to wonder if anyone actually cares about choices in pregnancyand birth and the state of maternity services in the UK?

(55 Posts)
TeggieCampbeggBlegg Tue 19-Mar-13 08:35:49

Do women want to have continuity of care?

Do women care about who looks after them in labour? Do women want to be cared for by the same midwife (or midwives) before, during snd after, birth?

Do women want to be offered choice or just be told what to do?

Flisspaps Tue 19-Mar-13 08:39:25

I wanted continuity of care, cared who looked after me during and after birth and wanted a choice.

The problem is, it only becomes an issue once you're 'in the system' so to speak, and maternity services are only used for such a short time by each woman that often, by the time you realise that these things really do matter, it's too late and you've already given birth!

Tubegirl Tue 19-Mar-13 08:45:47

Yes and no personally. I would have liked the same midwife throughout, I think thats so helpful with being able to trust your healthcare prof and feel able to contact them to ask questions. Also I suffered with ante natal depression during my first pregnancy- I never saw the same hc prof twice and had to explain things over and over. I was able to do that but imagine had my depression been worse I may have ceased to engage. In terms of the choices, I've little experience of this. I have two dc. The first pregnancy was complicated so I was told to have hospital birth and so it led to the second being hospital birth. Those were decisions made by profs with no input from me. In my case that was right and I ddn't have any strong feelings on it other than wanting baby to be born safely. I do understand however that the method of birth is more impirtant to others and in my view where there is no good reason to deny choice then there should be choice.

emsyj Tue 19-Mar-13 08:48:29

I was very lucky to have the same midwife throughout my second pregnancy, and she also delivered my baby. I think it did make a difference. It is not a service that is widely available though.

cory Tue 19-Mar-13 08:53:03

I did care about labour- but not necessarily for continuity in care; it isn't the most important thing for every woman. I was just as reassured by seeing a new person as long as they were pleasant and intelligent and had read my notes.

Tbh the first midwife who saw me in labour was a grumpy cow: I was delighted when her shift came to an end. Being cared for by her in the name of continuity would have been a nightmare. Rather half a dozen new pleasant faces, than the same unpleasant one. But if you could stipulate that you could have continuity of care with the most charming midwife in the practice, then I'd be all for it grin

I think these threads sometimes tend to assume that all women who care about their labour experience want the same thing.

JollyYellowGiant Tue 19-Mar-13 08:57:09

I'm not bothered about continuity at all. I just wanted someone in the room who knew what they were talking about.

This time I'm fed up of my community midwife already wouldn't want her at the birth.

TeggieCampbeggBlegg Tue 19-Mar-13 08:58:52

Very true cory.

I've heard it argued that what matters most is kindness, no matter who from.

But you can't research kindness and write a policy on being nice.

TeggieCampbeggBlegg Tue 19-Mar-13 09:00:28

But....

Do you want to be given the choice?

shellshock7 Tue 19-Mar-13 09:01:54

I have one DS and am v early days PG again and have thought abt this...I really am not bothered abt continuity of care for antenatal appts and post birth, but my MW stayed for the whole of my labour (the hospital part!) way after her shift had finished and that was so important to my state of mind, which was in a bad way tbh hmm. So much so the first thing I'm going to do is ask if she is on shift, she made that much of a difference to me smile

tomatoplantproject Tue 19-Mar-13 09:02:17

Had the same community midwife all the way trough which was helpful - didn't have to keep going over the same ground with her. Didn't care about hospital - I was booked into the midwife led centre but went straight to the labour ward when meconium in waters, and had a lovely midwife who was v supportive. However dd was breech and it was only picked up by dr when I was 5cm. I would have given up rather a lot to have had a midwife suspect a breech earlier so it wasn't such a shock.

bigkidsdidit Tue 19-Mar-13 09:02:42

my last birth was in a big London hospital adn I didn't see the same midwife twice, not throughout all my appts, and I had three during the birth. I didn't mind at all.

However, I had an easy pg, a supportive DH, and no issues such as alcohol / drugs / domestic violence etc, nothing I might want to discuss in confidence. Saying something difficult to ten different people might be very hard.

shellshock7 Tue 19-Mar-13 09:02:56

And jolly I agree actually, the thought of the community midwives delivering my baby gives me the shivers shock

cory Tue 19-Mar-13 09:04:49

"Do you want to be given the choice?"

Depends on what the choice would look like. If it was "do you want the same midwife throughout" (but not know who she was), then I would probably say no, just in case she wasn't very nice. And they're not going to let you take a look at your midwife and then let you decide, are they; that would be unmanageable.

cory Tue 19-Mar-13 09:06:04

I would be happy for other women to be given this service if they care about it, but I would also want to know how the choice would affect other services which I might care more about. If it costs more money, then what else would have to give?

HoldMeCloserTonyDanza Tue 19-Mar-13 09:09:38

I agree very much with cory.

Prior to DDs birth I thought I cared about continuity of care, and I was supposed to be getting it as a part of the midwife scheme I was on. As it happened, I went into labour in the middle of the night on a national holiday and my midwife wasn't available. I had a hospital midwife I'd never seen before. And she was amazing. Within a couple of minutes of meeting her I was reassured, comforted, and felt like I'd known her all my life.

That's a skill. And it's a really important one. I don't care who delivers this baby, as long as they are as good at putting a strange patient at ease. And most midwives are.

I also agree that it's only a minority of people who research different labour choices. The majority of people don't, and there's nothing wrong with that.

Having given birth abroad I think the NHS does a really great job of providing a host of different, free options to women. It could certainly do better but women here are very, very lucky and have far more options than in some other first world countries. I am really glad to be living here for this pregnancy.

TeggieCampbeggBlegg Tue 19-Mar-13 09:09:46

I suppose I mean the coice of what sort of care pathway;

Continuity

Same community mw but different one for birth

Dr appointments, clinics etc, with or without mw input.

I'm just pondering really. (with a sore head from all those walls i've been beating)

Meglet Tue 19-Mar-13 09:11:50

I'd settle for decent post natal care, especially for post CS mums.

Message withdrawn at poster's request.

TeggieCampbeggBlegg Tue 19-Mar-13 09:16:35

Yes. Postnatal care is crap minimal.

If I had not had continuity of care in having the same community midwife throughout, I and my baby might not be here today. Unlike the gp who did not know me at all, she spotted that I did not look right as she knew how I was usually.

I'm afraid I can't comment on continuity into labour as I never got there.

purrpurr Tue 19-Mar-13 09:20:09

I'd like the choice. I've chosen a maternity unit very near to my home, but ALL the community midwives are based at a hospital in the nearest town. They have NO idea about the unit I've chosen and get extremely snotty with me every time I ask a question. The unit itself is known for being clean and modern, the opposite of where they work. I really feel like they believe I'm Up Myself because I chose the unit. It's frustrating and upsetting. I feel like I'm preparing for labour in the dark. None of the midwives know ANYTHING about the facilities or procedures of the unit. I haven't even been able to find out about antenatal classes or anything.

It's distressing. I would have chosen anything but this.

I saw a variety of midwives through both pregnancies and births, but they were all nice and reassuring so as Cory is saying, it's the attitude, rather than seeing the same one which is important to me.

TeggieCampbeggBlegg Tue 19-Mar-13 09:25:11

When i am in charge of the world and while i am overhauling the midwife education system, attitude will be top of the list of requirements.

I was a bit annoyed never to see the same midwife twice for my antenatal appointments because I had to explain the background to an aspect of my health every single time & get all the sympathy etc etc when all I wanted was to hear the heartbeat & leave.

Couldn't have cared less during labour.

Caitycat Tue 19-Mar-13 09:36:56

Had a great community midwife and would probably have asked for her if given a choice. But chose a smaller town hospital rather than the manic city hospital she was based at. It was the best decision I could have made, the midwives who delivered dd were perfect in every way, experienced, competent and caring. I would have been wrong to choose my less experienced community midwife over them and am glad I didn't get the choice. Might be different if I hadn't had such a good experience though!

ENormaSnob Tue 19-Mar-13 09:40:32

I am a midwife and also 37 weeks pregnant with dc4.

I think continuity is overrated for both patient and hcp.

I don't care who looks after me in labour as long as they are knowledgable, competent and kind. Listening and explaining are vital for a delivery suite mw imo.

Postnatal care is shit as there are no where near enough staff per number of patients, there is a massive increase in the workload of said staff, an awful lot of very high risk mums and babies mean that staff are stretched to capacit and beyond.

Madmum24 Tue 19-Mar-13 09:41:23

I had great complaints about the system until I lived in a developing country where conditions are horrendous. I am so grateful now to have the care that we do.

Message withdrawn at poster's request.

Pigsmummy Tue 19-Mar-13 10:22:04

I saw three community mid wives for ante natal, they were lovely and I felt well cared for and don't see the need to have just seen one?

ICBINEG Tue 19-Mar-13 10:26:01

The thing I care most about is that midwives actually follow the advice of their college and keep up to date with the latest NICE guidelines instead of doing things because they always have done them that way.

Evidence based midwives or bust!

HolidayArmadillo Tue 19-Mar-13 10:28:48

Plus on a postnatal ward it's double the patients. More if there are a few sets of twins. It's a bloody nightmare tbh.

I'm a midwife and have had two babies, I wasn't fussed about continuity of carer, plus you can't work for much longer than 12 hours shifts, I'd rather have a nice friendly midwife who was awake and 'with it' to support me, than one who has been at work for 12 hours already and hasn't had the opportunity for a break because its going like a fair outside the room.

Having said that, the death of independent midwifery will reduce choices by quite a bit come October.

Thingiebob Tue 19-Mar-13 10:34:32

Continuity would have been nice, although just having midwives who knew what was happening would have been good. It was horrid having to 'start all over again' with a new midwife and did on a number of occasions result in mistakes, some of which could have been serious. There seemed to be little handover or continuity during the days I was in hospital.

sandberry Tue 19-Mar-13 11:02:52

As a midwife, it is noticeable that attitude is better when the ward is adequately staffed. Last month it was very quiet, midwives were calm, every time I went to see a woman, they told me what wonderful care they had had.
This month, super busy, stressed out midwives and much less happy women.

Babies are not counted in the numbers when determining postnatal staffing so I guess helping with breastfeeding, changing nappies for women who have had caesarean sections, or even providing medical care for the number of sick babies we have is not important.

The only way maternity care will change is if women who are past, current or future users of the service and midwives work together to change it as in New Zealand but midwives are overburdened, disillusioned and averse to industrial action and women access the service for such a short time in their lives that this is just not going to happen.

TeggieCampbeggBlegg Tue 19-Mar-13 11:05:26

I agree sand.

I think change has to be led by women.

TeggieCampbeggBlegg Tue 19-Mar-13 11:12:35

Sorry. Lost the other half of my srntence.

Change needs to be led by women but what changes do they want?

Pontouf Tue 19-Mar-13 11:26:12

Agree with previous posters that "continuity of care" and "choice" is much much less important to me than good post natal care. I had a relatively good experience on the post natal ward followings ELCS but some fairly major bits we're a bit crap! I was supposed to have TED stockings on post op (am DVT risk due to high bmi, spinal anaesthetic and family history of DVT - had to have 6 weeks of post op clexane) but despite repeated requests and the stockings having been prescribed on my drug chart, I was not given them. I was in for three days. During that time my sheets were only changed once - and that was at my request despite the fact that they were covered in blood. I was never shown how to bath my baby and had serious problems with BFing which was not picked up until I was back in the community and my DS had lost a significant amount of weight due to crap latch. Nobody helped me with BF at all.

All of this was due to low staffing levels. The MWs were very kind and friendly but simply did not have time to do much outside drug rounds and care plans. They were obviously extremely harassed and lots of patients, and partners especially were extremely vocal about certain aspects of care they felt were lacking so you sort of felt sorry for them and didn't want to add to their problems which is obviously not ideal.

So yes better post natal care would certainly be a top priority for me.

IsItMeBU Tue 19-Mar-13 11:36:32

I say the same midwife during my pregnancy and she was lovely, we got along really well with her and I would have loved to have her with me at the hospital because I trusted her and felt comfortable in her care however I had a c section and I can't fault any of the staff who were there, they were all lovely except a horrible MW who refused to pass me my DD during the night when I was still stuck in bed

ChunkyPickle Tue 19-Mar-13 11:48:58

Like many here, I don't much care about continuity as long as the people themselves are competent, and listen to you. I'm on my second, and so far my community midwives haven't impressed me - I really feel like they're ticking boxes rather than listening and seeing me as an individual patient (it's hard to explain)

Having met a load of the nursing (during a recent stay for my son) and maternity staff (at scans) at the hospital I'm a lot more comforted though - they all seemed really on the ball, properly listened and answered questions and were generally brilliant.

Like many others here, my worry is post-natal. I had my previous baby abroad, and my partner could stay with me the whole time to provide that extra bit of care you need after a CS. In the UK with wards, and visiting hours that is against the rules (rules which the childrens ward ignored - to everyone's benefit - I noticed), so even though I would hope to be up and about very quickly after my next CS I know I'm going to miss that little bit of extra on-hand help I had by having my partner next to me.

ISpyPlumPie Tue 19-Mar-13 11:59:16

I'm really fortunate as have had 2:1 care from two pairs of fantastic mws during both births (one hospital birth with a supervising and student mw, and one hb). This has been assisted by having relatively short labours but I found it so beneficial having the same carers throughout. Difficult to see how this could be guarenteed though as shifts must come to an end.

I saw different mws both times for antenatal appts. Second time round, they were all great and the lack of continuity didn't bother me though as a PP said this was prob due to having an uncomplicated pg and no other issues that would have been difficult to discuss with a variety of people. I found it a bit harder first time round, partly due to being more anxious with everything being new to me and also due to one particular mw (the one I saw the most) who was rude and dismissive, to the point that had she turned up to deliver DS2 I'd have transfered in there and then! So I agree continuity of care can be a mixed blessing - depends who you end up with.

Overall, think continuty in labour is desirable if it can realistically be achieved but attitude of hcps is the priority and also that the choices of all women should be respected irrespective of venue/method opted for.

TeggieCampbeggBlegg Tue 19-Mar-13 11:59:52

How apt.

Look up at the top of active convos for the Site Stuff sticky, regarding the new Birth Choices factsheet.

badguider Tue 19-Mar-13 12:05:14

choice is important to me, and i like to be well-informed but i'm happy to do my own research (i work in science communication).

but continuity doesn't bother me much, i am currently 'low-risk' without any ongoing health issues so not much to explain or worry about the MW understanding. i don't care about continuity of GP either, probably cause i have no ongoing issues, so i just see whichever doctor at the practice is free. I appreciate there are many reasons why continuity of MW or GP would be good for some people but it's not important to me.

I saw one MW for booking in, a sonographer and a different MW for my 12wk scan, I spoke to a third MW on the phone to get my 16wk appt and 20wk scan appt and "my" midwife named on my notes is another name entirely. Doesn't bother me, I'm more concerned about convenient appointments so I can try to keep my business functioning than seeing the same MW (which would really constrain availble appointments).

tigerlilygrr Tue 19-Mar-13 12:18:33

Another vote for kindness being more important than continuity. I am not sure the skillset for community midwives is necessarily the same as for midwives who actually deal with labour? Please correct me if I am wrong. I want someone who can negotiate through the various care options with me while I am pregnant, and someone who has a greater or perhaps more recent level of obstetric knowledge, for the birth. In my area there seemed to be pronounced differences between the two; I don't know if this is common.

Yy btw to post natal care being of a much lower standard. I gave birth in a busy London hospital and I struggled to make myself understood to some of the post natal ward staff. Such a contrast to the other HCPs I met whilst pregnant.

stargirl1701 Tue 19-Mar-13 12:24:13

I had continuity of care. The midwife who cared for me in my pregnancy delivered my baby. NHS Tayside at Perth MLU.

manicinsomniac Tue 19-Mar-13 12:35:16

I didn't care about any of those things.

I just wanted someone - anyone - to get the baby the hell out of me as quickly as they could. grin

louschmoo Tue 19-Mar-13 12:43:31

Yep, same goes for me as most posters - competence, kindness and willingnessto listen/treat me as a real person. That's really all I need! And higher staffing levels on postnatal wards so the staff aren't running round like blue arsed flies. I couldn't care less about continuity and if I have confidence in the staff I meet then I am not so concerned about choice.

Continuity of community care is good because they learn you. I had the same community mw for both DCs and will be trying to get on her clinic again this time because she is ace.

As for labour... my first labour straddled three shifts. Nobody who had been around on the Fri/Sat night shift would still have been much use on Sunday morning without a significant break (I include myself and DH here).

Second time I was very quick but still managed to arrive during shift handover.

Perhaps it would be helpful to stagger shifts - ours on L&D appeared to be 8-8 and 8-8, and if some staff had been on 2-2 or similar instead it would have made a big difference to my care.

autumnmum Tue 19-Mar-13 13:43:38

My first child was born in NZ where I had the same midwife the whole way through. It was a disaster! She had no back up and when I went into labour she was so tired she actually fell asleep. Birth was horriffc because she missed my daughter was breech and I ended up having an ECS. DC two was born in the UK and I never had the same midwife twice, but none of them fell asleep! It's standards of care that matter, not having just one person.

sandberry Tue 19-Mar-13 20:13:54

When I was first a midwife I actually worked in a team providing continuity of care and it was great.

We attended at least 15 births a month between us so were up to date with the whole range of care, all appointments from booking to postnatal were done at home which was great for the women but not so great for the midwives. Every woman (except those having ELCS and induction) was offered a home assessment in early labour so nobody went to hospital too early and got sent home. Women could choose place of birth right up until labour. 30% chose to give birth at home.

Midwives worked in pairs and it was a team of six who backed each other up, so no falling asleep in labour for the midwives and women while they had a closer relationship with one or two midwives could meet all six during pregnancy if they wanted to and since we all shared antenatal classes many did. I did pull a couple of 24 hour shifts but only because I was very close to those particular women and I had another midwife there too.
If you didn't like your allocated midwife, nobody ever had a problem with you asking for an alternative midwife.

It was a model for great maternity care and was in inner London too. It is still going although they have changed how they do care slightly and it is more of a team approach and most antenatal visits are in a clinic.

It isn't impossible to provide both continuity and high quality care in the NHS for reasonable cost, it is just someone has to be committed to the organization of it and consider how to provide it within the constraints of midwife work-life balance. It is notable that out of 6 midwives, 5 were young and childless.

sandberry Tue 19-Mar-13 20:14:43

As for continuity, I think most of the research shows that if you've had continuity of care, you think it is important.If you haven't you think it isn't.

INeedThatForkOff Tue 19-Mar-13 20:20:06

I consider myself (us, as a nation) very lucky to have free and skilled midwifery. Giving birth in safe, experienced hands was enough for me.

I tend to agree with my midwife aunt who believes home birthing to be an unnecessary risk. It also seems to be a waste of resources to me when a hospital delivery would more than suffice. Perhaps choice should come at a (monetary) price.

INeedThatForkOff Tue 19-Mar-13 20:29:24

I sort of missed the point there, didn't I?

I did initially hope for continuity at antenatal, during labour and postnatal stages, but it wasn't a problem that I didn't really get it. This time I remember wishing that there didn't have to be a shift change as I was comfortable with my midwife, but the one who came on shift was absolutely bloody wonderful.

Postnatally I saw three different MWs, none of them my antenatal MW, but they all brought something different to the experience.

I think I'm quite lucky in that of the many, many MWs I came into contact with during two pregnancies, including the postnatal stay and home visits, there was only one I didn't take to, and she was just a bit snotty, not unkind. I actually think they're a special bunch of people.

MiaowTheCat Tue 19-Mar-13 20:30:15

I had a horrific birth last time leavibg me with severe trauma issues and haunted by nightmares for nearly a year.

Just given birth again today and while the same physical stuff went wrong- I was listened to and treated like a person and not just a piece of meat
Made more difference than having the same face dealing with me to be honest!

redwellybluewelly Tue 19-Mar-13 20:39:55

I've posted tonight in SN and in Childbirth topics

DC1 - left brain injured due to shocking maternity care in delivery. Completely and utterly avoidable.

DC2 - promised continuity of care, assistance with severe anxiety. Found out today the consultant who promised better care has gone ahead and booked my ELCS without any discussion on dates. As yet I also have no MH support. There is no MH support for pg women in our PCT. I'm fairly sure they are breaking NICE clinical guidelines.

Good maternity care isn't just about the birth, its about being supported during the pregnancy as well.

oohlaalaa Tue 19-Mar-13 20:46:16

I had different midwives throughout. It didn't bother me. I also had a straightforward labour, and good birth experience. Perhaps if it had been different, I'd care more.

ukatlast Tue 19-Mar-13 23:57:57

The main thing I care about is for a woman to have a right to choose pain relief (eg epidural) early on during labour - why suffer unnecessarily? Ditto elective C-section in advance.

It is good to have the same midwife ante-natally but highly unlikely you will see the same one at delivery - don't mind this as people do have to change shift anyway.
Kindness and competence are the most important factors as others have said.

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