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Live webchat with shadow health secretary Andrew Lansley, Tues 24 Feb, 12-12.45pm

(109 Posts)
GeraldineMumsnet (MNHQ) Thu 19-Feb-09 11:11:27

We're welcoming Andrew Lansley as our webchat guest on Tues 24 Feb. He's interested in Mumsnetters' take on the Tories' research about women in labour being turned away from maternity units. Please join us if you can, or post questions in advance if you can't make it on the day.

Lulumama Thu 19-Feb-09 11:30:52

Surely the answer is obvious? maternity services need a massive injection of cash. Our local unit has had to close due to lack of staff, there are simply not enough to cover due to unexpected illness /absence . There is not enough money there to pay for more staff.

Surely it is cheaper in the long run to employ more midwives and keep more units open than to face expensive, time consuming litigation to babies being born compromised ( or worse ) or mothers being compromised due to lack of care in labour.

Our local MLU closed a number of years ago due to lack of use, the CLU has had to close a number of times to being full over the last year... cost cutting in the wrong areas?

a bad birth experience can scar a woman emotionally and physically for years, which in itself means more use of NHS resources, cost cutting in maternity seems to mean costs rise elsewhere. false economy and putting the vulnerable at risk... newborns and pregnant women

How would the tories raise more funds to pay for more staff/units if they don;t want to raise taxes? or how else do they propose to tackle this issue?

<<gets off soapbox>>

OracleInaCoracle Thu 19-Feb-09 12:37:06

what lulu said. I find it shocking that in this day and age a woman can labour on her own for hours without a professional so much as looking in on her. I too was left alone for 4 hours during labour with ds, i was unconcious for 3. my dh didnt know what to do or who to look for. he was terrified and in the end knocked on a cons's door, cue terrifying dash to theatre because we were both dying. as a result i was severely depressed for a long time and quite possibly will not have any more children. could have been avoided with more mw's and less notice taken on keeping statistics within national guidelines

rubyslippers Thu 19-Feb-09 13:24:13

what Lulu said

my MW do homebirths in their own time hmm

I have been told that things are even worse at the moment as well - severely over stretched and unlikely to get better

it is a disgrace

SnowlightMcKenzie Thu 19-Feb-09 15:57:40

Hello Andrew,

In my area, women are guilted, blackmailed and turned away from their choice of birth place very regularly.

Do the Torys support the right of women to birth at home? Do the Torys support the training of MW to feel confident and competent with homebirths? Do the Torys acknowledge that homebirths generally require less medical intervention and therefore would cost the NHS less overall i it were normalised, even with aditional midwives?

As an aside, but extremely important with regards to maternity provision, there is currently a ridiculous drive to encourage women to breastfeed, but lack of support and help if a woman hits problems, resulting in many women experiencing misery for weeks and then guilt when giving up, or worse a dehydrated newborn (current news). Do you have any plans to address this?

Thank you.

Maiakins Thu 19-Feb-09 17:44:43

Hi Andrew,

The main answer is surely more investment in maternity - more normal maternity beds, more special care beds, and more midwives (especially those trained in home births).

However, I'd also like to make the point in relation to hospitals being overstretched and turning people away, this is a big issue for women expecting multiples (twins/triplets etc). Lots of my friends have gone into labour and then ended up having to be airlifted to hospitals where there are enough special care beds to cope with the twins. Or had the babies and then one or more baby has been sent to other hospitals hundreds of miles away immediately after the birth. You can just imagine what kinds of implications this has for the mother-child bonding, when the child is miles away! Perhaps the Conservatives could review whether IVF clinics should implant more than one embryo, as it is a proven fact that multiples generally require special care and maybe this would relieve pressure on already overstretched special care units and mean less turning away of expectant mothers who need the space?

Thanks.

Angela2105 Thu 19-Feb-09 20:10:18

Hi there,

I would agree with it all. Midwives are overstretched to the limit. I was a week overdue before going into labour, which lasted 5 days before C-section. When I finally (self-admitted against the advice of the midwife on the end of the phone) went to hospital, I was 3cm dilated and not allowed to go into labour suite or receive pain relief until 5cm. When finally "allowed" to go upstairs to the labour ward, we had to wait for another hour in the staff room until a suite was free. By this point I was 10 days overdue, had been in labour for 4 days with no pain relief, afraid and terrified of being sent home whilst the staff were coming in and out for their coats and tea! I never did get to 5cm as baby was in wrong position and we would have died before reaching that magic number. Obvious statement but we need more midwives and one-to-one care. It's tough, but essential. What could be more important?
Thanks.

herbietea Thu 19-Feb-09 21:22:03

More money needs to be put into maternity services in general.

Women need support in order for them to have the birth of their choice.

More midwives need to be able to find employment in this counrty once they have qualified.

It is a waste of money, time and resources to train midwives in order for them to end up on the dole or the checkout at Tesco as there are no posts available for them as midwives.

Slight hijack here - but in the light of the tragic case of Jade Goody will the Torys get rid of the post code lottery that is health care. Young women in England are dying as they can't get smears until they are 25 yet it is age 20 in the rest of the UK.

I am sick of being treated like a second class citizen with regards to health care because I am English and live in England.

hunkermunker Thu 19-Feb-09 21:35:54

Hi Andrew

Maternity services are underfunded and in many areas woefully inadequate. There are many decent, hardworking professionals in the service and it's often only their dedication that means things don't go wrong more often.

One of the enormous issues is breastfeeding support and the conflicting messages that women get whilst pregnant and as new mothers. Health professionals are often poorly trained, have no idea how to support a woman to start to breastfeed or what to do if she hits problems. All too often the "answer" is "here's a bottle".

And then there's guilt. I've written more about it here: http://www.howbreastfeedingworks.com/?p=58

I'd be interested to hear your thoughts on breastfeeding support. And not just "oh, yes, there should be some" but what you'd do to increase it. Do you, for instance, support the ban on ALL formula advertising, which would make it far easier for eg parenting magazines to run better articles because they're not worried about upsetting their advertisers? How about infant formula advertising to health professionals? Why is that still allowed?

Since nobody ever clicks links (wink), I've reproduced the guilt article here with, er, my permission:

"Breastfeeding Awareness Week, like a lot of the breastfeeding promotion stuff - I wonder whether it’s really only speaking to those who are likely to breastfeed anyway, come what may. Don’t get me wrong, I’m not knocking the excellent work done in raising awareness of the issues surrounding breastfeeding. For instance, campaigning for women to be able to breastfeed in public without people harassing them (and new legislation means this is the case, not just in Scotland but in England and Wales as well - at last!). The comments on that article show that this legislation is sadly needed. And there’s no doubt that more women are beginning to breastfeed now than ten years ago, than twenty years ago. But the length of time for which women breastfeed exclusively is still all too brief, so something’s going awry between initiation of breastfeeding and first and subsequent formula feeds that needs to be addressed.

We could perhaps begin do this is if we were to move away from talking about the benefits of breastfeeding and start talking about breastfeeding as the default option, the baseline. To do this, we would necessarily have to talk in terms of the “risks” of formula feeding. This would be uncomfortable for many women with children of all ages who have had the “choice” to formula feed thrust upon them by poor support from ill-informed and badly-trained healthcare professionals and also the general bottlefeeding culture we have in the UK - we don’t, as a rule, know how to support our friends and family to breastfeed.

One of the ways that formula manufacturers try to limit discussion of risk is by putting the “don’t make women who can’t breastfeed feel guilty” message out there (it’s a key marketing strategy) and I promise, that’s the last thing I want to do. But I’d like to unpick that statement, if I may.

Why do women feel guilty about formula feeding?
One possible reason is that they wanted desperately to breastfeed, they bought into the list of “benefits” wholeheartedly and they are aware that, whilst their child is likely to thrive on formula (in the West, anyway), it’s not what they wanted to do. It’s not how they envisaged being a mum. And the unspoken question is always if “breast is best” then what is formula?

Another reason is that they don’t want to breastfeed at all, yet feel they ought to, or ought to want to. Some women in this situation might breastfeed for a time, but not really enjoy it and feeling burdened by something you are doing, or feel you should be doing is often a reason to feel guilty about it. This is especially the case when it comes to children - so much airtime is given to how we’re meant to raise children these days (from Annabel Karmel’s endless reams on “how to make mashed potato interesting by putting faces on it with salad vegetables” to Supernanny’s insistence on “unasseptable behav-yur”) that it’s impossible to have a baby and not know you’re “meant” to want to breastfeed.

Can anything be done about this?
Well, the first group of women, those who wanted to breastfeed and were let down by those who ought to have been helping them - yes, a lot can be done there. Better-trained staff, a society that accepts breastfeeding, whether in a job centre, in family court, in McDonald’s or in an art gallery - all this would help to ensure a more conducive atmosphere for breastfeeding for any length of time. I believe that this would address to some extent the second group of women I mention - those who don’t really want to breastfeed. If it was the default option, more of them would feel comfortable giving it a try and if more women were breastfeeding in wider society, it might not be the isolating experience it can be now for some women.

What about the “can’t”?
This is something I often question when I am told “don’t make women who can’t breastfeed feel guilty”. There are women who can’t breastfeed, of course there are. And of course I would hate to make them feel guilty. But this statement doesn’t mean them - or rather it doesn’t mean just them. It really means “don’t say anything to make women who could actually have breastfed perfectly well, but were let down by those who were meant to be helping them feel guilty - because otherwise we might have to do something to improve support for them in the future and that’s bound to be expensive”. I’ve heard this exact statement from an MP, a local councillor and a GP in recent weeks in the context of “it’s all well and good trying to improve breastfeeding support, but it makes women who can’t breastfeed feel guilty”. Depressing, eh? The very people who are placed to help - and they’re peddling the line that formula companies use to stifle debate about infant feeding.

So, shouldn’t we be aiming for a situation whereby every woman who wants to breastfeed and can physically do so (and some 98 or 99% of women fall into this category - and yes, I’m well aware that it’s not just physical ability that informs a woman’s feeding decision) actually does breastfeed for as long as she wants? What would we need in order for that to happen?

We’d need to stop talking about breastfeeding as a “nice to have”, an “optional extra”, something that “adds benefit” - because if we keep referencing it in those terms, we necessarily set formula feeding as the baseline, the “good enough”, the “norm”. And we sweep any risks or detriments of formula feeding under the carpet, in case we make anyone feel bad.

But I wonder whether, for long-term gain, we need to start thinking in ways that are likely to cause discomfort for some women - by starting to talk more openly about the risks of formula feeding. Only then will society begin to see that breastfeeding shouldn’t be seen as something you do for a bit, if you must, something that isn’t very important, because formula is the same as breastmilk - or very nearly. Isn’t it?

Let’s see how we might talk about risk rather than benefit. Here’s a list of “benefits” of breastfeeding - we can turn them very easily into a list of “risks” of formula feeding - look:

Breastfeeding helps protect your baby against:

* ear infections
* gastro-intestinal infections
* chest infections
* urine infections
* childhood diabetes
* eczema
* obesity
* asthma.

Breastfeeding helps protect mothers against:

* ovarian cancer
* breast cancer
* weak bones later in life.

Women who breastfeed return to their pre-pregnancy figure faster.

Formula feeding increases the risk to your baby of:

* ear infections
* gastro-intestinal infections
* chest infections
* urine infections
* childhood diabetes
* eczema
* obesity
* asthma.

Formula feeding increases the risk to the mother of:

* ovarian cancer
* breast cancer
* weak bones later in life.

Women who formula feed return to their pre-pregnancy figure more slowly.

There are more risks listed here and numerous studies listed here

I appreciate that this is an uncomfortable way to talk about this and I am truly sorry if I’ve upset anybody. But I do think it’s necessary - or we run the risk of reaching a plateau with breastfeeding rates in this country - initiation will be OK, but numbers will still dwindle and women will still be being let down in the first six weeks. If breastfeeding isn’t viewed as important by those whose jobs it is to change things, if it’s deemed inappropriate to talk about the issues surrounding the risks of formula feeding for fear of upsetting those who have already been let down or made decisions based on half-truths and saccharine facts, nothing will change.

What do you think? Is it kinder not to talk about risks for fear of upsetting women who’ve already formula fed? Or is it doing a disservice to those women yet to have babies if we don’t talk about infant feeding in these terms? Is it, in fact, one of the biggest lies of early motherhood that it doesn’t matter how we feed our babies and women should concentrate on not feeling guilty or making other women feel guilty? Please don’t regale me with anecdotes of sickly breastfed babies you know and robust toddlers who’ve been formula fed. I appreciate that both of these exist, but it’s not helpful to get too involved with snapshots of children at a particular point in time.

Should we, in fact, have a Formula Feeding Awareness Week as well, where risks are discussed, rather than benefits? It would raise more eyebrows than Breastfeeding Awareness Week - but would it achieve anything except anger at “breastfeeding mafia” types? Because if we look a bit more closely at the women who are supporting breastfeeding, for every one smug idiot type, there must be 100 who get on with it, quietly, intelligently and empathetically. And the smug idiot types do exist - and I loathe them, as much as you do, if not more - because they make my job considerably harder. Not only am I trying to compete with the £multimillion spend of the formula manufacturers, I have to also counter the idiotic statements made by boorish fools who think they’re supporting breastfeeding, but they’re in fact just trying to bolster their own self-esteem and mask their own failings by being smug about the one thing they’ve got right in their tiny lives."

SnowlightMcKenzie Thu 19-Feb-09 21:53:11

Erm, - what Hunkermumker said. Yes all of it!

hunkermunker Thu 19-Feb-09 23:01:19

Hmm, people can't click links if they're not links... www.howbreastfeedingworks.com/?p=58

sassy Fri 20-Feb-09 10:06:32

<applauds hunker>

Exactly what I was coming here to say. Let's have more pressure for proper breastfeeding support.

TheyCallMePeachy Fri 20-Feb-09 10:33:08

What Lulu and Hunker said.

I had to fight for my homebirth,not wanted because of any hippy tendencies (not that I havea problem with thos eeither- a woman should have a right to birth how she needs), but for the very simple reason that I did not have access to childcare for two autistic children and wanted my Husband with me. Forcing vulnerabe womeen to fight for something they need is wrong. Yet it seems only the 'strongest' can make themselves heard.

Then to BF- staff employed in a role where thwy give breastfeeding support yet less qualified than myself! Every staff member likely to come into cntact with women needing support (Midwives, Health Visitors, GP's, HCA's), should be trained to at least BFI level as a minimum. Thr HV who told me 'you can't breastfeed as you are allergic to milk so can't make any' is now employed in a breastfeeding advice role. Unbeleivable.

Thank you for coming in, we really do appreciate it. Now,if you could send your colleague in the education dept here I would like chat about SN education smile. Thank you.

TheyCallMePeachy Fri 20-Feb-09 10:33:56

(Oh and apologies for typo's- out to get my new keyboard this very day!)

cmotdibbler Fri 20-Feb-09 13:02:53

When I went into premature labour, I got the last bed in the maternity unit. That night a woman gave birth on the antenatal ward as there was no where else for her to labour. The area I was in had the highest rates of maternity unit closure in the country, yet still the services were being reduced such that Mid Sussex would have one CLU for the whole area - a drive of an hour from where I lived.

I had poor care - no one checked on me, spoke to me, or seemed to worry once I had been admitted with PROM until I was found in full blown labour in the night. I had 8 different midwives in the labour suite in 6 hours (no, not crossing shifts). After birth and a haemorrage I was left on my own and expected to take myself to SCBU to see my baby. In 5 days on the ward I was not examined once, and wasn't even spoken to more than being seen in the corridor.

I could go on a lot about this, but even so, my birth experience was 1000x better than my miscarriage 'care'. You might like to read some of the experiences posted on Mumsnet to see how appallingly women and their families are treated at a traumatic time

HerBeatitudeLittleBella Fri 20-Feb-09 15:19:44

Absolutely everything Hunker said. Proper breastfeeding support as opposed to the current lip service, is probably the single biggest public health measure we could take at very little cost to the public purse considering the huge benefits, but amazingly, politicians who should know and care about it, are in utter ignorance. Please don't be one of them, Andrew, read and learn!

TheyCallMePeachy Fri 20-Feb-09 18:09:08

cmot that'ssad.

Had I not got my homebirth ds4 would have been bornm on the roadside, probably in Tesco Express petrol station hmm- not everyone can get to a unit an hour away in time! Only one MW made it as it was, fortunately there were no issues and I had a lovely doula to help. The current system is failing.

Bluemary3000 Fri 20-Feb-09 21:24:51

I whole heartedly argree that women should be able to give birth where ever they choose. I live in West Sussex and 20 mins drive away (30 mins peak tarffic)from another hospital in East Sussex, but yet I am told that I should give birth in a West Sussexeven though it is approx 1hrs drive, with good traffic. Thankfully I stuck my foot down and I managed to get the one I wanted and ended up having a long and painfully drawn out, but very successful birth. That was Nov 2007, since then they have been trying to close my hospital of choice's Maternity unit down and so wanting a 2nd child, have felt a race against time, just so I can go to the hospital of my choice. I am now 9wks preg again, and booked in, so heres hoping for a good birth this time.

A quick note though about this breastfeeding stuff. I too said I would breastfeed for as long as possible, and got fantastic support for it, but when it came down to it, I loathed and I mean not only disliked, but hated it. It was the most un-natural thing for me to do and I must say I was made to feel like a criminal by my health visitor and found no support or advice on how to go about changing from breast to formula. (I managed 2 wks solid feeding, with 2 wks, mix of bottle and breast.) I understand statistically that 'breast is best' ( Though if I am told that one more time I will scream!!), but how are you suppose to formula feed a child as safely as possible if no one will help. I will second time round bite the bullet and breastfeed for the same amount of time and at least I will now know what to do and will not feel guilt ridden that society hates me for not doing the supposed right thing.

I dont mean to rant, but I was always asked if I felt post natally depressed and the one thing that would have made me, was the health Authorities way of dealing with formula feeding mums, so please can more advise be given if asked for on formula feeding, because if you get it wrong, there is the potential to cause serious illness to your child.

Sorry forgot to say if you want loads of MW's at your birth, go into labour evening time when England are playing football and make sure you get one of those TV's. They all come flocking to your room then!!

grin

noonki Fri 20-Feb-09 22:05:23

Hi Andrew

my main question is around hospital cleaning.

Would he also be advocating the re-nationalisation of hospital cleaning. A major issue on maternity wards.

I was a cleaner at a hospital in 1992/3 when the service became privatised and instantly saw the decline in the service. Would the tories reverse this disastrous act?

I was at hope hospital maternity ward for 10 ddays and had to ask the cleaner to clean under my bed 6 days in as theor were dirty cotton balls from the previous patient in there.

I would have been well and truely told off by the ward sister (a big loss).

noonki Fri 20-Feb-09 22:05:25

Hi Andrew

my main question is around hospital cleaning.

Would he also be advocating the re-nationalisation of hospital cleaning. A major issue on maternity wards.

I was a cleaner at a hospital in 1992/3 when the service became privatised and instantly saw the decline in the service. Would the tories reverse this disastrous act?

I was at hope hospital maternity ward for 10 ddays and had to ask the cleaner to clean under my bed 6 days in as theor were dirty cotton balls from the previous patient in there.

I would have been well and truely told off by the ward sister (a big loss).

Quattrocento Sat 21-Feb-09 10:41:53

There is a closely related issue which I am not sure if Andrew Lansley is aware of - which is of women being taken into maternity units but not being assigned delivery rooms. This means they have to lie in antenatal delivery wards which are in public to do their labouring - pretty shitty environment when all you want is a bit of privacy. Also some antenatal delivery wards (mine) are not fitted with gas and air. So imagine that level of physical pain being endured in public without any pain relief. In my case this went on for 8 hours.

That's what happens when the units want to avoid the bad publicity of closure. Vile way to treat women, IMO.

TheFallenMadonna Sat 21-Feb-09 21:39:02

Hello. I know you are asking specifically about maternity services, but may I ask about another healthcare service? I raised concerns about my daughters language development at 18 months. She was seen very quickly in an audiology clinic, and this was followed up as promised at age 3. I have no complaints about this service smile. She was referred to the Speech and Language
Therapy Service aged 24 months. They are committed to an initial assessment within 6 weeks. That was not the case. She was seen after 3 months and put on the waiting list. We were told it would be about 6 months. She was in fact had to wait 13 months. I do have friends who were seen more quickly and received excellent support for their children with more significant language disorders, but my impression was of a severely overstretched service, particularly for those children who were lower priority. I wonder if you have any thoughts on support services and ways to improve access for all children who need them.

bizibee Sun 22-Feb-09 21:35:16

The ONLY intervention that has been shown to improve outcomes in labour for both mother and baby is one-to-one care. It doesn't have to be a midwife but it does have to NOT be a husband/partner. Time and time again we hear that one-to-one care is a goal but we are no closer to providing it now than we have been for years. Midwifery numbers are constantly shaved when Trusts have to make "cost efficiency" savings. If the improvement in outcomes could be achieved by a prescribable drug NICE would have long ago insisted on it being available for every pregnant woman. Women can choose a Caesarean section (with about 3 doctors, one midwife, and 5 operating theatre staff) but cannot choose one-to-one care in labour. It is no wonder that some women choose the CS route, knowing that the theatre will be properly staffed.
Women being turned away is simply a symptom of a system that is not designed to run at maximum capacity because providing over-capacity is too expensive (if you are a manager rather than a prospective mother). Perhaps each pregnant mother should be allocated their own pot of money to spend on the delivery of their choice, in the place they choose. Or perhaps we could appeal to NICE to make midwifery care in labour a precription so that they could then force Trusts to provide it.

BigTeuchLittleTeuch Mon 23-Feb-09 10:45:01

From my personal experience, I would like to see some flexibility in the strict admission protocol that many maternity units have.

Whilst I suspect that this is a symptom of lack of space/funding, it is seriously short-sighted when women (like myself) end up labouring without pain relief and having a more traumatic birth than was necessary.

It was the strict "contractions must be closer than 2-3 minutes and lasting 1 minute" rules that meant I was turned away less than 2 hours before delivery (in the early hours on a very icy night) and only returning minutes before delivery.

This was my 2nd child and despite repeatedly telling anyine that would listen that my contractions never regulated and never lasted more than 45-55 seconds NOBODY LISTENED.

I was reluctantly re-admitted, they refused to give me even gas&air as I would 'need it later' apparently, and were reluctant to examine me. I know all of the justification for this approach, but surely listening to the woman would be top of the list? I gave birth a few minutes after I requested an examination.

Rant over!

BoffinMum Mon 23-Feb-09 14:32:08

Please could we have a view on what the Tories plan to do about independent midwifery?

In some parts of the country the only way of being sure you can get a midwife when you need one is to actually hire your own, yet they are on the brink of being outlawed by the current administration because of the unavailability of indemnity insurance. Apparently this situation rose because of a negligent private dental surgeon, and had nothing to do with poor midwifery practice and associated increased risk. Midwifery is, after all, one of the most closely regulated professions in the UK and many independent midwives work as NHS bank midwives concurrently with running their private practice, so are highly professional.

Perhaps if a voucher system existed for midwifery care, women could vote with their feet and receive the care they deserved, instead of being herded like heifers into overstrained and inadequate maternity departments. We could probably save the cost of many Caesarians as well.

BumpMakesTwoAndABit Mon 23-Feb-09 14:54:08

I can't make the webchat due to work, but I wholeheartedly second pretty much everything that's been written above.

I'm planning a homebirth, because

1. I think it would be considerably less stressful to have a planned homebirth than to be turned away from the hospital 3 times and then have an unplanned, unattended home birth 10 mins after arriving home for the 3rd time, as happened to a friend of mine.

2. At present, no strains of MRSA, C.Diff, salmonella, or anything else have been discovered at my house, unlike in the ante- and postnatal wards of my hospital.

3. None of the loos, or loo/bathroom floors, in my home are covered in blood and faeces, unlike the ones I have experienced in the A&E and gynaecology wards of the local hospital.

4. My local hospital frequently closes its L&D wards due to lack of capacity. Women are diverted to another hospital approx. 20 minutes away in off-peak, or well over an hour away in rush hour (the South Circular isn't known for being a speedy route at 8am). This 'next nearest' hospital is due to have its maternity facilities closed at some point in the first six months of 2009 (I'm due in July), raising two questions: where will women from hospital 1 be diverted when hospital 2 closes?; and which hospital will absorb all of hospital 2's usual capacity? It seems to me that my chances of finding a hospital bed within 90 minutes of home by the time of my due date are very low indeed.

5. There is considerable discussion at the moment over whether or not there are enough midwives to attend home births. However, it seems that being in a hospital delivery room is no guarantee of being attended, either. I know two women who were left unattended in labour, as the MW was looking after 3 delivery rooms simultaneously, and in both cases the husband had to search for help when he saw the baby's head crown. If by the late stages of labour at home no MW has turned up, I would at least feel confident that paramedics or even my local GP would make it in time to help. I would feel extremely distressed and upset in hospital if I was left alone, with the baby's head crowned, whilst my husband had to leave me in order to search for help.

In summary, I have absolutely zero confidence in the ability of the local NHS hospital to deliver my baby safely and without unnecessary distress. I wouldn't choose to have my baby at home, but I feel it is by far the lowest-risk option.

To be fair, I do realise that it is not always the hospital's fault; several friends are hospital consultants, anaesthetists, etc, and all have said that in my area (South London), there is a very big problem with immigrant women turning up in later stages of labour, not registered with a hospital, not registered with a GP but who obviously need to be cared for. The issue is that although the hospital knows how many pregnant women are registered to give birth within a particular date range, it does not know how many unregistered women will turn up. One friend said that during his obs&gynae rotation, 50% of the deliveries on one particular day were to women not registered with the NHS, and of whom the hospital had no prior knowledge (and who didn't speak English, making the MW's job that much more difficult and requiring more people to be present). How can you plan for that?

I don't have a solution, but the problem of under-staffed, under-resourced, filthy hospitals needs to be addressed fast. Preferably before July grin.

MARGOsBeenPlayingWithMyNooNoo Mon 23-Feb-09 18:29:17

I find it extremely confusing that freebirthing (it that is the correct term) is so severely frowned upon when effectively that is what the NHS seems to be forcing on labouring mums.

One of my friends gave birth last week and they told her not to come in as it was too busy. When she did go in, she was placed in 5 different rooms over the duration of her labour, one of them being the MW staff room.

BoffinMum Mon 23-Feb-09 18:46:22

That is a shrewd observation, Margo. My local hospital is stuffed to the gills with women labouring alone. What a horrid situation to find yourself in.

HalfMumHalfBiscuit Mon 23-Feb-09 19:21:10

I won't be able to join the discussion due to work but I would like to add that I was really shocked by my experiences during pregnancy and birth due to the lack of Midwives and facilities in North Wales.

I had a different midwife just about every time I went for an appointment which I found quite stressful. I actually cried after my first appointment as I felt so disappointed at the rushed session. I felt that the midwives were rushed as there were not enough of them to cover all the pregnant ladies.

I had a terrible time in labour and at the hospital. There were not enough doctors or midwives on the ward. I was in labour for 36 hours then ended up having an emergency c section after one of the more experienced midwives decided enough was enough. I planned a home birth but lack of attention by midwives meant that the baby being in the wrong position was not noticed. I would point out that if this had been correctly diagnosed earlier it could have saved the NHS a lot of time and money - and would have saved me going through such a long labour followed by a serious operation!

After the birth I was amazed at the lack of attention I was given on the ward due to lack of nurses / midwives. They were great people but just too busy to help everyone enough. There were at least 10 ladies who had just gone through a c section on my ward and one night there was just one midwife on cover. I would like to point out that if you need to feed your baby it is very difficult to sit up after a c section, pick up your baby and breast feed without assistance. I often pressed the call button for help but was told to wait or I didn't feel I could press the call button. Please, please increase the number of staff and options available during pregnancy, birth and after care. I sincerely hope no one has the terrible experience I had. To top it off I had PND. Would this have been the case if I had had more help in the first days after the op?

I have only recently got over this experience enough to even contemplate getting pregnant again. Surely the state of the local maternity unit should not be a factor of family planning.

Please look after Mums and new babies. It is your duty.

What would a Conservative government plan to do with primary care?
Are you in favour of continuing fragmenting care with poly-clinics and walk-in centres, therefore providing at best average care but which costs more in the long term?

Poohbah Mon 23-Feb-09 21:33:52

I gave birth at Chelsea & Westminster Hospital in 2006. I had a different midwife for every antenatal appointment and each shift, 3 shifts a day for the 8 days that I was in hospital following the birth. I was in labour with the tealady mopping around me on the antenatal ward in full view of visitors and other patients following an induction. I had pre eclampsia and the clinic midwife couldn't get me an appointment with the consultant basically putting my life at risk. Eventually I saw him at his gynae clinic which is really inappropriate given women in that clinic are in that clinic for very different reasons.
The midwives could not provide any sensible continuity of care and my baby became jaundiced due to lack of support. I had no practical help from the midwives to care for my baby despite having a really high blood pressure and having not slept at all following labour to enable me to rest. I couldn't rest at all as my baby was having phototherapy and kept kicking off the visor that was protecting his eyes. I slept for 2 hours in total during the 8 days I was there. I had a lot of conflicting advice. The paediatricians prescribed formula milk but the midwives refused to provide enough formula milk to prevent him becoming dehydrated. I had to beg and I mean beg for milk for my baby off them. There weren't enough breastpumps, milk bottles, sterilising units, teats, for the ward which meant waiting for up to half an hour for some things. This was a real problem given that I had to feed my baby every 2.5 hours, change his inco pads (he wasn't wearing a nappy due phototherapy) and the pads needed changing every 2 hours and sometimes more, and then try to pump my own milk for 20 mins to try to get some breastmilk into him. I had to beg for incopads for him and the midwives would tut when I asked them for more as they kept running out of supplies. The whole thing was degrading, disgusting and even writing this three years later I'm becoming really upset at the memory of it all. I work in the NHS myself and was so horrified at the attitudes of some staff, completely numb and unempathetic as they are so stressed out. Also language was a big barrier when speaking with less qualified and auxillary staff some staff couldn't speak english well enough to be able to do their jobs properly. There was broken glass under my bed for two days. The toilets had blood and faeces in them on regular occassions. The bidet was blocked for five days. One day I got served rotten carrots (with worm holes in) and another day a baked potato without anything else, when I asked for butter, I was told that they had had no butter for 10 days. I could go on. I hope it's better now and that was just a bad patch but It was truly that bad, no mother and baby should have to go through that experience.

Poohbah Mon 23-Feb-09 21:51:45

Oh my point, this is what it is really about....

Stretched services have to maintain a safe level of provision.

The team manager has to make a decision is it better to turn away a mum in labour or provide inadequate care and that hospital risk litigation when the mum and baby suffer or even die to due poor care????

Who takes the blame if the mum or baby is injured prior to receiving a service?? Without adequate assessment and medical notes it is more difficult to prove a compensation claim so it is in an Trusts financial interest to turn a woman away.

Labour have not improved access to maternity services since coming to power, they are obsessed with micromanaging the health services without addressing the real basic issues. Lowered bed occupancy rates, increased staff, cleaners on wards, people who can manage staff and know how to encourage high standards of service. That costs money but would save money as better care reduces unnecessary care.

Finally, they have presided over increased immigration which has put an additional pressure on certain hospitals in certain parts of the country without increasing resources to match the level of immigration. I'm sorry loads of people will not like me saying that but it's true, it's a huge elephant in the room and it needs to be said for the sake of us all.

RANT OVER!!!!! Thanks for listening.

SparklingSarah Mon 23-Feb-09 21:54:46

I agree with the general feeling here.

I am a huge home birth advocate however we should all have the right to birth where we'd like to.
With the full support of everyone on the team.
We should see the same MW each time and aim to know who will most likely deliver.
Our judgement should be encouraged our thoughts and feelings need to be addressed
more needs to be done to help our OH's know what is "normal" and what is not.
and for them to play a role in helping us be it hold our hands rub our back and say you're fantastic or be it kneel behind us in tandem deep breathing - whatever works for us!

Personally I can not imagine birthing anywhere except home I do though realise some women would not feel safe nor comfortable.

There is SO little support with choices
in Northants there are no birth centres the PCT do not advocate nor support home birthing
and will go out of their way to terrify you out of the idea.

the MW attached to the GP surgery would have anyone believe that not having routine tests is a death sentence birthing any other way aside from on back lots of instruments and drugs everyone screaming push is a "hideous idea"
the GP told me I was a ridiculous woman because I wanted to HB.

trying to change MW results in lots of ill feeling.

Luckily I ended up with a MW who had a small client group and a passion for her job who was mostly happy to support my choices

I had a home birth no pain no drugs no intervention no worry.
I went into established labour whispered to hubby had dinner with my family sent my daughter to bed at 9, ran a bath tidied the house up made sure I had things I wanted round me.
11 rang the labour ward to warn them
midnight rang again to say better hurry this is moving quicker than I anticipated
12:15 MW rings to see how I'm going and to tell me he was taking an amble over 12:17 changes his mind about walking the 10 minutes gets in the car.
12:28 he walks up the stairs says hello to my bum!
12:31 he dives across my bed to catch my son

my first HB was unplanned and paramedics delivered because the labour ward was too busy to have me in and asked me to hang on a while no one could have predicted that my first child would only take 5 hours from first contraction to birth.

Luckily all went well and I was glad it went that way.

However what is apparent is that if a woman chooses not to go into hospital we are left to it - I was expected to travel a hour away for the hearing test when baby was just 3 days old the Dr that comes out after a HB as per protocol had NO idea why he was there
I had to explain the MW rang as per protocol to give baby the once over and sign him off to say he's got 10 fingers & toes 2 balls and a willy!
Breastfeeding - again luckily my son has always fed wonderfully but no one really supported me during the early days.
with my daughter noone asked what I wanted to do.

Ladies - the Tories started all the closing down of the small personal units the MW's with such large loads that they are desparatly overstretched the idea that first birth should take 4 hours subsequents only 2 hours before the scalpel comes out.

Labour has done VERY well for the maternity sector.

SparklingSarah Mon 23-Feb-09 22:02:13

oh for any ladies who are Hb ing and worried look up Laura Shanley there gives some decent advice on the whole scenario no holds barred and good middle of the road ideas.

foxytocin Tue 24-Feb-09 05:10:45

Another huge supporter of home births here.

The experience of lack of support in my first labour where I was admitted then induced for pre-eclampsia was so horrendous that I suffered Post Traumatic Stress for at least the first year of my daughter's life due to lack of care on the antenatal ward and more lack of care on the post natal ward. All due to overstretched services and the idea that as long as their actions fell 'within guidelines' then, what is your problem? Where is the humanity in it all?

I still had to fight for a homebirth. The fight left my confidence in the maternity system even more eroded and I then understood why some women preferred to free birth than to ever put our bodies and our baby's lives in the hands of NHS staff again.

scary, isn't it.

foxytocin Tue 24-Feb-09 05:18:12

Exactly what I was thinking when I was pg with DD2 Margo. Some women go to hospital to just about freebirth which must be terrifying.

Most women who plan a home birth educate themselves about the birthing process before hand and would be more mentally prepared to face the eventuality if the midwife didn't make it in time.

wahwah Tue 24-Feb-09 07:18:26

Hi Andrew

I am just old enough to find your party championing improved health services a rather new and strange concept, unless what you're really talking about is improved health care for those who pay more into private insurance schemes. Forgive me my cynicism, in these post new labour days, perhaps the world really has turned upside down.

So what does need to improve and can I ask how you might fund any improvements, would it be through higher taxes, diverting funding from another area, or 'efficiency savings'?

From my own experience, I was amazed by the quality maternity services I received. My community midwives were fantastic and I was supported to have two positive home birth experiences. I couldn't have asked for any more.

londonartemis Tue 24-Feb-09 08:26:44

Hi Andrew
Hospital pregnancy clinics - ..grrrr.
Why are 50 people told to turn up at 2pm, and then hang around all afternoon (when we have work, or other children, or pick ups to do) until we are taken, maybe 2 and a half hours on - all the time trying to work out how the queue to be seen is working? The arrogance of the consultants/midwives who assume we have nothing better to do than wait is infuriating. Why can't they organise timings better? Our time is valuable. We pay for the NHS and deserve a service to suit us, not one which just herds us in. If there wasn't a nine month natural deadline, some of us would still be waiting to be seen.

Jaime29 Tue 24-Feb-09 09:42:38

Hi Andrew

My question is whether the Tories would support an extension of Individual/Personalised budgets into maternity services, enabling many more women to have the option of an individual midwife, home birth etc?

Andrew,

I'm a fairly recently qualified m/w. When I qualified just over a year ago I along with many others struggled to find a job. The press keep on about a shortage of midwives when in reality there is a shortage of midwife posts. The trusts, although understaffed do not have the money to employ more midwives. Therefore qualified midwives are taking office work and stacking shelves - as I had to for many months. What would you do about this?

I have got a job now and the paperwork is unbeliveable and seems to be steadily increasing. For instance if a woman has to be taken into theatre for any proceedure I have to write down exact times of when she went into theatre, what time anasthetic was, names of all staff in theatre, time out of theatre, time into recovery. I have to write this in;

her handheld notes
a sheet that goes in main notes
the main computer system
the theatre book
and now a new ORMIS computer system which is some sort of management/accountant information/auditing system.

Thats 5 different places I have to write down the exact same information. Thats just one example, there are plenty of oter instances where we're duplicating information over and oevr again. I would say that 75% of my job is paperwork/computing. The women suffer as a result.

Another thing - if a maternity unit does have to shut as its full I believe the hospital gets fined. I used to work at a small hospital where one shift all 5 labour rooms were full. We needed to close but the decision to close had to be made by a hospital director (non clinical) as even the head m/w was not allowed to make that decision. We were told we were not allowed to close as we would be fined so the next lady that arrived had to labour and give birth in the coffee room!!!!!

Totally unacceptable and potentially unsafe. If there had been an obstetric emergency the consequences could have been very poor. I find it unbelivable that a hospital gets fined for closing if thats the safe thing to do. What would the Tories do about that?

Its all very well having targets but to fine the hospitals only takes money and resources away from those hosptials. If they're struggling to stay open then they're in need of more resources, not less. Again its the women that suffer as a result.

bizibee Tue 24-Feb-09 10:56:19

Hi Andrew,
a number of points for consideration:
Managers who change posts every 3 years and who are bound by strict financial targets will NEVER invest in quality. Neither will they have the balls to make courageous changes that could enhance real choice.

Targets lead to bean counting and no emphasis on quality.

The hospital/community divide fragments maternity care making things like achieving breast feeding rates we would like impossible.

Have one to one midwifery care underpinned by the Clinical Negligence Scheme for Trusts and it would happen almost overnight.
CNST has been effective in improving outcomes in those areas where it has produced a standard that Trusts have to meet.

As a recent mother and NHS worker I can see that small improvements in basic standards of care will enhance the experience for every mother, but this is a quality issue so not valued by managers striving to meet the budget.
Good luck

AndrewLansley Tue 24-Feb-09 11:42:48

Test

Maiakins Tue 24-Feb-09 11:45:22

Hi - I agree with the women who have made the point about maternity wards temporarily closing being the tip of the iceberg when it comes to overstretched maternity wards. Many more hospitals do not close their doors, but let the women give birth in corridors, in waiting rooms, in any available space really! Several of my friends have given birth in the corridor of our local hospital as there were no beds available! With no access to pain relief and in full view of people walking up and down the corridor. It really is unacceptable in 21st century Britain and this dimension of the maternity crisis should be considered alongside the issue of hospitals shutting their doors. Do the Conservatives agree that this related issue should also be addressed?

wasuup3000 Tue 24-Feb-09 11:47:07

Do you think the government needs to review its services to pregnant woman? Trouble is will a review do any good or just be filled of hot air and money thrown at the Problem?
The main difficulty seems to be a baby boom and lack of midwives and by the time any review policies would make any difference in 5 or 10 years time the baby boom and midwife shortage difficulty may not exist anyway.

GeraldineMumsnet (MNHQ) Tue 24-Feb-09 11:57:01

Andrew is poised to join us, but just a quick reminder that this webchat is 45 mins, not an hour. Welcome to MN, Andrew, and thanks for coming on. There are lots of posts here already, so over to you...

AndrewLansley Tue 24-Feb-09 12:00:41

Hi, thank you for inviting me to join you today. I've been looking forward to our discussion. I've been reading a lot of your questions and views already. I can see that many of you share my concerns about the needs of our maternity services.

ScottishMummy Tue 24-Feb-09 12:03:09

so called "post code lottery".the inconsistent and unequal allocation of resources eg prescribed drugs and services.currently individual PCT and Foundation trusts can chose how and on what they spend budgets resulting in inequitable patchy provision.

the kings fund noted recently said: "The quality of ongoing care varies markedly by geographic location and needs to be improved".

this impacts upon access to prescribed drugs,specialist care, waiting lists for consultants,therapists.causing considerable distress

BoffinMum Tue 24-Feb-09 12:04:26

Having been more or less abandoned by the NHS in my current pregnancy, I'd like to ask what the Conservatives plan to do about independent midwifery. In my area the maternity services are so strained the only way of guaranteeing someone can attend you in labour is to hire your own midwife, yet the Labour administration is seeking to outlaw this because independent midwives are not able to purchase indemnity insurance. This situation arose because of a negligent dental practitioner and has nothing to do with the evidence base for independent widwifery practice. Many independent midwives are also NHS bank midwives and there is no question about their professional competence. So two questions: will you help them continue to practice privately, and will you reimburse women the costs of hiring them, perhaps via a voucher system?

bizibee Tue 24-Feb-09 12:05:35

Hi Andrew,
what exactly are your concerns and do you have any innovatve solutions?

wasuup3000 Tue 24-Feb-09 12:06:03

and the people that run these trusts are often ex supermarket managers trying to run the health service the same way as a supermarket...

AndrewLansley Tue 24-Feb-09 12:08:50

Many of you have raised the issue of home births so let's start with that.

SnowlightMcKenzie, you raised an important question about the right of women to give birth at home. One of my key aims for the NHS is to make it more centred on the needs of patients by making sure that the service is geared towards actually listening to their wishes. That means that women should be able to choose a home birth if they want it, and should know that they will be properly supported in giving birth at
home. It does mean support for midwives too. In the Netherlands, where one third of all births take place at home, there are three levels of support:

1. Maternity Care Assistants
2. Kraamszorg workers who support mothers at home
3. A consultant-led maternity unit within 30 minutes.

I think BigTeuchLittleTeuch touched on this when she shared her story. In that situation what was needed was for someone to actually take the time to listen to the mother. It is about empowering mothers with the right information and resources to make a choice about what's the best option for them and their baby. One way of doing this is to encourage more community-based midwifery teams who can provide continuity of care
for mothers, and support home births.

cmotdibbler Tue 24-Feb-09 12:10:34

Actually, if only the trust management had the level of expertise to run a supermarket.

Part of the issue is that trusts are multi million pound businesses, being run by people who are not professional, well qualified and experienced managers.

AndrewLansley Tue 24-Feb-09 12:11:13

Quattrocento, you asked if I was aware of the practice of women being taken into maternity units but not being assigned delivery rooms. First let me say how sorry I am to hear about your experience; it sounds
very distressing. Sadly, yours isn't the only story that I've heard about women being denied privacy and dignity in childbirth. I feel really strongly about this. Privacy and dignity should be basic rights for any mother. We have promised to provide new mothers with privacy and dignity during and after childbirth, by guaranteeing every women who wants one a single room in hospital. This pledge will be delivered as
part of our plans to provide 45,000 more single rooms in the NHS.

BoffinMum Tue 24-Feb-09 12:11:49

Another questions: it is one thing maternity units being closed, but there is also the issue of Midwife Led Birthing Units being closed more than half of the time. These facilities have mopped up considerable financial resources, yet seem hardly used in some cases because of pressures on staffing. Most mothers are denied access to them and instead forced to labour flat on their backs in public wards instead for most of the time, which is an undignified as it gets. Question: are you planning to collect data on how frequently these units close??

cmotdibbler Tue 24-Feb-09 12:13:57

Andrew, what do you think of a return to the domino system, where a community midwife was responsible for a woman throughout her birth and return hom, no matter where that birth took place. For instance when I was born, my mother called the midwife team, someone met her at the hospital, stayed with her throughout, settled her onto the ward, and then met her when she came home - so total care. I understand that there is a team in London working in this way to the great delight of their patients

Do single rooms include postnatal room as well? Just wondering how the hospital where I work will achieve this as we're on the 3rd floor, take up the whole of the 3rd floor and can't extend. Will we have to move to a new building? The expense will be huge!

AndrewLansley Tue 24-Feb-09 12:15:35

On breastfeeding, which many of you raised, the discussions that went back and forth on were really interesting. There are clearly different views; I do believe that 'breast is best' for babies (although I know that isn't your favourite phrase Bluemary3000!) but it seems to me that the most important thing for government to do is empower women with the freedom and information to make the best choice. I think nannying and lecturing mothers about this is likely to be counter-productive. Providing information,
examples, positive peer support and supportive role models will all help
mums to make the decision that's best for them and their baby. Specifically, I do think that Government should be working with
employers and businesses to tackle any stigma that surrounds breastfeeding. We have to encourage them to support mothers in their choice.

Maiakins Tue 24-Feb-09 12:16:26

Hi, about home births and the Netherlands experience. In the Netherlands, one of the reasons they have a high number of home births is that the compulsory medical insurance system in the Netherlands (their equivalent to the NHS) does not cover the full cost of having a baby in hospital unless this is necessary for medical reasons. So, can you reassure us, that the Conservatives won't move to a system whereby we have to pay any money to give birth in hospital if we want to (i.e. if there is no medical reason)?

ScottishMummy Tue 24-Feb-09 12:16:29

the NHS Next Stage Review-the Darzi Review has recommended many changes to NHS manangement and the role and involvement of clinical staff.to boost staff input,staff influence at policies and procedures level. concerns about PCT and foundation trust ability to achieve these aims have been raised by commons health select committee

will PCT and trusts be compelled to accept the NHS Next Stage Review-the Darzi Review recommendations

bizibee Tue 24-Feb-09 12:16:58

Accommodation is short, but what women need is a midwife of their own in labour. If the Conservatives made this a manifesto pledge I think almost every woman of child bearing age would vote for them!

BoffinMum Tue 24-Feb-09 12:18:01

And more (sorry Andrew, this is turning into a tsunami of BoffinMum anxiety to communicate).

On MumsNet we spend a lot of time late at night collectively diagnosing serious conditions such as retained placenta and puerperal infection as total amateurs because women do not receive sufficient postnatal visits, have trouble accessing out of hours services, and get fobbed off by NHS Direct with long call back times. We should not have to do this.

Question: will the Tories be able to bring back daily postnatal visits for new mothers and ensure they have access to medical professionals with proper experience of childbirth, rather than GPs who don't know them and who do not have enough current topical knowledge?

AndrewLansley Tue 24-Feb-09 12:18:41

In response to wasuup3000, I agree, that the NHS is suffering from 'review fatigue'. The issues now are less about analysis and more about delivering (forgive the pun!). We have known for five years that the birth rate is rising. The number of midwives has simply not increased in line with this. We have to encourage midwifery training and those who wish to return to work. By giving more autonomy to midwifery teams - like the famous Albany Practice in South East London -we can give midwives more encouragement and stimulate recruitment.

Stimulate recruitment?

THERE ARE MIDWIVES STACKING SHELVES IN TESCOS WHO ARE DESPERATE FOR JOBS

wasuup3000 Tue 24-Feb-09 12:21:07

With my 4th child I drove myself to hospital after my waters broke 4 days early. I was then made to wait 24 hours until advised by a nurse on the ward that I could say I wanted my baby induced after 24 hours that they would have to do so. So I asked and was induced obviously worrying about your baby for over 24 hours after your waters have gone is not ideal.

I told them my labours were quick and I was induced. During may stay on the ward pregnant mothers had been sent back up as they were not enough into their labours to be on the delivery suite.

I knew my labour was progressing and that I was due to give birth soon and wanted some gas and air. My midwife did not believe me insisted on moving me to an empty ward and examined me. After which I was bundled quickly to the delivery suite and gave birth within 2 minutes off arriving there.

Mothers are just treated like cattle and it is not good enough.

AndrewLansley Tue 24-Feb-09 12:21:25

Yes - Maiakins - I do understand. Closed wards in some maternity units are also part of the problem. Closing units to mothers is the tip of the iceberg. As I just said in response to 'wasuup3000', we need to recruit more midwives. But we also need to ensure that the hospitals are given the right 'tariff'(i.e. the payment they get for providing services) to support maternity. The money they are paid should accurately reflect the costs and the level of standards we need.

bizibee Tue 24-Feb-09 12:21:36

SKSS is right. the midwives are there but the jobs are not. Only London has recruitment problems.

BoffinMum Tue 24-Feb-09 12:22:30
cmotdibbler Tue 24-Feb-09 12:22:42

Did you see Stripysocks posting further up that as a newly qualified midwife she couldn't get a job (along with others). Just like Health Visitors, it isn't people, it's posts the NHS is lacking. Unlike clinical scientists which the UK produces about 50% of it's requirements each year out of training - leaving a massive shortfall which is unaddressed by politicians as unexciting

He should know this as I wrote to him some months ago about the fact that there is no shortage of midwives in the UK, but a lack of funding to employ midwives.

Anyway I'm off to work for a shift on the labour ward, where if the last few weeks are anything to go by I will probably be looking after 3 labouring women.

AndrewLansley Tue 24-Feb-09 12:25:04

Thanks Bizibee, there are some things I wish to highlight. One is our intention to introduce universal and more intensive health-visiting in the first weeks after birth, helping to get every family on the right track. This would help with everything from breastfeeding to family health and relationships - not least, working with father and the family to establish how a newly expanded family works.

AndrewLansley Tue 24-Feb-09 12:25:46

BoffinMum, we have worked with independent midwives to tackle this problem. Independent practitioners should have access to indemnity insurance, but there is a major cost involved.

ScottishMummy Tue 24-Feb-09 12:26:21

Graduate employment NHS. newly qualified highly trained healthcare graduates cannot find training posts eg Medicine,nursing, Allied health professionals. MTAS was a well documented disaster, and health care graduates are unemployed.graduate entry level posts are over subscribed

this is a real waste of talent for graduates who have pursued vocational training and want to work for NHS

AndrewLansley Tue 24-Feb-09 12:26:31

StripeyKinckersSpottySocks, Yes I do mean postnatal as well, although choice should mean a single room for those mothers who want it - not everyone does. I know some units are constrained physically, but we have to look at how to accommodate expansion and higher standards, for example, by developing midwife-led units alongside an obstetric service.

slalomsuki Tue 24-Feb-09 12:28:21

Can I change tack here a little bit since I had the experience of actually being admitted to hospital while in labour with my first but due to fact that I had been diagnosed with IUGR and was 6 weeks early there was a requirement for a special care bed.

While in labour I was told that there was none free in my local health authority area or indeed in the Midlands where I live and they were contacting Glasgow and London hospitals for me. In the end the neighbouring health authority took ds in to special care as an emergency and I was left traumitised at having to be moved in an ambulance with a blue flashing light in my latter stages of labour and almost giving birth on the ring road of a large local town.

My question surround the lack of communication by NHS give to mothers and how this could be imporved and what initatives would the conservative party put in place to ensure that other mothers and babies are not put in such a traumatic and bewildering situation while in labour?

BoffinMum Tue 24-Feb-09 12:29:37

<This is a little flippant but I have to express infantile amusement at Andrew typing
StripeyKnickersSpottySocks> grin

As you were, ladies.

Could have been worse, AnyFucker could have been here. grin <must go to work NOW>

AndrewLansley Tue 24-Feb-09 12:30:59

Cmotdibbler, Yes - this is, I think, the Albany community midwifery team in Peckham, South East London. It is very important we enable midwives to act together as a team to provide the continuity of care which mothers clearly value

BoffinMum Tue 24-Feb-09 12:31:25

LOL! [grin}

Sorry Andrew. This is all very MumsNet!

ScottishMummy Tue 24-Feb-09 12:32:43

oh i didnt read correctly.just read the thread title,thought it was general health format

apologies

AndrewLansley Tue 24-Feb-09 12:33:45

Boffinmum, you mentioned Midwife Led Birthing Units. These units are included in our data; we need to see how more mothers can have a 'home from home'birth.

AndrewLansley Tue 24-Feb-09 12:34:58

ScottishMummy, Yes. It was a scandal in 2006 when newly qualified midwives couldn't find posts. Now we have unfilled vacancies. We need our nursing and midwifery education and training to be more consistently related to workforce plans. Unfortunatley, it took several years before the Government woke up to the fact that the birth rate was rising after 2001.

cmotdibbler Tue 24-Feb-09 12:35:08

But enabling them to work as a team is rather different to asking them and resourcing them to work in different ways. I for instance, live in a rural area where the nearest maternity units are 30 minutes to regular care, an hour to SCBU level care on a good day. There is just not the density of women here to enable the kind of practice that Albany have. After all, we have a health visitor 2 hours a week for approx 300 sq mile GP catchment.

Maiakins Tue 24-Feb-09 12:36:11

Hi - I agree with Slalomsuki that there is a real crisis with special care beds for newborns, which impacts upon where mothers give birth. For example, people from Slough being airlifted to Manchester. I think a really cost-effective way of freeing up special care beds would be to make it illegal for IVF clinics to implant more than 1 embryo, as twins/triplets need special care in 50% of cases. This wouldn't cost the Conservatives any money and of course would need to be carefully reviewed, but it really would make the experience of families who require special care beds much less traumatic by easing up the pressure on the number of beds required.

AndrewLansley Tue 24-Feb-09 12:37:42

To 'Scottish Mummy' - The Darzi Review contains of lot of good material about the kind of services we want. It is less clear about how it is to be delivered. Emphasising quality is right, but setting up a National Quality Board isn't enough. Quality comes from professional staff, empowered and equipped to provide the care, properly accountable to the public for the services they provide, responsive to choice, and accountable for outcomes.

ScottishMummy Tue 24-Feb-09 12:37:53

Bliss 2008 report NeoNatal units regularly forced to close due to staff shortages or undertake inappropriate transfers due to pressure on beds

do you plan to recruit more NICU/SCBU staff.how would you encourage retention of staff and more units open

BoffinMum Tue 24-Feb-09 12:38:15

Thanks for responses, Andrew.

There is a thread on MN at the moment which argues that high risk mothers are being deprived of things like active birthing as a direct consequence of heavy investment in the Midwife Led Birthing Units, even though there are no medical grounds for doing so. In other words, if you are diabetic or whatever, you are doomed to a passive birth and subsequent obstetric intervention for no good reason, whereas 'normal' women get mood lighting, birthing balls and a cosier environment. I am wondering if again, some sort of maternity services voucher system would help women vote with their feet. Are the Tories anti-vouchers?

AndrewLansley Tue 24-Feb-09 12:39:04

To Bizibee
Yes, I agree. The Government promised one to one midwifery care but have failed to deliver it. Mothers should have the option and that's what matters.

AndrewLansley Tue 24-Feb-09 12:39:38

To Maiakins
Yes, I can assure you that the Conservatives are committed to an NHS free at the point of use, based on need and not ability to pay. This of course, covers NHS maternity services.

wasuup3000 Tue 24-Feb-09 12:40:30

Will the conservatives deliver is the key question?

BoffinMum Tue 24-Feb-09 12:41:22

I think a linked question to ScottishMummy's might be are the Tories prepared to maintain unused capacity in SCBU (and indeed hospitals) as there is probably a trend here started under the Thatcher administration, in reducing 'surplus' capacity to the bone to 'improve efficiency'. Sort fo 'just in time healthcare'.

cmotdibbler Tue 24-Feb-09 12:42:13

Yes, one of the first things the Dr said to me when I was in prem labour was that it was really good news that there was actually a bed for my DS at the hospital. They didn't tell me that in order to keep the SCBU at that hospital open, there was no consultant paediatrician there and it was entirely nurse led. Thus anything more than basic care required and your baby was blue lighted across Sussex, or worse.

Any comment on care (or lack therof) for women experiencing pregnancy loss Andrew ? Your opponents promised us a review, but we've heard nothing so far

bizibee Tue 24-Feb-09 12:43:03

if you put one-to-one care in labour as a manifesto promise I would vote Conservative for the first time in my life, Promise!

wasuup3000 Tue 24-Feb-09 12:43:18

Just a quick off topic reminder to you before you go not to forget to support the autism bill in parliament on Friday 27th.

BoffinMum Tue 24-Feb-09 12:44:05

Our pregnancy loss unit is only open during office hours. They put you next to the terminal gynae cancer patients if you have the audacity to miscarry out of hours.

AndrewLansley Tue 24-Feb-09 12:44:21

Thanks for all your questions and input. Sorry I haven't been able to answer all of them in the time we've had available. But, HerBeatitudeLittleBella, you urged me to 'read and learn' and I certainly have learnt from all your stories and comments. The figures that I published about mothers being turned away from maternity wards were shocking in themselves, with an increase in closures from 400 in 2007 to 550 last year. But hearing your stories has brought home to me the fact that every one of those numbers tells an awful story about mothers being turned away from hospital at a hugely emotional time. I've enjoyed our discussion and there's lots of issues here for me to look at further.

GeraldineMumsnet (MNHQ) Tue 24-Feb-09 12:44:53

Sadly, nearly the end of today's webchat. Thanks to everyone who has posted and to Andrew for lots of responses.

BoffinMum Tue 24-Feb-09 12:44:57

Thank you for coming on, Andrew. You have responded to more questions than I thought you would be able to in the time, and it has been really helpful.

bizibee Tue 24-Feb-09 12:45:34

our early preg unit just closed and so now if we find miscarriage on scan have to go to the next hosiptal

ScottishMummy Tue 24-Feb-09 12:45:52

chronic shortage of level III NICU cots,due to shortage of Neonatal nurses.inadequate planning and projection meant not enough nurses trained,posts frozen as staff leave,constrained budgets

the clinical impact is huge,the sickest babies being blue lighted across regions to get a cot

will you invest in more training, recruit staff to address this.

cmotdibbler Tue 24-Feb-09 12:48:11

Thanks Andrew - we're always here with an opinion to share if you want to find out what life is like on the ground grin

BoffinMum Tue 24-Feb-09 12:51:03

<leads applause for Andrew>

Maiakins Tue 24-Feb-09 12:52:13

Thank you Andrew for listening to our concerns about the UK's maternity crisis!

rubyslippers Tue 24-Feb-09 12:53:10

thought he was pretty good

thank you Andrew

<<claps>>

neenztwinz Tue 24-Feb-09 13:37:41

That was really interesting. I thought Andrew was very good but words are cheap and would the Tories deliver?

The problem the NHS has is it is very hard to make it perfect for every person with every single illness/ailment.

More midwives would be a good start.

I had a wonderful birth - with twins, felt very well cared for from consultant down to student midwife and the care I received postnatally was excellent as was the BFing advice and support I got antenatally and postnatally. So it is not all terrible in today's NHS maternity services.

morningpaper Tue 24-Feb-09 14:12:00

It is interesting to read this sort of debate but it is hard to feel optimistic about the future - whoever wins the next election will have to make massive cuts across the public sector. Cameron has already pledged to cut public services by £5 billion and plenty of people are thinking this is going to be much, much higher. I doubt investment in midwifery is going to be remotely on anyone's radar for quite some time.

<eeyore>

Personally, I've had really good experiences in terms of NHS care.

SnowlightMcKenzie Tue 24-Feb-09 16:59:42

Thank you Andrew.

<thought he was good too, and certainly impressed with his fast, accurate typing>

It's a sensible thing for the Tories to be looking at I think. Child-bearing women as a group are a very large section of society/voters.

hunkermunker Thu 26-Feb-09 21:48:11

Thank you, Andrew.

Bit disappointed with the response re bf, but at least I can assume he read my post.

The bit about more intensive health visiting concerns me though - how is that going to be feasible? Employing more health visitors? What bf training will they have? (I know he's gone and this is therefore rhetorical, but hey, posting anyway!).

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