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

[GeraldineMumsnet]

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]

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?

[OracleInaCoracle]

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]

what Lulu said

my MW do homebirths in their own time

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]

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]

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]

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.

[hunkermunker]

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: 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 (), 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]

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

[hunkermunker]

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

[sassy]

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

[TheyCallMePeachy]

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 . Thank you.

[TheyCallMePeachy]

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

[cmotdibbler]

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]

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]

cmot that'ssad.

Had I not got my homebirth ds4 would have been bornm on the roadside, probably in Tesco Express petrol station - 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]

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!!

[noonki]

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]

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]

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]

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 . 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]

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]

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]

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]

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.

1. 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.

1. 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.

1. 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.

1. 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 .