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Live webchat with 'Maternity Tsar' Dr Gwyneth Lewis, Mon 27 April (10-11am)(85 Posts)
We've had a lot of discussion over the years on Mumsnet about Group B strep and the anxiety and in some cases devastation this can cause, yet it's rarely - if ever - mentioned by the maternity services and the test isn't offered routinely on the NHS - is this something you have a view on?
Postnatal care is really rubbish, isn't it - especially in London. Is there any serious prospect of it improving, or do we have to accept that - in these straitened times - resources will continue to be focused on intrapartum care?
In my experience, and that of many women on Mumsnet, there is a huge failing in support for women in pregnancy and postnatally.
In my experience, I was only able to call a midwife for advice between 8.30 and 9am, Monday to Friday - if you couldn't get through, tough. No other way of getting help apart from calling the maternity unit, and if you did that you were made to feel like a pita.
Many women post on here desperatly worried, or indeed desperatly ill, but without a dedicated team to call with pregnancy/postnatal issues, they feel unable to access the help they need. Many women feel that postnatally they have to wait for the midwife to come to them and can't ask for extra visits.
I was discharged from SCBU with a premature baby who had only been feeding independantly of an ng tube for 36 hours to home, and not visited for 3 days - one more visit from the mw, and that was it for my postnatal care. In 5 days on the ward, I was only examined by a midwife once as I was discharged - my sole 'care' from them.
What are your thoughts on improving pn care ?
A hardy perennial here...what is the government doing to guarantee sufficient support from midwives in maternity units? Does it even have a target for the number of midwives per labouring women?
At present, unless I have a high risk birth, there is no way you would get me into a hospital, to labour on my own and face hours of snappy, miserable midwives on the postnatal wards, when I could be at home, with the full attention of a midwive keeping me and my baby safe. Which is how it should be FOR EVERYONE.
I just read this title completely wrong. Scanned it and Maternity Tsar Gwyneth Paltrow bobbed round my head Then who made her a Tsar and a Gillian McKeath style doctor?
Hi Dr Lewis
The government made this commitment:
'every woman will be supported by a midwife she knows and trusts throughout her pregnancy and after the birth'by the end of 2009
great in theory, but in reality, women do not have continuity of care, and are often delivered by a MW they have never met.
why do women still have to fight for their right to give birth at home, or in a birth pool , or make an informed decision to have a 'high risk' birth in an MLU? how can women be expected to make informed decisions about their care, when they are frequently given scare mongering tactics.. or given untruths..
last week, a client of mine (I am a doula) was told she should not have a water birth , it was dangerous , as the baby might drown
how can women make informed choices based on that?
another woman had to explain to her MW what a VBAC was.
There is still only the illusion of choice, and nowhere near enough MWs. Birth centres have been closed left , right and centre, and women are being forced by default to labour in CLUs.
I appreciate change takes a long time, but these issues have been going on for decades.
Women and babies are being compromised and traumatised daily. When does it end?
can you tell i feel very strongly about this ??
I am dismayed and upset that I cannot store the cord blood from the forthcoming birth of my child because it is not 'hospital policy' (UCH London) to allow staff to extract the blood and place it into the collection pack that I will provide via a private blood bank.
Nor can I donate it to medical research for the same reasons.
THis is waste material, it will be incinerated as after-birth, but could potentially save the life of my child, or someone else's child in the next 20 years.
They will wrap it up and let me take it home, but not decant it into a collection bag!! It will be off by the time I get home.
Is it not worth the Government intervening to ensure that this is allowed to take place?
If any child dies from childhood leukaemia who could have been treated with my cord blood stem cells, then the hospital should be ashamed (not to mention sued!)
I would like to know that you are doing something to persuade these hospitals to change their practices.
Postnatal care - Ok, it was a couple of years back, but after my son was born I didn't see "my" midwife at all. I saw a couple of "the team" (who I had never met), and even had my final appointment cancelled via phone call due to staff shortages and me being too nice to say "actually, I would quite like a final visit please". How is one mother, one midwife going?
Thankfully my current midwife is actually shuffling her appointments with me so that it is her seeing me because I explained that I couldn't remember "my" midwife's name from last time due to only having met her about 3 times. (I think of her as being mine as the others I met twice at most, more often once).
Despite having had two "normal" waterbirths (no drugs, no stitches, etc.) in midwife-run birthing centres I am apparently not allowed another one at the same centre due to the birth weight of my last baby (10lb 1oz). Apparently it is something to do with greater blood loss and therefore higher risk. I would not want a hospital birth or a homebirth for any future babies; birthing centre births were the perfect middle ground for me as I felt safe but able to do what I wanted and needed to in labour. I suspect that different birthing centres have different weight restrictions with regard to previous births - surely there should be some kind of set rule and this should be communicated to women as it was quite a shock to me?
Dr Lewis, this is an issue i know that a lot of women feel strongly about, their partners presence on the Post Natal ward. Many women go through very traumatic births including c sections and their partners often get sent straight home afterwards with their partners/wives panicking with what to do with a newborn and copious amounts of stitches not to mention being extrememely tired and in pain.
I can understand hospital policy not having men wandering around wards at night when there will obviously be women who have recently given birth but i dont see why when many of the new hospitials have amenity rooms that can cost upwards of £150 for the duration of the patients stay that men cannot be allowed to stay at least the first night to help out and support their partners when they are probably needed the most?
I had my son 11 weeks ago and had to wait all day for my scheduled c section, by the time he was delivered and i was taken to the post natal ward it was nearly 8 o clock (end of vistiting hours). I have diabetes and my son needed intensive feeding every three hours after he was born to keep him out of scbu but i was in no way capable of doing this after delivering 4 hours previously - thank goodness for the midwife who said she would help me out till 6 o clock the next morning! This really is something that i think needs to be addressed, i realise that for some there are more important and pressing issues in maternity care but i dont think that with the amount of amenity rooms available (especially in my local hospital) there is a reason why this issue cannot be considered.
Hello, thankyou for talking to us. I am a paediatric gastroenterologist as well as a mother. I want to ask what is being done to practically help women breastfeed?
I feel women get so much information promoting breastfeeeding during pregnancy, many would like to breastfeed, but at the crucial time, on the postnatal ward, the help just isnt there. Midwives are too busy, or not skilled enough to sit down & show the first time mums - breastfeeding specialists only work limited hours and many women dont even know they exist. So women (feeling guilty beacuse 'breast is best' has been drummed into them)are forced to give up. The Breastfeeding rates in this country are a disgrace and we are letting down a whole generation who are losing all the benefits of breastmilk.
What are your thoughts on this?
I wanted to ask what your views are on the issue of elective caesarean by maternal request (i.e. when there is no medical need). This is something that is standard practice in many countries but still not the case in the UK. Do you think this is for financial reasons only and do you think it's ever likely to change?
I feel strongly that every woman should be able to choose the birth she wants - assuming she fully understands the risks and benefits of course.
I had very personal reasons for wanting an elective caesarean for my first pregnancy, and actually went private because I couldn't face the additional anxiety and trauma of having to 'persuade' possibly hostile midwives/consultants of my case. We're not rich, and so this cost is a stretch for us, and I feel it's very wrong that intelligent and informed women should be denied this choice.
I'd be interested to hear your thoughts on this.
Dr Lewis I am part of a support thread on this site for women who are pregnant after having had one or more previous miscarriages - it is an enormous source of support during a time when women in our position are under enormous emotional strain.
What has become clear is that there is an enormous "postcode lottery" regarding the possibility of early reassurance scans for women - even in situations when the woman in question is currently suffering from bloodloss or unusual pains.
Given the additional worries of possible antenatal depression and other stress-related health problems, would it not be possible to have a nationwide policy allowing scans for those who need them (even if the need is psychological rather than physical)?
If some GPs and midwives are so concerned about their patients that they are willing to lie to get ultrasound scans (and I was lucky enough to have a midwife who could see just how ill the worry was making me), then clearly there must be a case for allowing these scans?
I have had expereince of two different London hospitals and while both were busy one was light years ahead of the other. I gave birth 2 weeks ago in Kings and despite it being very busy they were very good. Not sure if I should name the not so good hosp but there is only a few miles between them. Both have similar challenges and I would like to know what is being done so that some hospitals can learn from others. I recently met a pregnant midwife at Kings who confided that she had worked in the other hospital and told me that none of the midwives who worked there would choose to be delivered there nor would they let their daughters have their kids there.
Also as a person who tends to go overdue I am usually put under pressure to have an induction. This is not something I want having had one awful induction and I end up getting very stressed and anxious and spend hours reading about different ways to bring on labour which in turn stresses me which I'm sure intereferes with natural onset of labour. I would love to see a more relaxed approach witrh women like me that want to avoid induction. Perhaps offereing alternatives such as reflexology or massage that would have the added benifit of relaxing a very uptight pregnant Mum.
I gave birth 2 weeks late to the day and jsut managed to avoid an induction.
On the subject of Breast is Best. I am interested to understand why so many midwives suggest topping up without advice on how to reduce topping up when the need passes. My baby needed extra fluids for jaundice and polycythemia and I am and was happy to do that but now am wondering when and how to reduce formula. I know other mums who are ewncouraged to top up as baby is big.
Now, I've been reminded that maternity care should include care of women and families going through pregnancy loss, I have some comments...
Pregnancy loss services would be a joke if it wasn't such a terrible time for women/families.
Sitting in a busy antenatal department amongst happy pg ladies, waiting to find out whether your baby has died
Waiting days or weeks to get a scan to see if they are hanging in there
Having to wait for ERPCs or medical management, knowing that your baby has died
Being told to pull yourself together, it's terribly common you know
Being told that 'there's nothing we can do, if you are miscarrying then you'll find out soon enough' to someone who had a very missed miscarriage before
Being denied any sort of follow up or care post miscarriage
Poor or inadequate information on what is happening and choices of treatment
And I could go on, and on, and on - and my experiences over 3 miscarriages are nothing to some people on here.
Alan Johnson promised us that he would make enquiries on miscarriage care. What do you have to say ?
I don't know if NHS Scotland has a different policy to that of the rest of the UK as regards pregnancy loss, or whether it was just my hospital, but would like to suggest you look at Ninewells Hospital in Dundee as a useful example of good practice.
I've had two complicated pregnancy losses there, and have received exemplary care in both, and in my healthy pregnancy in between - I've been lucky to have utterly the opposite to the list that CMOT posted above, but know that my experience is sadly far from the norm.
I am curious about why Midwives do not seem to be able to work on a 'caseload' system, where two midwifes are assigned to each woman (one lead, one backup) to ensure continuity of care. This practice seems to give good results at the Albany Midwife practice in Deptford - and appears to meet the Government's stated aim (and most women's desire) for continuity of care. Why are we seeing teams of midwives, never the same one, for antenatal care - none of whom will be those who see us in a hospital delivery?
Whilst there are some brilliant people working in maternity services, postnatal care does seem to be, for too many women, a case of "you didn't die, your baby didn't die, anything more than that's a bonus". Women who want to breastfeed are often treated scornfully, as if they're expecting special treatment or chasing some ridiculous ideal.
Also, what is being done to ensure that midwives are treated decently by their employers, to allow them to look after the women in their care? I know many, many midwives (and health visitors) have to cope with bullying from their superiors - how is it possible to provide a caring service if you're not being looked after yourself?
Apparently by the end of the year every woman will be able to chose where they give birth - inluding home birth. However I was told recently by my midwife that due to staffing problems I may "have to" go into hospital to give birth despite planning a home birth, having an uncomplicated pregnancy and having had a previously successful and wonderful home birth.
I have spoken to many other women around the country who have experienced exactly the same thing - staff shortages being given as the reason why women are being denied home births or being warned off them.
What are you going to do about this? How can the Government offer "choice" of birth place, yet not provide enough midwives to make this happen?
More effective and individually tailored post-natal support for all women would surely prevent the development of post-natal illnesses (particularly depression and anxiety).
Aside from the moral imperative to support vulnerable women, there must be a cost incentive for the government?
It took me over 2 years to bring my post-natal depression under control. I delayed my return to work, accessed the available NHS services (anti-depressents, group CBT), and of course I have no idea what the potential long-term affect on my son might be. Had local services picked up on my mental health problems sooner (I was finally given the Edinburgh test and a proper home visit from a HV at 5 months, after breaking down at a clinic) I am convinced that the long term impact of PND on my health and that of my child would have been significantly reduced and even eliminated.
I would happily return the £190 Health in Pregnancy Grant for more assurances that the quality of post-natal care will improve.
i am due to have my second child and the MWs where i live are so over stretched - there are 5 midwives for 1,100 women (and they aren't all full time)
how can this be safe and deliver a high quality service where women can really choose the type of birth they want?
my first DS was delivered by a hospital MW, who i had never met before, but who, luckily, was AMAZING
the breast feeding support i had in hospital was great but once home this tailed off spectaculalry - i ended up paying over £100 for a visit from a lactation consultant and still gave up the next day
My sister has had 2 babies in Switzerland (in hospital) within the last 6 years and she received amazing breastfeeding support both times - the policy there is to have a dedicated trained breastfeeding counsellor come and sit by you each time you feed your baby for the whole feed. I think if we could get more mums breastfeeding confidently by adopting this policy in the NHS this would save a massive amount of money in terms of the improved health of babies not to mention the longterm health benefits to mum and baby.
I had difficulties breastfeeding my son when he was born (at home) last year and the community midwives were amazing with someone coming to my home every day for a week to help me out. None of them sat there for the whole feed and some said 'oh he's latching on fine' when he was not. I was about to give up until I saw an NCT breastfeeding counsellor who gave me confidence and better explained the techniques - most importantly, she sat with me whilst I fed my son. I'm not sure what training midwives have on breastfeeding but each one told me something different; my sister in law saw 10 midwives in hospital when she was having difficulties and all of them said something different. She gave up. Perhaps the Swiss system would have helped us both - is this something the NHS could consider?
We are told that all women will have a dedictated midwife with them during labour - I think this would be really appreciated by all women and would reduce (expensive) interventions. I chose to have my baby at home so that I would have the luxury of a dedicated midwife and I hope all women have that luxury where ever they choose to give birth. I am concerned it will not happen though as I have heard anecdotally of terrible midwife shortages throughout the NHS. Money that should be allocated to midwifery services is being siphoned off by trusts to other areas of service - I question whether the government really is committed as a whole to one to one care. How will midwifery get the funding it needs when NHS trusts have different priorities?
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