Live webchat with shadow health secretary Andrew Lansley, Tues 24 Feb, 12-12.45pm

[GeraldineMumsnet]

We're welcoming Andrew Lansley as our webchat guest on Tues 24 Feb. He's interested in Mumsnetters' take on the Tories' research about women in labour being turned away from maternity units. Please join us if you can, or post questions in advance if you can't make it on the day.

I find it extremely confusing that freebirthing (it that is the correct term) is so severely frowned upon when effectively that is what the NHS seems to be forcing on labouring mums.

One of my friends gave birth last week and they told her not to come in as it was too busy. When she did go in, she was placed in 5 different rooms over the duration of her labour, one of them being the MW staff room.

That is a shrewd observation, Margo. My local hospital is stuffed to the gills with women labouring alone. What a horrid situation to find yourself in.

I won't be able to join the discussion due to work but I would like to add that I was really shocked by my experiences during pregnancy and birth due to the lack of Midwives and facilities in North Wales.

I had a different midwife just about every time I went for an appointment which I found quite stressful. I actually cried after my first appointment as I felt so disappointed at the rushed session. I felt that the midwives were rushed as there were not enough of them to cover all the pregnant ladies.

I had a terrible time in labour and at the hospital. There were not enough doctors or midwives on the ward. I was in labour for 36 hours then ended up having an emergency c section after one of the more experienced midwives decided enough was enough. I planned a home birth but lack of attention by midwives meant that the baby being in the wrong position was not noticed. I would point out that if this had been correctly diagnosed earlier it could have saved the NHS a lot of time and money - and would have saved me going through such a long labour followed by a serious operation!

After the birth I was amazed at the lack of attention I was given on the ward due to lack of nurses / midwives. They were great people but just too busy to help everyone enough. There were at least 10 ladies who had just gone through a c section on my ward and one night there was just one midwife on cover. I would like to point out that if you need to feed your baby it is very difficult to sit up after a c section, pick up your baby and breast feed without assistance. I often pressed the call button for help but was told to wait or I didn't feel I could press the call button. Please, please increase the number of staff and options available during pregnancy, birth and after care. I sincerely hope no one has the terrible experience I had. To top it off I had PND. Would this have been the case if I had had more help in the first days after the op?

I have only recently got over this experience enough to even contemplate getting pregnant again. Surely the state of the local maternity unit should not be a factor of family planning.

Please look after Mums and new babies. It is your duty.

What would a Conservative government plan to do with primary care?
Are you in favour of continuing fragmenting care with poly-clinics and walk-in centres, therefore providing at best average care but which costs more in the long term?

I gave birth at Chelsea & Westminster Hospital in 2006. I had a different midwife for every antenatal appointment and each shift, 3 shifts a day for the 8 days that I was in hospital following the birth. I was in labour with the tealady mopping around me on the antenatal ward in full view of visitors and other patients following an induction. I had pre eclampsia and the clinic midwife couldn't get me an appointment with the consultant basically putting my life at risk. Eventually I saw him at his gynae clinic which is really inappropriate given women in that clinic are in that clinic for very different reasons.
The midwives could not provide any sensible continuity of care and my baby became jaundiced due to lack of support. I had no practical help from the midwives to care for my baby despite having a really high blood pressure and having not slept at all following labour to enable me to rest. I couldn't rest at all as my baby was having phototherapy and kept kicking off the visor that was protecting his eyes. I slept for 2 hours in total during the 8 days I was there. I had a lot of conflicting advice. The paediatricians prescribed formula milk but the midwives refused to provide enough formula milk to prevent him becoming dehydrated. I had to beg and I mean beg for milk for my baby off them. There weren't enough breastpumps, milk bottles, sterilising units, teats, for the ward which meant waiting for up to half an hour for some things. This was a real problem given that I had to feed my baby every 2.5 hours, change his inco pads (he wasn't wearing a nappy due phototherapy) and the pads needed changing every 2 hours and sometimes more, and then try to pump my own milk for 20 mins to try to get some breastmilk into him. I had to beg for incopads for him and the midwives would tut when I asked them for more as they kept running out of supplies. The whole thing was degrading, disgusting and even writing this three years later I'm becoming really upset at the memory of it all. I work in the NHS myself and was so horrified at the attitudes of some staff, completely numb and unempathetic as they are so stressed out. Also language was a big barrier when speaking with less qualified and auxillary staff some staff couldn't speak english well enough to be able to do their jobs properly. There was broken glass under my bed for two days. The toilets had blood and faeces in them on regular occassions. The bidet was blocked for five days. One day I got served rotten carrots (with worm holes in) and another day a baked potato without anything else, when I asked for butter, I was told that they had had no butter for 10 days. I could go on. I hope it's better now and that was just a bad patch but It was truly that bad, no mother and baby should have to go through that experience.

Oh my point, this is what it is really about....

Stretched services have to maintain a safe level of provision.

The team manager has to make a decision is it better to turn away a mum in labour or provide inadequate care and that hospital risk litigation when the mum and baby suffer or even die to due poor care????

Who takes the blame if the mum or baby is injured prior to receiving a service?? Without adequate assessment and medical notes it is more difficult to prove a compensation claim so it is in an Trusts financial interest to turn a woman away.

Labour have not improved access to maternity services since coming to power, they are obsessed with micromanaging the health services without addressing the real basic issues. Lowered bed occupancy rates, increased staff, cleaners on wards, people who can manage staff and know how to encourage high standards of service. That costs money but would save money as better care reduces unnecessary care.

Finally, they have presided over increased immigration which has put an additional pressure on certain hospitals in certain parts of the country without increasing resources to match the level of immigration. I'm sorry loads of people will not like me saying that but it's true, it's a huge elephant in the room and it needs to be said for the sake of us all.

RANT OVER!!!!! Thanks for listening.

I agree with the general feeling here.

I am a huge home birth advocate however we should all have the right to birth where we'd like to.
With the full support of everyone on the team.
We should see the same MW each time and aim to know who will most likely deliver.
Our judgement should be encouraged our thoughts and feelings need to be addressed
more needs to be done to help our OH's know what is "normal" and what is not.
and for them to play a role in helping us be it hold our hands rub our back and say you're fantastic or be it kneel behind us in tandem deep breathing - whatever works for us!

Personally I can not imagine birthing anywhere except home I do though realise some women would not feel safe nor comfortable.

There is SO little support with choices
in Northants there are no birth centres the PCT do not advocate nor support home birthing
and will go out of their way to terrify you out of the idea.

the MW attached to the GP surgery would have anyone believe that not having routine tests is a death sentence birthing any other way aside from on back lots of instruments and drugs everyone screaming push is a "hideous idea"
the GP told me I was a ridiculous woman because I wanted to HB.

trying to change MW results in lots of ill feeling.

Luckily I ended up with a MW who had a small client group and a passion for her job who was mostly happy to support my choices

I had a home birth no pain no drugs no intervention no worry.
I went into established labour whispered to hubby had dinner with my family sent my daughter to bed at 9, ran a bath tidied the house up made sure I had things I wanted round me.
11 rang the labour ward to warn them
midnight rang again to say better hurry this is moving quicker than I anticipated
12:15 MW rings to see how I'm going and to tell me he was taking an amble over 12:17 changes his mind about walking the 10 minutes gets in the car.
12:28 he walks up the stairs says hello to my bum!
12:31 he dives across my bed to catch my son

my first HB was unplanned and paramedics delivered because the labour ward was too busy to have me in and asked me to hang on a while no one could have predicted that my first child would only take 5 hours from first contraction to birth.

Luckily all went well and I was glad it went that way.

However what is apparent is that if a woman chooses not to go into hospital we are left to it - I was expected to travel a hour away for the hearing test when baby was just 3 days old the Dr that comes out after a HB as per protocol had NO idea why he was there
I had to explain the MW rang as per protocol to give baby the once over and sign him off to say he's got 10 fingers & toes 2 balls and a willy!
Breastfeeding - again luckily my son has always fed wonderfully but no one really supported me during the early days.
with my daughter noone asked what I wanted to do.

Ladies - the Tories started all the closing down of the small personal units the MW's with such large loads that they are desparatly overstretched the idea that first birth should take 4 hours subsequents only 2 hours before the scalpel comes out.

Labour has done VERY well for the maternity sector.

oh for any ladies who are Hb ing and worried look up Laura Shanley there gives some decent advice on the whole scenario no holds barred and good middle of the road ideas.

Another huge supporter of home births here.

The experience of lack of support in my first labour where I was admitted then induced for pre-eclampsia was so horrendous that I suffered Post Traumatic Stress for at least the first year of my daughter's life due to lack of care on the antenatal ward and more lack of care on the post natal ward. All due to overstretched services and the idea that as long as their actions fell 'within guidelines' then, what is your problem? Where is the humanity in it all?

I still had to fight for a homebirth. The fight left my confidence in the maternity system even more eroded and I then understood why some women preferred to free birth than to ever put our bodies and our baby's lives in the hands of NHS staff again.

scary, isn't it.

Exactly what I was thinking when I was pg with DD2 Margo. Some women go to hospital to just about freebirth which must be terrifying.

Most women who plan a home birth educate themselves about the birthing process before hand and would be more mentally prepared to face the eventuality if the midwife didn't make it in time.

Hi Andrew

I am just old enough to find your party championing improved health services a rather new and strange concept, unless what you're really talking about is improved health care for those who pay more into private insurance schemes. Forgive me my cynicism, in these post new labour days, perhaps the world really has turned upside down.

So what does need to improve and can I ask how you might fund any improvements, would it be through higher taxes, diverting funding from another area, or 'efficiency savings'?

From my own experience, I was amazed by the quality maternity services I received. My community midwives were fantastic and I was supported to have two positive home birth experiences. I couldn't have asked for any more.

Hi Andrew
Hospital pregnancy clinics - ..grrrr.
Why are 50 people told to turn up at 2pm, and then hang around all afternoon (when we have work, or other children, or pick ups to do) until we are taken, maybe 2 and a half hours on - all the time trying to work out how the queue to be seen is working? The arrogance of the consultants/midwives who assume we have nothing better to do than wait is infuriating. Why can't they organise timings better? Our time is valuable. We pay for the NHS and deserve a service to suit us, not one which just herds us in. If there wasn't a nine month natural deadline, some of us would still be waiting to be seen.

Hi Andrew

My question is whether the Tories would support an extension of Individual/Personalised budgets into maternity services, enabling many more women to have the option of an individual midwife, home birth etc?

Andrew,

I'm a fairly recently qualified m/w. When I qualified just over a year ago I along with many others struggled to find a job. The press keep on about a shortage of midwives when in reality there is a shortage of midwife posts. The trusts, although understaffed do not have the money to employ more midwives. Therefore qualified midwives are taking office work and stacking shelves - as I had to for many months. What would you do about this?

I have got a job now and the paperwork is unbeliveable and seems to be steadily increasing. For instance if a woman has to be taken into theatre for any proceedure I have to write down exact times of when she went into theatre, what time anasthetic was, names of all staff in theatre, time out of theatre, time into recovery. I have to write this in;

her handheld notes
a sheet that goes in main notes
the main computer system
the theatre book
and now a new ORMIS computer system which is some sort of management/accountant information/auditing system.

Thats 5 different places I have to write down the exact same information. Thats just one example, there are plenty of oter instances where we're duplicating information over and oevr again. I would say that 75% of my job is paperwork/computing. The women suffer as a result.

Another thing - if a maternity unit does have to shut as its full I believe the hospital gets fined. I used to work at a small hospital where one shift all 5 labour rooms were full. We needed to close but the decision to close had to be made by a hospital director (non clinical) as even the head m/w was not allowed to make that decision. We were told we were not allowed to close as we would be fined so the next lady that arrived had to labour and give birth in the coffee room!!!!!

Totally unacceptable and potentially unsafe. If there had been an obstetric emergency the consequences could have been very poor. I find it unbelivable that a hospital gets fined for closing if thats the safe thing to do. What would the Tories do about that?

Its all very well having targets but to fine the hospitals only takes money and resources away from those hosptials. If they're struggling to stay open then they're in need of more resources, not less. Again its the women that suffer as a result.

Hi Andrew,
a number of points for consideration:
Managers who change posts every 3 years and who are bound by strict financial targets will NEVER invest in quality. Neither will they have the balls to make courageous changes that could enhance real choice.

Targets lead to bean counting and no emphasis on quality.

The hospital/community divide fragments maternity care making things like achieving breast feeding rates we would like impossible.

Have one to one midwifery care underpinned by the Clinical Negligence Scheme for Trusts and it would happen almost overnight.
CNST has been effective in improving outcomes in those areas where it has produced a standard that Trusts have to meet.

As a recent mother and NHS worker I can see that small improvements in basic standards of care will enhance the experience for every mother, but this is a quality issue so not valued by managers striving to meet the budget.
Good luck

Test

Hi - I agree with the women who have made the point about maternity wards temporarily closing being the tip of the iceberg when it comes to overstretched maternity wards. Many more hospitals do not close their doors, but let the women give birth in corridors, in waiting rooms, in any available space really! Several of my friends have given birth in the corridor of our local hospital as there were no beds available! With no access to pain relief and in full view of people walking up and down the corridor. It really is unacceptable in 21st century Britain and this dimension of the maternity crisis should be considered alongside the issue of hospitals shutting their doors. Do the Conservatives agree that this related issue should also be addressed?

Do you think the government needs to review its services to pregnant woman? Trouble is will a review do any good or just be filled of hot air and money thrown at the Problem?
The main difficulty seems to be a baby boom and lack of midwives and by the time any review policies would make any difference in 5 or 10 years time the baby boom and midwife shortage difficulty may not exist anyway.

Andrew is poised to join us, but just a quick reminder that this webchat is 45 mins, not an hour. Welcome to MN, Andrew, and thanks for coming on. There are lots of posts here already, so over to you...

Hi, thank you for inviting me to join you today. I've been looking forward to our discussion. I've been reading a lot of your questions and views already. I can see that many of you share my concerns about the needs of our maternity services.

so called "post code lottery".the inconsistent and unequal allocation of resources eg prescribed drugs and services.currently individual PCT and Foundation trusts can chose how and on what they spend budgets resulting in inequitable patchy provision.

the kings fund noted recently said: "The quality of ongoing care varies markedly by geographic location and needs to be improved".

this impacts upon access to prescribed drugs,specialist care, waiting lists for consultants,therapists.causing considerable distress

Having been more or less abandoned by the NHS in my current pregnancy, I'd like to ask what the Conservatives plan to do about independent midwifery. In my area the maternity services are so strained the only way of guaranteeing someone can attend you in labour is to hire your own midwife, yet the Labour administration is seeking to outlaw this because independent midwives are not able to purchase indemnity insurance. This situation arose because of a negligent dental practitioner and has nothing to do with the evidence base for independent widwifery practice. Many independent midwives are also NHS bank midwives and there is no question about their professional competence. So two questions: will you help them continue to practice privately, and will you reimburse women the costs of hiring them, perhaps via a voucher system?

Hi Andrew,
what exactly are your concerns and do you have any innovatve solutions?

and the people that run these trusts are often ex supermarket managers trying to run the health service the same way as a supermarket...