The Optimistic Mum: why choice in maternity care isn’t always an option

Jenny Hicken, a Network Delivery Facilitator for NHS England’s Northern Clinical Networks and Senate on Tyneside, reflects on the Friends and Family Test being introduced to maternity services.

This month has seen the launch of the NHS Friends and Family Test (FFT) for maternity services.

The FFT is seen as a vital tool for allowing patients a voice to comment on the care they have received, and enabling any issues identified to be acted on quickly.

Empowering patients and respecting their opinions is high on the NHS agenda these days, but why is this perhaps even more important when it comes to pregnant women and new mums?

Having a baby is not the same as having an illness; it is a normal human life event which in a low risk pregnancy should allow the woman to enjoy as little medical intervention as possible. That said, not all pregnancies can be considered low risk, and it is down to the expertise of our midwives and doctors to ensure every woman receives the care appropriate to their circumstances.

Part of the empowerment of patients means offering them choices and involvement in decisions about their care, but all too often for pregnant women, their circumstances mean these choices can be taken away from them.

I had always planned to have my son at my local hospital obstetric unit and was happy with this decision. I wanted to use a birthing pool and as a first time mum I had a wonderfully relaxing (and probably wildly optimistic) birth planned out in my head.

Then at 36 weeks I developed pre-eclampsia.

My water birth went out the window. There would be no natural birth for me and the choices open to me became increasingly diminished. The remainder of my pregnancy was planned for me and I had to go along with it.

Once I had passed 37 weeks, after almost a week on an antenatal ward, the decision was made to induce my labour. I spent over 24 hours in a curtained cubicle on the induction suite, waiting for a delivery room to become free. I was kept waiting as long as necessary whilst woman after woman in advanced labour jumped the queue ahead of me.

When my time finally came, my clinical circumstances dictated a highly medicalised labour I never really wanted but felt like I had no choice about. I had to have total faith in the staff caring for me – and they were without exception really wonderful and knowledgeable people.

Everything progressed so quickly that the only pain relief I was able to have was gas and air. I was confined to a bed with a drip in one arm to force my contractions, a blood pressure cuff on the other, and a foetal monitor strapped across my stomach the entire time. Nobody would choose this.

Pregnancy is exciting and daunting, exhilarating and exhausting, filled with expectation and wrought with confusion. The way a woman is treated throughout it and her perception of her own experience can have a huge psychological effect which can have far-reaching consequences.

Reflecting on my own experience, the latter stages of my pregnancy and particularly my labour were scary events. I felt like I had no control over what was happening to me. Fortunately, my son was born safely and healthy, and we spent four days on a postnatal ward where I received more exemplary care from the supportive staff, preparing me well for going home. However, many women who feel they have had a negative birth experience don’t always move on from it so easily.

It is at this extremely emotional time that women will be asked to complete one part of the maternity FFT and I think the honest and useful feedback to be gained from the answers provided at this time will be a real eye-opener for a lot of maternity units.

If I had been asked my opinion at the time of my son’s birth I might have been highly critical of the lack of shared decision making and personal choice offered to me – but how could I criticise the caring and supportive midwives; the ability of the doctors to prioritise the safe delivery of my baby over my own ideal birth; the valuable help I received from the postnatal nurses to recover after such a stressful and exhausting labour?

I hope that mums won’t shy away from giving valid criticism of their care if necessary but that also they will give credit where it is due and realise that successfully delivering a healthy baby, as I was lucky enough to do, is the outcome that everybody would choose, regardless of how you achieve it. However, maternity providers need to be aware that some mums will need more support and should recognise where this is the case, enabling women to feel optimistic about, not afraid of,future pregnancies.

Jenny Hicken

Jenny Hicken is a Network Delivery Facilitator in the Northern England Clinical Networks, and is part of the Mental Health and Dementia Network team.

She is currently working on projects addressing the wellbeing of vulnerable groups, and represents the Network team on the North East and North Cumbria ICS Zero Suicide Ambition Steering Group. She also keeps a hand in with the Maternity Network team, with whom she has worked closely on a number of pieces of work.

Jenny lives in Newcastle upon Tyne with her husband and two young sons, and has worked in the NHS since 2009.


  1. Christine McCourt says:

    Dear Jenny
    I do have some concerns that the Family and Friends test has not been validated and was developed on something of a political whim. If you look at research studies and the main national surveys of women’s experiences of care you do find consistently that women are not inclined to complain about care unless it is really quite poor. Most understand that sometimes intervention is needed and what makes the difference to the evaluation of this is good information, good care and support and being confident that the right clinical care was received. In my long experience of researching women’s experiences and views, women are very ready to praise good quality care regardless of whether they had interventions, although some are left traumatised or deeply disappointed by poor quality of care and support. The key really is whether the interventions were clinically warranted, explained well (and the limits of emergency situations are understood) and handled with kindness and care. Currently intervention levels nationally are higher than they should be, and some women are subject to interventions that should not have been needed if our models of care were better designed. Many women don’t have access to evidence-based information which would help them to know whether the interventions they received were (as in your case) needed, or associate with the way care is provided.

  2. John Ferguson says:

    Thank you Jenny for this very good blog and it was great that your circumstances came good in the end.

    However the vast majority of maternity episodes for women are low risk and can be managed in a ‘normalised’ model of midwifery care. It is therefore essential that women have the choice to access this type of care and not be placed (often against their own wishes) in a medicalised model of service. The evidence of same midwife leading to continuity of care results in normality which in turn produces improved physical, psychological and public health outcomes.

    Women all over the country are currently are having to accept the bar being ‘low’ in maternity outcomes and provision. Most commissioners say they offer choice in maternity (e.g. the 2 or 3 local NHS providers) but the reality is the service and the outcomes are the same. This choice being offered is not the same as the woman having HER choice to meet her and her families needs.

    Commissioners should expect providers to raise the bar to deliver the type of care women are entitled to or help women look elsewhere to other providers with capacity that do provide high level outcomes. It is time the NHS allows real choice of maternity services for women. I do recall the previous secretary of state saying ‘no decision about me, without me’. After all choice is available in virtually every other area of health.