefers ‘windy Walney’ (our holiday home) with outside loo because it is warmer there. And it is.
The Scott of the Antarctic Memorial Society are holding their annual re-enactment at 89 Zoo Lane to which all who have the appropriate clothing are invited. Bring a penguin. Placement students from the British Antarctic Survey are also welcome. (None of this is true but its sounds good! - ed)
And so here I sit with large jumper retrieved from case of clothes from my student days and woolley hat (I may look silly but I feel warm!) writing my blog. IN four weeks time I want the embryo Birth Reosurce Centre to be ready for birth – I suspect, like every mother, I will have to learn the art of contented waiting. In the mean time there are boxes to empty, furniture to arrange, walls to paint, workmen to find and organise. And at the same time, meals to cook ( where is that pan it can’t be in a box), washing to do, children to take (or not) to school, customers to deal with, bills to pay.
If I count how many steps it would take to climb this mountain I would go no further: I would sit down and cry. But I have decided to be a believer. So instead I count the steps I have made and look back at how far I have travelled. With the courage this gives me I can turn my face forward.
I know that in three years time we will hardly believe the distance we have covered. I am a believer.
Tuesday, 7 July 2009
Birthstory: The gift of a good midwife
This story tells the world why we need professional independent midwves who are with woman and not with the medical systems. Read and be inspired! Then go to www.independentmidwives.org.uk/?node=8765 to find out what you can do to save them.
"Having Michelle there gave me confidence and she did that through allowing me to birth my own way, to be the expert on my own body and not taking that body and not taking that power away from me. "
Birth Story – Owen Conor
Ok, some back story to my choices. My first son was a planned homebirth. He had been three weeks late and I had a real battle with the NHS. I had a really positive 1st stage but a difficult second stage due to him being back to back with the cord wrapped twice around him. I went into hospital afterwards as his apgars were low and it was the most horrendous experience and made me vow to never go in again!
This time round I decided to take no chances with the NHS and booked an independent midwife. Michelle is the most amazing woman, experienced, knowledgeable, calm, confident and utterly convinced that women will labour instinctively and positively if allowed to do so.
Michelle visited the day before Owen was born and we joked that I had decided to labour the next day, after breakfast, and be done before Niall’s bedtime so he could meet his baby brother.
The next morning was a beautiful sunny Saturday. We all got up, had breakfast together and began to potter. At around 10am I had a brief achy feeling in my lower back which made me stand up. I got a few more of these before starting to experience some random tightenings with mild cramps. This made me really hopeful, but I tried not to get too excited. Just after noon we went for a walk to the local shop and they became more frequent, between 5-7 minutes apart but not very intense. I phoned Michelle to let her know that things were starting and agreed to ring when they were more regular. Dermot began assembling and filling the pool and I put the TENS on.
I then started reorganising my kitchen in between contractions! My friend Debbie popped over and joined in with me. Niall went over to a neighbour’s house to play. By 2pm the surges were becoming more intense and regular – every 5 minutes and by 3pm I was making low noises and concentrating with each one. I rang Michelle who said she’d be straight over and then put on some music. At this point I just started dancing. I had a playlist with lots of stuff like Faithless, Basement Jaxx, Chicane, Moby etc. It felt so right just to be dancing round the kitchen, swaying my hips. I had my clary sage oil burning on the work top and bent over that rotating my hips to each contraction, then carried on dancing. I would recommend this to anyone especially as I was later told that belly dancing was originally a birth dance! My system was flooded with endorphins and I felt so high. Both Debbie and Michelle had a dance with me before Debbie went home.
At around 6pm the surges started to be felt more in my lower back and I was asking Michelle and Dermot to put counter pressure to the base of my spine – heaven! At 6.25pm I decided to get in the pool. The warm water was lovely and I got on all 4 fours swinging my hips and lowing with the surges. Both Michelle and Dermot continued with the counter pressure, putting their full weight into it. I’m surprised I’m not bruised back there! Derm told me at one point he released pressure to change position and I growled at him ‘BACK!’ It was the voice of command apparently.
I soon began to feel mounting pressure as Owen began to descend, I stayed very relaxed and made positive noises, saying ‘yes’ and other words of encouragement. My waters eventually went in the pool at 6:55 and were clear. Over the next 15 minutes I could feel Owen’s head moving down and at 7:10 I could feel the top of his head with my hand. The contractions were now very strong expulsive ones and I knew with some help from me I could birth him quickly, however, I was conscious of not wanting to tear and took it very slowly. I talked to him all the way through, telling him what a good boy he was and how well he was doing and what I was doing. I went easy on the next few contractions, easing him out slowly and holding the top of his head. I pushed the sides of my labia over his head and felt him crown. I remember telling him over and over ‘it’s ok’ and I was also telling myself, reminding myself not to panic but to stay calm and relaxed. Two minutes later the next contraction moved his head out and with the next one he was born. He did a bit of a corkscrew and shot out. Michelle pushed him back between my legs and I lifted him out of the water for his first cuddle! Michelle and I blew on his face and talked to him as he cried and gasped a couple of times before breathing and pinking up.
10 minutes later Niall came home and met his little brother for the first time. He seemed quite impressed! Owen and I stayed in the pool together for another hour. Owen latched onto my breast like a pro and had a good half hour feed. At around 8:30 I had still not birthed the placenta and was having lots of cramps. Dermot cut the cord once it had stopped pulsating and had his first skin to skin cuddle with his new son. I eventually turned onto my back and manually removed the placenta. It slid free with a little pressure on the cord. I then got out of the pool to be checked over by Michelle. Owen was weighed and surprised us all by being 9lb 6oz! We’d all guessed lower. Niall’s grandparents took him to theirs for the night and Dermot and Michelle emptied the pool whilst I had a well earned glass of fizz! We were then tucked up in bed together with our little treasure to spend the first of many sleepless nights.
All in all I could not have wished for a better birth experience. I had one small 2nd degree tear but it’s healing nicely on its own. I felt happy and relaxed throughout and this is what made it so manageable. Having Michelle there gave me confidence and she did that through allowing me to birth my own way, to be the expert on my own body and not taking that power away from me. She checked Owen’s heart rate periodically but that was the extent of her intervention (besides the counter pressure).
I would advise anyone wanting a natural birth to look at hiring an independent midwife, they are fantastic. I had great care from the team at Yorkshire Storks throughout my pregnancy, a wonderful birth experience and the post natal care has been outstanding. Michelle made me stay in bed for a week after the birth, and despite my initial reluctance I am so glad I listened. 3 Cheers for babymoons!
Rhian
Michelle can be contacted via Yorkshire Storks Midwifery Practice http://www.yorkstorks.co.uk/ or telephone 01423 360 460
"Having Michelle there gave me confidence and she did that through allowing me to birth my own way, to be the expert on my own body and not taking that body and not taking that power away from me. "
Birth Story – Owen Conor
Ok, some back story to my choices. My first son was a planned homebirth. He had been three weeks late and I had a real battle with the NHS. I had a really positive 1st stage but a difficult second stage due to him being back to back with the cord wrapped twice around him. I went into hospital afterwards as his apgars were low and it was the most horrendous experience and made me vow to never go in again!
This time round I decided to take no chances with the NHS and booked an independent midwife. Michelle is the most amazing woman, experienced, knowledgeable, calm, confident and utterly convinced that women will labour instinctively and positively if allowed to do so.
Michelle visited the day before Owen was born and we joked that I had decided to labour the next day, after breakfast, and be done before Niall’s bedtime so he could meet his baby brother.
The next morning was a beautiful sunny Saturday. We all got up, had breakfast together and began to potter. At around 10am I had a brief achy feeling in my lower back which made me stand up. I got a few more of these before starting to experience some random tightenings with mild cramps. This made me really hopeful, but I tried not to get too excited. Just after noon we went for a walk to the local shop and they became more frequent, between 5-7 minutes apart but not very intense. I phoned Michelle to let her know that things were starting and agreed to ring when they were more regular. Dermot began assembling and filling the pool and I put the TENS on.
I then started reorganising my kitchen in between contractions! My friend Debbie popped over and joined in with me. Niall went over to a neighbour’s house to play. By 2pm the surges were becoming more intense and regular – every 5 minutes and by 3pm I was making low noises and concentrating with each one. I rang Michelle who said she’d be straight over and then put on some music. At this point I just started dancing. I had a playlist with lots of stuff like Faithless, Basement Jaxx, Chicane, Moby etc. It felt so right just to be dancing round the kitchen, swaying my hips. I had my clary sage oil burning on the work top and bent over that rotating my hips to each contraction, then carried on dancing. I would recommend this to anyone especially as I was later told that belly dancing was originally a birth dance! My system was flooded with endorphins and I felt so high. Both Debbie and Michelle had a dance with me before Debbie went home.
At around 6pm the surges started to be felt more in my lower back and I was asking Michelle and Dermot to put counter pressure to the base of my spine – heaven! At 6.25pm I decided to get in the pool. The warm water was lovely and I got on all 4 fours swinging my hips and lowing with the surges. Both Michelle and Dermot continued with the counter pressure, putting their full weight into it. I’m surprised I’m not bruised back there! Derm told me at one point he released pressure to change position and I growled at him ‘BACK!’ It was the voice of command apparently.
I soon began to feel mounting pressure as Owen began to descend, I stayed very relaxed and made positive noises, saying ‘yes’ and other words of encouragement. My waters eventually went in the pool at 6:55 and were clear. Over the next 15 minutes I could feel Owen’s head moving down and at 7:10 I could feel the top of his head with my hand. The contractions were now very strong expulsive ones and I knew with some help from me I could birth him quickly, however, I was conscious of not wanting to tear and took it very slowly. I talked to him all the way through, telling him what a good boy he was and how well he was doing and what I was doing. I went easy on the next few contractions, easing him out slowly and holding the top of his head. I pushed the sides of my labia over his head and felt him crown. I remember telling him over and over ‘it’s ok’ and I was also telling myself, reminding myself not to panic but to stay calm and relaxed. Two minutes later the next contraction moved his head out and with the next one he was born. He did a bit of a corkscrew and shot out. Michelle pushed him back between my legs and I lifted him out of the water for his first cuddle! Michelle and I blew on his face and talked to him as he cried and gasped a couple of times before breathing and pinking up.
10 minutes later Niall came home and met his little brother for the first time. He seemed quite impressed! Owen and I stayed in the pool together for another hour. Owen latched onto my breast like a pro and had a good half hour feed. At around 8:30 I had still not birthed the placenta and was having lots of cramps. Dermot cut the cord once it had stopped pulsating and had his first skin to skin cuddle with his new son. I eventually turned onto my back and manually removed the placenta. It slid free with a little pressure on the cord. I then got out of the pool to be checked over by Michelle. Owen was weighed and surprised us all by being 9lb 6oz! We’d all guessed lower. Niall’s grandparents took him to theirs for the night and Dermot and Michelle emptied the pool whilst I had a well earned glass of fizz! We were then tucked up in bed together with our little treasure to spend the first of many sleepless nights.
All in all I could not have wished for a better birth experience. I had one small 2nd degree tear but it’s healing nicely on its own. I felt happy and relaxed throughout and this is what made it so manageable. Having Michelle there gave me confidence and she did that through allowing me to birth my own way, to be the expert on my own body and not taking that power away from me. She checked Owen’s heart rate periodically but that was the extent of her intervention (besides the counter pressure).
I would advise anyone wanting a natural birth to look at hiring an independent midwife, they are fantastic. I had great care from the team at Yorkshire Storks throughout my pregnancy, a wonderful birth experience and the post natal care has been outstanding. Michelle made me stay in bed for a week after the birth, and despite my initial reluctance I am so glad I listened. 3 Cheers for babymoons!
Rhian
Michelle can be contacted via Yorkshire Storks Midwifery Practice http://www.yorkstorks.co.uk/ or telephone 01423 360 460
Have your say! (Again)
This is another consultation that the Government has put out about 'nursing and midwfery'. Don't fret, mothers, just put in your workbasket, get some needles and some brightly coloured wool and knit your response. We have until 10th Augst (and beyond) - so hit the link and say what you think! Love to you all!
Ruth
Commission on the Future of Nursing and Midwifery
Core Script - June
The Prime Minister launched the Commission on March 10, 2009. It will report by March 2010. It covers England, and considers midwifery and all branches of nursing, in all settings, services and sectors. Partly in recognition of her previous experience in nursing practice, management and leadership, Ann Keen MP was asked to chair the Commission in her current role as Health Minister. The Commission is made up of 20 leaders in nursing and midwifery practice, management, education and research.
Lord Darzi in High Quality Care for All rightly identified nurses and midwives as key to providing quality care. The Commission has been set up to ensure that frontline nurses and midwives have the support, skills, and competencies that they will need to design and deliver 21st century quality services for those that are in need of health and social care and to promote health and well-being.
The Commission has been asked by the Prime Minister to:
· identify the competencies, skills and support that frontline nurses and midwives need to take a central role in the design and delivery of 21st century services for those that are sick and to promote health and well-being. In particular, to identify any barriers that impede the pivotal role that wards sisters/charge nurses/community team leaders provide.
· identify the potential and benefits for nurses and midwives, particularly in primary and community care, of leading and managing their own services.
· engage with the professions, patients and the public in an interactive and robust dialogue which will identify challenges and opportunities for nurses and midwives.
Commissioners will also receive advice from expert advisors in relation to specific aspects of their work including independent sector, workforce planning, regulation and international perspectives on human resources issues.
The Commission met for the first time on the 28th April and considered how the NHS Constitution linked to the role of nurses and midwives, identified their priorities for the coming months and agreed that the first phase of their work would be to kickstart a process of listening to the views of the NHS, patients, public and wider stakeholders.
The Commission met for the second time on 2nd June and discussed patients’ views of nursing and degree-level nursing registration.
Commissioners agreed to form five workstreams to take their discussions forward. Workstreams, which will be led by Commissioners will focus on: quality and innovation, the vision and image of nursing and midwifery, the socioeconomic case for nursing and midwifery, helping and hindering forces, and workforce and leadership issues. (The attached table shows which Commissioner will be leading and working on each workstream.)
The first phase of the Commission’s work is to engage with the public, patients, professions and organisations to hear their views on the what the challenges and opportunities will be for nurses and midwives in the 21st Century.
The Commission will work with an external agency (Opinion Leader Research) to shape the engagement process, which will include national events, events hosted by the NHS/organisations, to engage patients, the public and voices from seldom heard groups.
As a first strand of this engagement the Commission has launched a call for the views of patients, the public, staff and organisations.
Questions centre on:
1. What are the knowledge, skills and attributes that nurses / midwives require to take a central role in the design and delivery of 21st century services?
2. What would you like to see nurses and midwives doing more of and/or doing differently in the future - whether in people’s own homes, in the community or in hospital?
3. What might be preventing nurses and midwives from doing this now?
4. How can these barriers be overcome?
Members of the multidisciplinary team or those who have particular expertise are also being asked their views on:
5. What is the potential for, and benefits of, nurses and midwives leading and managing their own services and the framework and support that would be needed to for this in the context of the multi-disciplinary team?
People are encouraged to submit their views via the website at: http://www.cnm.independent.gov.uk/ although views can also be submitted via email to contact@cnm.independent.gov.uk or by post to the Commission on the Future of Nursing and Midwifery, Room 159, Department of Health, 79 Whitehall, London, SW1A 2 NS. Views are sought by the 10th August.
This date will not be the end of dialogue, however. All responses will be studied and will inform the Commission’s key messages. We will check these messages back through the website, public events and the media to see whether we have got them right, which in turn will shape our final recommendations to the Prime Minister.
Composition of Workstream Groups
Title
Lead Comm
Other Comm
1 Quality and Innovation
Janice Sigsworth
Peter Carter, Claire Rayner, Tamar Thompson
2 Vision & image
Eileen Sills
Dawn Chapman, Anne-Marie Rafferty, Laura Serrant-Green
3 Socio-economic case
Ray Walker
Judith Griffin, Heather Lawrence, Kathy Warwick
4 Helping and hindering forces
Gail Adams
Liz Fradd, Donna Kinnair, Jo Pritchard
5 Workforce and Leadership
Audrey Emerton
Chris Beasley, Sue Bernhauser, Kuldip Bharj
Lines to take written by the sender not by me:
We’ve just had High Quality Care for All, why do we need another review?
Lord Darzi rightly identified nurses and midwives as being key to providing quality care, and the Commission has a timely opportunity to take a longer-term view on how we can ensure that the nurses and midwives of the future will be trained, and supported by the whole healthcare system to continue to provide quality care in the future.
How can I get involved?
We want to hear your experiences of nursing and midwifery. We want to hear your views on what makes a good nurse/midwife. We want to hear your thoughts about how the role or nurses and midwives should change in the future. Please go to www.cnm.independent.gov.uk today to get involved.
What will it achieve/what difference will it make to nurses?
The Commission will ensure that frontline nurses and midwives in the future continue to have the support, skills, and competencies that they will need to design and deliver 21st century services for those that are sick and to promote health and well-being.
What difference will it make to patients?
As set out in the new NHS Constitution, patients have a right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality. The Commission will look to the future to ensure that in the future the NHS fulfils this right to patients by ensuring nurses continue to have the support, skills, and competencies that they will need to design and deliver 21st century services for those that are sick and to promote health and well-being.
For more about this see the July choices mailing at http://www.aquabirthsathome.co.uk/. You can also sign up for the monthly Choices e-newletter
Ruth
Commission on the Future of Nursing and Midwifery
Core Script - June
The Prime Minister launched the Commission on March 10, 2009. It will report by March 2010. It covers England, and considers midwifery and all branches of nursing, in all settings, services and sectors. Partly in recognition of her previous experience in nursing practice, management and leadership, Ann Keen MP was asked to chair the Commission in her current role as Health Minister. The Commission is made up of 20 leaders in nursing and midwifery practice, management, education and research.
Lord Darzi in High Quality Care for All rightly identified nurses and midwives as key to providing quality care. The Commission has been set up to ensure that frontline nurses and midwives have the support, skills, and competencies that they will need to design and deliver 21st century quality services for those that are in need of health and social care and to promote health and well-being.
The Commission has been asked by the Prime Minister to:
· identify the competencies, skills and support that frontline nurses and midwives need to take a central role in the design and delivery of 21st century services for those that are sick and to promote health and well-being. In particular, to identify any barriers that impede the pivotal role that wards sisters/charge nurses/community team leaders provide.
· identify the potential and benefits for nurses and midwives, particularly in primary and community care, of leading and managing their own services.
· engage with the professions, patients and the public in an interactive and robust dialogue which will identify challenges and opportunities for nurses and midwives.
Commissioners will also receive advice from expert advisors in relation to specific aspects of their work including independent sector, workforce planning, regulation and international perspectives on human resources issues.
The Commission met for the first time on the 28th April and considered how the NHS Constitution linked to the role of nurses and midwives, identified their priorities for the coming months and agreed that the first phase of their work would be to kickstart a process of listening to the views of the NHS, patients, public and wider stakeholders.
The Commission met for the second time on 2nd June and discussed patients’ views of nursing and degree-level nursing registration.
Commissioners agreed to form five workstreams to take their discussions forward. Workstreams, which will be led by Commissioners will focus on: quality and innovation, the vision and image of nursing and midwifery, the socioeconomic case for nursing and midwifery, helping and hindering forces, and workforce and leadership issues. (The attached table shows which Commissioner will be leading and working on each workstream.)
The first phase of the Commission’s work is to engage with the public, patients, professions and organisations to hear their views on the what the challenges and opportunities will be for nurses and midwives in the 21st Century.
The Commission will work with an external agency (Opinion Leader Research) to shape the engagement process, which will include national events, events hosted by the NHS/organisations, to engage patients, the public and voices from seldom heard groups.
As a first strand of this engagement the Commission has launched a call for the views of patients, the public, staff and organisations.
Questions centre on:
1. What are the knowledge, skills and attributes that nurses / midwives require to take a central role in the design and delivery of 21st century services?
2. What would you like to see nurses and midwives doing more of and/or doing differently in the future - whether in people’s own homes, in the community or in hospital?
3. What might be preventing nurses and midwives from doing this now?
4. How can these barriers be overcome?
Members of the multidisciplinary team or those who have particular expertise are also being asked their views on:
5. What is the potential for, and benefits of, nurses and midwives leading and managing their own services and the framework and support that would be needed to for this in the context of the multi-disciplinary team?
People are encouraged to submit their views via the website at: http://www.cnm.independent.gov.uk/ although views can also be submitted via email to contact@cnm.independent.gov.uk or by post to the Commission on the Future of Nursing and Midwifery, Room 159, Department of Health, 79 Whitehall, London, SW1A 2 NS. Views are sought by the 10th August.
This date will not be the end of dialogue, however. All responses will be studied and will inform the Commission’s key messages. We will check these messages back through the website, public events and the media to see whether we have got them right, which in turn will shape our final recommendations to the Prime Minister.
Composition of Workstream Groups
Title
Lead Comm
Other Comm
1 Quality and Innovation
Janice Sigsworth
Peter Carter, Claire Rayner, Tamar Thompson
2 Vision & image
Eileen Sills
Dawn Chapman, Anne-Marie Rafferty, Laura Serrant-Green
3 Socio-economic case
Ray Walker
Judith Griffin, Heather Lawrence, Kathy Warwick
4 Helping and hindering forces
Gail Adams
Liz Fradd, Donna Kinnair, Jo Pritchard
5 Workforce and Leadership
Audrey Emerton
Chris Beasley, Sue Bernhauser, Kuldip Bharj
Lines to take written by the sender not by me:
We’ve just had High Quality Care for All, why do we need another review?
Lord Darzi rightly identified nurses and midwives as being key to providing quality care, and the Commission has a timely opportunity to take a longer-term view on how we can ensure that the nurses and midwives of the future will be trained, and supported by the whole healthcare system to continue to provide quality care in the future.
How can I get involved?
We want to hear your experiences of nursing and midwifery. We want to hear your views on what makes a good nurse/midwife. We want to hear your thoughts about how the role or nurses and midwives should change in the future. Please go to www.cnm.independent.gov.uk today to get involved.
What will it achieve/what difference will it make to nurses?
The Commission will ensure that frontline nurses and midwives in the future continue to have the support, skills, and competencies that they will need to design and deliver 21st century services for those that are sick and to promote health and well-being.
What difference will it make to patients?
As set out in the new NHS Constitution, patients have a right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality. The Commission will look to the future to ensure that in the future the NHS fulfils this right to patients by ensuring nurses continue to have the support, skills, and competencies that they will need to design and deliver 21st century services for those that are sick and to promote health and well-being.
For more about this see the July choices mailing at http://www.aquabirthsathome.co.uk/. You can also sign up for the monthly Choices e-newletter
Wednesday, 3 June 2009
Because of those hands . . .
Birth Matters made by Dr Nadine Edwards is an immensely moving montage of pictures, quotations and music which communicates the importance of treating birth with care and compassion. As I watched the film I read the words:
"Birth is not just about making babies
but about making mothers
strong competent mothers"
And I heard and saw no more as I was caught up in the powerful memory of the birth of my second child and the photograph I have of those hands - my midwife's hands. And then I wrote:
Because of those Hands
Dear Madge,
I will never forget you taking me by the hands, looking me straight in the eyes and saying, "We are going to do this, woman to woman!" And we did. You will never know how much strength and confidence you gave me to birth my first son. And what a healing birth that was.
I do what I do now because of your hands.
Thank you Madge Boyle.
To find out more about 'Birth Matters' or contact Nadine Edwards see her website: http://www.nadineedwards.org.uk or visit www.aims.org
As
"Birth is not just about making babies
but about making mothers
strong competent mothers"
And I heard and saw no more as I was caught up in the powerful memory of the birth of my second child and the photograph I have of those hands - my midwife's hands. And then I wrote:
Because of those Hands
Dear Madge,
I will never forget you taking me by the hands, looking me straight in the eyes and saying, "We are going to do this, woman to woman!" And we did. You will never know how much strength and confidence you gave me to birth my first son. And what a healing birth that was.
I do what I do now because of your hands.
Thank you Madge Boyle.
To find out more about 'Birth Matters' or contact Nadine Edwards see her website: http://www.nadineedwards.org.uk or visit www.aims.org
As
Friday, 22 May 2009
Questioning Nick Clegg
Just a quick missive to the world and my friends out there!
I managed it! I took my work basket to Idle Parish Church, BRADFORD, today, where, I learned, Nick Clegg, Leader of the Liberal Democrats was going to have a question and answer session. And I challenged him to do something for maternity services in this country.
I wanted my question to be well delivered and have maximum impact so I wrote out my question in advance. My question was the last one and I got a round of applause for asking it. the text is below.
And because questions at a public meeting like that are less about the response and more about raising an issue I have followed up our exchange with a letter reiterating the question. And for your interest and inspiration here it is!
If anyone out there is a Labour or Conservative Party supporter/member. Please go out there and do the same. It is not about changing the men in suits at the top of our country, it is about changing the way the political wind blows!
Ruth Weston
c/o Aquabirths
Unit 3, Carlisle Business Centre
Carlisle Road, BRADFORD
BD8 8BD
ruth@aquabirths.co.uk
07 824 990 345
Dear Nick,
I am writing to follow up on the question that I raised today regarding maternity issues at Idle’s Parish Church 22nd May 2009 (I was the woman with a purple cardigan!).
First of all, thank you for your time and discussion. I was most impressed. I wished I had brought my 14 year old daughter along who is talking of going into politics and would have enjoyed the exchanges. Another time.
In these sort of settings it is much more about asking the question rather than getting an answer and so I wanted to re-iterate my question so that I might have a fuller response from you (and the party) and that there might be a more comprehensive discussion of the matter.
My question is this:
Although the World Health Organisation recommends an 8-10% Ceaserean Section rate for 1st World countries, the UK figure as I saw it on Monday of this week, was 25% nationally.
Although Ceaserean Sections cost around five times more than a Homebirth, and research ( in UK of 5000 births) shows that a woman is HALF as likely to have a CS if she books for a homebirth (even if she subsequently births in hospital), homebirths are actively discouraged in many parts of the country and women give birth in high risk, high intervention obstetric units.
Although research shows One Mother One Midwife Care reduces length of labour, pain experienced by women, intervention rates, Postnatal Depression, and increases normal birth rates and the likelihood of a woman breastfeeding; midwifery care has deteriorated so much that women in Bradford for instance can see a different midwife at each appointment and receive conveyor belt care in hospital.
Although the only alternative to accepting this kind of care is employing an Independent Midwife (we hired one for our fifth child, the cost was 15% of our small income and worth every penny!) this Government is outlawing them by the back door by insisting they have insurance but not providing the means to obtain it.
Birth and maternity issues are not just a woman’s issue but an issue that effects the whole community – a good or bad birth and good and bad maternity care can have profound effects on the wellbeing of mother and baby, her husband and family. Through the knock on effects of community mental and physical health service provision and social security this issue affects us all.
I am therefore asking what you, Nick, and the Liberal Democrats of which I am a member, are going to do about this.
Obviously this was a complex question for you to answer at the time but I just want to pick up on a couple of points you made to feed into your more considered response:
I do advocate homebirth but the point I am making is not really about homebirth per se but the lack of healthy choices women have when giving birth. It is less healthy for healthy women to give birth in an obstetric unit than to give birth in a stand alone birth centre or at home. Yet most healthy women in our PCT area as well as many parts of the country do not have (in reality) the choice of having either a homebirth or a birth in a midwifery-led or independent ( from the obstetric unit) birthing centre.
You spoke the system not being set up for homebirths – and this will take time to sort. I agree but there are two immediate actions that can take place:
1) The current ‘tariff’ system rewards high CS rates as it is based on the cost of the procedures – rather than being paid on population risk and rewarding higher normal birth rates. This means that Trusts who do fewer CS and more homebirths get paid less, although the Trust is saving us a lot of money and sparing hundreds of women and babies the trauma of an unnecessary major operation. We need to reward Trusts for promoting normal birth.
2) The Independent Midwives Association have put forward the Community Midwifery Model (cf.http://www.independentmidwives.org.uk/?node=8766) as a model that can run alongside current NHS provision which enables women to choose midwifery-led, low intervention care from a known midwife. As a user this system is particularly attractive because the money follows the woman – not the procedure putting her at the centre of care rather than where she is now – at the bottom of the hierarchy. I would commend this model to become a central plank of Lib Dem maternity policy. It is not as radical as changing to election by proportional representation!
You spoke of the dangers of homebirths being advocated where the system and training is not in place and implied ‘it would be dangerous to advocate homebirths until the system can bear it’. I would warn that as the system deteriorates further and the option to engage an Independent Midwife is closed, women will take the matter into their own hands and will opt out of the system altogether and free birth (birthing without a trained professional present). The movement is growing in the US and is already in evidence in the UK, masked by I suspect (but I do not have the evidence as yet) a rising rate of ‘Born Before Arrival’s’ where the midwife is called ‘too late’. I know this is happening now. If women cannot choose to have the birth and care they want within the NHS a small but growing number WILL free birth – this is the danger of not providing low tech compassionate care for birthing women where they need/want it.
Finally, in the light of the above, we urgently need YOU to take action to save my fabulous Independent Midwives from being outlawed by a crazy policy which insists they have insurance but makes no provision for it. The current insurance system for midwifery is a mess as it is mixed up with obstetrics (the care of abnormal births) where the highest claims are made. Independent Midwives are poorly paid, highly committed, highly competent professionals and I find it immensely upsetting to see them once again treated in this way whilst consultants continue to work privately and lucratively with NHS insurance. Patriarchy and discrimination are therefore, still in evidence in our maternity services. With this point in particular I would like your urgent attention.
I speak as a mother of five children born in Bradford, and a user of maternity services. I speak also as someone who lives and is active amongst our diverse community in Bradford, is a Bradford Breastfeeding Peer Supporter and Trainer and the Acting Chair of the Maternity Services Liaison Committee. I want answers to my questions (and I raise these regularly with the local Trust and PCT) but I also want to be part of the solution – and offer that to you as someone with an interest and expertise in the subject.
With every good wish and looking forward to being in contact
Ruth Weston
ruth@aquabirths.co.uk
07 824 990 345
Unit 3, Carlisle Business Centre, Carlisle Road, BRADFORD, BD8 8 BD
I managed it! I took my work basket to Idle Parish Church, BRADFORD, today, where, I learned, Nick Clegg, Leader of the Liberal Democrats was going to have a question and answer session. And I challenged him to do something for maternity services in this country.
I wanted my question to be well delivered and have maximum impact so I wrote out my question in advance. My question was the last one and I got a round of applause for asking it. the text is below.
And because questions at a public meeting like that are less about the response and more about raising an issue I have followed up our exchange with a letter reiterating the question. And for your interest and inspiration here it is!
If anyone out there is a Labour or Conservative Party supporter/member. Please go out there and do the same. It is not about changing the men in suits at the top of our country, it is about changing the way the political wind blows!
Ruth Weston
c/o Aquabirths
Unit 3, Carlisle Business Centre
Carlisle Road, BRADFORD
BD8 8BD
ruth@aquabirths.co.uk
07 824 990 345
Dear Nick,
I am writing to follow up on the question that I raised today regarding maternity issues at Idle’s Parish Church 22nd May 2009 (I was the woman with a purple cardigan!).
First of all, thank you for your time and discussion. I was most impressed. I wished I had brought my 14 year old daughter along who is talking of going into politics and would have enjoyed the exchanges. Another time.
In these sort of settings it is much more about asking the question rather than getting an answer and so I wanted to re-iterate my question so that I might have a fuller response from you (and the party) and that there might be a more comprehensive discussion of the matter.
My question is this:
Although the World Health Organisation recommends an 8-10% Ceaserean Section rate for 1st World countries, the UK figure as I saw it on Monday of this week, was 25% nationally.
Although Ceaserean Sections cost around five times more than a Homebirth, and research ( in UK of 5000 births) shows that a woman is HALF as likely to have a CS if she books for a homebirth (even if she subsequently births in hospital), homebirths are actively discouraged in many parts of the country and women give birth in high risk, high intervention obstetric units.
Although research shows One Mother One Midwife Care reduces length of labour, pain experienced by women, intervention rates, Postnatal Depression, and increases normal birth rates and the likelihood of a woman breastfeeding; midwifery care has deteriorated so much that women in Bradford for instance can see a different midwife at each appointment and receive conveyor belt care in hospital.
Although the only alternative to accepting this kind of care is employing an Independent Midwife (we hired one for our fifth child, the cost was 15% of our small income and worth every penny!) this Government is outlawing them by the back door by insisting they have insurance but not providing the means to obtain it.
Birth and maternity issues are not just a woman’s issue but an issue that effects the whole community – a good or bad birth and good and bad maternity care can have profound effects on the wellbeing of mother and baby, her husband and family. Through the knock on effects of community mental and physical health service provision and social security this issue affects us all.
I am therefore asking what you, Nick, and the Liberal Democrats of which I am a member, are going to do about this.
Obviously this was a complex question for you to answer at the time but I just want to pick up on a couple of points you made to feed into your more considered response:
I do advocate homebirth but the point I am making is not really about homebirth per se but the lack of healthy choices women have when giving birth. It is less healthy for healthy women to give birth in an obstetric unit than to give birth in a stand alone birth centre or at home. Yet most healthy women in our PCT area as well as many parts of the country do not have (in reality) the choice of having either a homebirth or a birth in a midwifery-led or independent ( from the obstetric unit) birthing centre.
You spoke the system not being set up for homebirths – and this will take time to sort. I agree but there are two immediate actions that can take place:
1) The current ‘tariff’ system rewards high CS rates as it is based on the cost of the procedures – rather than being paid on population risk and rewarding higher normal birth rates. This means that Trusts who do fewer CS and more homebirths get paid less, although the Trust is saving us a lot of money and sparing hundreds of women and babies the trauma of an unnecessary major operation. We need to reward Trusts for promoting normal birth.
2) The Independent Midwives Association have put forward the Community Midwifery Model (cf.http://www.independentmidwives.org.uk/?node=8766) as a model that can run alongside current NHS provision which enables women to choose midwifery-led, low intervention care from a known midwife. As a user this system is particularly attractive because the money follows the woman – not the procedure putting her at the centre of care rather than where she is now – at the bottom of the hierarchy. I would commend this model to become a central plank of Lib Dem maternity policy. It is not as radical as changing to election by proportional representation!
You spoke of the dangers of homebirths being advocated where the system and training is not in place and implied ‘it would be dangerous to advocate homebirths until the system can bear it’. I would warn that as the system deteriorates further and the option to engage an Independent Midwife is closed, women will take the matter into their own hands and will opt out of the system altogether and free birth (birthing without a trained professional present). The movement is growing in the US and is already in evidence in the UK, masked by I suspect (but I do not have the evidence as yet) a rising rate of ‘Born Before Arrival’s’ where the midwife is called ‘too late’. I know this is happening now. If women cannot choose to have the birth and care they want within the NHS a small but growing number WILL free birth – this is the danger of not providing low tech compassionate care for birthing women where they need/want it.
Finally, in the light of the above, we urgently need YOU to take action to save my fabulous Independent Midwives from being outlawed by a crazy policy which insists they have insurance but makes no provision for it. The current insurance system for midwifery is a mess as it is mixed up with obstetrics (the care of abnormal births) where the highest claims are made. Independent Midwives are poorly paid, highly committed, highly competent professionals and I find it immensely upsetting to see them once again treated in this way whilst consultants continue to work privately and lucratively with NHS insurance. Patriarchy and discrimination are therefore, still in evidence in our maternity services. With this point in particular I would like your urgent attention.
I speak as a mother of five children born in Bradford, and a user of maternity services. I speak also as someone who lives and is active amongst our diverse community in Bradford, is a Bradford Breastfeeding Peer Supporter and Trainer and the Acting Chair of the Maternity Services Liaison Committee. I want answers to my questions (and I raise these regularly with the local Trust and PCT) but I also want to be part of the solution – and offer that to you as someone with an interest and expertise in the subject.
With every good wish and looking forward to being in contact
Ruth Weston
ruth@aquabirths.co.uk
07 824 990 345
Unit 3, Carlisle Business Centre, Carlisle Road, BRADFORD, BD8 8 BD
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