Tuesday, 15 July 2014

Let's keep our babies free at the point of delivery!

In the USA having a baby is an expensive business. To bring home a new bundle of  joy can cost the doting parents $42,000 – roughly the same as a mid-range car but with a lot more noise, nappies and, however much you might be tempted, you can't trade it in for an improved model.

At the moment in the UK, our bundles of joy are free at the point of delivery. Bed, board and midwife are all inclusive. But, in a fragmented and privatised service such as the American healthcare system women are not at the centre of care, profit and the bottom-line is. Insurance based systems are perfect breeding grounds for unregulated intervention. Women and their partners are sold 'maternity packages' including regular scanning, epidural, even elective caesarian – never mind if these interventions are medically indicated, never mind that research has categorically shown that allowing childbirth to be as normal as possible is best for the mother and baby. And certainly no thought to public health policy which has years of experience and knowledge about serving the health and maternity needs of our population.

Mothers understand the complexity of maternity care. We believe that every woman should have a named midwife and that women be supported in their choice of where to give birth. We want a woman-centred care model that allows midwives to focus on our needs rather than the gruelling bureaucratic process of administration. We demand a compassionate midwife to woman ratio on our postnatal wards and that women are properly cared for in the community by regular postnatal visits at home. We are fighting for the right for every woman to have a free, safe and compassionate maternity service.  

Saturday, 24 May 2014

High Risk Births at a NICE price

OFFERED: Fabulous boutique room, freshly painted, king size bed, 24-hour staff, pool. REQUIRED: vaginal delivery of a perfect baby.

Of course, you'll be lucky to make it through the doors of this little piece of heaven within the NHS. If you have any hint of a complication you'll be sent packing to your standard local obstetric-led maternity suite. Oh, but hold on – there's no room at the inn: all of the obstetric-led units have been shut!

Don't get me wrong, I am all for natural childbirth, women should be supported to give birth at home or in a midwife-led unit; let's make sure every baby's first moments are skin-to-skin, suckling at the breast. But the harsh reality is that the sweet, sweet words from NICE are nothing more than a whispered lullaby to lull women into thinking that they have a heart and that they've listened to mums and midwives. With a shortage of nearly 5,000 midwives nationally and a maternity service in tatters thanks to countless hospitals being downgraded there is no way that a move to a midwife-led model of maternity care is a serious proposition.

So, let's get serious. Women need an individual service tailored to their needs. Home birth requires two midwives to be present but is otherwise cheap as chips and has very good outcomes for mums and babies (within reason). Birth Centre delivery requires one midwife, with very little intervention, is slightly more expensive and also has good, reliable outcomes for mums and babies (within reason). Acute Obstetric care is on a graded scale of expense with increasing intervention and has good outcomes for mums and babies (within reason). Reason, skill and medical training decide where it is most appropriate for a woman to give birth. In a service where the mother is at the centre of care, this should be a fairly straightforward decision – but in a service where profit and a confusing web of tariffs, CQUINS (and I'm not talking disco here) and penalties take centre stage, then the woman and her ever-expanding waistline are left to the mercy of a lottery of the market.

NICE can say what they like but the Department of Health are no longer accountable for our care and with the advent of the CCG they have no control of a national maternity strategy. When asked in a recent government report the Department of Health was not able to name a national policy for maternity. It's still Maternity Matters, by the way, Jeremy.

The Health and Social Care Act untethered the Department of Health from the NHS. It claimed to hand over power to the Clinical Commissioning Groups, but in reality they are at best confused and at worst rife with corruption. All of this while introducing an open market that is spiralling out of control. The result for women is that maternity services are floundering. In that government report it was found that the Department of Health is no longer responsible even for such basic and fundamental aspects of care such as how many midwives are employed by the NHS. So, who is? No one.

With Public Health banished to the savaged hinterland of the Local Authority there is no longer a powerful body integrated into either the NHS or the CCGs to ensure that local commissioning of maternity services is in line with Department of Health Policy. Even if they knew what that is. By breaking up the NHS, the Department of Health has made it perfectly clear that it is not remotely interested in having a public health policy at all. They prefer to focus on forcing hospitals into becoming Foundation Trusts as quickly as possible.

Jeremy Hunt and his cronies may not care about boring epidemiological studies and evidence-based care, but for us mums the fragmentation of services is a catastrophic blow to choice, continuity of care and equal access to healthcare. With the desperate shortfall of 4,800 midwives and almost half (47%) of UK hospitals lacking enough consultant obstetricians, along with a steady baby boom in England over the past decade, there is increasing strain on maternity services. Midwives and obstetricians look after women with much more complex needs. The Coalition, UKIP and other misguided souls push an identity parade of people to blame: Immigrants (the Polish get a hard time despite working legally, paying taxes and so therefore no different from Mr and Mrs Smith born and bred in Tunbridge Wells); The Poor (to listen to George Osborne and Iain Duncan Smith one could be forgiven for thinking that eugenics may well be on the cards for the next election manifesto); The Needy (we might as well kick the disabled while they're reeling from ATOS); and finally, The Labour Party (they gave those pesky women far too much with their tax credits, Child Benefit, Children's Centres and Maternity Matters).

Amid the frenzied dismemberment of the NHS we are hurtling towards an insurance-based system for our maternity care, which embraces intervention rather than holistic, aromatherapy and massage amongst caring midwives handy with a birth stool. We need to ask ourselves, do we seriously want to live in a society in which only the super-rich can afford to have babies while the rest of us lucky enough to have health insurance count the pennies to calculate whether we can afford for the stork to pay us a call?

Never forget that pre-NHS women died in their droves in cavernous lying-in wards or for want of an experienced midwife. The idea that all women are going to have the opportunity to lie-in in a luxurious birth centre would be a joke if it weren't so utterly terrifying that the back-up intensive obstetric care is being closed down. We mothers need to fight and fight hard for our hard-won maternity services. We need to join together and fight those seeking dismantle the NHS and fight them we shall: we shall fight them on the labour wards, we shall fight in the midwife-led units and we shall fight in the birthing pools; we shall never surrender. We shall go on to the end.  

Sunday, 27 April 2014

Taking the politics out of the NHS and putting patients before profits

Taking the politics out of the NHS and putting patients before profits

The proud prospective London Euro Election Candidates for the National Health Action Party along with the co-leaders Clive Peedell and Richard Taylor.

I am standing for the NHA to protect an already frail maternity service and to ensure that my own three girls are given the same care I had for their births when they become mothers themselves. 

Across the country maternity units are being down-graded or closed. More women are facing longer journeys to give birth to their babies in safety. Women are being denied choice in where to give birth and midwives are being strained and de-skilled. If we don't act now we are going to lose the NHS forever.

Why does this matter for women and maternity?

Maternity is unlike any other health service. The users are not patients, they do not need treatment: they need care – sometimes complex care – and they need respect. We need to demand named midwives for all women and a service that genuinely caters for all. 

I believe the National Health Action Party are the only Party that are calling the government to account over the NHS and exposing the reality of privatisation and cuts to our precious health service. You can find out more about the gorgeous candidates on the NHAp website. We're not like any other political party - we even have the magnificent Rufus Hound standing for us!

Sunday, 13 April 2014

Bounty Hunters are on the move

Hip hip hooray for Sarah Crown and Mumsnet for their new campaign to get rid of Bounty reps from our maternity wards. I've been banging on about this issue for years since the birth of my baby when I first encountered the astonishing Bounty Pack.

Stuffed full of what I assumed was nonsense, I found my child benefit form, some interesting information about local breast feeding groups and other NHS leaflets about how to keep my baby alive. I could hardly believe that Bounty were entrusted to deliver this vital information to parents and the fact that it came with heavy advertising from Pampers and Sudocrem seemed incongruous at best. Did I have to clad my baby's bum in Pampers and stinky zinc cream to claim my child benefit? Did I have to read all the endless bits of paper to make sure I wasn't missing some instructions on how to avoid cot death?

I read everything in my pack with raised eyebrows, increasing hilarity and finally wild-eyed fury. Who knows when Bounty first got its tentacles into our hospitals (they bear a striking resemblance to the Nestle Nurses of days gone by) but they are fresh from 1954. I found a pamphlet full of quotes from - I kid you not - the Daily Mail and The Sun claiming to offer relationship advice. What?! Yes, I too was unaware of their expertise in this area, they actually recommended 'ring fencing' 20 minutes of your day to not talking about your new bundle of joy and - even more repellent - resuming marital relations as soon as possible. Don't mind the stitches, honey, the only thing your man is interested in after a long, hard day in the episode of Mad Men he comes from is a long, hard ... chat about the golf course and a romantic spin about the sheets.

So, as it's now 2014 and we're all a little bit wiser about the machinations of advertising execs and want our healthcare delivered by midwives and doctors rather than underpaid Bounty reps let's politely ask them to leave and let new mums get on with recovering from childbirth, learning the mysterious art of breast feeding and having some toast and tea. Get the midwife to hand over the child benefit form. After all, far fewer of us are entitled to it these days.

Saturday, 5 April 2014

Just when you thought it was safe to have a baby....

Your new National Health Service starts on the 5th July. What is it? How do you get it?
It will provide you with all medical, dental, and nursing care. Everyone – rich or poor, man, woman or child – can use it or any part of it. There are no charges, except a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in times of illness (National Health Service Leaflet 1948).

There's a revolution in the NHS. No longer shall the NHS be shaped and driven by the health outcomes of everyone - rich or poor, man, woman or child. The NHS of the 21st century is financially driven; it's a market place and there's profit in numbers. So out with the old and in with the new – and that means a new approach to services. Specialist care centres, emergency centres serving wider geographic areas, phlebotomy centres, vasectomy clinics: more specialist, less general medicine is the way of the future. This model is possibly financially superior but is hopeless for the hapless users of the service. Previously, one could nip to one's local surgery to have a blood test, a veruca removed, or the coil fitted; now one has to trek across town to be serviced by a plethora of healthcare professionals in a disparate web of healthcare outlets. We're told that our care has improved and that we should be grateful for what we get because healthcare is draining the economy.

Now here's the nub: we all know that healthcare and the NHS has been re-shaped to operate as a business, and the bottom-line of business is profit. All NHS facilities – that's hospitals, GPs, sexual health clinics etc - have to meet the health needs of their clients while meeting their bottom-line and making a credible profit. At the same time as the move to a private sector model for our public services, we have been sold a myth: specialist services, hubs of care and improved 'customer services' in the NHS improves health outcomes. This is a fabrication sold to the public by the handsomely paid management consultants who populate health think-tanks and NHS England. And these consultants are being increasingly used – and paid for – by the Department of Health and individual Trusts to advise on changes to health services. It's no wonder that we have moved away from health as the focus for care when we no longer use public health professionals and doctors to improve service provision.

So, let's get down and dirty and talk mums and babies. Maternity is unlike any other health service. The users are not patients, they do not need treatment: they need care – sometimes complex care – and they need respect. We know that small maternity units, midwife or obstetric-led give a better and more valued service. So why are so many of these units being downgraded or closed?

Margaret Hodge stated in a recent report: "There is evidence that many maternity services are running at a loss, or at best breaking even, and that the available funding may be insufficient for trusts to employ enough midwives and consultants to provide high quality, safe care." A worrying statement when childbirth is always the end result of pregnancy, and the childbirth rate is rising.

Every day news stories report cases of women giving birth without a midwife and hospitals groaning with over-stretched capacity on labour wards. And yet the government writes and rewrites papers and policy that demands more “choice” for women in maternity and higher ratios of midwives to women. Ministers drone on about woman-centred care, about midwife-led birth centres, case-load midwifery. But the reality is that the service lacks thousands of midwives, and midwives are leaving the profession in their droves: within 10 years of qualifying a third of midwives leave the profession.

In 2013 Jeremy Hunt, Secretary of State for Health, attempted to downgrade Lewisham Hospital's maternity service to leave a stand-alone birth centre with no obstetric-led care – despite the fact that Lewisham sees over 4,000 births per year and houses some of our country's most deprived women, with all the complex healthcare and challenges of that population. Only 12% of women in Lewisham would have been able to use the midwife-led unit. The vast majority would have been forced to use the already burdened units at neighbouring hospitals, stretching their capacity to over 7,000 births per annum. Lewisham Hospital battled Hunt in the courts twice and won both times. Lewisham was a test case for many maternity centres up and down the country. And Hunt was so outraged that he had lost in Lewisham that he is using clause 119 of the Health and Social Care Bill to push through closures and downgrades to service provision more easily and without the hassle of having to go to court. And where are the headlines? Where is the debate? If the Coalition succeed in passing the bill no hospital or maternity service in the country will be safe and that means fewer and fewer women will have access to good, comprehensive local care.

Childbirth is intimate, it requires the mother to feel safe in her environment, confident about the support from her midwives. Women ask for a more personal service. No one wants to be herded into cavernous hospital wards with anonymous carers and a conveyor belt service to give birth in fear or by the surgeon's knife.

Sunday, 12 January 2014

21 Days Later

When I discovered I was expecting our third baby I started to think about how and where the wee tot would be delivered. I had my first daughter at Lewisham Hospital which had been such a traumatising experience that I vowed never to set foot in their labour ward again. Our second daughter shot out in St. Thomas' 'home from home' after a hair raising drive through SE London during which the labour moved swiftly from first to second stage. After that I thought it might be safer to have this one at home.

My only concern was that there wouldn't be enough midwives available to support the home birth; I was supremely confident that as this would be my third labour it would be quick and she would be born at home in the bosom of our family. I knew my dates exactly so when her due date arrived I was secretly disappointed that she hadn't (my second daughter was born, very conveniently, on her due date). The days passed slowly, one week went by and I was faced with that dreaded 41 week appointment.

I decided not to go...after all, the baby would probably turn up in the next couple of days...with a little struggle the midwives agreed to an appointment at 41+3, the days went by and the nights and despite being desperate to go into labour I had a sickening feeling that it wasn't going to happen. Finally at 43 weeks I gave in and went to Lewisham Hospital's Day Assessment Unit. I had a scan which showed a monster baby lurking inside. So, at 21 days late I found myself in the same room in which I had given birth 5.5 years before, I had the CTG (belt monitor) strapped to my tummy and had my waters broken: everything I had desperately wanted to avoid.

But this time was different; this time my midwife supported me wholeheartedly, she got mats for me to use, a birth ball and encouraged me through the contractions without staring constantly at the CTG. I was in control and as a result had the birth I had wanted all along: three hours from start to finish, totally natural and a lovely, beautiful, rather large baby at the end of it. It just wasn't where I had wanted it to be!

Thank you to the community midwives at Lewisham hospital particularly Shirley Peterson, the former Head of Community Midwifery, and thanks to Bola, Nicola and James who supported me during the labour. You made everything wonderful!