To think maternity is in a real mess?

[AgeingMillennial]

I had my last baby in 2023 and that was bad enough (no continuity of care, cattle on a conveyor belt feeling when I was induced, piss poor midwifery care in labour), but it seems to be even worse now.

Beautiful birth units that sit empty and half closed because hardly anyone is allowed in them. Chaotic hospital labour wards with no available rooms. Decisions made according to what would be easier for staff or their logistics. Everything ‘on the clock’, with heavy and constant interventions because midwives seem barely skilled past taking obs and fetching the anaesthetist when hours of labouring like a wild animal caught in a trap gets too much.

Despite our terrifyingly high c section rate and the vast majority of women giving birth in medicalised hospital wards, birth here still isn’t safe. We have some of the poorest outcomes in Europe.

Is it time to admit our medicalised, intervention heavy, risk averse approach isn’t actually working? Is it time to relax the guidelines a bit and focus more on a holistic, flexible approach? I don’t know what the answer is but it feels like the system is on the verge of collapse.

Sorry but I don’t think you really understand what is going on in hospitals across the country right now

Apparently many can’t meet demand in their planned lists. C-sections are taking place in their main theatres rather than maternity theatres. What should be planned c sections are turning into emergency or urgent care sections

Re: guidelines- this is standard in all clinical practice as far as I understand. There are many guidelines that are followed the most known to the public are the NICE guidelines as I understand. Clearly the recommendations have extended various guidelines and if you listen to what this (midwife?) is saying, it’s that they are being encouraged to risk assess more and more women as high risk and that means consultant led care. I heard only 10% of women now are allowed to use midwife led care. As said above rising gynae issues and accretas are the result

NHS maternity care is basically no longer fit for purpose and it's not getting any better.
Hence why I opted for an IM homebirth for my last baby.
Every penny was worth it.

It’s great that you had a good experience but if you needed specialist or emergency care, you would have needed the NHS. I can see why you chose this path and great that it worked out for you. Maybe more women will choose this option

But I’m not sure it’s that simple. If it’s true women are choosing c sections (rather than ending up with one or taking it as the last bad choice) why is that, what’s the alternative? Could it be that it’s the fear of being guilted down the path of early induction (routinely offered with no medical need - using language like “we will induce you” like I have no choice) then ending up with injury from assisted delivery or an unplanned c section….

women are being told no to home birth or the provision is being pulled entirely in areas.

It might if it made some saving on negligence claims 😬

https://www.bmj.com/content/391/bmj.r2211

I agree but I also think it’s the whole nhs - apart from cancer care which still seems to be doing ok. I’m struggling with gynae issues and have been told the waiting list is 2 years. Have been going private with husband’s workplace insurance but now they are being funny about what part of gynae they fund

Basically having a female body is not ideal right now

This sums it up perfectly in my opinion.

Judging from what I’ve been reading the intervention rate has skyrocketed because it is unsafe, not the other way round.

don’t forget all the maternity scandals. The intervention rates went up because of that. It’s happened much too quickly to be older mothers etc.

I had my first 20 years ago and it wasn’t brilliant, especially the aftercare, so I can’t imagine how bad it is now.

I've given birth twice and there simply weren't enough staff. The COVID birth was actually the better one as they were so keen to get us home I was in and out in hours. Strangely, when I had a minor gynae procedure at the same hospital there was no end of people in the room. I couldn't fathom how they could barely provide one midwife when I was 9cm arriving at hospital (husband had to find someone after I was dumped in a room) yet in gynae there was a completely unnecessary person there as a support to me, who I didn't remotely need.

Women have a better outcome if they are healthy before becoming pregnant.

A growing number of pregnant women in the UK are entering pregnancy with pre-existing health problems and experiencing complex medical complications.

Pregnant women in the UK are, on average, older, and more than half of women giving birth are overweight or obese.
.

Nail on the head. It’s not just maternity, the entire nhs has gone to pot. Virtually no communication, not just between different trusts but not even in the same hospital or the same ward. If you’ve more than one condition, the different consultants/departments won’t talk to eachother. One nurse/doctor will say they’ll do something, never happens, then a different one will say it’s impossible, and so the nonsense goes on. Something radical needs to change. Far too many in decision making roles havn’t a clue what they’re doing.

Please read the Birthplace UK Study. If anyone reads this thread and has an interest then it would really help your own knowledge if that was read.

The maternity scandals are awful and learning had to happen about accurate reporting and action from poor outcomes. I think NHS management should be absolutely bollocked for how they treat the families and their staff involved in poor outcomes. We should be looking at management - always.

Instead what happened is an idea that midwives trying to protect physiology have an agenda and are unsafe are rife. Bill Kirkcup in particular takes this line. This left a void. Midwives struggle to educate women on physiology and the importance of oxytocin, advocacy, felt safety etc without being accused of ‘pushing normal birth agenda’. There is no agenda. Birth is a hormonal process and the Birthplace UK Study demonstrated that midwives providing care according to that equates to the safest outcomes WITH obstetric support available when escalation happens.

Anyone who cares about the lives of women and babies should be shouting from the rooftops about place of birth evidence. And demanding we protect that and bring back some respect for physiology and the value of a midwife who trusts it and can and will escalate when clinically needed.

I agree completely.

I had an OK birth in 2018. Mistakes were definitely made however, during labour and post-birth, and this was at a top hospital with a high risk pregnancy (twins) were I was supposed to receive very attentive monitoring. I would feel very anxious to give birth now with what’s in the news – and I’m sure it was happening in 2018 too.

Yes I feel that c sections are being offered far too easily without any post op support. And I think it’s done for two reasons - quick in and out on the labour ward and so much red tape making midwives extremely nervous of every little thing. This idea of constantly being attached to a monitor in labour is insane - it stops the mother moving around and the drives spend ages adjusting these monitors. They need a better, wireless system and a lot more confidence in their ability to help the mother birth their babies instead of worrying about the red tape and paperwork and what if’s disciplinary.

Absolutely agree. DD1 was a difficult birth, but I wouldn't say it was a bad or traumatic one, even though things definitely didn't go to plan. And my feelings about the birth are positive because I know that I had skilled midwives throughout who listened to me and DH, allowed me to labour naturally by sitting quietly at the side of the calm dim water birth room I was labouring in, interrupting me for checks only when necessary and as 'peacefully' as possible.

Sometimes a traumatic birth isn't about what actually happens (that can't always be controlled), but how it is managed. Too many mums report feeling either 'interfered with' too much, or feeling unsafe that support wasn't available when needed. That is the true skill of a midwife, knowing when to intervene and when to sit back and allow nature to lead.

Absolutely, DC1 wasn’t easy but I felt all decisions were calm and considered and I didn’t feel chaos/rush. DC2 - totally different, everything felt scarily out of control and like nobody was stepping back and seeing the overall picture. A shitshow from beginning to end!

By “unsafe” I don’t mean inherently. I mean that the conditions in the hospitals are unsafe. This is cited as a reason women are scheduling C-sections.

for me, I was risked out to consultant at 16 weeks and delivered early due to severe pre-eclampsia. It wasn’t anything that could have been helped, only managed.

@CopeNorth It’s many things and definitely generational thing as well. None of the young women I know in family, friends, work acquaintances would consider a natural birth, not for any of the reasons you have listed but essentially they don’t want to ‘fluff around for days’ giving birth, they are not interested. They want to book a date, get it over and done with and have a baby within hours. They seem happy to trade off an old extended recovery time for this. I know my own DD asked me how long I was in labour for and when I said nearly 24hrs with your eldest sibling, there were utterly horrified with a definite ‘nope, I’ll never do that’ attitude, and it’s not uncommon.

I see that attitude, but far less extreme, with younger work colleagues, but still in the demographic as my daughter. It seems to be ‘it’s just easier’ as an approach (and yes, anyone could debate that, but just repeating what appears to be the common sentiment these days).

eta - just remembered a common line from work colleagues (again, decades younger than me but still late 30’s/early 40’s where a common theme is ‘I’m too old to go through that palaver’ when they say why they are electing for c-sections up front over natural births.