This week I launched Better Births, my team's report into maternity services in England. This report marks the culmination of 12 months' work reviewing current services and developing ways that they can be delivered better, for the benefit of all mothers, babies and their families.
The report lays out a series of recommendations which will make maternity services safer, more personal, kinder, professional and more family friendly. You may have already read about the personal maternity care budgets in the news. These will give women more choice, empowering them to spend NHS money on the NHS services which suit them. This is only one of the report's many recommendations, but I am looking forward to answering your questions in the comment thread below this post from 11am to 12pm on Wednesday 24th.
It has been a mammoth effort, and we couldn't have achieved it without the amazing support we received from mothers up and down the country, who have made so many vital contributions to the Review.
During the course of the Review we heard many heart-warming stories, but there have also been harrowing reports of when things have gone wrong. I am enduringly grateful to the women who have shared their experiences with us. In many cases it has taken great bravery and your contributions have been vital to our work improving maternity services.
Having heard from women, families, midwives, doctors and other service providers, we know that there is some excellent care in England but we also know there is significant variation and we could do better.
Women told us that they want to be able to make choices based on unbiased information and for their opinions and decisions to be respected. Better Births recommends that every woman should have a personal care plan developed by her and her midwife, built on her decisions, and informed by an assessment of the type of care she might need. This will put women, babies and their families at the centre of the care they receive.
We believe there should be more continuity of carer so that women can build a relationship of mutual trust and respect with their midwife. Under our recommendations, every woman will have a dedicated small team of midwives providing care throughout their pregnancy, allowing women to develop a rapport with their midwives and for their midwives to have an ongoing understanding and appreciation for the needs and wishes of the women in their care. Women will feel more supported and their pregnancy will be safer.
Our Review found that professionals don't always work together as well as they could. The Better Births recommendations will break down the barriers between midwives, obstetricians and other professionals to deliver multi-professional, safe and personalised care to women and their babies. This will be aided by better training, establishing the principle that professionals who work together train together. Working together across boundaries, professionals will ensure rapid referral and access to the right care in the right place. We will instil a safety culture within and across organisations, and will ensure that there is timely investigation, honesty and learning when things go wrong.
Women told us that they wanted better, more convenient access to maternity services so we are recommending that more services are delivered in the community. We aim to improve access to services and ensure that rapid referral to more specialist care is available when needed.
There is still much to do in ensuring that the recommendations of Better Births are effectively implemented across the country, but women throughout England have every reason to be optimistic. The publication of this report is truly exciting. It ushers in a new era of maternity care which will make services in England among the best in the world.
The report demonstrates what we've learnt and begins to bring into reality, across the country, our recommendations for the benefit of women and their families. We will ensure our recommendations are delivered sustainably now and in the long term, so that future generations will benefit from maternity services that are among the best in the world, putting the woman, her baby and family at the centre of care.
Knowing that this report will shape how maternity services are delivered in the UK for many years to come fills me with great excitement. I want to thank all the mothers, families and healthcare providers who have taken the time to provide us with their invaluable insights into maternity services and how they feel they can be improved. I especially want to take this opportunity to thank all the Mumsnetters who have contributed to this Review, and whose passion and insight have made the process so rewarding. Without the contributions of thousands of individuals up and down the country this Review could never have happened.
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Guest posts
Guest post and Q&A: "The National Maternity Review ushers in a new era of care"
49 replies
MumsnetGuestPosts · 23/02/2016 13:47
JugglingFromHereToThere ·
24/02/2016 12:14
Thank you for coming to talk with us about the review this morning BaronessJulia.
I hope we've provided further experience, insight, and challenge, although I appreciate you have already sought and listened to the experiences and views of many women in compiling the review and your recommendations.
I'm sure we all share a hope for the best possible maternity provision for every woman as we go forwards 
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BaronessJuliaCumberlege ·
24/02/2016 11:13
@WhoTheFuckIsSimon
I'm a midwife and have read the report today. Sadly I'm at work tomorrow. I totally agree with the main thrust of the review but I do think a lot of it such as personalised care is already been done. The thing I picked up on was the recommendation for team midwifery similar to the service on The Wirral.
Nationally we've been there and done that in the past, it's more expensive and requires more midwives. How can this be funded? Do you think the govt will act on your recommendations and will there be a move back to team midwifery?
Nationally we've been there and done that in the past, it's more expensive and requires more midwives. How can this be funded? Do you think the govt will act on your recommendations and will there be a move back to team midwifery?
Thank you for your comments Simon, you are right that we have much to learn from the past. Our work, however, has focused on finding people who are already providing the services of the future and people who want to change the way they do things. We’ve tapped into the energy and commitment of women and families as well as NHS professionals. Many of the services we visited have no choice but to change. Our role is to support them to make these changes.
Firstly, woman have told us that they want to see more personalised care and want to be given more choice on the type of care they receive. Therefore we want to put women, their babies and their families at the centre of their care so that they have more control over the decisions they make about where and how to have their baby.
We also need to provide better continuity of carer, to ensure safer care. We are recommending that every woman should have a midwife, who is part of a small team of 4 to 6 midwives, based in the community who knows the women and family, and can provide continuity throughout the pregnancy, birth and postnatally.
We have estimated the size of the midwifery workforce likely to be required to deliver these improvements. Although it is based on a number of assumptions and different challenges are likely to occur in different parts of England, it suggests that a significant increase in the midwifery workforce is not required.
@RevCharlotte
When I travelled to the parent panel in Manchester, I shared my experiences of a preventable Group b Strep infection that nearly cost my son his life, and has left him permanently and profoundly disabled. I know I was one of a number of parents who shared their Group b Strep experiences with the panel, both in Manchester and in London - and in the case of at least two of these parents, their children died as a result of these infections. At the end of the discussion, Sir Cyril looked me in the eye and said, "I will do everything I can to make sure that what happened to you does not happen to anyone else." He also said that informing women of the risks of Group b Strep and testing for it just makes sense.
So please, can you tell me why there is absolutely no mention of Group b Strep in this review, or any recommendations for changing the current, inadequate, risk-based approach?
Baroness Julia says in her comments that she hopes this review will contribute to making NHS maternity care among the best in the world but the UK is seriously lagging behind in the issue of Group b Strep. A huge number of countries already test for this preventable infection and have seen their infection rates drop by over 85% as a result. If the NHS is going to even attempt to become among the best in the world, then we MUST change the current policy on Group b Strep.
The attached picture is my son, four years ago, fighting for his life against Group b Strep.
So please, can you tell me why there is absolutely no mention of Group b Strep in this review, or any recommendations for changing the current, inadequate, risk-based approach?
Baroness Julia says in her comments that she hopes this review will contribute to making NHS maternity care among the best in the world but the UK is seriously lagging behind in the issue of Group b Strep. A huge number of countries already test for this preventable infection and have seen their infection rates drop by over 85% as a result. If the NHS is going to even attempt to become among the best in the world, then we MUST change the current policy on Group b Strep.
The attached picture is my son, four years ago, fighting for his life against Group b Strep.
Dear RevCharlotte, thank you once again for sharing your experiences with us, here and in the very emotional session in Manchester.
We believe strongly that our recommendations on safety, investigations and learning from mistakes work directly to make good on Cyril’s promise to you, to do everything we can to make sure that what happened to you does not happen to anyone else.
You are right that we do not mention Group b Strep, or other specific infections or conditions in the report. That is because it is so important that we do not replace the role of NICE in making evidence-based clinical recommendations. Our recommendations are about the future shape of maternity services, and safety is at the heart of our vision.
@SunIsShiningWeatherIsSweet
I love the idea of more consistent care. I saw a different midwife almost every time antenatally and for the birth and again afterwards. During the birth I had 3 different midwives due to shift changes at MLU, 1 new midwife for an emergency transfer (I cannot believe that they threw me in an ambulance with a midwife I'd met literally being wheeled to the ambulance) and then another midwife at hospital. I'd never met any of those midwives before that day and never saw any of them again after the birth. It was a distressing time and meeting all these new midwives was equally distressing as each would have a different opinion on things, a different way of doing things or simply a different way of supporting. I found this very confusing and it made me very anxious. As I never saw any of them again afterwards there was no one who was there who could explain what had happened. Do Trusts have to follow the recommendations or are they just guidelines? How long do you think it will take to make this change? I can't explain how much I hope they bring this into my local maternity services!
@SunIsShiningWeatherIsSweet
I love the idea of more consistent care. I saw a different midwife almost every time antenatally and for the birth and again afterwards. During the birth I had 3 different midwives due to shift changes at MLU, 1 new midwife for an emergency transfer (I cannot believe that they threw me in an ambulance with a midwife I'd met literally being wheeled to the ambulance) and then another midwife at hospital. I'd never met any of those midwives before that day and never saw any of them again after the birth. It was a distressing time and meeting all these new midwives was equally distressing as each would have a different opinion on things, a different way of doing things or simply a different way of supporting. I found this very confusing and it made me very anxious. As I never saw any of them again afterwards there was no one who was there who could explain what had happened. Do Trusts have to follow the recommendations or are they just guidelines? How long do you think it will take to make this change? I can't explain how much I hope they bring this into my local maternity services!
Hi SunIsShiningWeatherIsSweet, we absolutely must make more personal, safer care a reality for women across the country. Our work has focused on finding people who are already providing the services of the future and people who want to change the way they do things. We’ve tapped into the energy and commitment of women and families as well as NHS professionals. Our role is to support them to make these changes.
Some important work now needs to take place on the detail of implementation, but our outline plan is that it will work on a two phase basis: testing the recommendations through early adopter sites; followed by a national rollout, in line with the NHS’s five year planning cycle.
For recommendations that will be implemented nationally, like the new investigations system when something goes wrong, work will start immediately.
@April2013
I understand a lot of women want the same midwife but tbh I think it is safer dealing with many different ones as you are then given access to a variety of opinions\ideas\experiences which I think is much better than just those of one or a few. Plus it is better to briefly meet one that doesn't seem to be offering a great standard of care than to have that midwife throughout or for a long period until you manage to change, same goes for all health professionals.
Was this board asked for contributions to this report? If not it seems a bit rich that this Tory is now only seeking feedback once it has been written and published and makes me think it is likely to therefore be very biased towards a particular agenda rather than simply trying to make maternity services safer.
Is there any mention of additional doppler scans in the third trimester?
Was this board asked for contributions to this report? If not it seems a bit rich that this Tory is now only seeking feedback once it has been written and published and makes me think it is likely to therefore be very biased towards a particular agenda rather than simply trying to make maternity services safer.
Is there any mention of additional doppler scans in the third trimester?
Thank you April2013, these are important questions. I understand why you would want input from multiple midwives and these recommendations are about choice. Many women have told us that they’d like to receive consistent care from the same professional throughout their pregnancy, but if you would choose to see a range of midwives then we should wrap care around your choices.
I have already discussed how we sought contributions from a wide range of relevant sources, including mumsnetters, with our focus being on delivering safer services which put the woman and her baby at the centre of care.
When it comes to Doppler scans, our review is about the future shape of maternity services. It would be wrong of us to make clinical recommendations – the National Institute for Health and Care Excellence (NICE) already does this on the basis of the best available evidence.
We did, however, find that national guidance on screening and monitoring is not being followed consistently. Our recommendations on culture and learning, data collection and benchmarking, as well as teamwork and leadership are designed to address these problems.
@JugglingFromHereToThere
Good morning Julia, your introductionary post seems very encouraging and I'm also hopeful that the proposed changes will represent increased resourcing for maternity services in this country generally.
In particular I hope that better care will mean fewer still-births in the UK as I know more than one person who has suffered this tragedy.
I think birth is such an important time for women and their families and that getting this more right for more women is an excellent and long overdue use of our resources.
I was fortunate to have two good births including one where I was able to use a water-pool throughout. The care I received was good too although like many I see areas for improvement, especially in terms of continuity of care and the post-natal ward.
Most of all I now have a teenage DD and I hope if one day she has a baby that her experience can be even better than mine was.
My question .... I didn't have the opportunity to contribute directly to the review but have contributed my experiences and ideas to many pregnancy and birth threads on Mumsnet over the years.
I just wondered if you and your colleagues working on this review have been reading relevant threads here on Mumsnet at all?
It would be good to feel that our voices have been heard
In particular I hope that better care will mean fewer still-births in the UK as I know more than one person who has suffered this tragedy.
I think birth is such an important time for women and their families and that getting this more right for more women is an excellent and long overdue use of our resources.
I was fortunate to have two good births including one where I was able to use a water-pool throughout. The care I received was good too although like many I see areas for improvement, especially in terms of continuity of care and the post-natal ward.
Most of all I now have a teenage DD and I hope if one day she has a baby that her experience can be even better than mine was.
My question .... I didn't have the opportunity to contribute directly to the review but have contributed my experiences and ideas to many pregnancy and birth threads on Mumsnet over the years.
I just wondered if you and your colleagues working on this review have been reading relevant threads here on Mumsnet at all?
It would be good to feel that our voices have been heard
Good morning JugglingFromHereToThere, thank you for your kind words and for sharing your experiences. We certainly took the views of communities like Mumsnet very seriously. Indeed, Rowan Davies from Mumsnet Towers was a member of our Review Team. Rowan worked on Choice Workstream, shaping our proposals on putting women at the centre of care. She also fed in thoughts, ideas and experiences from Mumsnet users, which complimented our extensive engagement with women and families up and down the country. Certainly your voices have been heard.
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