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).

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 agree coercion is wrong but generally home birth are safe and safter than many people perceive.
www.nhs.uk/news/2011/11November/Pages/hospital-births-home-births-compared.aspx.

Having said that risks are greater with first and despite being offered a home birth we didn't want one with our first.

Just as I hated having my choice restricted with third pg and having my reasons for wanting HB belittled and scoffed at - I would have hated being forced or persuaded into a first time birth at home. If I'm been further from hospitals I wouldn't have wanted one either.

With monetary considerations coming in more and more pushing women to cheaper options or options you have staff for, common reason why HB are not liked by some HCP as they need two MW present - is a real concern.

The only people I see this benefiting are those who have private births, and will now have £3000 towards the cost. Not the best use of NHS money.

James Titcombe was on Victoria Derbyshire's BBC2 show this morning along with Baroness Cumberlege.

Mr Titcombe widely welcomed the report but did express some reservations and said he wasn't convinced by the payment system proposed.

I've been spending quite a bit of time reading the report and I'm also finding it frustrating just how little coverage to changes to the real issues within maternity. I worry that the outcome of the report in the long term, will be about money rather than a lot of these issues and as a result as there still won't be the political drive to see these changes actually come to fruition.

timeKeeping - from your link:

"They found that women having their first birth at home had a greater chance of complications leading to injury in the child than women who had planned to go to an obstetric unit in a hospital. This risk was almost doubled.
Furthermore, when the sample was restricted to women who had no complicating conditions at the start of labour, there was almost a three-times greater risk for women with planned home births than for women having planned hospital births"

Double or triple the risks of a home birth, for first time mothers with low risk pregnancies, compared to a hospital birth. This confirms my hunch that it's dangerous to encourage women to have a home birth.

I think there is a lot more to this than the news has reported, so I wouldn't worry yet. No one will be denied care; my interpretation is that there are different packages you can build which include the likes of hypno-birthing which won't be something everyone wants, therefore attempting to allow women to use the building blocks they want within that 3K for basic care.

I do, however, foresee patient choice in terms of hospital being more restricted due to patient flow issues in a lot of the hospitals I've worked with lately.

The BBC article has been updated since this morning. It now reads:

The details have yet to be fully ironed out. But the review authors said low-risk, standard births cost the NHS about £3,000, so women could expect that sum at the very least although more may be given if circumstances demand it and anyone needing urgent care because of complications would get it regardless of whether their personal budget had been spent.

I did say the risks were higher for first pg Home births - that is why I didn't want one for my first Treats despite being offered one where I was at the time.

There is also evidence that hospital environments increase interventions - there are benefits to home births for some women.

The greater risks don't apply to subsequent births and frankly the still birth I knew off was down to overworked MW in hospital missing obvious sign of problems due to it being a really busy time and not enough staff.

With my third both hospitals had choice of were understaffed with devastating results- being at home with two midwife watching me who at first sign something was wrong would ring for ambulance red light to hospital and pass on requirements in advance of arrival as all MW insisted they would do seemed safer to us. That was a risk assessment unique to our then circumstances.

This confirms my hunch that it's dangerous to encourage women to have a home birth.

You have a biased view and you've cherry picked the data to support pre-existing view point it really doesn't make your view right statistically.

From link:

though the risk associated with home births seems greatly elevated in women going through their first pregnancy, the absolute risks were still relatively low.

Though for me that was enough to want MW led unit for my first.

....

For women who had a previous pregnancy, the rates of such events did not differ between women who had planned a home birth, hospital birth or birth at a midwife-led centre.

So no greater risk at all.

The details have yet to be fully ironed out.

Is it really too much for them to have though though the proposals and their implications before they announce them?

I'm not cherry picking - the report you linked to clearly states that (first time) home births are riskier than hospital births. Which is why I don't think they should become the norm.

I don't care if I'm right or wrong statistically. When you lose a baby, it's no comfort to know that it was a statistically unlikely outcome. There is no way of knowing what the outcome of any birth is going to be, and that's why I'm opposed to people recommending less safe forms of birth on the basis of statistically likely outcomes.

I'm probably over-sensitive about the HB risks being played up TBH.

I've experienced everyone and their dog come out with supposed risks when they found out we planning HB assuming for some reason that as parents we haven' thought through and researched thoroughly.

One of the hoops with third was a consultant coming out with all manner of problems with risk factors that didn't apply to me then telling us if anything went wrong we would be responsible for killing our baby . The actual risk was same as prior pgs very very rapid labour which apparently never happens even after it did yet again with third .

Though like you forcing or unduly influencing women in their choices isn't something I would want to happen any more than it already does.

I'm sorry you had that experience - I'm absolutely in favour of homebirths for people who want them.

But it irritates me when people downplay childbirth risk because it suits their agenda. And I smell a massive whiff of agenda from this report.

I'm not cherry picking - the report you linked to clearly states that (first time) home births are riskier than hospital births. Which is why I don't think they should become the norm.

It doesn't it says for all births - I pointed out that risk were higher for first pg and HBbefore I linked..

I have no where state it should become the norm - I've also said several times that I didn't want the risks for my first pg so why you assume I'm advocating that is odd.

Your also ignoring all the data saying that HB are just as safe after first pg - which TBH is when most people I know who had them tried.

When you lose a baby, it's no comfort to know that it was a statistically unlikely outcome. There is no way of knowing what the outcome of any birth is going to be, and that's why I'm opposed to people recommending less safe forms of birth on the basis of statistically likely outcomes.

I understand that - but understaffed maternity units at busy times also have preventable deaths I know that as fact as people I know have gone through that trauma.

You have very particular views about HB - ones I don't share.

Though I don't think either of us think these proposals are actually making anything safer or increasing choice.

Is it really too much for them to have though though the proposals and their implications before they announce them?

They're not announcing a policy. They are announcing recommendations based on an independent review.
Which has resulted in a public debate, with further input from interest groups. Which is exactly how it should work.

If they were announcing a firm and irrevocable policy, you'd no doubt be complaining that you haven't been consulted or had a chance for your opinion to be heard

x-post Treats - I agree there is an agenda with these proposals.

It could equally limit HB more - as more MW are needed for HB meaning you need to employ more pushing up staff costs.

I suspect we both think maternity service in this country need more MW and more money not more stuff like this.

I'm not arguing with you timekeeping - i'm arguing with the report. I'm not saying you shouldn't have had a homebirth or that they shouldn't be available. I'm not opposed to them. I don't actually have "particular" views about homebirths per se .

I just don't want statistics to be used as an excuse for pushing women towards less safe ways of giving birth. I don't think statistics have any place in childbirth provision planning because any birth can go wrong at any time.

X'post with your x-post -

I think we do ultimately agree.

I haven't looked into this in much detail yet but it does just sound like an early form of privatisation. Eurgh. Sounds very American inspired as well which I'm not really keen on.

This is all great for very well informed women but where I worked I met a lot of women who wouldn't be interested in what kind of package they get. They just want to be able to go to their local hospital that's safe, clean, well staffed, have their baby and go home. And some women will need help to understand this or work out how to spend their money or even just want to discuss it with someone. Who's supposed to do this - midwives? I have a general understanding of how maternity services are funded but I'm not a financial advisor. Also wondering how we would have time to do this as well. Some community midwives only have 10-15min appointments - barely enough time to get all the basic care done and actually speak to the woman in any depth about how she is, never mind stuff like this! I would also be concerned that people would make their decisions based on the monetary value rather than because they genuinely want it. Such as choosing a home birth because it's cheaper, or conversely choosing a hospital birth because it's more expensive therefore must be better. I really don't like the thought of women in theory "paying" for care and acting like consumers to buy a home birth or whatever. Just seems against everything the NHS is about to me but then I guess that's the whole point of this idea.

Don't get me started on the whole funding for more midwives issue. I've known a good few hospitals only take on half their newly qualified students this year because they don't have the funds to employ them all. People always seemed shocked that I didn't have a job automatically at the hospital I'd trained at. Sadly, doesn't work like that.

If they were announcing a firm and irrevocable policy, you'd no doubt be complaining that you haven't been consulted or had a chance for your opinion to be heard

Last time I was consulted about health local services we all wanted to keep the local A& E HCP and public - after consultation went very against the idea of it closing it was dropped.

6 months after with no consultation they stopped child admission - ambulance took to next nearest A & E 30 min away- any that came through door they could't treat immediately transported them to next hospital. Then as numbers dropped they started talking again about closing it.

My experience of public consultation is they complete ignore what is said and do what they want anyway.

However I do expect then to be able to articulate via media a coherent well thought out message that explains what is up for debate, what the plans are and what still needs to be decided. God know why I still expect that after the legal highs bill but still.

Agreed. The public are not listened to when it comes to the NHS.

And this is a horrific proposal.

What is more it would be like "choice" about which school your kids go to. The reality is even if you are in a City where there is a real choice, not everyone can go to the best providers. So it will simply mean better educated people will access them. When in reality I know in our City it is mothers at the highest risk of complication who see the most qualified and experienced Drs and midwives. So it is based on need, rather than who is best at getting what they want.

I've just had a very worried my dad on the phone asking me if everything was going ok because he'd heard on the radio that all maternity care in the UK is awful. I had to spend quite some time reassuring him that actually in both my first pregnancy and this one I've had fab care despite having lots of risk factors. I hate that once again we get soundbites of reporting that sensationalise parts of subjects to make a good story rather than looking at the whole issue.
I know I am lucky with my care being consistantly good and that the issue is the patchiness and Inconsistency across the country but so far the headline reporting does little to express this to the public and just focusses on the £3k issue (which for various reasons doesn't work for me)

cleaty I think the stats you are referring to are deaths in the first year. If you look at the rate of deaths in the first two weeks after delivery the US has a lower rate than the UK. The reason for the higher rate of deaths in the first year is two fold. Most babies born before 30 weeks are kept alive for over 2 weeks and then pass. I'm very impressed here at the care available for preemies. It really is impressive when you know more than one parent with a baby who has made it with minimal issues that was born as early as 26weeks. There is a continued issue with getting care to the poorest sections of the community. The provision is there but the parents don't use it.

Maternal mortality ratio is the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births.

They are much worse in the US than in the UK.

data.worldbank.org/indicator/SH.STA.MMRT

And the US does not accurately measure still births. Some states record them in the same stats as abortions.

So the US is at 14 and the UK is at 10. What I know from living here is that there are many more older mothers here and more women having more than 5 children. It is still considered unusual in the UK to be having at baby at 44 yet I personally know two mothers who delivered at 45 and 46. The risks involved when you are older are much higher. Speaking from personal experience, I am finding my third pregnancy harder on my body than my previous two.

The recording of still births and abortions together is a state law issue. When the US compiles their records for still births they include abortions in the still birth rate if the state doesn't separate the numbers out.

Also instead of comparing ourselves to the US, why don't we look at what Poland, Norway and Sweden are doing? The UK statistic doesn't look so hot compared to other European countries and I fail to see how this policy change will help improve the statistics.

NurseryRhymes the experience of 'choice' in social care suggests that it's a bloody awful idea, and shouldn't be rolled out to health care. Have a look at Mark Neary's excellent blog to see what it works like in reality: markneary1dotcom1.wordpress.com. Luke Clements has also written some excellent pieces on the underlying political ideology behind 'choice' in community care: www.lukeclements.co.uk/resources/

I hate sounding all conspiracy theorist but it is all chilling. In an age of austerity and cutbacks it's naive to think the Gubmint are going to be handing out extra money. It's all about the funding, and I don't think they're giving owt for nowt.

As for the anti ELCS post, have a look at my previous post about my experience of CS and tell me you still reckon it was a luxury!

Also to be clear this policy would not fly in the US for a minute. You get standard care based on your needs. It doesn't matter what your income or assets are. All those things they are listing as options are in some hospitals if you want it. If that is what you want you find an obn who delivers at that hospital. If you are delivering in the US you have excellent maternity provision thanks to Hilary Clinton. Best thing she ever did.

Having had two babies and pregnant with my third I am high risk. I was in the hospital on Friday because I nearly passed out, my ankles ballooned and I started vomiting. I then had a bleed (felt major to me but apparently it wasn't). I am going in daily for monitoring of the baby at the hospital. If I didn't have health insurance and qualified for Medicare I would be getting exactly the same treatment carried out by the exact same staff.