An email to the NCT
October 27, 2009 at 11:58 am | In Maternity Services, NHS, Winds me up | 17 CommentsTags: Location location location, NCT
I read the NCTS’s research, Location, location, location and felt moved to email them. Here it is, will they reply? Will anyone out there stop the pressure and allow maternity services to make CONSIDERED changes rather than perform ill-judged and poorly planned knee-jerk reactions?
As a community midwife I know that your organisation is represented on local MLSC’s so you must appreciate the constraints which many Trusts are placing on local maternity services. In my area we do offer women ‘real choice’, homebirth, MLU or obstetric unit, but in reality it is the midwives who are allowing these choices to be offered by giving of their own time. Government make promises to the public and allocate monies but then tell trusts that they have to make cuts and, even though the maternity service is within budget, cuts are made within that service.
A snapshot. Locally we are now being told that home visits by midwives following birth will be phased out, with women having to attend drop-in clinics. I think this is a backward step and ultimately will have a more adverse impact than women not having choice in place of birth. The community service is about to lose 2 midwives on maternity leave, we have been told that there will be no cover as the trust cannot afford it. As it is I find myself donating over a day a month to cover my workload, and I am not alone. I can now look forward to more work time being unpaid as the team attempt to pick up 2 WTE’s work over the next year.
I read research like ‘Location, location, location’ and my heart sinks as I know there will be more pressure on midwives. Midwives, not managers, not heads of trusts and not government but midwives, on the coal face attempting to fulfill expectations with no support, just more demands.
You can read more of my thoughts on todays midwifery and the mismanagement of the maternity services on http://www.midwifemuse.wordpress.com
17 Comments »
RSS feed for comments on this post. TrackBack URI
Leave a comment
- If you use any part of this blog please acknowledge your source. Thank you!
-
A Midwife's Muse-
-
Blog at WordPress.com. | Theme: Pool by Borja Fernandez.
Entries and comments feeds.
I’m shocked that they’re going to be phasing out home visits. These are one of the great things about post-natal care in this country. I would not still be breast-feeding Eleanor if it weren’t for home visits. I’d probably be hospitalised with a uterine infection, instead of having it managed on antibiotics at home. And probably a bunch of other things too.
Comment by Coding Mamma (Tasha) — October 27, 2009 #
Tasha – I’m furious about it. I feel that the maternity services have been ‘boxed’ into a corner over this. With the government promising women in labour this choice and that choice then there has either got to be considerable monies pumped in to continue offering the home visits plus the birth options OR the postnatal domicilliary visits will have to be stopped. If the midwives working in the community are to support an increase in the number of homebirths, without an increase in their numbers then their other duties will have to suffer. In an ideal world women giving birth could have every choice plus good support following the birth but we don’t live in an ideal world. If there has to be a choice between the emphasis being on the birth or the postnatal care I lean toward the postnatal care for the reasons you gave. Yes, birth has to be in a safe, well-equipped, well-staffed location but when it comes down to the nitty-gritty then what is most important is the health of Mum and baby. It’s all very well giving birth in a chosen environment but if women then end up with undiagnosed infections; unresolved breatfeeding problems; under-nourished, poorly babies etc. will they then feel the time around the birth was a positive experience?
Comment by midwifemuse — October 27, 2009 #
Its a crazy idea to phase out postatal visits but maybe the NCT will step in and offer private postantal care as I se a lot of midwves now offering?
Comment by mememe! — October 27, 2009 #
mememe- The idea of being an Indie and providing postnatal care appeals to me until I consider the benefits of being linked to a maternity unit and a G.P surgery. I visited a woman the other week who has a doula for her postnatal support, brilliant idea (brilliant job as well £18 per hour!).
Comment by midwifemuse — October 27, 2009 #
“who has a doula for her postnatal support, brilliant idea (brilliant job as well £18 per hour!).”
Yes, it is a brilliant idea and a brilliant job (speaking as a postnatal doula), but doulas cannot replace the wonderful and completely necessary clinical support a community midwife supplies. I completely agree that removing home visits in the postnatal period is a retrograde step and potentially very dangerous.
Doulas are there for emotional and practical support only and should never be seen by PCTs or the Government as a cheap means to fill the cracks in service provision.
Oh, and most of us don’t earn anywhere near £18 an hour outside London, don’t work full time and sometimes have periods of not working at all while we wait for a client to come along, so not a financially easy life!
For more info on doulas and to make contact with doulas near you, go to http://www.doula.org.uk.
Keep up the fabulous work – women really do appreciate the marvellous job midwives do.
Comment by Doulamaddie — October 28, 2009 #
Doulamaddie – A well-trained, experienced doula can provide excellent support and certainly help women with routine breastfeeding issues, and they can also help smooth the transition into parenthood. I agree, they should never be used as a substitute for midwife visits but using them as they are in Holland may be an idea worth considering by the NHS.
Problem is cost though. I don’t work in London so there are areas outside the city where £18 is the going rate but, accepting this is above the norm, private doula’s are still nearly as expensive as midwives so the NHS will not pay anywhere near the sum a doula they can earn privately.
Comment by midwifemuse — October 28, 2009 #
Bloody good for you, well written and clear. Wishing you the energy you need to keep going. Awen xx
Comment by Awen Clement — October 28, 2009 #
Awen – Thank you for that.
Comment by midwifemuse — October 28, 2009 #
I assume that you’re not saying that the NCT are wrong in their report, but that the way that choice is currently being delivered is wrong? It seems to me that they are absolutely right that there should be choice.
I’ve commented before about the phasing out of home visits, which as a very soon to be parent, I find terrifying. I think mememe is missing the point slightly – the home visits need to be available to everyone, not just those that can afford it.
Comment by Jonathan — October 28, 2009 #
Jonathan – I have to admit that when I wrote the email and the entry I was performing a knee-jerk reaction, so it was possibly not well thought out, rather how government and the trusts appear to respond to critism, so thank you for the opportunity to clarify my writing!
You’re right, I was not saying that the NCT were wrong in their report, what I was suggesting was that applying more pressure to the maternity services at this time was counter-productive as it would force trusts to make cuts in other areas of the service.
However, as I said in my response to Tasha I do believe that, if there are limited funds available, spending them on increasing choice regarding place of birth and, as a result taking away home visits, is short-sighted. So, at this present time I’m saying slow down on the birth choices and THINK about how Maternity Matters can be implemented without stopping domicilliary visits. The problem, again, is government. They set a time when their vision would be a fact and rather than a happy place they have created a disaster.
P.S mememe has a web-site. She is an NHS midwife but also offers extra support.
Comment by midwifemuse — October 28, 2009 #
I agree that doulas can have a massively beneficial effect on the whole process of transition to parenthood, both as birth support and PN support. Many of us are also breastfeeding supporters and have other relevant skills and experience.
What we passionately believe though, is that part of the beneficial effect of doulas shown in studies is that we are independent, chosen by the parents and not tied by NHS protocols or agendas. We offer completely individualised support, focussing on validating a woman’s feelings, empowering her to take control of her care and signposting her to a range of evidence-based information so she can make informed decisions along the way.
The way it works in Holland offers the parents no flexibility as to who arrives in your house, the hours she works or the period of time she is available. She becomes a mini-midwife; trained to weigh babies, do obs on women and give advice. This changes the interaction with the parents in a subtle but important way, erodes the role of the midwife and perhaps allows issues to slip through the net that an experienced MW would have picked up.
The Dutch Doula is concerned with following her employee’s agenda, rather than just being a flexible, beniegn, loving, non-judgemental presence in the house – offering unconditional support WHATEVER the parents’ choices (within carefully thought out boundaries that focus on the health and safety of mother and child).
There are schemes in the UK that allow women access to a doula for no charge, not least the Doula UK Hardship Fund that allows doulas to have their expenses paid while they support families who need extra social support during the childbearing year. Many of us also work with Surestart Childrens’ Centres and PCTs – whilst arranging things so that we can retain our independence and families retain the ability to choose which doula supports them.
I’d also like to say that I don’t think we can make a clear division between spending money on intrapartum care and choice of place of birth and PN visiting. The experience a mother has during birth has a massive effect on her PN mental health and physical recovery – but you know that
Having said that, the NHS postnatal visiting system is the best in the world and something to be proud of – it would be a travesty if this was withdrawn and all of us; midwives, parents, lay birthworkers and activists need to work together to let the powers that be know that we will not stand for the service erosion we see going on all around us.
Comment by Doulamaddie — October 28, 2009 #
Doulamaddie – Rather sadly, since I’m a community midwife, I was not aware that the NHS did provide care by doulas for those identified as being in need, so thank you for alerting me to that.
We shouldn’t have to make choices as to whether intrapartum or postnatal care gets the funding BUT at the moment that is what is happening due to Maternity Matters and choice of place of birth. My concern is that a woman may have had the birth experience she desired, which should lead to a postive postnatal period but if during the PN time there is extremely limited support and, what there is may involve travelling, then women’s physical, emotional and psychological health will be adversely affected. As you say the 2 aspects cannot be seperated but due to pressure from many areas the intrapartum period is taking precidence as far as all aspects are concerned so that is what is happening. This is why I groaned when I read ‘Location’ location’ location’ as once again pressure is being applied which will force Trusts to knee-jerk and remove domicilliary visits for the sake of place of birth.
Comment by midwifemuse — October 28, 2009 #
As a midwife i’m obviously in the wrong job. £18 an hour! Home births are great if you have the staff to cover the clinic and visit workload or allow the midwife who has been up all night to sleep but this is rarely the case where i work. Homebirths are spoilt for me by the worry of the work that im missing or the situation the rest of the team are in trying to cover me.
Comment by Jo — October 28, 2009 #
Jo – we have many ex-midwives amongst our ranks, but unfortunately it’s not because the money is better! The work is irregular and unpredictable so, whilst it’s wonderful for a better work/life balance, sometimes I have no clients at all, and sometimes I’m juggling several clients. We also go on call for birth clients from 37/38 weeks, so can sometimes spend 4 or 5 weeks on call at a time.
I’m so sorry to hear that the magic of attending a homebirth is spoilt for you by outside pressures. I do hope you have the emotional support of your colleagues and SOM.
Comment by Doulamaddie — October 28, 2009 #
Doulamaddie – Support? You have to be joking. Colleagues are also stressed so they provide little emotional support and SoM’s appear to be more concerned with nit-picking than the emotions and welfare of their midwives. Odd situation really as SoM’s are there to ensure that the care families receive is safe and appropriate. Hmmmm.
Comment by midwifemuse — October 28, 2009 #
Jo – Someone who understands! One of the elements that I begin to wonder if people don’t understand is that midwives are human and cannot work 24 – 36 hours non-stop and be in 2 places at the same time.
Comment by midwifemuse — October 28, 2009 #
I can hardly recognise the way midwives are expected to work nowadays. When I was on the district,in the dark ages of the 60s
,we visited the patients everyday till the 10th day at least and twice for the first 4 days!
Some of the patients in my district (around Archway, N london) had no family back up and several other children, so would have been unlikely to travel to a clinic. It was hard enough to get them to ante- natal clinics. I know that we were poorly paid, but there were enough of us to cope, why can’t they afford it now. Could it be that the frontline money is spent on the army of bureacrats managing it?
Comment by Granny Anne — November 6, 2009 #