Birth budgets for nhs- what do you think?

[ReallyTired]

www.bbc.co.uk/news/health-35634524

Somethings that women might want are nice, others are life saving. The passage of pregnancy, childbirth and motherhood are unpredictable. I am not sure that budget idea will work. If a woman blows her budget on one to one care does that mean there will be no budget left to support her with postnatal depression? There are women who have the perfect birth experience, but still get very ill because of their genetic make up.

Costs vary from woman to woman. Not all women need a budget of 3k. Do you think that giving every woman a budget of 3k will mean that some woman are allocated too much and other women don't get enough care.

I believe the Baroness who wrote the report is having a webchat on mn tomorrow lunch time, so please engage with her. Will be at work but will try to log in on phone.

As a midwife I have concerns, that it's a quiet route to privatised care.

What of someone spends their 3k and then decides they want (rather than need) an epidural mid labour? Do we say, no, sorry you're spent up?

Where is the money coming from? The majority of low risk births I don't believe have 3k spent on them. Isn't the cost of a normal birth £750 to the nhs, im sure ive read that before. I guess this 3k also includes antenatal care rather than Just birth but does approx ten antenatal appts and two scans cost another £2250? I would say not.

I wonder if this is all a bit pie in the sky and won't be implemented? David Cameron promised 3000 extra midwives and never delivered. Previously was it changing childbirth who promised one to one care by 2012 and that never happened. Ive seen so many maternity reviews over the decades im a bit jaded.

A lot of the stuff in the review already happens. Women are generally offered a choice of place of birth, and indeed this is in the NICE guidelines. So not sure why we need a maternity review to tell us what's already in the nice guidelines. Lots of other stuff is already embedded in practice. Indivualised care? Of course it is. If a woman is poorly and needs extra appointments, scans, etc then she gets them. Nobody says oh no you must stick to the routine schedule.

Team midwifery will cost more money so again how is it to be funded. My concern is the govt will say they can't implement it so offer it up to a bidding war for companies to bid to provide the care. Will thag be better? I don't know. Women like the one to one service on The Wirral and that's private afaik.

This seems absurd to me. Not everybody needs the same resources. If a straightforward birth costs less than £3000, then that woman does not need her full allocation. But if people are told they are entitled to something, they will want to ensure that they get everything they are entitled to. The logical conclusion is that the cost of childbirth will go up because people will ask for extras to ensure they spend their budget.

How will the complicated births be funded? A fair NHS does not mean equal for everyone, it means that everyone gets what they need.

I'm expecting triplets....how would that work?

This is a very bad idea.

It's antenatal and I think postnatal care as well as the birth itself simon.

But it raises some interesting questions. I see a lot about one to one midwifery and breastfeeding support, rather less about ELCS. What if I couldn't be less interested in cascading care, home birth with two named midwives or any input from lactation consultants, can I skip all that and have my entirely elective section? Or is it just certain choices we're going to be empowered to make?

(Not me personally. I'm not having any more, and if I were, I'd get an ELCS on medical grounds as I had an EMCS previously. But the hypothetical me).

I think it's all pointless and bit of a non starter. I don't want a maternity budget, I just want a well staffed hospital with enough facilities to provide me with a safe birth when the time comes.

Even in private systems this isn't how it works. I'm pregnant and live in the US. Once we have paid the first $6000, insurance kicks in and pays off the rest for the year. In a straight forward pregnancy, you might expect to pay for all of it but if there are complications you'll be covered once you hit the max deductible for the year. This sounds like the opposite - everyone gets the first 3000 but then you get cut off?

I don't think there's any realistic chance of people being cut off. While I have concerns this will eventually usher in a two tier system, it's not going to result in women being denied EMCS for obstructed labour because they spunked their 3k on pregnancy aromatherapy and two midwives for an attempted home birth. It'll be more that there'll be the basic package, and women will have the 'choice' of topping up the service if they want fripperies like cascading care, more than one scan, breastfeeding support, actual postnatal care etc.

"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."

First its a "notional" budget not cash in hand, second it says more will be given for complications, and third its for NHS accredited treatments - so no aromatherapy.

Perhaps try a bit of reading before the predictable rants of privatisation and destroying the NHS.

But cdtay - it doesn't work even if it is just non-urgent care. Why would I expect "at least" the average spend on a low risk birth? What if I have a very short labour, already have 2 kids so don't need any antenatal classes and need no breastfeeding support? Then I cost less, because I need less, so why should I feel entitled to have that money in a pot with my name on to spend on something else non-essential?

And in simple maths terms, if everyone spends at least the average, the average cost would of course rise.

I think this is massively flawed, does it mean that things such as EMCS wouldn't be performed until the additional 6-9k (after personal budget 3k) had been paid for? I think in some cases it will increase risk to both mother and unborn infants

It's very unclear as to how variation would be covered and what 3k actually 'buys'. I would have no idea what each service ie. epidural etc actually cost. I was lucky and had a very straightforward pregnancy and delivery but not everyone does. How much would a pregnancy and delivery like mine cost as opposed to one with lots of complications? It's hard to know...

It is looking very much like privatising without actually saying it. We will all be required to take out insurance and save before even getting pregnant. THis could be very bad for maternal health as some might not be able to and just have unsupervised homebirths.

I'm guessing they're trying to look to a model where some of the more periphoral stuff - antenatal, postnatal, etc could be commissioned out to private contractors - paid £3000 per woman, so we could then shop around for which one was offering the best deal.

But still don't see how than can work when, as we all know, it's not just about making different choices, it's much more about having different levels of need.

The aromatherapy was a joke cdtay. Le sigh. And bluelillies makes a very good point.

Aromatherapy is an nhs accredited treatment in labour. We use it in my hospital, we use our budget to buy oils and diffusers, we use our budget to train midwives.

Apparently I wasn't joking after all. You learn something new every day! I was, however, not being serious with the things I listed as fripperies.

Oh my God, talk about privatization by the back door. Does this government think we're all idiots? I predict the next thing will be a budget for any other health condition that can be said to be caused by 'lifestyle choices'.

I had horrendous pregnancies and had to be induced both times. would my money be gone on anti nausea drugs for my hyperemesis and physio for my SPD before I even made it to the labour?

During my pregnancy, I had great continuity of care from a named midwife, choice about how and where I was going to give birth, and the options of midwife-led unit, water birth, antenatal classes. I had an incredibly healthy and low-risk pregnancy, and planned for a low-intervention birth on the home from home ward with a view to next day discharge. Then my baby was late, I was induced at 42 weeks, 30 hour labour, 2 failed inductions, epidural followed by emergency section when the baby's heart rate dropped, followed by a 3 day stay.

How would a personalised budget have made any of that better?

I would probably go for this. Ive had 4 children so far, the last one 2 yrs ago. All normal, no problem births. Im not saying the next one would be but I could have had the last one at home, very nearly had him alone, in the car. I was in no pain, contractions every 10 mins, no pain, for a couple of hours. Then my waters broke and I stood up and could feel something happening quick time. It was 2.45am and I was alone. I jumped in the car, sped to the hospital, luckily about 8 mins away, running all red lights. I had to. I pulled up ragga outside maternity and there was some random guy in the foyer whos wife had just given birth. He helped me in and I arrived on the ward at 3.13am. Time of birth, 3.15am. Looking back it was like a comedy, im running in, holding my bits, shouting for the nurse to pull off my uggs and leggings. She's thinking im over reacting and telling me to calm down and out he slid. No pain whatsoever. If id have known all that, I could have done it in my bedroom!

The US system shows what happens to prices when you 'shop around'.

I had morning sickness, went very late, induced, CS. But I also needed breastfeeding support. And had the prenatal classes. I couldn't have known what I needed at the beginning so how on earth does this work?