A Midwife’s Muse

I received this today from the NCT in response to my communication.

Dear Midwifemuse,

Firstly, I would like to thank you for your e-mail. It’s always really helpful to have feedback in this way.

My name is Jay, and I am the Campaigns Project Officer here at the NCT. As such, it’s very good to be told about the situation for midwives around the country.

We really do acknowledge the work that midwives do – as some of the entries in your blog, and the snapshot you provide show – often under very trying circumstances and without full compliments of staff. The situation you mention, in which two midwives on maternity leave are not being covered, is exactly the sort of situation we are campaigning to prevent. Throughout the country, women are being denied choice of place of birth because of financial constraints on the service. All too often, we are seeing services delivered dependent on budgets, rather than on the needs of women.

 For this reason, we are trying to work with, and put pressure on, the Department of Health and managers throughout the country in order to rectify the disincentives for community midwifery being seen as an option as viable as births in hospitals.

 We hear stories all the time from women who say that they are being actively discouraged from making use of community midwifery, because they can not be guaranteed the service on the day, as a result of staff shortages. Without these choices being realistic and presented to women as such, we will not see the fulfilment of the Government’s choice guarantee.

 We are speaking to the RCM, who are very supportive of this campaign and of the provision of choice. We hope that, by working with them, we will be able to generate a system whereby women have choice and where midwives are not thanklessly working their fingers to the bone. We believe many of the changes necessary for this are related to decision-makers, and should not negatively impact upon midwives themselves.

There are actions that both trusts and midwives can take in order to ensure choice is delivered. Trusts need to make sure that adequate funding and staffing is in place to support midwives in providing choice. Midwives can keep working with women and maternity services to encourage choice and efficient work practices are promoted.

We would also encourage as many people as possible to take action to promote the changes that are needed to bring about choice throughout the UK, not just in England, where the Maternity Matters guarantees apply. The campaign web page – www.nct.org.uk/choice – has information about the campaign, as well as two actions that are quick, easy, and will hopefully be highly effective.

I would also encourage you to join our activist network – NCT Active – as the sorts of views and feedback you have provided are exactly what we like to guide our campaigns and policy.

I apologise for the length of this e-mail, but hope that it explains NCT’s position, and makes clear that we truly have no desire to bring about a situation in which midwives are overworked.

If you have any questions about the campaign, or any wider issues, please do feel free to get in touch with me.

Very best regards,

Jay

I have responded -

Hi Jay,

Thank you for your reply, however the emphasis appears to be on delivering choice in place of birth and the role community midwives play in this. I know that pressure is being put upon government and trusts to improve funding within maternity services to enable the promises made by government to be fulfilled, but trusts are interpreting this as a green light to cease domiciliary visits postnatally and replace them with ‘clinics’. They have been given an open door to introduce this by Maternity Matters – Appendix B; B2

“Reorganisation gives local managers the chance to develop local services that are fit to deliver 21st century care, and in different locations. Antenatal and postnatal care may be provided in community settings such as Sure Start Children’s Centres but care that is more complex may be provided in a hospital within the local network. Reorganisation need not mean closure. It does however offer the option, using the existing infrastructure, to redesign services, which are responsive, flexible and meet the needs of the population, both as a whole and as individuals”

The paragraph which includes ‘to redesign services which are responsive, flexible and meets the needs of the population’ would appear to preclude stopping of postnatal visits but it doesn’t, and it hasn’t. In our area we already operate postnatal clinics at the weekend. How successful are they. Well it depends whether the women you ‘invite’ to attend will co-operate. There are always those who refuse to attend, those who agree but then don’t turn-up and then those who are unable to attend. The result of these non-attendees is that Mondays are now ridiculously busy with community midwives chasing-up, and visiting, those who failed to attend. What will happen when there is no provision for routine postnatal visits? Will the breastfeeding rates fall? Will more babies be re-admitted as ‘failure to thrive’? Will the SID rate rise? Etc.

Childbirth is the head-line catching element of the maternity services but antenatal and postnatal care is just as, if not more important, but we are really in the situation here of throwing the baby out with the bath water.

 Yours truly,

Midwifemuse