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We are shaping services for years to come
The Chair of the soon-to-be-published National Maternity Review explains how it will transform care for women, babies and their families across the country:
The Maternity Review is steadily drawing to its close, and we will soon publish our report on services in England.
During this process I have met inspiring women, midwives, and doctors up and down the country. It is no surprise to me that giving birth has never been safer.
I have blogged before about the stories we have heard, so many have been heart-warming, but there have also been agonising accounts of when things have gone wrong.
I am truly excited about publication as it demonstrates what we’ve learnt and begins to bring into reality, across the country, our recommendations for the benefit of all mothers, babies and their families.
Knowing that this report will shape how maternity services are delivered in the UK for many years to come fills me with great excitement. In the 20 years since my report Changing Childbirth was published we have witnessed great changes to maternity services, but we have not achieved everything we set out to achieve.
This time we have no choice – maternity services must become safer, more personalised, kinder, professional and more family friendly.
We are now confirming the finer details of how our recommendations will be put into practice. Naturally it is extremely important that we can ensure our recommendations can be delivered sustainably now and in the long term, so that future generations will benefit from maternity services that are among the best in the world, putting the woman, her baby and family at the centre of care.
The groundwork we are doing now will ensure that the report has maximum impact from the day that it is published.
I want to take this opportunity to thank all the mothers, families and healthcare providers who have taken the time to provide us with their invaluable insights into maternity services and how they feel they can be improved.
I will have to wait for the report publication to thank everyone who has contributed, but today I want to express particular gratitude to the charities including the NCT, Best Beginnings, Sands and Bliss who have helped us so much, and the professional bodies the Royal College of Midwives and Royal College of Obstetricians and Gynaecologists.
Without the contributions of thousands of individuals up and down the country this Review could never have happened.
Who on earth came up with the idea that fair skin/haired people would be more likely to be prone to B12 Deficiendy.
Due to the interest generated by my first post I have researched the background to this Review, in particular the original Cumberledge report. It is astounding to me that Ms Cumberledge was selected to head the latest NHS Maternity Review.
Isn’t it obvious that her original, plainly partisan, report is partly to blame for the disastrous changes of the last 20 years? The emphasis on CS as the key performance indicator of obstetric care, the dominance of the ideology of ‘vaginal birth at all cost’ is partly the result of the original Cumberledge report. And now the NHS task the person responsible for this document with assessing its negative consequences?
Well, I guess the NHS wanted a whitewash, and that’s what you’re about to get.
Ms Cumberledge writes above: “It is no surprise to me that giving birth has never been safer”. This is plainly untrue.
Childbirth in the UK has become substantially more likely to cause major, irreversible maternal trauma over the last ten years. Trauma that will, in many women, have life-changing consequences. This is not an opinion. We now have ample data to prove that point. I’d be very happy to give Ms Cumberledge a private briefing on the research covering this field.
HP Dietz PhD
I am hopeful that this report reaffirms the belief that the Midwife is the best person caring for low risk women and reinforces the need for sufficient Midwives to provide on to one care and facilitates full choice for all women in chosing a place for birth and what care or intervention is received.
It has been a very difficult time to work in the NHS with budgetary cuts, targets and press and public scrutiny and condemnation but this report will hopefully set out the blueprint for ideal future maternity care. I think there is always a cost put on care but quality of care should be the primary focus. Women should be at the centre of all care and an equal partner in it. Most women cite extreme trauma at having no choice and control during their birth and this must be avoided. For too long women have been coerced or pressured into unnecessary intervention instead of following their own intuitive and instinctive internal mechanisms.
It is important to have a balanced view of birth and risk and to have a skilled Midwife always on hand to identify when there is deviation from the normal.
It is through proper education and training we can identify how to deal with problems and through better collaborative working with doctors we can care together. There is much more known about still birth risks and we should continue to educate women about health promotion,regular antenatal care and simple measures to monitor fetal wellbeing. It is my hope that we can eliminate unnecessary intervention and decrease the caesarean section rate nationally and increase the satisfaction overall with maternity care.
I am the Research Officer for the Birth Trauma Association and I partially agree with you but with one or two strong reservations. There are indeed women who feel they have been coerced into unnecessary intervention but there are equally women who feel denied their informed choice of epidural pain relief or caesarean section. Professor Peter Dietz and the comments of Pauline Hull below make just these points. You rightly comment that most women exhibiting extreme trauma are those who have had no choice or control in how they give birth. I can think of no worse example than the terrified tokophobic women we hear from who are forced to endure a vaginal birth against their will. It is a barbaric system. Yes, women should be at the centre of care but in order to do that women need to be listened to and their choices, aspirations and fears respected. For some, support to achieve an intervention free birth will be best but for others the focus on avoiding intervention causes untold distress and mental breakdown.
The relentless pressure to reduce CS rates has, according to our modelling at my unit at the University of Sydney, resulted in over 100.000 excess cases of major maternal trauma to the pelvic floor and anal sphincter in England since 2005, due to the increase in Forceps alone. That’s not even mentioning rising PPH rates due to longer 2nd stages, dangerous VBAC, and the resurgence of rotational Forceps. That’s not mentioning dead mums and babies either.
With the enormous political pressures on maternity care in the UK (and notorious NHS micro-management by bureaucrats) this is not surprising. Obstetric colleagues are bullied into providing substandard care every day, and the Morecambe Report shows only the tip of the iceberg.
I wish you all the best in your endeavours, but you have a long way to go before maternity outcomes in the UK reach European averages.
The focus on natural or normal birth at any cost, and targets to reduce caesarean rates (as though a low percentage rate alone is a measure of good health outcomes – it is not) have endangered – and lost – the lives of countless mothers and babies giving birth in our maternity care system.
Women and their partners are not always listened to – be that a request for a caesarean birth during pregnancy or a request for intervention of any kind after the onset of labour – and all too often there are adverse consequences as a result. A fleeting glance at the cost and causes of obstetric litigation in the NHS will confirm this, and even this doesn’t reflect all the families who decide not to pursue a legal route.
Women who are at full-term in their pregnancy are rarely advised of the risk of stillbirth, and the option of a planned caesarean is not readily discussed in a balanced way alongside the other options available – i.e. to await spontaneous labour or to induce.
For women planning a small family, and especially for women who have risk factors for complications during a planned (and/or overdue) v. delivery – for example, first-time pregnancy with advanced maternal age or suspected macrosomia – the information provided about planned mode of birth is all too often unbalanced and ideological.
Also, the emphasis of maternity care research on ‘place’ of birth, instead of ‘mode’ of birth (both should be considered if balance of information is to be achieved) is unhelpful and biased. What matters to most women is their birth outcome rather than their birth process, and yet many people working in maternity care are so focused on women achieving the natural physiological process of birth that they ignore or miss vital warning signs.
There are two important perceptions about pregnancy and birth – one, that it is inherently safe and medical intervention should only be used as a last resort, and two, that it is inherently risky and medical intervention is a welcome aid throughout. There must be room for both views in our maternity care system, and there must be respect and support for delivering the birth plan choices of women who have these differing perspectives.
One is not superior to the other, and the cost difference is negligible (NICE 2011 reported an £84 cost difference between PVD and PCD when urinary incontinence was factored in, and this didn’t include any other pelvic floor damage, injuries to babies or litigation).
I sincerely hope that the National Maternity Review has incorporated the concerns and views of all contributors, including those of smaller organisations, particularly in light of continued calls from the NCT, RCM and RCOG to reduce the number of planned caesarean deliveries, and to communicate this as an important maternity care aim, strategy, policy or measure of good health outcomes.
We need to measure good maternity health outcomes in terms of the numbers of mothers and babies who have positive physical and psychological birth experiences. This is the most important thing; it’s time that the caesarean rate was viewed as a secondary, not primary, concern.
Now this is the reality of things today , not the finish in this article ! Babies and mothers are still loosing their life’s , their quality of life and their fertility due to simple neglect . This needs to be addressed , some babies should not even be attempted to be born naturally the constant pushing for it puts life’s at risk every day
Well said Pauline Hull and I only hope common sense prevails to produce a balanced & sustainable service run harmoniously by Obstetricians and Midwives as a Team. I sadly suspect the focus will be heavily on reducing intervention, more MLU’s and Home Birthing to save NHS money.
Personally would like to see improvements that should immediately start to reduce the stillbirth and Intrapartum death\damage rate in UK by way of more robust Risk Assessments throughout pregnancy & labour, need for a 3rd scan after 32wk, implementing use of GROW charts across NHS, optional monitoring whilst in labour and Coroners\External Investigations to look into unexpected Stillbirth & neonatal deaths.
Sadly too many babies and mothers are dying un-necessarily. Parents want the experience of child birth to be as idyllic and natural as possible but with safety nets in place should complications arise.
Men of course are an integral part of many families but it is women who become pregnant, give birth and have the capacity to breast feed so should be the focus of the maternity services review.
I am looking forward to reading the report . I am hoping that mothers will no longer be left vitamin b12 deficient which has caused them to have pre term babies born with a low birth weight and have then been at risk of having a precocious puberty , which can effect children as young as three and can cause six month old babies to have a false puberty and then maybe we can protect them from the ritual sexual abuse in care which they have been victims of . I am also hoping that forceps will no longer be used , which have been damaging the optic nerves of babies and which has caused optic nerve neuoropathy / atrophy and optic nerve hypoplasia which effects the hypothalamic function of the brain which controls temperature and effects the pituitary gland ( master gland ) which controls sex hormone and behaviour . An imbalance in sex hormone causes precocious puberty . I will be pleased if babies heads are no longer x-rayed , causing learning difficulties and precocious puberty . I think I would be most impressed if vitamin b12 deficiencies are addressed thouroughly , so that babies will not be genetically altered over several generations using nitrous oxide gas ( entonox ) to switch off vitamin b12 synthesis and using vitamin b12 lowering pharma medications such as proton pump inhibitors , anti biotics , metformin , anti depressants , antacids , innoculations , pain killers , mefenamic acid and a host of others and will not suffer microcephaly . . I would like to see mothers given enough vitamin b12 so that they do not need inducing in the last two weeks of pregnancy , which is a significant part of gestation . In the last two weeks , a mothers body fills up the baby`s liver with blood and then the process of the baby producing it`s own fresh red blood cells begins , starting in the liver , going through the kidney , into the bone marrow and the last place for erthropoisis being the liver . If this is interrupted , the process becomes immature and effects the circulatory system of the baby , causing blood cells to die off too quickly and means that the baby will struggle to hang onto iron in the circulatory system , which is known as anaemia of prematurity . I would like to see women having a lot more control of their own bodies , especially during pregnancy . One of the best improvements would be to be aware of people with Scandinavian , Indo European and African ancestral DNA , who have a genetic mutation which prevents them from producing intrinsic factor in their stomach , which is needed for the absorption of vitamin b12 . Fair haired , blue eyed people are particularly vulnerable to this deficiency . Too many fair haired babies and children have been taken into care both in the present and historically and have been sexually abused , due to being born with a low birth weight , which caused them to have a precocious puberty . Local Authority ” Children`s Services ” Health Assessment forms ( IHA – YP ) for children who have been medically kidnapped by the Nazi style ” Child Protection ” regime even has a section about hair colour and eye colour . They must think mothers are stupid . The Nazi`s said that the blonde blue eyed people were the superior race but not for the reasons people have been lead to believe and was entirely for the purposes of the ritual sexual abuse of babies and children . They even had a breeding program using blonde blue eyed women to produce babies . I watched a program called ” Inside Isis ” and listened to men talking about swapping the children they had abducted as though swapping playing cards . They said that they should be able to take children as young as nine to sexually abuse and that the blonde blue eyed ones were worth more . Judging by the religious art work depicting blonde blue eyed babies and children as angels and cherubs , it looks like this practice has been going on for millenia and must be stopped . The Nazi psychopathic child murdering geneticist Dr Joseph Mengele was even chemically altering eye colour to turn it blue and was interested in the 3rd generations . He escaped to Brazil and Argentina after the war , where generations later , babies are being born with microcephaly . The average age of a mother in Brazil is between 10 years of age and 19 years of age . We have this monster .to thank for the babies being born with underdeveloped brains and the use of ” estimated delivery dates ” and not a mosquito ! Making sure that mothers have enough vitamin b12 will be the key to preventing this happening in the UK . Hydroxycobalamin , which is an inactive form of vitamin b12 will not work on those who have had their vitamin b12 synthesis switched off with nitrous oxide gas or who have an inborn error of metabolism . These patients need methylcobalamin , the active form , which lo and behold is not available on the NHS and has been reserved for the private sector by the Nazi style ” Child Protection ” regime .
This is excellent news and we all look forward to the report. It is especially important that so many women have been listened to for a change.
May I however humbly suggest that the phrase ‘main caregivers’ is used throughout so that, for example, in the 8th paragraph above ” putting the woman, her baby and family at the centre of care” would be changed to ” putting the main caregivers, their babies and family at the centre of care”. This would ensure that the emphasis is kept on the main caregiver, rather than the gender. Or something in this vein.
Whilst mums’ are usually the main caregiver this is certainly not an absolute.
Many thanks for your kind considerations,
Richard NT Lohman, M.A. Advanced Social Work (merit)
Thank you for bringing our experiences and thoughts together. So important to listen to women as a way of making positive change and this report does that.
In 2014-15, 609,856 babies were born and 98,971 were diagnosed with neonatal jaundice. 17,070 babies were readmitted to hospital within 28 days into an NHS England Hospital due to a primary diagnosis of neonatal jaundice.
Through Hospital Episode Statistics (HES) analysis (Source Health and Social information centre HSCIC) we also saw a very clear correlation between ethnicity and neonatal jaundice readmission, showing a higher incidence with a particular subset of babies that are not British (white), Irish (White) and any other white background – ethnic groups D to S.
We offered the Maternity review details of this alarming issue and an innovative resolution to enable earlier diagnosis, and help alleviate the readmission issue which adds an average of 4 days length of stay to each readmitted baby. We were told by the review that this information was not of interest.
I would like to be as optimistic as you are on the improvement of the maternity service. I am sure you will improve so aspects as I can see it already improving.
I am a midwife and I work in a university hospital. I can see how the theatres in the delivery suite are improving their capacity and their safety and their health carers.
I can see how very difficult for our managers is to keep up with the midwives posts. They are all the time advertising posts and all the time midwives leaving.
The younger may stay for no longer than 6-12 months. Also the more experienced are leaving too. Most of the latest are cutting their hours as it is very difficult to work in the stressful environment for 12 h. At least this is what is difficult for me.
I can see there are several issues about the area the hospital is located.
The housing issue does not help. It is atrocious pricing for a room or an apartment.
For me I had many problems with being dyslexic and doing 12 hour shifts.
We are not paid for the lunch breaks, so we have to work 12:30 h and be paid for 11:30h).
I can see my colleagues that have to do that long hours and then travel for many miles home.
I can see the changes of patterns of days and nights in a very unhealthy way and I pity them, as I am now doing 8h shifts ( 7:30 h paid and sometimes I cannot take a break) because I had troubles when doing 12h shifts because unable to concentrate for 12h.
I understand that my colleagues with children are better doing 12h and less than 37.5 h a week, but the older we grow the difficult it is to do so.
I cannot say who to improve maternity but I can see that flexibility with working hours and patterns for midwives is very important, to keep us in our job and family. I believe we are more useful the more experienced we are. I am doing my best and helping as much as I can, but I find very difficult to be heard and communicate well with managers, supervisors and obstetricians as a simple band 6 midwife with 11 year of experience in a busy hospital.
This are my comments, hope it help at all!!
Dear Mr Branagan-Harris
Thank you for your comment.
We appreciate you bringing information about neonatal jaundice to our attention. It is, however, not within the scope of the review to make recommendations about the treatment of individual conditions. The Maternity Review was asked to assess the current state of maternity care in England and develop proposals for the future shape of modern, high quality and sustainable maternity services.
Nevertheless, we acknowledge the significance of the point you raise about health inequalities. We would like to assure you that our report will recognise the need to reduce health inequalities and the importance of delivering high quality care to all women and their families across the country.
If you have any further questions please feel free to contact us on email@example.com
Maternity Review Team