Step this way to help shape the future of maternity services in England

[RowanMumsnet]

Hello

As some of you will know, Mumsnet is on the panel of the National Maternity Review, which is an NHS England initiative set up in the wake of the report into the deaths of mothers and babies at the Morecambe Bay hospitals trust.

The remit of the review is to 'assess current maternity care provision and consider how services should be developed to meet the changing needs of women and babies'.

So we'd be really grateful if you could give us your feedback on the following two very broad themes:

Which choices do you wish to be able to make about the maternity care you receive?

What are the key barriers preventing women from making the choices that they wish to?

Thanks - any and all thoughts welcome. (And just FYI, this won't be your only opportunity to feed in, and more detailed feedback systems are going to be launched soon - we'll flag these up as they happen.)

I had my second child in hospital, as I was over 2 weeks and had to be induced. (The others were home births.)

Now, my local maternity provision has gone. You have to go the massive hospital in the city 12 miles away.

So, localised provision of birthing centres is very important imo. My town has over 60,000 people and is expanding. I can't really believe we don't deserve our own maternity facilities.

Every single baby born should be checked immediately after birth by a fully-trained, experienced person for tongue-tie, both anterior and posterior. If there is tongue tie present, it should be cut immediately (with mother's consent, obv). Then breastfeeding support should be offered for as long as the mother needs it. Not only by peer supporters (I am one) but by fully-trained healthcare professionals who are aware of current guidelines and research.

This would be a relatively cheap.way for the NHS to save a hell of a lot of money in the long term.

I would say that key barriers are risk averse policies. Women not being "allowed" to make informed choices if they don't meet the criteria for an MLU or a pool birth, etc. this will only get worse with the removal of supervisors of midwives who historically have been people that women can go to for help and to be their advocate.

Which choices do you wish to be able to make about the maternity care you receive?

I'd like to be able to choose how and where I deliver my child. I'd like to choose which professionals are available. Most importantly I'd like to revisit my choices toward the end of pregnancy and in early labour if possible, with my choices being specific to me, my circumstances, pregnancy progress, health etc.

I'd like all women to be tested for Group B Strep. And to be able to recieve it early in labour and then go back home to continue to labour if I wish, not to have to stay because they can't be bothered doing admission and discharge paperwork twice.

What are the key barriers preventing women from making the choices that they wish to?

INFORMATION.

There is a real lack of informed consent with regard to procedures surrounding delivering a baby.

Very general information is given which is based on population data, averages, hospital statistics.

There is a real lack of transparency when it looks like a woman might experience a prolonged or difficult labour. She is usually told it's just one of those things, unpredictable, bad luck etc.

But if a first time mum is in labour with a back to back baby which has not engaged, a difficult labour is predictable. An epidural is more likely. An instrumental delivery is likely. An emergency c- section is more likely. Women aren't informed. They just keep going, labouring with no idea that they are fighting against the odds. If they do deliver vaginally, there is a high likelihood of perineal trauma. Why is this kind of information kept from them? Why does noone say, during early labour, "the baby's position and lack of engagement makes an unassisted vaginal delivery unlikely", explain what might happen, give the woman the opportunity to choose an "elective" section?

If I put in my birth plan that I want to discuss the position of the baby and likely outcomes early in labour, would anyone really do this and have a meaningful conversation about possible outcomes, risks and offer me any real choices? I doubt it. The culture is that it's just something we have to get through...

RESOURCES.

There's little point in making any request if the NHS doesn't have the resources to back it up. If I say I want this discussion (above) I might be lucky if it's the right time of day with the right combination of staff...similarly if I requested any tears be sutured by a Consultant Obstetrician.

receive it -I mean receive treatment for Group B Strep.

I think the point about partners on the ward is interesting. On a shared ward the need for privacy is important. But in reality, having dp there was my only chance to get help getting to and from scbu or the kitchen or shower. The staff were simply too busy for that kind of thing.

I desperately wanted an epidural after complications following my first labour but due to lack of staffing and rooms I couldn't. I was supposed to be high risk but ended up on the mlu labouring for two days. More resources are needed. The choice of pain relief should be mine.
My post natal care with my first child was shocking, I was kept in overnight having had a pph and only one person came to see me briefly. No one helped me breast feed. I was ignored. There is a definite lack of bf support.

Babies with tongue ties need to get diagnosed and seen quickly. It's no good making them wait 6 weeks to get snipped.

^ I completely get that. My objection is the removal of visiting hours. I didn't want to sleep feet from strange men. I worried that any women in abusive relationships wouldn't be able to share their fears (possibly one of the first occasions they would be able to) with any of the HCP, because their partner was always there.

I just want women to have a choice.

That was to Snozzberry

Individual rooms would help with the men staying issue.

If you have a door you can close, there's no worrying about a strange man looking in/making a racket etc.

I HATED the PN ward. A total lack of appropriate care and quick responses to a woman buzzing at 3am for assistance, and being kept awake by other babies, buzzers, MWs taking/making phone calls, other women shuffling by is NOT conducive to a quick and safe recovery. I needed DH to stay to help me and he couldn't.

Bounty need removing sharpish too. Where else are you sold to on a hospital ward by a direct marketing company?!

Long term post birth care if needed

For problems after birth not to be written by gps etc, as 'just what you have to put up with as a result of giving birth'

This should apply to all types of birth as all types of birth can lead to complications, and long term physical or mental health problems.

Yes. Send Bounty to the far side of fuck.

SnozzberryPie I think the poster means partners staying overnight. I don't know if it's all hospitals or just certain ones that allow partners to stay over on the maternity ward. Our hospital didn't have anyone staying over when I had DS four years ago.

I would also like to the echo the posters who said about having to stay on the maternity ward while your baby is in SCBU. I was one of those mothers and it was horrible. I was crying to come home after three days because I couldn't bare it anymore. The SCBU in our hospital was through the maternity ward, out the doors, into a corridor, then a lift downstairs, then through a door to SCBU. So you're not exactly one minute away from your baby. I would love to have stayed on a dedicated ward for SCBU mums. To be around other women who were also missing their babies and understood. Instead of being surrounded by new mothers attending to their baby's cries and a nurse who came in to take my bloods in the middle of the night and said, "Where's your baby?" I dread to think how a grieving mother who'd had a stillbirth would feel if she was asked that question. The baby is clearly not there so why even risk asking such a stupid question?

Post-natal aftercare needs improving as well. The SCBU nurse who came to visit was lovely and so clued up on prem babies and DS. My HV first turned up a week after I'd had DS and I had to explain he wasn't at home. She then came two months later once DS was home then said she would visit again once the SCBU nurse had finished her visits. HV came again about a month later, then I never saw her again!

But if a first time mum is in labour with a back to back baby which has not engaged, a difficult labour is predictable. An epidural is more likely. An instrumental delivery is likely. An emergency c- section is more likely. Women aren't informed. They just keep going, labouring with no idea that they are fighting against the odds. If they do deliver vaginally, there is a high likelihood of perineal trauma. Why is this kind of information kept from them? Why does noone say, during early labour, "the baby's position and lack of engagement makes an unassisted vaginal delivery unlikely", explain what might happen, give the woman the opportunity to choose an "elective" section?

YES.

We hear a lot about informed consent to various procedures, which is quite right of course, but not so much about informed consent to vaginal birth and the risks involved with it. This is particularly important in VBs that are giving all the indications of being long and difficult. It seems it's fine to leave women to suffer through them uninformed and unadvised, especially first timers.

More staff - the day after I gave birth I had to wait for ages for help - one time I ran into the corridor crying desperately for help.

Minimal breast feeding support - 1 hr session with councillor did not resolve issue and suggested solution was to spend half the fat naked with baby - not feasible post baby and treatments after childbirth. I couldn't even lift my daughter after birth and very little support to facilitate managing that and feeding.

Too few visits after birth. Calling and begging for help from midwives. Only came when they knew I was feeding formula as would affect their quotas (probably).

No explanation of things that were happening e.g. That baby is not bathed.

Love Dutch system where nurse helps out around house for 40 hours/5 days after birth with anything from breast-feeding to washing up.

The only good thing about DS being on the NICU was the bounty woman didn't come near me!

Oh and the Bounty woman came and asked me where my baby was (NICU) despite it being pretty obvious something was wrong.

I'd like to have seen more flexibility around both ante and post natal care.
If all that's happening is having your weight checked, stomach felt and blood pressure checked, insisting it is in the middle of the day, miles from where you work, is neither necessary nor helpful. Equally, once you are back at work, I found any access to support was nil - despite the fact I was willing to travel / not fussed about seeing the same person etc.

I completely agree about the right to an epidural. You get fobbed off in agony possibly especially with back to back labour.
G&a and codeine didnt touch the pain.
Im 40w and not been asked about a birth plan.

I also agree you probably need more food on ward.
Im going to refuse ventouse as it did nothing with dc1.

I can't believe the disparity between the swanky midwife led units in London and the hospitals . In some cases the low risk only birth centres are completely empty whilst hospitals make you feel like you are a factory chicken on a conveyor belt .

Which choices do you wish to be able to make about the maternity care you receive?

I would like to be able to make an informed but free choice about where and how I give birth. This should include all permutations between homebirth and elcs.

I would like to be told the truth about the risks which these different choices pose, without being fobbed off by a dogmatic attachment to where in my body my baby exits from.

What are the key barriers preventing women from making the choices that they wish to?

Lack of funding, targets - why is there a target rate for cs for eg? Lack of continuity of care from specific hcps. And a sense that women's health doesn't matter - there is a very informative and sad thread about this in Childbirth atm.

I agree with a lot of the comments here.

More choice of pain relief. I was terrified and in agony. I had pre eclampsia, and was advised to have an epidural, but it didn't come for hours until I was having back to back contractions and screaming in pain.

Post natal care was poor, especially at night. I was glad my partner could stay as I physically couldn't move to reach my baby and no one would help me. I was also left in a bed swimming full of blood with a catheter also full of blood from 7pm to the next afternoon. I was so out of it I hadn't actually realised I had a catheter still in. Left me with some short term problems.

I would like early scans offered to people who have had a previous missed miscarriage.

I think the nhs needs more staff and a more flexible attitude. They seem really stretched.

Continuity of care.

Just an idea, wouldn't it be better for patients if midwives did antenatal, delivery and postnatal care in small teams so that you had opportunity to meet them all before one of them delivers?

Having a divide between hospital/community means you can't get to know your midwife before delivery.

Which I'm sure impacts on Labour.

1. Choices:
   Women should be able to choose the kind of birth that they want, consenting to or refusing any intervention once the true risks and benefits of each have been explained to them. Some of the health professionals do have a bit of a "we know what's best for you" attitude that seems to trump what women actually want. Totally agree with elliej above about post-natal care for "high risk" women. MLU/homebirth isn't even an option for me due to my medical history (even despite a textbook, no complications delivery with DD). Fair enough, they need to manage the risk during delivery, but I would quite like the option of a private, calm, spacious room for DH and I to share afterwards à la MLU rather than the seventh circle of hell aka the post natal ward. More information provided about the risks of our choices, not just scaremongering us into doing what they think we should.

2. Barriers to choice:
   Biggest ones are staffing and money. I know c-sections carry significant risks, but the reason trusts refuse a lot of ELCS' is financial, I am sure. Health professionals not really listening to what women want an why. And a shortage of midwives. I lucked out and had a midwife and student with DD. The student didn't leave my side the entire time and that in itself helped me stay calm and progress well. Compare that to my SIL who was left alone for long periods and ended up labouring for 3 times as long as me. She firmly puts this down to anxiety slowing her contractions. One to one care makes such a difference.

Please keep DP/DHs staying overnight as an option in hospital, I loved that my DP could stay - it didn't even occur to me other women wouldn't like it Separate postnatal rooms for women who don't want this and more again for women who have babies in NICU maybe?

I am incredibly lucky and lived in an area with community midwives so had the same named midwife from a 6 woman team for both my DC. It would be great if more women could have this available. These women keep close ties to hospital but aren't so hospital focused, and they enabled me to have a home-birth I would never have considered without them there.

I did breastfed but never used any cafés or support centres but I can see that these need to be readily available - it is a hard to thing to do and at a basic level the existence of the cafés normalises breast feeding and gives it presence in the community, which gives women confidence to continue.