Step this way to help shape the future of maternity services in England

Which choices do you wish to be able to make about the maternity care you receive?

I think shared wards are outdated and not conducive to the physical and mental rest women need after giving birth, especially if the birth has been traumatic. My hospital had some private rooms you could pay for, which we were happy to do, but they were all occupied. So, even if you are eligible for one, if they are all taken, you still have to stay on a shared ward. I know it's a matter of space and finding but perhaps midwife led units and more support for home births would free up space in hospital so private rooms would be more of a possibility for those that have to give birth in hospital.

I echo others' who mention breastfeeding support. The 'breast is best' message is pushed by the NHS but from one area to another support and information differs. And his follows on in post natal care too.

What are the key barriers preventing women from making the choices that they wish to?

Lack of funding and resources: In some areas, people can request a home birth but if the home birth team are dealing with a birth/s elsewhere then someone planning a home birth may have to go into hospital.

Inconsistency in training and knowledge amongst health care practitioners: I was given different information and advice from midwives and consultants during and after (RE breastfeeding) pregnancy.

Which choices do you wish to be able to make about the maternity care you receive?

I would like the midwife appointments to be available throughout the day, as are doctors appointments, so that I can actually have an appointment at 9, or 9:15 or 4, so that I can minimise disruption to my work. I know that I am entitled to time off for the appointments, but that doesn't mean that I don't want to minimise disruption to my colleagues and clients.

I would have liked some discussion of the options for birth, or some literature, explaining the options (but I do take the point that round here it's just one hospital or a home birth).

As a single mother (the first time I was pregnant/gave birth) I think that there needs to be some thought given to the needs of women in that position. I was left alone to labour and completely ignored. I waddled out to ask for some paracetamol, was ignored. Second time (c1/2 hour later) went to ask again and was ignored again. I then went out (I have been left alone for 2 hours at this point, after initial assessment showed me to be in early stages) and asked to be examined...which revealed me to be 9 cms. Too late for any pain relief (I had wanted an epidural) and straight to the labour ward. If I hadn't gone out and demanded attention I honestly think that I would have given birth alone. I also believe that this was because I had no one with me to advocate for me.

Whilst we're at it-also antenatal classes specifically for single mothers would be good. There is nothing so isolating during pregnancy as sitting in those classes without a partner. Depressing as hell.

I would also have liked to see the same midwife for most of the pregnancy (at the clinic I went to I saw I think 4-5).

Also, it would be good to have some baby clinics in the evening. Where I used to live our surgery had one a month in the evening, which was great. however, when I moved and ds was 4 months there was nothing in the evening. As I was wohm full time, and a single mother with no support it was impossible to attend, so I had no support or feedback regarding development etc.

What are the key barriers preventing women from making the choices that they wish to?

lack of information.

Lack of staffing.

I was particularly struck by the lack of assistance re:breastfeeding. I breastfed both of mine, and really struggled the first day with with ds1, basically with knowing what to do. Help was not forthcoming. I saw f/f mothers being brought warmed bottles in the middle of the night, but when I wanted a bit of advice as to how ds was doing I was made to feel like I was being a pain (I only asked the once...believe me). If I could have had 5 minutes of advice I would have been so much less stressed. I was never given any encouragement to breastfeed and I wonder how much impact that has on the takeup figures. It's really the harder option in hospital.

Lack of choice. My friend was adamant she wanted an elective c-section. She was clear this was not for strictly medical reasons-it was her choice. She ended up going private for it, because she was basically told she could not on the NHS. There are many stories of women being refused epidurals when they ask for them. It's really as if women are not allowed to make these choices over their birth.

A lack of realisation that mothers also have a life independent of their children. There is an assumption (tbh this carries on into school) that facilities can/will be attended in the middle of the day. There is nothing at the weekends or in the evening. For example I had PND with ds1, but was unable to access any support or help-sessions were all during the day.

Agree with Oly4 a MW led unit would have had me running the other way! My anxiety meant I wanted 24/7 obstetric led unit care! With anaesthetists, theatres, NICU etc on tap!!!

I would like more private rooms on postnatal wards, the few at my local hospital were full so I had to stay on a 4 bedded ward after a very traumatic delivery.

...Too many visitors, partners staying overnight (although my own DH was a godsend as tbh the staff basically left you to it) but I understand that he was a stranger to the other women. Although they let you keep the curtains closed for privacy, it just made you feel hemmed in with no fresh air. A private room with a window and own bathroom(!) would have been lovey....instead of having to shuffle down the hall, barely able to walk, bleeding heavily, stared at by relatives and partners....!!

No actual practical breastfeedimg support from the nhs. I asked countless MWs , HVs etc to check my latch because DD had a tongue tie. Was told, yeh it looks about right from a cursory glance. I wanted someone to sit with me help me latch her on, actually watch her have a feed!! Tried to access NCT BF support in the community but everyone was so busy they just said, come to group! Not remotely practical when you can't walk, drive, or leave the house with a colicky, refluxy, tongue tied newborn!!!

Also, the same MW throughout would be lovely. So you didn't keep having to tell your 'story' at every single appointment!

Women want choices but not everyone wants to give birth in midwife led units. I personally wanted the highest level of professional care possible in a hospital. Don't assume all women do not want intervention. Some do - we want pain relief, we want to be induced if we go over to prevent the risk of stillbirth. Those are our choices but some midwives refuse to accept we wish those levels of care.
I echo the sentiment about breastfeeding - women need much more information about where to go for help when things go wrong. Maybe a 24/7 helpline?
And postnatal care is dreadful in hospital - women are extremely vulnerable at this time and many feel left alone with the care of a newborn.
Barriers to making choices include entrenched NHS attitudes, paternalism and a postcode lottery of available services.

I'd like to see more homebirth midwives available who don't just call an ambulance at the slightest thing & are trained in actually supporting a labouring woman in her choices rather than spending all the labour either writing notes or on the phone. Both my labours could've been a lot easier if I'd had more supportive midwives. I wanted it to be as un-medical-ised as possible. I'd have been better off without any midwives there, they just added stress to the situation.

My antenatal care was much better second time round - first time, I barely saw the same midwife twice and the number of available appointments with MWs at my local GP were so limited I ended up seeing the GP instead.

But postnatal was as bad as everyone else on this thread has said - in my case a very young midwife visitor me at home saying cheerfully 'Oh you should increase formula top ups, baby will be back to birth weight in no time'. I wanted to carry on breastfeeding but felt I was being discouraged from doing so. Baby getting back to birth weight was all they cared about.

Thankfully with amazing support from expert breastfeeding midwifes at drop-in cafes I was able to carry on BFing, but now my hospital trust is pulling the funding for them. How can such a short-sighted idea really be what is best for the parents and children? I predict BF continuation rates will plummet in our area, but all the hospital care about is the % initiating breastfeeding in hospital. No matter that most will stop after 2 weeks, probably, because of lack of support. The hospital only cares about what happens on its ward. The after care is SO important too, though!

Which choices do you wish to be able to make about the maternity care you receive?

I think a birth debrief should be offered or booked after you have given birth. I didn't even know this was available until a few months ago (my son is three years old). I think it's important for every woman to understand what actually happened during her labour, especially if any sort of intervention was involved, decisions were made without her consent and if anything classed as an emergency occurred during her labour.
For me this simple option would have avoided a lot of distress, fear and years of anger. The NHS now has to pay for me to go through therapy and for a midwife to come and see me for a Birth Reflections appointment. Whether this is offered to some women afterwards, I don't know, but it was definitely not mentioned to me. You get told after an operation what happened, why is this any different? We get left in the dark.

What are the key barriers preventing women from making the choices that they wish to?

Every woman makes a birth plan however a lot of women's plans are not adhered to due to unforeseen circumstances. Had I been kept more informed during the labour mine could have been followed. A lack of information on my progress resulted in an emergency situation, which I didn't know about at the time, meaning the plan had to be abandoned leaving me upset, disappointed and confused. I feel that had I been given the right information and support during my labour I could have taken steps to avoid an unpleasant outcome and the degradation of the birth I truly wanted.

The main issue with my birth experience was a lack of communication. The NHS needs to address the fact that what may seem ordinary to the midwife is new for the mother, especially first-time mothers. She needs to be listened to, encouraged and acknowledged; and not have procedures done to her without any sort of explanation or consent.

I was left alone a lot both during and after labour. It has left me with PTSD and anxiety that was undiagnosed for over 3 years.

I also agree with others about midwives attitudes to due dates. I was the only one who knew when I conceived. My son was born premature yet the midwives assumed my dates were wrong just by the appearance of my son.

I agree with much of what's already been said, but I would say that given that we (supposedly) have a national health system, I found it ridiculous that I couldn't opt to have antenatal care near my work and that all appointments were in the middle of the day and all made for the same time for everyone (so my school had to get cover each time even though I was never seen until after the end of the the school day).

DH was astonished by the basic and inaccurate methods that are used to establish due date. Given how much hangs on it, from induction to maternity leave dates, he felt more training in statistics was needed. We knew the date of conception to the minute (IVF) but no-one we saw would even take the info into account.

I would like the following, thinking about it further:

• women don't get turned away from hospital just because they aren't dilated enough. Early labour an be incredibly painful and scary if you are alone, the health system has a duty of care not to brush women off with a suggestion to take paracetamol.

• hospital consolidation decisions set birth and maternity requirements as wholly separate. Yes, this may mean a lot of small maternity-only hospitals. But it's ridiculous to suggest that maternity (which will almost certainly happen to a large percentage of half the population at some point and is totally time critical) is the same as other medical services provision. It's not an illness.

I wish there were more choices of stand alone birth centres, run by midwives. There are none which are close enough to me to attend.

I must say I would have to disagree with that. These units should be sited in hospitals and be physically close enough to the labour ward that a transfer can be made in seconds/minutes if something goes wrong. I've worked on labour ward and have seen plenty of healthy low risk women who have had sudden, unpredictable complications where being down the corridor from an operating theatre has saved the life of mother, baby or both.

Which choices do you wish to be able to make about the maternity care you receive?

Well, just choices, within reason, actually explained, without prejudice.

What are the key barriers preventing women from making the choices that they wish to?

Staffing levels, time available, training of staff who are available, attitudes and prejudices of some of the staff that are available (I'm looking at you, maternity assistant who told me I couldn't breast feed because my boobs were too big and Midwife who told me, with an eyeroll, that after five days of almost no sleep on the ward I was being defeatist to consider going home and mix feeding rather than staying in and struggling to exclusively breastfeed).

Yeah, that's worrying. You think to yourself, you presumably took a midwifery degree, was there no mention of CONSENT or were you just skiving the day they covered that?

MN can (and should) advocate for women to have the right to choose to refuse induction

This. Absolutely this. When I went in to the day assessment unit for a check at 8 days overdue they told me they would book me in for an induction at 14 days overdue. I told them I wanted expectant monitoring and an appointment with the consultant to discuss that instead. The midwife told me she would check "if I was allowed".

Sorry? If I want to refuse a medical procedure I'll refuse a medical procedure, and if you think I need a medical procedure you will seek my consent not tell me I have to have it.

We are entitled to our own views baffled, but not our own facts. Which is what someone who is claiming that inductions cause complications and cost more money is doing: actually, some inductions do just the opposite. It's a fact that induction at 41 weeks makes EMCS less likely. I'm no advocate for reducing sections as a goal in itself, but clearly most women would prefer to avoid EMCS ideally. Just saying 'induction causes complications' is far too simplistic, and if MN go in saying that to a load of maternity experts, they're going to look silly and be taken less seriously. This is a separate issue entirely from women being pressured into induction, which of course is wrong. And it's no more or less wrong if it happens before or after the point at which induction makes EMCS less likely.

And sorry, but comments like 'the risk of stillbirth is still relatively low' are completely inappropriate- I will be the one to decide whether that risk is acceptable to me, nobody else. The post I was replying to highlighted 'excessive defensive medicine' as something that limits women's choices, which it certainly can. However, the post was also problematic in itself because of the minimisation of the greater stillbirth risk the further postdates a woman goes. MN can (and should) advocate for women to have the right to choose to refuse induction without minimising the increased stilbirth rates if a woman chooses expectant management instead. They shouldn't be mutually exclusive.

I'd like to see the health of the mother (particularly mental health) taken more into account with feeding issues. I was kept in hospital for a week after an emergency c-section and was put into a routine of pumping and cup feeding which only allowed 20 minutes sleep every 3 hours, was forcibly woken, my son became seriously ill because there was not enough milk because the midwives kept dismissing me when I told them there was nothing coming out. The ward was a horrible environment with no privacy, it felt like prison. The prioritisation of breastfeeding over all other issues made the staff seem like warders who considered mothers to be merely milking machines. I felt pressured and harangued. I was told I was a bad parent and that I didn't care as much about my child as I should. I was just struggling to get enough milk out but was accused of being squeamish and precious.

It ruined what should have been a really happy time for me with a baby I'd waited over 10 years for. I was okay when I went home, but I firmly believe that other women would have been pushed over the edge into post natal depression.

I believe breastfeeding should only be promoted in positive terms, and not by making women feel guilty or like a bad parent if they can't or don't want to do it.

This is an interesting thread, I'm currently pregnant with my first so I am yet to experience the care you receive during labour and post birth. However I have been really frustrated with the lack of information about where I can give birth.

When I found out I was pregnant. I was interested in finding out more about the MLU in our area. However in my first midwife appointment I was only given the options of hospital or home birth. When I asked specifically about the MLU my midwife said she didn't know much about it and as the local hospital has just been done up it should be a similar experience but with doctors on hand if needed. She seemed quite insistent that I should put down the local hospital for now and I can always change it later which I agreed to.

Following that I have tried to find out more about the maternity ward at my local hospital but the only information online is a bit of text dated before the refurbishment was done. They also don't allow ward tours here so it is impossible to make an informed choice.

Still not convinced that it will be a similar experience to the MLU. I asked about changing my choice to the MLU again on my last appointment but the responses I got seemed odd. The midwife said she wouldn't change it on my notes but said I could have my baby anywhere I liked. She said I should call the unit if I wanted to have my baby their but she couldn't find a number. It also wasn't clear if I should be calling them now or just when I'm in labour to see if they have space.

It really sounded like she was saying no and yes at the same time which just left me and my husband confused. I'm also not sure what the point of specifying anything on my notes is if it's not really what I want!

Whatare, your post about the underlying attitudes around childbirth is spot on. Even if it's not intentional on the part of some hpc's. I was admitted to the labour ward in established labour, in agony (back to back baby, came in by ambulance as I couldn't sit in the car for more than 10 seconds) and I was given the overriding impression by the first couple of midwives (intentionally or not) that I was being a bit of a wuss as I was "only" 4cm dilated. Told no-one would be free to give me an epidural for at least 90 minutes. 2.5 hours later, midwife starts talking about pethidine, I state I don't want it, I want an epidural! Her answer "well we'll just examine how far along you are, and then discuss it!" Turns out by then I was 10cm and had been transitioning while they hadn't noticed. Must confess to feeling a bit smug but there is a patronising attitude, especially for first timers - "There, there dear. It's childbirth, of course it's going to hurt" and to make you feel like you're making a fuss about nothing rather than actually listening to what you're saying.

Just to be clear, needing any form of pain relief at ANY stage of labour, does not make a woman a wimp/wuss. We are all different and have different labours. That is what hpc's need to remember, not just give the impression "well you can't be in that much pain already!"

I can already tell I'm going to be a lot more bolshy about stuff with DC2!

1. a free choice in what happens to your body - i.e. being able to choose a c-section, pain relief, natural birth.

No partners staying over night in pn wards

No Bounty reps on pn wards.

2. the barriers are paternalism and greed. Putting money before women's health and bodily autonomy.

More birth centres and MLUs

More continuity of care during pregnancy and birth - not the current 'you get who you get' system

Which choices do you wish to be able to make about the maternity care you receive?

I was quite lucky - there is a good amount of choice in my trust, including a well-established and well-resources home birth team. This should be available everywhere - the place of birth study showed that for low risk multiparous women home birth is just as safe for mother and baby. And cheaper for the NHS incidentally.

The choice that was not available to me, and I wish it had been, was one-to-one continuity of care from a midwife. I paid for this privately and I genuinely believe it's one of the reasons I had such a good birth outcome (not the only reason obviously).

What are the key barriers preventing women from making the choices that they wish to?

Well obviously the NHS machine - you get what you're given.

But underlying that is an attitude.

I genuinely believe that there is a view that women should take what they're given with birth and just shut up - it's romanticised as necessarily difficult ("wimmin's issues" and things like hormones which, you know, cause problems, albeit unspecified most of the time). A pain-relief free birth is also mythologised as ideal which is utter bollocks. If men so much as stub their toe there is a generous view on the need for pain relief.

Things that no one else in the health system would put up with are inflicted on birthing women. Overlooking normal consent standards when it comes to internals and interventions during brith. Allowing Bounty ladies and their notoriously aggressive ways and inappropriate access. Failure to prevent visitors on the ward at all hours including partners overnight, despite this discomforting other patients. Dire after care and a belief that a 5-month pregnant-sized stomach for life is "normal" when it's really not. I could go on and on.

Saying that inductions cause complications that cost money is a generalisation and not necessarily accurate. For example, induction at 41 weeks reduces the chance of emcs on average. So please don't go in making that argument HQ. Also, stillbirth rates do increase after term and it should be for every woman to make the call about what level of risk is acceptable to her. Someone else's ideas about what constitutes defensive medicine shouldn't even come into it, indeed this is detrimental to women's right to choose.