Government Review of Maternity Services

[Marina]

You probably all read about the Department of Health allocating £100 million to improve maternity services in England and Wales. This was announced a couple of months ago and there are now widespread consultations taking place through channels such as local NCT branches etc. The aim is to find out what improvements consumers of these services would like to see.
"Giving birth in the UK" clearly demonstrates that some of us did not enjoy our time in the maternity unit. I have volunteered to collate the Mumsnet response to this call from the Department of Health.
If you would like to make your views known to the Department of Health, please post them here and I will see they reach the relevant minister, once I have found out when Yvette Cooper goes off on maternity leave, and if she is still the contact point (she was before the election).
To kick off, this is what I would like to see:

Properly cleaned lavatories, showers and baths. Newly delivered and heavily pregnant women are vulnerable to infection and there are two (or more) people's health at stake. My maternity unit was squalid beyond belief because there were no cleaners. The solution in Greenwich appeared to be to pump mums full of antibiotics instead. We have a brand new hospital in SE London and apparently the toilets are still disgusting.

More privacy. Newly delivered women should not be in six-to-a-room wards with thin curtains as their only privacy. I would like to see more units providing smaller rooms, maybe even singles where possible. Then women could often labour, give birth and recover in the same private space.

More provision for partners. Partners should be allowed to stay over - another good reason for making single rooms the norm. A proper bed, even if only a z-bed, should be provided. Partners should not be treated like perverts or trouble-makers because they want to spend as much time as possible in the hospital.

More support for breastfeeding. Most maternity units are hugely understaffed, which means that midwives and care assistants don't have enough time to spend with women who need 1-1 support to get breast-feeding established. My maternity unit had allegedly won awards for being breast-feeding-friendly. This was not my experience and mostly this was down to the staff being too overworked to put theory into practice.

What do others think? What would you like to see done differently?

Some of these stories are very frightening! I think I'm very glad to have given birth in rural Australia! I know my experiences are not suitable for the purpose here, but I really want you all to know that birth and aftercare isn't always so terrible.

Throughout preganancy I visited my GP at her practice and she was to deliver the baby at the local hospital. I attended the hospital's pre-natal classes and we met some of the midwives and had a tour of the delivery rooms and Maternity Motel.

The Maternity Motel is not common in Australia and I am just lucky enough to live near a town that had one (I say "had" as, due to funding problems it has since been closed down...but they have redone the ward in the hospital making it all single rooms with ensuites, so that should be OK too!). The Maternity Motel was a separate unit in the grounds of the hospital. Women were admitted to the maternity ward (where there were four single rooms but shared bathrooms) and delivered in one of the 4 delivery rooms which had everything that opens and shuts, comfy lounge, birthing stools etc and one spa bath between them (if you are lucky enough to get in first). After delivery (at which at least one midwife was present 100% of the time and you can have as many support people present as you wish) that night is generally spent in one of the ward rooms and the midwives offer to take the baby for you so you can catch up on sleep, although this is not compulsory if you'd prefer to keep baby with you.

The next morning (barring complications) women and babies are generally moved to the Motel. The Motel consists of 12 single rooms with ensuites and a large common room area with kitchen facilities and TV. Mobile phones are allowed in the Motel, but not in the hospital rooms, and the Motel also has a phone that mothers are free to use for local calls and there are two public pay phones available for long distance calls.

The Motel provides cloth nappies, gowns and booties for babies and a laundry service for these is provided. The Motel also provides baby baths (and bathing lessons), soaps, creams etc for babies. The mother needs to provide all her own clothes and toiletries. All the rooms (including ensuites) were cleaned every day while I was there and bed linen was changed every second day unless it needed to be changed each day. Meals were brought to the common room and most women ate there (food was mostly pretty gross but I guess that's how it is with bulk cooking), but there were also tea, coffee, biscuits, toast etc available 24 hours.

Each day the new mums and bubs were gathered together in the common room (not compulsory, but suggested) for group chats on baby care stuff (bathing, settling baby, latching on etc), to watch videos (on breastfeeding, settling baby, recognising signs of overtired infant etc) and for the physio to come in and start us off with things like correct posture for feeding, lifting baby, pelvic floor and abdominal muscle exercises etc.

There were two midwives present in the Motel 24 hours a day and while the skill was very varied and some of the advice conflicting, they all tried to help with breasfeeding and any other problems we may have had.

The doctors (obstetricians, GP, paediatrician) visited each mother/baby they were responsible for every day and we all had to have breastfeeding established (if we were choosing to breastfeed, which all of us were), or a definite plan of action before they were happy for us to leave. I think the average stay for a first time mum is 4 days, long enough for most women's milk to come in.

Partners were welcome to stay as long as they wanted and folding beds and breakfast were available if they decided to stay the night. Other family visitors were also welcome to visit whenever the mother was up to it. The whole Maternity Motel was surrounded by a childsafe fence (with appropriate childproof gates) allowing a large area with tables, chairs and some toys for a safe area for visiting toddlers. Overall, the whole experience was generally pretty good for mums, babies and visitors.

Unfortunately, the Motel has been closed down, but the new facilities in the hospital look pretty good (single rooms with ensuites and the same common room system) and the same midwives etc are still there.....only now mum's are in the hopsital environment where they can hear women in labour at all hours!

I know the majority of Australian public hosptials would not have a system this good and there are many problems with our health system in general (long waiting lists for surgery, overcrowded wards etc) but I just wanted you all to know that it can happen, a pleasant hospital birth can exist for people withour private health insurance!!

Good luck to you all and I hope highlighting the problems helps you to get better facilities and care for women and babies in the UK.

Chelle, I found your experience very interesting - wow, hospital providing cloth nappies! that's really good. In the UK, it's bring your own disposables. So there's another request: hospitals to provide cloth nappies instead of just giving the impression that disposables are the only option. If new mums got the chance to use cloth nappies, they might understand that disposables are a poor second to the real thing.

Just two points to reinforce what has already been said (my experiences relate to St. Michael's, Bristol):
1)Adequate midwife staffing levels are essential (my husband had to go and cause a scene at the reception desk at the birth of my second, because he could see our daughter's head appearing through my legs and no one had been present for the previous 30 minutes)
2)Good food at all times is essential (porridge on tap, I say). How can you ask sometime who has just given birth and whose newborn baby obeys no timetable whatsoever, to walk to a canteen where food is only availabe at certain times?
In general I would say that staff were brilliant but under severe pressure.
Let us know what you end up writing!

Chelle, can you tell us how public hospitals are funded in Australia? Do you have to pay anything up front, or is it all free at point of delivery (ha ha!).

If you go to a public hospital as a public patient everything is free, not a cent to pay. This includes the room, the food (wouldn't want to have to pay for that!), theatre costs (if necessary), X-rays, scans, pathology tests etc and visits by specialists. Of course, once you leave hospital, you are billed directly for any further tests required after you leave or further visits to a specialist etc.

If you go to a public hospital as a private patient (most towns do not have a private hospital) you have to pay for everything and claim what you can back on your private health insurance. Usually there is a gap between what the insurance will cover and what you are charged and many hospital cover policies have and excess, just like car etc insurance, where you have to pay the first $500 or so. Some public hospitals will cover the excess though.

We did not have health insurance when Tom was born, we do now but are still likely to go in as a public patient in our closest town to avoid paying anything unless of course being a private patient gives an advantage. This is what is wrong with the Australian health system!!! In most cases (such as emergencies, having a baby) it does not pay to have private insurance so most people don't bother and if they do, pretend they don't so it doesn't end up costing more (paying for the privelege of paying for health insurance but getting the same service)! This puts extra pressure on the health system.

It is worthwhile to have private insurance for dental, physio, optical etc and private hospital in case you need elective (non-emergency) surgery. If you go public for those things it can take a couple of years on the waiting list...not so good if you're waiting to have painful wisdom teeth removed, a hip replacement or gommits put in!

Also worth pointing that Medicare contributions in Australia (i.e. to the public health system) are a fraction of the cost of NI contributions.

Rhiannon you've reminded me - a good tip for the NHS Marina, is regarding private rooms. I paid £100 each night at hospital (best money ever spent) but I wasn't billed until 6MONTHS afterwards. I know friends of mine who were never billed at all. How ridiculous is that? The NHS are there own worst enemy!

Suew, sorry to hear about your tooth troubles. Having what's called sensitive cementum ie pain along the gum line is quite common and caused by fierce brushing in the wrong direction exposing the softer part of the tooth that is more sensitive. A good way of solving this is to use Sensodyne toothpaste but just by putting it on like you would an antiseptic cream just on the place that hurts 2 or 3 times a day. Sensodyne does work and does do what the advert says. Brush with warm water and brush downwards only over the sore bits.

Removing the nerve (root canal) is a very extreme treatment for this. Removing a nerve basically 'kills' a tooth removing any sensitivity at all. As a result the tooth becomes more brittle and will break far more easily than a healthy tooth, hence the need for a crown (cap).

I think it should be made possible for your husband/partner/or birthing partner to stay with you. It was awful when my husband had to go home after going through everthing with me (although I did have a very special bonding night with my son).

I'd like to add :
more information about breastfeeding before hand at antenatal classes as well as alot more help postnatally. To be honest more information on breastfeeding in the books and leaflets (including the NCT one) would also be good. More consistent and sympathetic help postnatally also would have been good.

More emphasis on sufficient food, regardless of whether breast or bottle I thought would have been helpful.

I agree with everyone else in terms of more food and better food in hospital and partners being allowed to stay.

My baby was delivered at the homerton in london and I thought the delivery itself and antenatal care was fine.

Dear Alexsmum
What a ghastly story. I couldn't bear the thought of staying on the postnatal ward but didn't want a home birth.As I gave birth 4 years ago when I was 40 (second child) I felt I wanted to be near "all the equipment"! But as it was my second birth I went into hospital after the contractions had built up so that I didn't have to spend more time there than necessary. The birth went well, normal delivery, no "equipment" necessary except gas and air for the last 20 mins. Afterwards, stayed in the labour ward for 6 - 8 hours, baby checked by paediatrician, went off home with 8 hour old babe! Husband stayed with us the whole time and we didn't go anywhere near the postnatal ward. Being at home straightaway was fantastic: own bed, food, bathroom, etc.