Given the choice would any woman opt to have her baby in the presence of people she doesn’t know? Common sense and research would suggest not.
Yet of the 2000 women giving birth today, 1620 will not be attended at any point in their labour by a midwife they have met before.
Despite it being widely evidenced and widely acknowledged that having a known and trusted midwife with them through pregnancy, birth and beyond delivers the best outcomes for mothers, babies and their families (and can save the NHS money), our maternity service is delivering far from this kind of care for the vast majority of women.
This is failing women and their families, as well as midwives. And it does not need to be this way.
WHO ARE WE AND WHAT DO WE WANT?
A Midwife for Me and My Baby (http://www.m4m.org.uk) is a new campaign gathering momentum with support from a growing number of maternity related organisations. We’ve identified a shared goal – one that would deliver the woman-centred care that women want, need and deserve, and we’ve started to look at the solutions necessary to deliver it. Our Manifesto is HERE.
We want every woman to have a midwife that she can get to know and trust, who can support her through pregnancy, birth and beyond, regardless of her circumstances or where her baby is to be born
WHAT IS WRONG WITH THE CURRENT SYSTEM?
The current system is working against women and it is working against the midwives providing the care. Maternity care has evolved into its current shape not because the women using the service ask for it or because the midwives delivering the care want it, but because policy makers – government, have not created the environment in which a truly woman-centred system can be delivered. The system as is, drives care into hospital, out of the community, incentivises the wrong things and without enough midwives to cope with the rising birth rate, midwives are stretched and pressured to the max. No time to form relationships let alone provide continuity.
Provision of continuity also fails to grow because midwives providing this level of commitment are not paid to do so. In the NHS they receive the same level of remuneration as those working shift patterns. They are also often lacking the management support to provide continuity and are often expected (on top of their case load commitments) to provide cover when the acute unit is short staffed.
HOW COULD CHANGE BE DELIVERED?
With the advent of clinical commissioning every user of maternity services has an opportunity to have a real say about how local services should look. But the ability to shape and influence will continue to be limited just as it has been for years if the barriers that currently stand in the way of true continuity of care are not taken down.
The maternity landscape must change so that continuity of care is encouraged, incentivised and nurtured rather than fought against or not even considered a possibility. This is about breaking down barriers. Only once the barriers are removed can models of care that deliver true continuity and a known and trusted midwife for many more women, start to flourish.
The government must set the scene and the commissioning groups must honour their commitment to commissioning services that the service user wants.
The government acknowledge the improved outcomes that a known and trusted midwife can deliver, yet has failed to create the environment in which this type of woman-centred care can flourish. It needs to set the system up so that it incentivises the kind of care that delivers the best outcomes. This is about incentivisation rather than central direction, it is not dictatorial. It saves money long run. It incentivises better outcomes. It allows local contracting and negotiation.
- Continuity should be incentivised, with midwives being paid per woman and savings made from improved outcomes being reinvested into remunerating those midwives working to deliver continuity
- The midwife shortage should be urgently addressed
- PBR should also be designed to ensure there is no incentive for intervention and does not disadvantage midwifery-only maternity providers.
- Capital charges should be changed from a charge for the space to a charge for the person, so there is less incentive to pull all births into consultant units
Commissioners everywhere must commit to contract midwifery provision that delivers the best possible outcomes for women and their babies. This means woman-centred models, such as caseloading must be included in the mix of maternity care. Everywhere.
WHAT CAN YOU DO?
The success of this campaign rests largely on policy makers making changes to the maternity care system, so we need MPs to understand the issues women and midwives are facing. We’ve created a print -outable baby for you to send to your MP – You will find all you need here. http://www.m4m.org.uk/takeActionDeliver.php Please do let us know when you hear back from your MP via email@example.com or via our FB page
You can also follow us on Twitter @Midwife4me. Please use the hashtag #m4m
And if you want any further information do please contact firstname.lastname@example.org
Vicky Garner (Founder, The Birth I Want) on behalf of A Midwife 4 Me