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

Wanted to feed into this because something MUST be done to improve postnatal care. I have heard so many horror stories from women about their time on postnatal wards. - no care, no privacy , no compassion, no sleep. My own experience with my first child was dreadful. A time that should have been joyful was full of fear, exhaustion and stress. I've never felt so alone. Postnatal wards need more midwives & more walls!!

Can I ask a question? Is it normal for delivery rooms to have a private loo? Mine didn't and I found putting on my clothes and walking down the corridor for a wee too much bother. I ended up being catheterised as I wasn't going enough and in hindsight a private loo might have stopped this from happening.

Also...

What developments or improvements can realistically happen with the NHS virtually bankrupt?

Really?

At what point will women/service users/staff just have to accept that there is nothing they can do because the money has run out.?

The changes in Supervison of Midwifery will have huge impact on women accessing choices.
At the moment a SOM will be available to discuss, sdvise and care plan. Without that independent advocacy role women who want care outside the norm will be scuppered. Managers of maternity services have to focus on the policies and guidelines of the institution. Supervisors are independent of that. If/when Supervision is scrapped there will be no support for this.

Also Supervision is massively important for midwives. SOMs are there to support and encourage professional development. Without that midwifery morale will be even lower.

I gave birth to my first in a consultant led unit and second in a midwife led unit in the same hospital. I love the option of mlu in a hospital with that safety net, this wasn't available in my more local hospital where the mlu was 20 mins drive from the hospital. It did occur to me after the birth in mlu why is the care not similar in consultant led? In consultant led I had a rubbish birthing pool and none of the other equipment which could have made it comfortable. And afterwards I was transfered to a horrible crowded ward. I had had a spinal block and was literally stuck in bed with no call button and didn't see a member of staff for ages. Then they kept fobbing me off about having a shower. I wasn't 'allowed' one until about 10hrs after birth. I felt so vulnerable and humiliated. I assume that cost is the reason the consultant led unit did not let me and dp stay in a private room with double bed and ensuite as the mlu did but I think it is such a shame that having a slightly riskier birth means you miss out on that additional comfort which helps whole family bond and breastfeeding get established.

I also think that midwives and health visitors should maybe be trained a bit more in asking difficult questions. At my midwife booking appointment she asked 'so there is no domestic violence, is there?' Luckily there wasn't as it would take amazing courage to answer 'actually there is' to that. And I had a similar experience with a health visitor when mentioning an emotional problem I had. 'But you feel fine now, don't you?' I didn't actually but 'oh yes, if course' was the only answer I felt able to give.

That all said I have hdlad fantastic care over all. Thank you NHS!

Better (or indeed any) breast feeding support from staff with expert up to date knowledge. All of the expert help I (eventually) got was from volunteers or private. It felt like the NHS only paid lip service to breast feeding then the minute you had a problem they wanted you to bottle feed as it was less hassle for them and they didn't know how to help.

Which choices do you wish to be able to make about the maternity care you receive?
I don't see you should have choose between a nice birthing center and Dr led care. I liked the idea of all the facilities they had in a birthing unit. Why should wanting the back up of a Dr stop you from having these?

I was stuck on an antenatal ward with three other labouring women and visitors coming too and fro over 12 hours before I went to the delivery suite. I don't think you should have to deal with that in any part of your labour - I found it extremely stressful. I just wanted to be on my own.

I wish there wasn't such a bad attitude to C-sections in this country. No where else in the world do they push so hard for V-backs after traumatic deliveries. They do not take into account the long term costs such as incontinence especially postmenopausal problems.

What are the key barriers preventing women from making the choices that they wish to?
Obviously money.
Thing is there are plenty of people who have the money to improve their surroundings (that don't live in London) and want to top up their care. I have private health insurance and it is frustrating that if i want a simple op I can get luxurious care but when it comes to having a baby there is no private option for me. I would quite happily have paid money for a private room for instance it the facilities were there. It's a shame more trusts don't take the initiative and be more business like - have add on/optional extras. (doesn't help they are always selling off every last scrap of land with no forethought for the future).

Which choices do you wish to be able to make about the maternity care you receive?
-More balanced information on birth options.
-Being told that ELCS is a valid option
-Being given proper data about different options (eg not getting EMCS outcomes mixed up with ELCS ones)

• right to opt out of any contact with Bounty whatsoever, from moment one of your first AN appointment.
• proper consultation with an actual doctor re tongue tie if child is not breastfeeding by time you leave hospital

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

• Targets, such as "we must get our CS rate down below X%"
• The Royal College of Midwives, whose main interest in ensuring its members have plenty of work and run the show
• not enough consultant obstetricians on actual, physical, present, duty at the weekends (our hospital= ZERO)
• A generally patronising attitude widespread in the NHS that they always know what's best for you and you don't. As demonstrated in hospital near us, where they warn you that if you dare ask for an ELCS (a perfectly rational and reasonable request, and one supported by NICE guidelines) they will automatically refer you to mental health.

What women will get is what interested parties think they want or should want, rather than what they really do want.

Yes. For example it's no great coincidence that unmedicated vaginal delivery is being promoted as the most desirable outcome, despite the fact that even low risk women often have no interest in it whatsoever. Nothing wrong in NCB for those who want it, hence I'm supportive of other posters desire for more FMLUs etc, but there's a great deal of interested parties deciding this is what we should want and what's best for us. Equally, the partners overnight thing is clearly the way it's going in order to be able to further reduce staffing levels, despite the HUGE issues a lot of women have with it. It gets advocated for a lot on the basis of one pretty small survey of patient experience.

And yes, percentage targets for eg sections, numbers of women exclusively breastfeeding etc are not ok at all. The very concept of aiming for a certain number of women doing X just has a great big shit all over the right to choose.

Stop perpetuating the "nipple confusion" lie- there is very little evidence (versus opinion) on this and what does exist is of a very poor quality yet it is preached as gospel to mums antenatally Yes milk supply needs to be established but there is no such thing as a "lazy baby" and for some mothers mixed feeding or nipple shields help them to carry on breast feeding and the failure to apply the WHO exclusive breastfeeding evidence to the context of the UK (as opposed to developing countries where there may be issues of availability of clean water etc for formula where breast is clearly best).

Better postnatal care for mums of premature babies. Fortunately the post natal ward at my local hospital were great at doing my checks on the ward that should have been done by the community midwife as I was in NICU with my son but this is not the case for all. Better transitional care units for mums of premature babies- where dads can stay too- before dischage from NICU to home to support parents and help mums make the shift from expressing to breast feeding if they want to.
Sadly as an NHS employee I don't think the funding exists for any of this and what women will get is what interested parties think they want or should want, rather than what they really do want.

Please keep DP/DHs staying overnight as an option in hospital, I loved that my DP could stay - it didn't even occur to me other women wouldn't like it Separate postnatal rooms for women who don't want this and more again for women who have babies in NICU maybe?

I am incredibly lucky and lived in an area with community midwives so had the same named midwife from a 6 woman team for both my DC. It would be great if more women could have this available. These women keep close ties to hospital but aren't so hospital focused, and they enabled me to have a home-birth I would never have considered without them there.

I did breastfed but never used any cafés or support centres but I can see that these need to be readily available - it is a hard to thing to do and at a basic level the existence of the cafés normalises breast feeding and gives it presence in the community, which gives women confidence to continue.

1. Choices:
   Women should be able to choose the kind of birth that they want, consenting to or refusing any intervention once the true risks and benefits of each have been explained to them. Some of the health professionals do have a bit of a "we know what's best for you" attitude that seems to trump what women actually want. Totally agree with elliej above about post-natal care for "high risk" women. MLU/homebirth isn't even an option for me due to my medical history (even despite a textbook, no complications delivery with DD). Fair enough, they need to manage the risk during delivery, but I would quite like the option of a private, calm, spacious room for DH and I to share afterwards à la MLU rather than the seventh circle of hell aka the post natal ward. More information provided about the risks of our choices, not just scaremongering us into doing what they think we should.

2. Barriers to choice:
   Biggest ones are staffing and money. I know c-sections carry significant risks, but the reason trusts refuse a lot of ELCS' is financial, I am sure. Health professionals not really listening to what women want an why. And a shortage of midwives. I lucked out and had a midwife and student with DD. The student didn't leave my side the entire time and that in itself helped me stay calm and progress well. Compare that to my SIL who was left alone for long periods and ended up labouring for 3 times as long as me. She firmly puts this down to anxiety slowing her contractions. One to one care makes such a difference.

Continuity of care.

Just an idea, wouldn't it be better for patients if midwives did antenatal, delivery and postnatal care in small teams so that you had opportunity to meet them all before one of them delivers?

Having a divide between hospital/community means you can't get to know your midwife before delivery.

Which I'm sure impacts on Labour.

I agree with a lot of the comments here.

More choice of pain relief. I was terrified and in agony. I had pre eclampsia, and was advised to have an epidural, but it didn't come for hours until I was having back to back contractions and screaming in pain.

Post natal care was poor, especially at night. I was glad my partner could stay as I physically couldn't move to reach my baby and no one would help me. I was also left in a bed swimming full of blood with a catheter also full of blood from 7pm to the next afternoon. I was so out of it I hadn't actually realised I had a catheter still in. Left me with some short term problems.

I would like early scans offered to people who have had a previous missed miscarriage.

I think the nhs needs more staff and a more flexible attitude. They seem really stretched.

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

I would like to be able to make an informed but free choice about where and how I give birth. This should include all permutations between homebirth and elcs.

I would like to be told the truth about the risks which these different choices pose, without being fobbed off by a dogmatic attachment to where in my body my baby exits from.

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

Lack of funding, targets - why is there a target rate for cs for eg? Lack of continuity of care from specific hcps. And a sense that women's health doesn't matter - there is a very informative and sad thread about this in Childbirth atm.

I can't believe the disparity between the swanky midwife led units in London and the hospitals . In some cases the low risk only birth centres are completely empty whilst hospitals make you feel like you are a factory chicken on a conveyor belt .

I completely agree about the right to an epidural. You get fobbed off in agony possibly especially with back to back labour.
G&a and codeine didnt touch the pain.
Im 40w and not been asked about a birth plan.

I also agree you probably need more food on ward.
Im going to refuse ventouse as it did nothing with dc1.

I'd like to have seen more flexibility around both ante and post natal care.
If all that's happening is having your weight checked, stomach felt and blood pressure checked, insisting it is in the middle of the day, miles from where you work, is neither necessary nor helpful. Equally, once you are back at work, I found any access to support was nil - despite the fact I was willing to travel / not fussed about seeing the same person etc.

Oh and the Bounty woman came and asked me where my baby was (NICU) despite it being pretty obvious something was wrong.

The only good thing about DS being on the NICU was the bounty woman didn't come near me!

More staff - the day after I gave birth I had to wait for ages for help - one time I ran into the corridor crying desperately for help.

Minimal breast feeding support - 1 hr session with councillor did not resolve issue and suggested solution was to spend half the fat naked with baby - not feasible post baby and treatments after childbirth. I couldn't even lift my daughter after birth and very little support to facilitate managing that and feeding.

Too few visits after birth. Calling and begging for help from midwives. Only came when they knew I was feeding formula as would affect their quotas (probably).

No explanation of things that were happening e.g. That baby is not bathed.

Love Dutch system where nurse helps out around house for 40 hours/5 days after birth with anything from breast-feeding to washing up.

But if a first time mum is in labour with a back to back baby which has not engaged, a difficult labour is predictable. An epidural is more likely. An instrumental delivery is likely. An emergency c- section is more likely. Women aren't informed. They just keep going, labouring with no idea that they are fighting against the odds. If they do deliver vaginally, there is a high likelihood of perineal trauma. Why is this kind of information kept from them? Why does noone say, during early labour, "the baby's position and lack of engagement makes an unassisted vaginal delivery unlikely", explain what might happen, give the woman the opportunity to choose an "elective" section?

YES.

We hear a lot about informed consent to various procedures, which is quite right of course, but not so much about informed consent to vaginal birth and the risks involved with it. This is particularly important in VBs that are giving all the indications of being long and difficult. It seems it's fine to leave women to suffer through them uninformed and unadvised, especially first timers.

SnozzberryPie I think the poster means partners staying overnight. I don't know if it's all hospitals or just certain ones that allow partners to stay over on the maternity ward. Our hospital didn't have anyone staying over when I had DS four years ago.

I would also like to the echo the posters who said about having to stay on the maternity ward while your baby is in SCBU. I was one of those mothers and it was horrible. I was crying to come home after three days because I couldn't bare it anymore. The SCBU in our hospital was through the maternity ward, out the doors, into a corridor, then a lift downstairs, then through a door to SCBU. So you're not exactly one minute away from your baby. I would love to have stayed on a dedicated ward for SCBU mums. To be around other women who were also missing their babies and understood. Instead of being surrounded by new mothers attending to their baby's cries and a nurse who came in to take my bloods in the middle of the night and said, "Where's your baby?" I dread to think how a grieving mother who'd had a stillbirth would feel if she was asked that question. The baby is clearly not there so why even risk asking such a stupid question?

Post-natal aftercare needs improving as well. The SCBU nurse who came to visit was lovely and so clued up on prem babies and DS. My HV first turned up a week after I'd had DS and I had to explain he wasn't at home. She then came two months later once DS was home then said she would visit again once the SCBU nurse had finished her visits. HV came again about a month later, then I never saw her again!

Yes. Send Bounty to the far side of fuck.

Long term post birth care if needed

For problems after birth not to be written by gps etc, as 'just what you have to put up with as a result of giving birth'

This should apply to all types of birth as all types of birth can lead to complications, and long term physical or mental health problems.