Alice Thomson
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In between the tea ceremonies, the cruises and learning to fold kimonos, the wives at the G8 summit in Lake Toya have been campaigning against maternal mortality. It's the perfect choice for the spouses, a subject surely as uncontentious as gazing at waterlilies.
No one wants mothers to die in childbirth. Everyone must be shocked that a woman dies every minute giving birth and that there is a global shortage of four million midwives. Yet no one does anything about it.
The British should know. We are increasingly bad at giving birth. In the past ten years spending on maternity services has gone up by a quarter in real terms. Yet the satisfaction rates have plummeted, Britain's maternal death rate is one of the highest in Europe at 7.3 per 100,000 births compared with an average of 6.8, and the free-market think-tank Reform says that maternity care now accounts for more than half of all negligence claims against the NHS.
According to a study into maternal care published by the Healthcare Commission yesterday, most units do not have enough beds or showers and two thirds of trusts still offer no choice of how to deliver baby, leaving women feeling powerless. But the real problem is that the money has been directed at building projects rather than people. The proportion of the NHS workforce represented by midwives has dropped from 2.1 per cent to 1.7 per cent in ten years and some midwives are now in charge of a quarter more births than they were in 2001.
When I had my first child, in 2000, I gave birth in the cramped Queen Charlotte's Hospital in London in the same room where I had been born. The paint was peeling off the radiators, the blinds were stuck in a June heatwave and you had to import your Jaffa cakes from the local garage. Yet the system worked. You had your own midwife who followed your every twinge and came to celebrate your baby's first birthday. “This is not a hotel,” the midwives would say when you asked for more than one piece of toast on the ward, but they had the time to teach mothers how to feed their babies and change their nappies.
When my second baby was born two years later, the hospital had moved to a gleaming new site overlooking Wormwood Scrubs, with cappuccinos in the canteen - but the experience was harrowing. The midwives appeared as exhausted as the patients and rotated faster than the fans. They had to follow a raft of directives rather than their intuition. I got down on my knees just minutes after the birth to clean the floor before my parents arrived because nobody else had time to clear up the mess.
When my fourth child arrived, I brought in a bucket and brush but I didn't need it. The hospital was so overstretched that I was sent home within two hours of giving birth.
The postnatal experience has deteriorated even more rapidly. Terry, my first health visitor, had been looking after new mothers for more than 20 years. While she made us both tea, she was quietly working out whether I was elated or depressed and how many bottles of wine were stacked in the bin.
But she had given up by the time I had my second child because she couldn't stand the doubling of her workload. She never saw the same mother twice; instead her job was to collate information on the religion and ethnicity of every baby. Our last health visitor spent an hour filling out forms and never touched our baby, which is presumably why she registered my son as a girl on every document.
Although under Lord Darzi of Denham's plans more money will be spent on building new supersize units, in recent years 41 small maternity units have been closed or are now under threat. Yet Britain already has the biggest maternity units in Europe, and these have shown no improvement on maternal mortality.
The bigger the unit, the more impersonal and daunting the service will become. There may be more consultants for emergencies but most women will never see one. The Government has promised it will solve this by returning to one-to-one midwife care but there is already a shortage of 5,000 midwives and there isn't the money to fund such a specialised system.
It's easy to think that pregnant women don't matter: they are not ill (as I was constantly told) and they are not going to come back often. Very few actually die in childbirth or of postnatal complications, so all they need is a building, a nameless face shouting “push” and an ability to cross their legs until they actually make it - sometimes miles away - to their nearest super-hospital.
But for many women this is the first time they have ventured into a hospital since they were born and the weeks after their baby's birth can be crucial in helping them to cope with motherhood.
Instead of queueing up to drop their children in supersize baby battery farms, they need to feel that someone cares about this new life. So let women go free-range and choose the type of care they want - whether in smaller units, at home or in a larger hospital with a consultant on hand - and give them a friendly face to guide them through the process.
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Money needs strict ring fencing so that maternity funding is spent on maternity services - GPs are given over £130 million a year for providing care to their pregnant patients when this could be ploughed into community midwifery care and make a real difference.
Maria Mills, London,
I gave birth at one of the largest units in the country. I heard they had to close the labour ward to new arrivals while I was there - both that day and the following day so I was 'lucky' to get in. A horrible experience with plenty of unjustified intervention and birth plan not even glanced at.
Sharon, London,
Sally,
The NHS is not free, my family in the US earn a similar wage as us but pay much less in tax and private health care than we do in tax alone. People might chose private care if they weren't forced to pay for the NHS; if they are forced to pay then they have a right to expect good service.
WB, Oxford, UK
I agree with Sally; people do need to change their financial priorities rather than hope for the best with the hit-and-miss NHS. Expectant parents deserve far more than what is currently offered. Home births should not be discouraged either in favour of the appalling 'battery farm' maternity wards.
Louise, Manchester, England
I gave birth in a London hosp. in 2006. I was left in a waiting room, with a midwife who stayed 5 mins overall, until I was 9 cms dilated. I then had to walk to a delivery room. There was no anesthesist available until too late. To say that the natal units are overstretched is an understatement
Florence, london, uk
I had both my sons at the Royal Berks, Reading. 1st baby in 1997 - maternity ward filthy, midwives too busy, rude at times, conflicting advice, I'll never forget the blood splattered shower curtain. 2nd baby in 2000 - dirty ensuite room (£75 per night), similar experience. Sally, London is right.
Joanna, Reading,
Why not go back to the smallest possible, your own home?!
In many European countries, where the mortality is well below the average 6.8, the majority of women give birth at home. The midwife comes to you, not the other way around.
Hospitals are for sick people.
Erwin, London,
Forget hospitals, my partner gave birth at home, in our hot tub, in the garden! I delivered our daughter, the midwife arrived 20 mins after she was born. It was the most amazing experience and all done with hypnobirthing techniques which meant that my partner experienced no pain.
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Darren, Tauton, UK
1st baby 14 years ago in a large impersonalised unit. My views were completely ignored and the lack of dignity was appalling. Hence two home births 10 years apart, different part of the country, both fantastic experiences with 1-1 caring and experienced community midwives.
Helen Scott, Preston,
going private is fine if you've the money; but on low pay you've no choice, however you prioritize.
there is too much emphasis on costs. when will politicians learn that a service should be just that, a service. it's not a supermarket.
Phil Barnes, preston, england
My wife and I had our baby in a large NHS hospital in Aberdeen and the experience was wonderful. The professionalism and care of the midwife and hospital staff was faultless. Read the birth announcements in the paper - they all say the same: God bless the NHS!
Liam, Glasgow, UK
Alice, you are 100% right. Where I live, we have the choice of a small unit where you can stay as long as you like until you are comfortable with baby, or a huge impersonal battery farm which chucks you out after a couple of hours to get the next one in. Guess which unit is under threat of closure?
Syd, Cambridge,
With a week to go before our 1st baby, my wife has seen a different midwife on every appointment, been told they were too busy to discuss birth plans and to plan routes to alternate hospitals as there is a good chance they will be closed to admissions due to a lack of beds/midwives.
Matt, Leicester,
I totally agree; small is best. I was lucky enough to birth my son at a midwife lead unit with six beds in Chipping Norton. The experience was really positive, with kind, patient and experienced midwives, no doctor in sight. Bring back more of these special places, they are best for Mums and babies.
Judith Howard, Kings Sutton, England
It's time women stopped using the NHS just because it is "free". Giving birth in the private sector is a truly wonderful experience because there is choice for all types of consumer from the elective caesarean to the intervention free. People need to change their financial priorities.
Sally, London,
I am an obstetrician who has left the uk.
the system is in meltdown because -
1) Labour interfering and managerising the nhs
2) UK grads not wanting to do it anymore
3) Senior consultants not complaining enough
4) The UK population DOESN'T TRUST DOCTORS ENOUGH.
- cheap isn't better.
ob, nsw, au