AIBU to think that NHS maternity care is only sustainable with these kind of changes?

[Dragonflyby]

I've been asked to take part in a focus group looking at potential changes to maternity care, where more things that are currently done by midwives will be done instead by maternity support workers or other trained non-midwives. So things like breastfeeding support, antenatal classes, smoking cessation/weight management advice; the non-clinical stuff, basically.

I've got some mixed feelings about it - on the one hand I know there's a staffing/financial crisis in the NHS and there have got to be changes and finding new ways of working, on the other hand, I wonder how midwives will feel about their roles being pared down like that, and whether it's what women actually want.

So is it reasonable to delegate more of midwives' current duties to trained laypeople? Has it worked/failed already with MSWs, and with nursing and HCAs? Or do they just need a lot more midwives instead?

Better than those things not being done at all- which is the case where I am.

I don’t think there’s anything wrong with them doing it per se (and I think the woman who did breastfeeding support for me a few years ago wasn’t actually a midwife). My concern would be that those interventions are an opportunity for a trained and experienced eye to spot other issues.

I think there should be an opportunity, for people to pay for extra midwifery appointments. I’d be willing to pay up to £100 a time to see my midwife monthly for all of those things - people who can’t afford that can still get the services through a support worker.

Surely any support a new and unconfident mother gets is better than none? Smoking cessation and weight management is best provided by people who have been trained in those fields anyway.

The horror stories I’ve read here about maternity wards has made my hair curl. If it was possible for me to volunteer so women got the help they needed without having to put up with other people’s partners compromising their privacy and dignity, I’d do it in a heartbeat. And I bet it would be appreciated too.

I understand there is a real midwife shortage. Having the non clinical duties handled by someone else would help with this. However, I would also think that midwives enjoy interacting with their patients.
Hopefully there are a fair few midwives on this focus group as I hate it when management make decisions without consulting the people who do the work every day!

breastfeeding support, antenatal classes, smoking cessation/weight management advice; the non-clinical stuff, basically.

The only one of these I'd be keen to see a MW for is antenatal classes - I think a trained practitioner is fine for the other stuff and actually that MW's time might be better spent elsewhere.

@TestingTestingWonTooFree that concerns me, too - it's those non-clinical interactions where a woman might open up to the MW, or the MW might notice a problem.

All maternity services are meant to be moving towards more continuity of carer (ie seeing the same midwife/small team of midwives throughout your care), so I guess a MW getting to know the woman would give her more chance to spot if something's amiss.

@Teddybear45 doesn't that create a two-tier service?

I don’t see the problem. The woman who helped me with breastfeeding was not a midwife. I had healthcare assistants handle my discharge and ward care. They were all excellent and very professional. Delegating such jobs leaves midwifes free to handle the higher risk patients and babies.

Obviously there needs to be more funding for qualified midwifes but since that isn’t happening then this is a good compromise.

@Alsohuman I know it's possible to train as a breastfeeding peer supporter, and at some hospitals they go on the wards to help women.

I think the majority of midwives really want to help women, but they just don't get the time to spend with them because they're stretched so thin. That doesn't help the woman who's not getting the attention she needs, though!

@Pipandmum yes mixture of staff, women who've used the service, and service user reps from the MVP (maternity voices partnership). I'm part of the MVP.

@EssentialHummus the NCT antenatal classes are run by NCT practitioners rather than midwives (I think?). I think most women would rather have a midwife to ask questions, though. I didn't do antenatal classes when I had my DD, so I can't answer on that one - I was too scared.

Id rather there were more midwives and a statutory charge for maternity care to be introduced. There could be a flat rate for everyone, regardless of how much or how little care they need. Obviously working out the details would be complicated as not every pregnancy ends with a living baby, but I do think that maternity is one area of healthcare that patients can reasonably be expected to contribute to.

Things like weight management and smoking cessation could be carried out by trained non midwives though.

I've recently had DC2 and noticed throughout my pregnancy and aftercare that the midwifery service in my area has gone really downhill, even in the two years since I had DC1. It's not the fault of the midwives, they are just so stretched but for example, I didn't get my first appointment with a midwife until I was 13 weeks, it should have been 10 weeks in this area but there were just no appointments available sooner. I could only have midwife appointments on a Tuesday as that was the only day they were at my surgery, I think I saw a different midwife each time throughout my entire pregnancy bar one that I saw twice. They just seemed so rushed and stretched I do really feel for them. But actually, for a lot of the non clinical things I would have been happy to see a support worker if it meant I actually saw someone sooner or they could offer more frequent services. Similarly with breastfeeding support, I don't mind who I see as long as they have been trained. It doesn't need to be a midwife, it could be a peer supporter, a health visitor etc etc.

To be honest, I was thinking more of the really practical stuff that midwives don’t seem to have time for like helping someone to the loo/shower, bringing food - the things that used to be taken for granted on maternity wards that just don’t happen any more. The accounts I’ve read sound like the third world.

NailsNeed- yes to more midwives, but hell no to an extra charge! Obese people don’t pay a fat tax for the billions a year extra they cause the NHS so why should there be a baby tax? At least a baby is actually necessary to the continuation of the species!
We already contribute to the cost with our NIC and income taxes.

I am in favour of an increase to NIC to cover all NHS funding shortfalls, but a specific baby tax to be paid by pregnant women is insane.

dragon I did nct and nhs classes, and the nhs one was so much better - led by two no-nonsense and very experienced midwives. Nct - the less said the better, imo.

I’ve found that’s already happened; it’s also happened in social work which I’m involved in. The downside of it is that then midwives are doing all the clinical stuff but not the part that builds the relationship and trust of a person and probably reduces a Midwife’s enjoyment in the job as there’s more to looking after a pregnant woman than the routine medical tests.

Id rather there were more midwives and a statutory charge for maternity care to be introduced. There could be a flat rate for everyone, regardless of how much or how little care they need. Obviously working out the details would be complicated as not every pregnancy ends with a living baby

And in a paid for service the number of pregnancies not ending with a living baby would increase as some people would go without antenatal care due to the cost (e.g., those who don't qualify to have it for free but equally can't afford to pay the fee).

What I would really like (though I know there's not the money to pay for it) is a standard 3rd trimester scan like in a lot of European countries.

It all seems so area dependent too, in London I'm not sure I ever had the same person twice and where I am now it's always the same lady which is nice.

Personally I'd be fine with the non-clinical stuff being done by trained support workers if it freed up midwives for the medical stuff.

Apart from the antenatal classes I don’t really see a need for midwives at all. A more obvious solution would’ve to just charge people who can afford it on a sliding scale. We would have happily paid for whatever given the option (and did wherever possible) of it meant we would have got a decent level of care. If the majority of patients are paying (something at least, not necessarily the full cost which a lot of people couldn’t be expected to afford) then that could actually be used to drag the NHS back into the developed world.

I think there should be a charge for seeing a midwife as well as towards the birth. Nobody has to have children, it’s a choice. That way we could sustain the services, ensure enough staff etc. Not on a sliding scale though, a set charge for all as much fairer.

A maternity tax is a complete non starter. It would go against one of the basic tenets of the NHS: free at the point of delivery (that’s what says, it isn’t a pun). Do we want to return to the days of the untrained midwife delivering the babies of women with no money? Because that’s what it would mean.

Maternity tax would see the stillbirth rates, which are already fairly high for a developed country, rise even further as well as the maternal mortality rate.

And a clear cut case of sex discrimination to boot!

In my area midwives don't run these things anyway (well when dd2 was born 6 years ago). Breastfeeding support is a completely different team, bosom buddies volunteers on the hospital, and peer support visitors/ other busom buddies after discharge. I had a home visit from a breastfeeding support worker, completely different to my midwife. Smoking cessation is a referral to a nurse at hospital/local GP centres. Seems to work well enough.

I know in my area they’ve started peer support for breastfeeding. I never got any support (although I did bf) so anything is better than nothing.