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From here to maternity… and hopefully better care

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The announcement earlier this week of funding allocations for new maternity equipment reminded me that I planned to write something about the national maternity review, but never got round to it.

I had wanted to do so because it is now 14 months since the birth of my own child (a baby girl who has just started walking and is increasingly fond of animals, especially bears –not teddies, the real ones) so felt I had some personal experience, if anecdotal, to contribute.

“I strongly welcomed some of what was recommended by the national maternity review”

However, as I think back to the birth itself, I realise how naive my wife and I were about it.

We saw a lot of different healthcare professionals in the months running up to the main event – but usually in a hurry – and arrived at most of our decisions based on a mix of what we remembered having been told and what we had gleaned from working for Nursing Times over the years.

It wasn’t quite how I had imagined it, with both us sitting down and discussing options with a midwife that we were familiar with and in control of all the facts and realities of the situation. But of course you can only plan so much for these things.

We arrived at hospital expecting to have our baby in the midwife-led unit using as little intervention as possible, eg gas and air. We ended up – after many hours, several midwives and all possible forms of pain relief – having an emergency Caesarean. I increasingly recognise that it was probably a closer run thing than I realised at the time.

Therefore, I strongly welcomed some of what was recommended by the national maternity review – particularly the stuff on continuity of care with teams of midwives assigned to women, care planning and unbiased information.

It would have been a much, much more positive experience for us if we had arrived at hospital already knowing the team of midwives that were going to help deliver our baby and with a clear plan of what we wanted in place and ready to go.

National maternity review

Peer announced as chair of national review of maternity in England

Baroness Cumberlege

However, I was less sure about the importance of Baroness Cumberlege and her review panel’s big headline grabbing recommendation, which was giving women a personal budget to spend on their choice of care options.

In theory, it sounded great; in reality it sounded complex and a deviation from more important issues in maternity care. Would we have wanted a budget to think about on top of everything else, I’m not sure.

What was more worrying were the report’s warnings about the wide variation in maternity care standards around the country and silo working and lack of respect between different groups of professionals – something also found by Bill Kirkup in his investigation into what went wrong at Morecambe Bay.

Talking of Dr Kirkup, he warned last week in an interview with Health Service Journal that he was concerned at the slow progress in taking forward the recommendations from his own high profile review into maternal and infant deaths at Furness Hospital.

This week has, however, seen some developments that, on the whole, look pretty positive.

On Monday, the Department of Health revealed the trusts that would be receiving a slice of £2.2m made available for updating maternity equipment.

First mention of the funding was made back in the autumn, when Jeremy Hunt announced it alongside the laudable “ambition” of halving the rate of stillbirths by 2030.

A second mention followed in January when trusts were asked to apply for the money, and then thirdly we had the allocations revealed on Monday – so three bites of the cherry for the DH media mandarins. But news about the money made the headlines again, so happy days for them.

Anyway, the windfall was obviously welcome news for the beneficiaries, though when you split it up £2.2m between 90-odd trusts, it looks slightly less impressive.

It is also welcome that more money is also on the way for staff training packages and a new system to “review and learn” from every stillbirth and neonatal death.

“For me, the elephant in the room once again is staffing”

Meanwhile, in the latest move, announced today, hospitals in England are being asked to make a public commitment to improve their maternity care with the help of new guidance.

The DH has said hospitals will be expected to set out “concrete actions” to improve care, including rolling out training for all maternity staff on the risks and symptoms of perinatal mental health and ensuring staff focus on safety when handing over to colleagues at the end of a shift.

However, for me, the elephant in the room once again is staffing. The Royal College of Midwifery has banged the drum eloquently and repeatedly on the issue so I won’t make the case again here.

Yes, we need better equipment, better guidance, better continuity of care and a better working culture between nurses and doctors – we need all of these things.

But better staffing with appropriate levels of midwives on maternity units would surely go some of the way, if not all, towards making birth safer and reducing the risk of what must be the utter devastation of avoidable stillbirth.

It might also go some of the way to making Baroness Cumberlege’s vision for better continuity of care and more personalised care a reality – something I would very much welcome.

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