Monday, 9 February 2009

Maternity Units ‘Shut to Mothers’

Okay, I just opened up my home page which is always set to the BBC news; I tend to watch very little news on TV these days and tend to find my information on the net. A headline caught my eye in the Health section: Maternity Units 'Shut to Mothers'. A précis of the article states that nearly half of 104 trusts responding to a recent survey by the Conservative party said that in the last year they shut their maternity units at least once and diverted women to other hospitals. The total of closures for 2008 was 553 compared to 402 in 2007. It didn't say if any women who were affected by these closures had untoward experiences or complications in their labours and births associated with these closures. I hope not but I suspect otherwise.

Now, I have been filming pregnancy and birth matters for many years and this particular scenario does seem to be happening with increasing regularity. A woman I spoke to only a couple of weeks ago said that she had been booked to have her baby at her local maternity unit in Brighton, the unit was closed to labouring women so she was asked to call the next maternity unit in Haywards Heath which was also closed, she eventually found a maternity unit to take her in Eastbourne. Fortunately she gave birth in the maternity unit and not in a car on the way there, which has happened to so many women over the last few years. This is not a local problem to Brighton, it is country wide as the Tories report shows and the main cause is increased birth rate coupled with decreased midwives and facilities. So, I then remembered an article that I had seen only a couple of days ago dated 6 th Feb: NHS facing £700 million negligence bill, The shocking fact is that more than half of the payouts are for maternity related cases Now,it doesn't take a genius to work out that maybe one is linked to the other? This figure is for 2010 alone. Surely it must be obvious that when you have shortages of midwives and maternity unit closures due to lack of funding the outcome is going to mean more mistakes being made by overstretched staff leading to more litigation?

So, more than £350 million has been set aside for next year's litigation budget for maternity services. Can you imagine what our consultant led maternity units, midwifery led units and homebirth midwives could do with that money?

If for example £100 million was put in to training and employing more midwives in the most overstretched units, how much could be saved from this horrendous litigation budget?

The Kings Fund has launched the Safer Births Initiative to improve safety in maternity services, it will be launched in October 2009 and I hope that when they have completed their research their recommendations will be implemented.

Thursday, 5 February 2009

Filming a beautiful homebirth

Okay I was in the middle of writing a piece for my blog about Group B Strep as we’ve had so many queries on the website, when events took over. I shall do a blog on Group B strep next time, but I thought I’d write about this instead as it is fresh in my mind and I have lots to say.

Yesterday evening Katherine texted me to say that she'd been having period like pains all afternoon and she thought 'tonight could be the night' I texted back and said 'bring it on'. Last time I filmed Katherine she went 26 days past her due date (Birth Diaries - Katherine and Brian's story - on ) and I had half expected her to do the same this time, so with that in mind I had already booked the dog into kennels for the end of the month for a weekend away, as being on call 24/7 can be a bit tiring, I don’t know how the independent midwives cope with it all year round!

Anyway, back to Katherine. At 6 O'clock she called me to say that she was definitely in labour and finding it hard to talk through a contraction (a good sign), so I grabbed a sandwich, packed the camera and set off for Kent. On Monday we had had the heaviest snowfall in the South for 18 years so I was a little worried about the roads, but other than her road where she lives, the Highways Agency had done a good job on gritting. At 7.15 Brian called me on the mobile to tell me that her waters had just broken, luckily I was only ten minutes away by that time.
When I arrived, Katherine was leaning over the sofa with her Mum Pam rubbing her back furiously, little Beatrix was running around the room totally oblivious to her mother’s labours and Brian was there making a cup of tea. The pool was nowhere to be seen, as the labour had started up so quickly Brian hadn’t had a chance to inflate it. Katherine’s contractions were coming thick and fast and between her Mum and Brian her back was looking sore with all the rubbing, but that is what she wanted. I got on with the filming and when Kay her midwife arrived a short while later, there was nothing to hold Katherine back. The labour stepped up a pace, Kay checked the position of the baby, its heartbeat and Katherine’s blood pressure, everything was perfectly normal. Katherine also hadn’t had a chance to put on her TENS machine, but to be honest I don’t think at this stage it would have been of much use. Kay had brought in her infant resuscitation kit and also the entonox for pain relief, none of which were needed I am pleased to say. Katherine was experiencing some very strong contractions and couldn’t get comfortable, it was obvious she was close to giving birth, and Kay observed patiently beside her. Brian continued to rub her back and Pam took Beatrix up for a bath. It seemed like no time at all before Katherine was pushing with her contractions and at 9.19 she gave birth to a lovely baby girl, Beatrix had just fallen asleep and missed the whole thing, Katherine lifted her up and they sat on the floor recovering from the surprise and shock of it all, Kay waited for the umbilical cord to stop pulsating before Pam clamped and cut it, a short time later the placenta was delivered and Katherine went for a bath while her Mum dressed the baby. Half an hour later Katherine came back downstairs, by which time Kay had cleared away her things, the towels were already in the washing machine and Pam had brought in dinner and pudding from the car which she had prepared earlier.

By midnight everything in the house was as it had been at 5 .00 that evening, except that Katherine and Brian’s baby was here, delivered safely in her own home without a fuss and leaving very little mess except for a damp patch on the carpet where her waters broke.
I have filmed many homebirths over the last five years and it never fails to amaze me at how natural it all seems. That is not to say that I have always witnessed straightforward births; some have been complicated and a few have transferred to hospital for an instrumental delivery, and for these few women the maternity unit was the right place to be, but for the remainder a homebirth was wonderful. I practiced as a midwife in the 1980’s and returned for a short spell in 2003. My observations are that there is such a strong contrast between a hospital birth and a homebirth, and I feel saddened that more women don’t experience homebirth and all that it brings. I have to put my hand up here and say that my own four children were all born in a maternity unit; the care I received was second to none and definitely with my third child (born at 31 weeks) I know that she would not have survived had it not been for the technology and medical care that she received at that time. For me, having a baby in a maternity unit was not scary- I knew the environment intimately and the machines that go Ping held no fear, but for many women these contraptions take away the natural instincts of a woman to birth her child, and it is no surprise that our induction, instrumental and caesarean section rates are increasing exponentially. Perhaps it is time to have a very grown up discussion about maternity services in our country and forge a new way forward?