A whole new world

In the second of a series of intensely personal blogs, NHS England’s Maternity Transformation Programme Manager and mum-to-be throws the spotlight on her work as she records key stages of her own pregnancy:

I’m now comfortably into my second trimester and finding I have got a bit of my mojo back!

I’ve stepped up my exercise a bit and started seeing my friends again, which is a welcomed relief from the first trimester, which I personally found slightly trickier.

I’m eagerly waiting the anomaly scan which takes place around 20 weeks, after seeing my baby at 12 weeks; I just can’t wait to see it again – and of course hoping to see a baby shape rather than a mango.

So to confirm the date and time of the scan, I text my midwife, yep, a simple text. I’m actually very lucky and I live in the borough of Waltham Forrest, London, where the CCG has a fantastic pilot running between the NHS and Neighbourhood Midwives.

Neighbourhood Midwives have introduced me to a new way of delivering maternity care based on the Buurtzorg model. I have met two midwives in the comfort of my own home, one at booking and one at 16 weeks.

I know that one of these two midwives, Paulette or Becky, will be at my baby’s birth, and will be available throughout my pregnancy for appointments and questions. It’s fantastic for me, because my baby story becomes a continuum, not a regularly interrupted, repeated version of events.

I have quickly built a relationship with both of them, and by the time I get to labour, I will be confident that they are clear on my choices, and my health history will be at their finger-tips should anything need to change from my birth plan. I already feel really relaxed in their company, and I’m excited about them being there when it comes to baby’s birthday.

This has already been particularly helpful, when I developed a UTI – a relatively common occurrence in pregnancy – my midwife was able to have a quick chat with me and put my mind at rest with clear advice on the day I felt unwell.

There is more to continuity of care than just anecdotal ‘it feels nice to know your midwife’. Evidence shows that continuity models improve safety and outcomes. In particular, it shows that women who had midwife-led continuity models of care were:

  • 16% less likely to lose their baby and 19% less likely to lose their baby before 24 weeks
  • 24% less likely to experience pre-term birth
  • 15% less likely to have regional analgesia
  • 16% less likely to have an episiotomy.

Becky and Paulette seem really content with this arrangement too, they speak fondly of the women they are supporting, they get to rotate between community care and deliveries, and they manage their own diaries.

NHS England has a target for 20% of women booking into Maternity services by March 2019 to be receiving continuity of care, and if you are yourself in an area and want to do more to ensure this is the kind of care you receive make your voice heard through your local Maternity Voices Partnership.

I’m also tapping into a whole new pregnancy world. Being the maternity transformation programme manager, I came to the table knowing a little about maternity services, but what I wasn’t prepared for was the sense of community there is amongst expectant and new mums.

East London seems awash with networks, Facebook groups, meet ups, pregnancy yoga classes amongst lots of other things. A bit of googling, and chatting to my neighbourhood midwife, and I have comfortably found myself at the doorstep of ‘The Health Works’ in Walthamstow. This one stop shop offers so much support and alternative therapies for women, under one roof and the watchful gaze of the somewhat local hypnobirthing guru Jo Redmond.

This little side door tucked off a busy road opens up a whole world of support, pre and postnatal activities, and a network of like-minded women going through their journey. It’s a welcoming environment full of understanding staff – it’s like someone read my mind when I thought about all of the things I wanted to get out of my pregnancy.

I think the combination of Neighbourhood Midwives and The Health Works has made me realise that right on my doorstep there is a world of innovation in maternity care taking place, whether this is delivered outside of NHS buildings by other companies and charities, or even funded by the NHS but in the comfort of your home.

I would encourage all pregnant women to have a look what is going on in your local community, and if there isn’t anything immediately that takes your fancy, set something up, and definitely have your say with your local Maternity Voices Partnership.

Katie Ratcliffe

Katie Ratcliffe is a health policy and programme manager, with 12 years’ experience in central government roles in the UK, South East Asia, and the Middle East.

Completing her Masters in Health Policy from Imperial College in 2012, she has brought to the Maternity and Women’s’ Health team in NHS England a combination of programme management skills and broad policy knowledge which is supporting the transformation of maternity services across England.

In her spare time, Katie is a keen traveller, follows politics and social affairs and enjoys swimming and Pilates.

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  1. A Midwide says:

    Dear Katie,
    I would love to know what the caseload numbers are for your 2 midwives.In my experience Neighbourhood midwives have 30 women maximum to look after at any one time. In the real world, NHS midwives have caseloads of 100 women! Where is all the money going to come from to pay for this new service, and more importantly, where are all the midwives going to come from? Midwives are leaving the profession at a faster rate than they can be trained or recruited.We’re 3500 midwives short already, and the ones we train leave after a year or to because the working conditions are so dreadful. The bright sparks in our area who are implementing Better Births have decided midwives can have caseloads of 40 each and be oncall 24/7 7 days a week! No thought that midwives might have lives,husbands or families of their own.And do women really want to be cared for by someone who’s been working for 24 hours straight!.I note you’ve never worked as a midwife on the front line. Enough said!

  2. Dennis Woodhouse says:

    Dear Katie
    When will Neighbourhood Midwives be available as a commissioned NHS service in Croydon CCG area.They are supposed to be a Personal Maternity Care Budget pilot area but when my spouse was expecting a child in 2017 we ended up having to pay privately (service was excellent compared to NHS)
    We asked the CCG and NHS England right up to Senior Level and they did not act.What are you going to do about this!