Women have been promised a wider range of options in the kind of care that they receive before, during and after childbirth in a report on the future of maternity services.

Maternity Matters, published yesterday by the Department of Health, says that by 2009 women in England will have more choice about how they access services — through a GP or directly through a midwife — what kind of antenatal care they have, where they have the baby and where they get postnatal care.

The document outlines a “minimum guarantee” about the service that women can expect from the NHS, including a “full range of birthing choices”: a home birth, a midwife-led birth or a consultant-led birth.

The promises were greeted sceptically by the opposition parties, which did not criticise the aspirations but questioned whether there would be enough staff to fulfil them. Patricia Hewitt, the Health Secretary, acknowledged that there was a shortfall in the number of midwives but said that 1,000 were in training and would qualify in the next couple of years.

During a visit to Queen Charlotte’s and Chelsea Hospital, in West London, she insisted that the targets could be met by the end of 2009. “We know that giving birth in Britain is safer than ever before but we want it to be as safe and satisfying for every woman in every part of the country as it can be.”

Asked whether promoting home births would increase the risks for mother and child, she said: “The important thing is to give women an informed choice.” Of course there were women for whom home births would carry extra risk of complications, but she said: “There are also many women who can have their baby perfectly safely at home or in the midwife-led unit like the one we have here.”

The Royal College of Paediat-rics and Child Health said that the interests of the baby should not be forgotten. “While it is right that women should have greater choice over where to give birth, that decision has to be based on good information about the risks and benefits for the baby,” the college said.

“Maternity and newborn services need to be networked so that mothers know where they and their baby may be referred if this becomes necessary. Postnatal care must include checks on the baby by personnel trained and experienced in these skills.”

The Royal College of Midwives calculated that England would need the equivalent of 22,000 full-time NHS midwives to implement the plan, against 19,000 today. It wants there to be at least 20,000 midwives by 2009, rising to at least 22,000 by 2012.

Dame Karlene Davis, general secretary of the college, said: “Although the number of midwives is up and spending is up too, it is also true to point out that both the proportion of the NHS workforce represented by midwives, and the share of the NHS budget being spent on maternity services, have dropped since 1997.”

Andrew Lansley, the Shadow Health Secretary, said: “I find it astonishing that Patricia Hewitt can mislead expectant mothers and unemployed midwives by making this announcement without acknowledging the shortage of midwives, that antenatal classes are being cut or that Labour are divided over threatened maternity unit closures. We support giving women greater choice, including the option of a home birth, but it is hard to see how Patricia Hewitt expects to deliver on it.”

Sandra Gidley, for the Liberal Democrats, said: “Many more midwives need to be recruited. We’ve seen repeated evidence that maternity services are being cut in a desperate bid by trusts to balance the books. Where are they now going to find the money to recruit all these extra staff?

“Giving birth at home should not be encouraged for all mothers as a cheap option. It should be available to those who want it and must come with the guaranteed support of fully qualified midwives.”

A recent study from the Healthcare Commission found that a fifth of women did not have a midwife or doctor by their side throughout delivery. Some women have said that they were left alone for long periods while others felt that they were left too much in the care of maternity support workers.

The Department of Health admits that support workers are occasionally left alone with a woman in the early stages of labour, enabling the midwife to take a break. It said that it was not planning to use them as substitutes for midwives. Alice Miles, page 19

Class matters

— Women who, with their partners, are unemployed are 20 times more likely to die in childbirth
— Single mothers are three times more likely to die as those in stable relationships
— Women living in the most deprived areas have a 45% higher chance of dying than those in affluent areas
— Almost a third of domestic violence starts or escalates during pregnancy; such violence is linked to miscarriage, premature birth, foetal injury and foetal death

Source: Department of Health report, Maternity Matters

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