to wonder if anyone actually cares about choices in pregnancyand birth and the state of maternity services in the UK?(55 Posts)
Do women want to have continuity of care?
Do women care about who looks after them in labour? Do women want to be cared for by the same midwife (or midwives) before, during snd after, birth?
Do women want to be offered choice or just be told what to do?
I am a midwife and also 37 weeks pregnant with dc4.
I think continuity is overrated for both patient and hcp.
I don't care who looks after me in labour as long as they are knowledgable, competent and kind. Listening and explaining are vital for a delivery suite mw imo.
Postnatal care is shit as there are no where near enough staff per number of patients, there is a massive increase in the workload of said staff, an awful lot of very high risk mums and babies mean that staff are stretched to capacit and beyond.
I had great complaints about the system until I lived in a developing country where conditions are horrendous. I am so grateful now to have the care that we do.
I saw three community mid wives for ante natal, they were lovely and I felt well cared for and don't see the need to have just seen one?
The thing I care most about is that midwives actually follow the advice of their college and keep up to date with the latest NICE guidelines instead of doing things because they always have done them that way.
Evidence based midwives or bust!
Plus on a postnatal ward it's double the patients. More if there are a few sets of twins. It's a bloody nightmare tbh.
I'm a midwife and have had two babies, I wasn't fussed about continuity of carer, plus you can't work for much longer than 12 hours shifts, I'd rather have a nice friendly midwife who was awake and 'with it' to support me, than one who has been at work for 12 hours already and hasn't had the opportunity for a break because its going like a fair outside the room.
Having said that, the death of independent midwifery will reduce choices by quite a bit come October.
Continuity would have been nice, although just having midwives who knew what was happening would have been good. It was horrid having to 'start all over again' with a new midwife and did on a number of occasions result in mistakes, some of which could have been serious. There seemed to be little handover or continuity during the days I was in hospital.
As a midwife, it is noticeable that attitude is better when the ward is adequately staffed. Last month it was very quiet, midwives were calm, every time I went to see a woman, they told me what wonderful care they had had.
This month, super busy, stressed out midwives and much less happy women.
Babies are not counted in the numbers when determining postnatal staffing so I guess helping with breastfeeding, changing nappies for women who have had caesarean sections, or even providing medical care for the number of sick babies we have is not important.
The only way maternity care will change is if women who are past, current or future users of the service and midwives work together to change it as in New Zealand but midwives are overburdened, disillusioned and averse to industrial action and women access the service for such a short time in their lives that this is just not going to happen.
I agree sand.
I think change has to be led by women.
Sorry. Lost the other half of my srntence.
Change needs to be led by women but what changes do they want?
Agree with previous posters that "continuity of care" and "choice" is much much less important to me than good post natal care. I had a relatively good experience on the post natal ward followings ELCS but some fairly major bits we're a bit crap! I was supposed to have TED stockings on post op (am DVT risk due to high bmi, spinal anaesthetic and family history of DVT - had to have 6 weeks of post op clexane) but despite repeated requests and the stockings having been prescribed on my drug chart, I was not given them. I was in for three days. During that time my sheets were only changed once - and that was at my request despite the fact that they were covered in blood. I was never shown how to bath my baby and had serious problems with BFing which was not picked up until I was back in the community and my DS had lost a significant amount of weight due to crap latch. Nobody helped me with BF at all.
All of this was due to low staffing levels. The MWs were very kind and friendly but simply did not have time to do much outside drug rounds and care plans. They were obviously extremely harassed and lots of patients, and partners especially were extremely vocal about certain aspects of care they felt were lacking so you sort of felt sorry for them and didn't want to add to their problems which is obviously not ideal.
So yes better post natal care would certainly be a top priority for me.
I say the same midwife during my pregnancy and she was lovely, we got along really well with her and I would have loved to have her with me at the hospital because I trusted her and felt comfortable in her care however I had a c section and I can't fault any of the staff who were there, they were all lovely except a horrible MW who refused to pass me my DD during the night when I was still stuck in bed
Like many here, I don't much care about continuity as long as the people themselves are competent, and listen to you. I'm on my second, and so far my community midwives haven't impressed me - I really feel like they're ticking boxes rather than listening and seeing me as an individual patient (it's hard to explain)
Having met a load of the nursing (during a recent stay for my son) and maternity staff (at scans) at the hospital I'm a lot more comforted though - they all seemed really on the ball, properly listened and answered questions and were generally brilliant.
Like many others here, my worry is post-natal. I had my previous baby abroad, and my partner could stay with me the whole time to provide that extra bit of care you need after a CS. In the UK with wards, and visiting hours that is against the rules (rules which the childrens ward ignored - to everyone's benefit - I noticed), so even though I would hope to be up and about very quickly after my next CS I know I'm going to miss that little bit of extra on-hand help I had by having my partner next to me.
I'm really fortunate as have had 2:1 care from two pairs of fantastic mws during both births (one hospital birth with a supervising and student mw, and one hb). This has been assisted by having relatively short labours but I found it so beneficial having the same carers throughout. Difficult to see how this could be guarenteed though as shifts must come to an end.
I saw different mws both times for antenatal appts. Second time round, they were all great and the lack of continuity didn't bother me though as a PP said this was prob due to having an uncomplicated pg and no other issues that would have been difficult to discuss with a variety of people. I found it a bit harder first time round, partly due to being more anxious with everything being new to me and also due to one particular mw (the one I saw the most) who was rude and dismissive, to the point that had she turned up to deliver DS2 I'd have transfered in there and then! So I agree continuity of care can be a mixed blessing - depends who you end up with.
Overall, think continuty in labour is desirable if it can realistically be achieved but attitude of hcps is the priority and also that the choices of all women should be respected irrespective of venue/method opted for.
Look up at the top of active convos for the Site Stuff sticky, regarding the new Birth Choices factsheet.
choice is important to me, and i like to be well-informed but i'm happy to do my own research (i work in science communication).
but continuity doesn't bother me much, i am currently 'low-risk' without any ongoing health issues so not much to explain or worry about the MW understanding. i don't care about continuity of GP either, probably cause i have no ongoing issues, so i just see whichever doctor at the practice is free. I appreciate there are many reasons why continuity of MW or GP would be good for some people but it's not important to me.
I saw one MW for booking in, a sonographer and a different MW for my 12wk scan, I spoke to a third MW on the phone to get my 16wk appt and 20wk scan appt and "my" midwife named on my notes is another name entirely. Doesn't bother me, I'm more concerned about convenient appointments so I can try to keep my business functioning than seeing the same MW (which would really constrain availble appointments).
Another vote for kindness being more important than continuity. I am not sure the skillset for community midwives is necessarily the same as for midwives who actually deal with labour? Please correct me if I am wrong. I want someone who can negotiate through the various care options with me while I am pregnant, and someone who has a greater or perhaps more recent level of obstetric knowledge, for the birth. In my area there seemed to be pronounced differences between the two; I don't know if this is common.
Yy btw to post natal care being of a much lower standard. I gave birth in a busy London hospital and I struggled to make myself understood to some of the post natal ward staff. Such a contrast to the other HCPs I met whilst pregnant.
I had continuity of care. The midwife who cared for me in my pregnancy delivered my baby. NHS Tayside at Perth MLU.
I didn't care about any of those things.
I just wanted someone - anyone - to get the baby the hell out of me as quickly as they could.
Yep, same goes for me as most posters - competence, kindness and willingnessto listen/treat me as a real person. That's really all I need! And higher staffing levels on postnatal wards so the staff aren't running round like blue arsed flies. I couldn't care less about continuity and if I have confidence in the staff I meet then I am not so concerned about choice.
Continuity of community care is good because they learn you. I had the same community mw for both DCs and will be trying to get on her clinic again this time because she is ace.
As for labour... my first labour straddled three shifts. Nobody who had been around on the Fri/Sat night shift would still have been much use on Sunday morning without a significant break (I include myself and DH here).
Second time I was very quick but still managed to arrive during shift handover.
Perhaps it would be helpful to stagger shifts - ours on L&D appeared to be 8-8 and 8-8, and if some staff had been on 2-2 or similar instead it would have made a big difference to my care.
My first child was born in NZ where I had the same midwife the whole way through. It was a disaster! She had no back up and when I went into labour she was so tired she actually fell asleep. Birth was horriffc because she missed my daughter was breech and I ended up having an ECS. DC two was born in the UK and I never had the same midwife twice, but none of them fell asleep! It's standards of care that matter, not having just one person.
When I was first a midwife I actually worked in a team providing continuity of care and it was great.
We attended at least 15 births a month between us so were up to date with the whole range of care, all appointments from booking to postnatal were done at home which was great for the women but not so great for the midwives. Every woman (except those having ELCS and induction) was offered a home assessment in early labour so nobody went to hospital too early and got sent home. Women could choose place of birth right up until labour. 30% chose to give birth at home.
Midwives worked in pairs and it was a team of six who backed each other up, so no falling asleep in labour for the midwives and women while they had a closer relationship with one or two midwives could meet all six during pregnancy if they wanted to and since we all shared antenatal classes many did. I did pull a couple of 24 hour shifts but only because I was very close to those particular women and I had another midwife there too.
If you didn't like your allocated midwife, nobody ever had a problem with you asking for an alternative midwife.
It was a model for great maternity care and was in inner London too. It is still going although they have changed how they do care slightly and it is more of a team approach and most antenatal visits are in a clinic.
It isn't impossible to provide both continuity and high quality care in the NHS for reasonable cost, it is just someone has to be committed to the organization of it and consider how to provide it within the constraints of midwife work-life balance. It is notable that out of 6 midwives, 5 were young and childless.
As for continuity, I think most of the research shows that if you've had continuity of care, you think it is important.If you haven't you think it isn't.
I consider myself (us, as a nation) very lucky to have free and skilled midwifery. Giving birth in safe, experienced hands was enough for me.
I tend to agree with my midwife aunt who believes home birthing to be an unnecessary risk. It also seems to be a waste of resources to me when a hospital delivery would more than suffice. Perhaps choice should come at a (monetary) price.
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