The Demise of Community Midwifery – part 2

Previously in ‘The Demise of Community Midwifery :-

The PCT’s, in some areas, are with holding the government monies which were supposedly ring-fenced for the improvement of the maternity services. The result is that the maternity care providers, the hospital trusts, have increased consultant availability, improved facilities and employed (in some cases) more midwives in line with recommendations but the promised monies have not been forthcoming from the PCT’s, so they are now having to make cut-backs.

Next on my list of ‘those responsible’ are the ‘user’ and ‘interest’ groups. Within maternity care the focus, their focus, is on the birth itself. Fair enough, that is what is most important, a healthy baby and Mum. Childbirth is not an isolated event though, there are 40 weeks leading up to the birth of a healthy baby, the antenatal period. Traditionally this care is provided in a variety of ways but, within the NHS, the majority of care options will involve a midwife to a greater or lesser extent. G.P’s may also be involved, if the G.P is registered as providing maternity care s/he will receive extra funding from the PCT for each of his pregnant women, regardless of how much input s/he actually has and, surprise, surprise, the PCT’s are still paying G.P’s this.

Back to the interested parties and why I point a finger at them. They lobby, they lobby for women’s choice. Women’s choice in where they give birth. Nothing against this, in theory, but everything against it when it appears that they place more emphasis on this than on antenatal and postnatal care and so this is where the money and focus is. Wonderful for a woman to give birth in a friendly, tastefully decorated, home-from-home room, littered with birthing balls, fully equiped with a birthing-pool and aromatherapy diffusers. Is it still wonderful though if, after the birth of her choice to a healthy baby, baby fails to thrive, develops jaundice and is, eventually, readmitted to hospital for IV fluids and phototherapy? This happens now, how much more often will this happen when community midwives no longer visit? G.P’s will see an increase in visits by, or to, newborns and their Mothers. Why the Mothers? Well, wounds become infected. Presently a midwife will visit, suspect an infection, take a swab and then phone the G.P to request that a prescription be issued for antibiotics. The infection will be caught early and the wound will, in most cases, heal well. If an infection is not treated promptly then it will ‘break down’ leading to a longer healing period or a readmission to hospital for re-suturing. I’m not even going to discuss the effect that reduced domiciliary visits will have on breastfeeding rates, all at a time when WHO are emphasing the importance of community support. Much is written about the detection of postnatal depression, as a community midwife I may suspect that a woman is likely to suffer PND, but serious PND generally shows after I have finished visiting. My role in this is to ensure that women know where to access help and to not  be ashamed, as many women are, of admitting that she is suffering from depression. Then there is an illness which does present whilst community midwives are visiting, puerperal psychosis, yes, it is rare but when a woman does begin to suffer from it early detection is beneficial as this illness can have tragic outcomes, as recognised in Why Mothers Die.

The essence of my argument with the ‘interest’ groups, who concentrate so single-mindedly on the ‘birth day experience, is ‘what point an ecstatic birth if, as the result of poor follow-up care, the mother and/or baby are unnecessarily ill, or die?’ It is wonderful that there are groups out there who apply pressure to government and care providers to improve care within the maternity services. Come on though, widen your focus from the glamour, headline catching time of birth and acknowledge the importance of good care before and after birth

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