AIBU to think that the £3000 budget for births is potentially a misleading con.

[RedToothBrush]

Women to be offered their own £3,000 'birth budgets' announced today.

Sounds great in principal. But it worries me too.

The way it sounds is that the idea is to let low risk women choose the care they receive. My worry with it though is it will mean that women are pushed into the low risk category even if not appropriate. I think it could have real implications for VBAC v ELCS. I note that no where does it say anything about choosing an ELCS. Would there be concerns where someone has 'used up' their budget and then couldn't afford pain relief? (Incidentally the cost of an ELCS was estimated as £2,369 by NICE in 2011 guidance). What if the hospital closest to you and your preferred choice is too expensive so you have to go to the unattached birthing centre otherwise you won't get breastfeeding support?

Also when its being described in the article, I get the impression that one to one care, home births and extra breastfeeding support are being framed as extras or expensive options rather than basic bog standard choices. Given that a homebirth is the CHEAPEST option, I find this misleading. Given each of these has proven long term health benefits which make them cost effective and indeed economically preferable it makes me raise my eyebrows.

The NHS patient charter states that all patients should get the most appropriate care for them already. This just appears to be a media headline grabbing stunt, which in practice could in fact be a way of LIMITING options rather than expanding the idea of raising the baseline for ALL care.

It strikes me as really smoke and mirrors to look good and win support. Its being heralded as empowering women. I personally think that empowering women with regard to childbirth isn't about budgets but attitudes within society and within medical circles. (Again going back to the article the fact that ELCS are not mentioned highlights the point to me)

(Incidently as an aside, the NICE guidelines for CS are due for review this year. I know there are a lot of women on MN who are pro-choice for ELCS for various reasons. I have grown alarmed in the last 6 months that there seems to be an increase in rationing ELCS going by the posts on MN. MN could in theory register as a stakeholder to represent some of our views. I would be over the moon if they could as there are very few organisations that directly represent the experiences of women in this area).

This is scary. And I agree that if enacted will lead to more health inequality. Some women do not need a budget of £3,000, and so money will be spent on unneeded extras. Others need far far more. And you don't actually know what camp you will be in until you give birth.
Its not like buying a washing machine. There is only so much planning ahead you can realistically do. I don't want women afraid to ask for pain relief as they know they have an existing health problem that means the cost of care will be more overall, and so try and save money.

pausingflatly

The main thing I meant by highlighting the already is that although it's being published as though women are going to be given this almost as a cash grant to spend however they want, it's actually not that big a shift from the way the tariff system already works.

Evidence based practice and policy is always good - and I hope that the review has looked at different ways of measuring the outcomes from services like One to One, Neighbourhood Midwives etc and take those into account. Totally anecdotally my own experience of this type of care has been very good, and for the same cost to the NHS as during my first pregnancy the care I had/am having for my second has been more personalised and flexible which has been better for me.

How would it even work? If I choose to spend my £3,000 on a home birth with whale music, birthing pool and a doula but as labour progresses it turns out I need hospital admission, epidural and csection then its going to cost alot more than 3k.

My first birth was way more difficult and protracted than I'd anicipated, the second much, much easier. You have no way of knowing.

I do support the provision of 1:1 midwife care during birth though - that made a huge difference to me.

Won't personal budgets allow for competitive provision of services? So if the local hospital decides to close down the birthing centre and only run a labour ward, another provider could come in and set up a birthing centre to provide that service to low risk women and there wouldn't be anything the hospital could do about that?

This is how maternity services are currently funded

JugglingFromHereToThere the article suggests its just low risk women who will get choices to me, but I wholeheartedly agree that all women should be getting choices.

The report though says that women dislike these risk level labels for this very reason. So it is recognised in the report.

However given how its already being interpreted in the press (which tends to have a significant influence on implementation of recommendations and makes you sometimes wonder if the NHS managers read these reports properly), it does make you wonder whether women who are in higher risk groups will have the same level of choice.

I don't get how you will be able to have a national workable scheme that addresses the two conflicting ideas where budgets will be according to your need but women don't like to be labelled according to risk. Somewhere along the line, either choice is restricted or women labelled. Or both. And that it is not subject to wide disparities in its interpretation on a national level.

I am struggling hugely to work out how its going to operate in practice on this basis. It does seem like an idea that has not been thought through in its entirety.

Anyway, for anyone who wants to read the report in full (its pretty readable and understandable as far as NHS reports go.) it can be found linked here

This is part of the privatisation process. Right now women won't be able to take that £3000 and use it towards private birth care, to cover part of the costs or to top up their health insurance. Give it a couple of years and that's exactly what will be happening. You get a voucher and do what you like with it - the basics for the poor, a helping hand for those going to the Portland. It stinks.

Another step towards privatizing the NHS

This won't work, it will put women and babies more at risk, and it will put people into a hierarchy that shouldn't exist in a labour suite.

And the suggestion that ANYONE should have to pay for breastfeeding support pisses me off hugely. I'm an BF volunteer. If I was an ILC that would be different - but people already have to pay privately for that! The government complain about low breastfeeding rates, then put extra hurdles in the way for new mothers.

Perhaps if they stopped closing and rejigging maternity services, so that women actually had access to services that were local to begin with....

This is just another creep of privatisation. We already have the right to choose services and method/location of birth. FFS.

Even if implemented poorly it will mean service providers could court women with the sorts of services they want.

And conversely no-one wanting to touch the expensive/complex cases? A bit like the way the private healthcare sector cherry-picks the straightforward elective surgeries like knee replacements and catarract sugery and leaves all the expensive, tricky stuff to the NHS (like cancer and neuro rehabilitation)? Let's not forget, thos proposal doesn't bring any additional funding for struggling maternity units. Sounds to me like the free-marketeers want the unpopular units to go to the wall, but who wants to travel out of area when they are in active labour? Where's the patient choice in that scenario?

When I saw the headline I thought it was a nice idea. Having read the thread, I've changed my mind. Yanbu.

I see the £3000 becoming like tuition fees for university. I wholly disagree with it and think it's an absolute joke that women are 'given' a budget. If you need care you need it. The services for you to pick from should be offered to all. It's patronising and if love to see what would happen if they introduced something like this for men. It will also become a tax on families which is totally wrong and you will see far less middle income people forgo care or have less babies. Long term it's a stupid policy at best.

So happy im having my babies here in the US. It's not cheap but I get a lot of help and care. I'm listened to and respected. I was in hospital on Friday because I didn't feel well. That care is all part of the maternity package our insurance pays $10k for (having a CS). We pay $50 for prenatal care, $50 for delivery, about $200 for the specialists (ie pain relief such as epidural) and $500 a night for your hospital stay. We pay about 10% income tax so it all balances out.

I really don't see how this would work. To be honest I'm quite glad I'm going to give birth before this comes in. My first birth will have cost over £3000 as I was induced in hospital for three days for that and ended up in theatre with a full team for forceps delivery. No way that was under 'budget'
This time I'm under consultant care with extra scans and I'd be surprised if I haven't had nearly £3000 of care yet - so what would happen with my actual birth which will be hospital again so straight away more expensive.
Never mind things like where are all the extra midwifes going to come from when everyone is 'paying' for 1:1 care (which quite frankly should be given anyway)

I wholeheartedly agree that all women should be getting choices

With third pg I wasn't told no to home birth at any point though it was frequently implied - miss information and scaremongering were tried then when that didn't work hurdles and hoops we had to jump through.

I'm not sure have control over where the money was spent would have changed any of that and it took a fair bit of research and backbone to get our choice that when we finally complained had apparently always been available to us.

But if the average cost is currently 3k, presumably a fair proportion went over that (about half, if it was compleatly bell shaped, which it won't be).

And how much did my birth cost? Intending to go to hospital, but baby decided 2 hrs of labour was plenty, and was coming out. So I got an ambulance, and then a midwife at home. That was 3 medically qualified people, and a vehicle for a couple of hours (DS2 arrived about 30 s after the paramedics and before the midwife). Drug free. It's certainly not what I'd have chosen, and not cheep, I wouldn't have thought.

Or is it for writing your birth plan? You can't have everything, so tick what you want to a max, but if you need something more, you can have it on standard NHS procedures. Not the nice to have extras?

I actually love the idea! It needs to be put in place properly of course. We can never have a situation where someone has 'run out of money' that would not be acceptable at all. But this is the first time I've seen a proposal where I could, in theory at least, log onto my pregnancy website and make my choices really clear without having to fight with a midwife who might disagree with me. If my midwife disagrees she can advise but cannot put a barrier in my way as I could go home and setup my choices regardless. The whole thing also sends a really clear message to all involved that the care will be centered around the woman's choice and that should do a lot to change attitudes of paternalism that I've seen and heard of so many times in this area. I really hope it's in place for my next pregnancy! Haven't they done something similar in areas of social care? Would be interesting to see how that's worked out. Might be some good lessons learnt there that would help the implementation of this in maternity services

This is a way of getting people used to paying for an NHS service. Very underhand.

After a while, women will be offered "upgrades" to the £3K budget and a two tier maternity service will suddenly appear.

As PPs have suggested, women are already supposed to have a choice.

I agree with the people who say the real choice needs to be available. I live in an area where the MLUs have such bad staff shortages that although we have 3 choices of birth location on paper, the reality is that it depends on whats open/not full. In reality I had only 1option on the day as 2/3 were closed/struggling to cope with demand. But that's a separate issue. Let's not stop choice in the areas where we do have it just because we haven't yet fixed some areas where we don't have choice yet. I wouldn't want to penalise the choices I do have just because some choices don't work out in reality.

I agree that this is the beginning of the end of "to each according to need". With birth particularly you cannot budget in advance for care needed individually. You just don't know how things will go. Over a general population things even out, but individually they don't. I also despise 'choice' politics, which enable choice only for those who already have the means to take advantage. Those that don't get the dregs,which are usually underfunded as a result. If we all had decent local services there would be no need for choice.

But this is the first time I've seen a proposal where I could, in theory at least, log onto my pregnancy website and make my choices really clear without having to fight with a midwife who might disagree with me. If my midwife disagrees she can advise but cannot put a barrier in my way as I could go home and setup my choices regardless.

The problem is I don't think that this WILL stop that. You will still have to be talked through your choices with regard to whether they are medically appropriate for your circumstances. I don't think it necessarily will change this gate keeping.

If it did it could be forcing midwives and doctors to do something against their will. They could argue that they are bound by codes of conduct to 'do no harm' as they see it.

The report was primarily about setting up safer maternity in the wake or Morecambe. So the idea that you would be able to 'overrule' medical advice and potentially endanger life, is very much at odds with that.

There will be still be plenty of opportunity to 'persuade' you differently.

Plus, you can only choose something if you are presented with that choice in an equal and fair manner. The reality is that disadvantaged / vulnerable groups are not as likely to have access to that information / be able to make those choices even if on offer.

This is where I see the problem really lying. It's in institutional beliefs and personal ideology as well as evidence based medicine not always being given the respect it should be being given. Care should come from midwives and doctors in conjunction with patients not despite one or the other. Its a two way process where both sides need to be listening and open minded rather than narrow or single minded.

Where higher risk women do decide to do something that is against what would normally be advised, this is whether greater communication and mutual respect between women and HCPs needs to be employed. Women need to be helped to facilitate choices which are going to keep any potential risks resulting from those choices to a minimum.

In short, there needs to be a way of compromising on both sides. Women thinking they have a right to 'demand' whatever they want, isn't going to help anymore than a midwife being obstructive. Especially if the reality they then come across, is little more than the 'school choice' others talked about upthread.

Culturally women simply need to be viewed as PART of the conversation and their needs/choices respected.

I'm very suspicious of this report. It was commissioned after the death of Joshua Titcombe in Morecambe Bay in which conflict between midwives and doctors was found to play a part. James Titcombe, Joshua's father, was invited to be part of the review, but resigned last year because he felt that the review was being biased towards the professionals' agenda and not taking enough account of safety concerns or the views of parents.

Proper staffing of hospital-led services is what we all need. Enabling women to give birth at home is desirable if this is what individual women request. "Encouraging" low-risk women to give birth outside a hospital setting is a slippery slope imo. I dislike these "surveys" that purport to show that we all really want to give birth at home, and that that is where provision should therefore be weighted. That's not my view, and it's not the view of anyone I know.

My second pregnancy was as low risk as was possible to be, but my baby died as a result of unforeseen labour complications. My best friend had a low risk pregnancy but nearly died after a serious haemorrhage. Childbirth is unpredictable - you can calculate the risks all you like but you can never be certain what will happen in each individual case.

So sorry about your baby

And yes of course you can not predict with 100% accuracy who is low risk. So some low risk women allocated £3,000 will have births that cost far more than that.

Has anyone noticed the appalling high rate of infant death in the US? That is because they have a two tier system. Fine if you have money to top up or have a low risk birth, terrible if you have complications or need extra pre natal care.

It's not so much the £3,000 that bothers me, as the creeping implication that low risk women "ought" to give birth at home. While I totally appreciate and support that some women want to do that, I think it's dangerous to start promoting that as the new normal.

I can only think of two or three births amongst all those of my friends and family that haven't had complications that needed to be managed in hospital. I'm frightened at the thought that some of these mothers might have been "encouraged" to birth at home because of their apparent low risk, and what might have happened as a result.

I don't understand how this works at all. Sounds totally bizarre, as if we're children being told to think carefully about how to spend their pocket money.

I had technically straightforward births, although one was high risk. However what was available on the day was so limited that my preferences were totally irrelevant.

If there is genuinely to be extra funding then surely this should be focused entirely on making sure there are enough midwifes and medical staff to ensure that the safety of the mother and baby is absolutely paramount.

If there is no extra funding then aren't most hospitals/mid-wife centres going to be bound whatever resources they have, just as they are now.

But I'm also a strong supporter of publicly-funded healthcare. The idea that individuals get given vouchers to give to their provider of choice means money leaching away from the NHS. It means less money spent on infrastructure and staffing. It means less emergency provision when things go wrong.

And I worry that lots of unnecessary, even dangerous, providers of "services" to pregnant women could pop up for them to spend their vouchers on. Money that could go towards funding more midwives would instead be spent on vitamin supplements and yoga classes.