Professor Wendy Savage
Birth is such an important matter and government policy has been extremely important in changing way give birth. A 1946 survey of births in one week found that 46% were at home. By 1956 one-third at home, more than 50% these were there or in GP-led units that were effectively run by midwives. By 1970 this had fallen to 12% home birth, one-third out of hospital. Sir John Peel, the queen’s obstetrician, wrote a report saying that all women should have opportunity to have “benefits” of hospital birth, although there was no definition what were.
By 1980 only 1 per cent of births were at home, half of these didn’t intended to. In 1982 a Commons committee on perinatal mortality found that it was safer to have baby in hospital but at home, but they weren’t comparing like with like, given that half of home births were unplanned. In 1979 a comparison that considered women who had booked for a home birth and they had extremely low perinatal mortality. Nevertheless the Commons study was used by obstetricians to further push women to have babies in hospital.
In 1981-2 it was the first time voices of women heard by any government enquiry; this study said that there was no reason not to have home birth. But the programme had to be cost-neutral to change to midwifery services. Lots of pilots showed women have better deal, but no money, so nothing much changed.
I still remember the euphoria of that night in 1997, bitterly now, when I look at what New Labour has done. But birth wasn’t one of their priorities.
Home births rose slightly 1-2pc – some parts of country up to 10 or 12pc. It is a woman’s right to have her baby at home. Such an important thing – you are in your own home with the professional as a visitor. For most people hospitals are associated with death and dying, and the way midwifery is organised in NHS is just hopeless. There is no continuity of care. I find it really tragic that the only way for many women have a proper birth is by having an independent midwife. Tears come to my eyes when see videos of births at home; we have made such a mess of birth in the NHS.
Health care commission did huge study in 1997 – 89pc of women happy antenatal care, 90 happy in care, only about 60pc happy with postnatal care.
My solution change the way to midwives organised. Think of it arranged just as doctors: there are GPs and hospital doctors. We should have midwives in community who look after the majority of women – only refer to obstetrician if necessary.: obstetricians are a risk factor for caesarean section.
Choice is supposed to be being provided, but there are endless e-bulletins say nothing, piffling amounts of money. In 2008 the government said 360m pounds would be put in, but it hasn’t reached the midwives. I had a look to today at the latest ebulletins. Absolutely nothing about midwives, only about the tariffs, part of this govt trying to turn the NHS into business.
Sarah Davies, senior lecturer in midwifery at the University of Salford
In 1980 I started training as a student midwife – just at the beginning against the fight back of extremes of medicalisation. I went on a march demonstrating against an obstetrician insisting women lie down to give birth. As a feminist I was very keen on idea of normal birth – knew instinctively right thing. Since then had more and more evidence that right. Normality is best supported by midwives: medicalisation doesn’t improve outcomes for women and doesn’t make for happy midwives.
There is a huge gap between rhetoric and reality at the moment. It is very difficult for student midwives learning about what should be happening – they see harassed midwives in huge hospitals trying to deal with heaps of bureaucracy. At the same time you have got policy saying midwife-led care is way forward. Currently there is a reconfiguratioin in Greater Manchester – closing five out of 12 maternity hospitals. The scheme is called “making it better” – this is typical of the doublespeak that goes on at moment. There are no plans for higher rates of home births and birth centres and the whole scheme is driven more by neonatologists than people in a community midwifery.
Birth is about relationships – current New Labour project is about moving to fragmentation of care. All these reports about safety – teamwork about relationships essential, yet all getting more and more fragmented.
Britain has the most centralised medical service in Europe – hospitals like Liverpool with 8,000 births a year. Women when they get to choose, they chose small, private places.
And we now have more evidence than we ever had – in 2008 there was a big review of midwifery-led care and it is clear that all women should be offered it. This is not up for debate – the question is how do we implement it?
Britain does have pockets of really good practice: in the Albany practice 98pc of women in labour don’t use analgesia. Quite astounding. In some areas home births as high as 20pn. Got group practices in Wales, South Devon, Blackburn. One to one relationship with midwife will optimise the service. One way forward similar to what happened in NZ – women and midwives took to streets to demand change, instead of central govt leaving to individual trusts and local areas to forge own decisions,
In 2003-4 with my first son I was a “floating voter” – quite agnostic on natural birth. I was a bit complacent. Thought I knew about childbirth, but I knew nothing. I ended up making documentary about childbirth. Initially after my terrible birth: “I thought thank god I was in hospital – they saved my child, they saved me, we would both have died.” I changed my mind afterwards, but only because I made a documentary. Addenbrooke’s in Cambridge is like the Savoy compared to most of the London hospital. Big teaching hospital, very keen to intervene. If you are induced you have a 50pc chance of ending up with caesarean section. They didn’t tell me.
With my first midwife, I saw her for perhaps 10 minutes over seven hours. Then there was a change of midwives, two young women came in, and it all continued. At some point they thought it was going a bit slowly – at no stage did anyone put her hands on tummy, to try to see position of baby. There was trainee saying “maybe you should walk around” but no one took much notice. Next thing I knew one went off to speak to registrar. “He thinks should be speeded up – just put you on this hormone drip.” Within less than 20 minutes I was in one continuous contraction, howling like a wolf. I have never known pain like it, and the baby’s heartbeat had gone off scale and his oxygen levels were bad. They rushed me to surgery. I remember the anaesthetist asking me about allergies, and the registrar saying: “there’s no time, we have to get this baby out now”. I didn’t know my son had been born, I thought the baby was clearly dead, and I didn’t see him for 24 hours. Then had problems with breastfeeding. I didn’t feel that I bonded – probably a year before I felt as close as other parents. Only after started making documentary realised wasn’t just me.
That was birth trauma – it was three years before I could even think about having another child. Other women also say they feel: “I’d rather do anything than go through that again”.
But I did, and I decided that I’d either have a home birth, or a selective caesarean. I was advised to look at my notes from the first birth. Midwife said it was clear to her that the baby was in wrong position and I clearly shouldn‘t have been given the hormone..
I only decided when I met a fantastic midwife – Jane Evans. She is legendary in midwife circles – the minute I met her there was a completely different atmosphere, the confidence she inspired. Absolutely empowered to give birth. The view at the Albany practice: this is not a hellish, terrible torturous thing, this is something to celebrate. Jane – took me four months of talking to her before I said ‘yes I’m going to do it’. She said: “You can do this.”
I did give birth at home, 17 March last year – I really learnt from it how vast a difference the relationship with brilliant midwife can make. Was 17 hours, very slow, second stage five hours, in hospitals they give you an hour then you’d be taken off for C-section. It was because I bloody well didn’t know how to push. I’ve talked to lots of women who are the same. Jane was coaching me like a gymnastic coach – she always knew where baby was, she knew when he went posterior, she knew how to get him back. Baby without doubt and most spiritual moment of my life – I understood in way never could from all the rhetoric – how true it is, how extraordinary, how different it is to give birth like that.
I could breastfeed immediately, I had a bond with the baby immediately. So different this time around. Feel passionately now – routinely women denied this choice – only reason I got it because I paid. Every woman in the country should have this choice. Having experienced one-to-one midwife care :This sort of care, this sort of relationship, this sort of happiness. Should be available to every woman in the country.
Most women I know have had a second-rate experience of giving birth. And they don’t know it.
Annie Francis – Independent Midwives UK
The medical model of childbirth is being increasingly challenged. Excellent care exists despite the system not because of it. System prioritises the processing of numbers over the experience. Independent midwives UK know that our model of care works. All research shows where women feel well supported, have a more empowering and positive experience. 76pc experience normal birth, 46pc in NHS – more likely breastfeed, less likely to have postnatal depression.
We are a social enterprise – national, not for profit organisation – the vision is to contract in at the primary trust care level – not talking about quasi-private service, but alternative way of providing within the NHS,
I asked what practically the Green Party could do: MEPs, councillors, local parties:
Wendy Savage – Find out in your local area: have they had this share of 360m released a year ago? If it hasn’t got to your PCT put pressure on to ask why it hasn’t. Then ask “are you short of midwives in your area?” One midwife on average oversees 32.5 births per year – less than one birth per week – 10 antenatal and post-natal visits, which isn’t a huge workload. We’ve somehow got to make people working in hospitals, the managers of midwives, look at the way they deploy them. If they provide continuity of care that is much more efficient.
There are maternity service liaison committees – get someone on that who can stand up to obstetricians: although I am one myself I think they are part of the problem. I know two consultant obstetricians who had babies at home
Annie Francis: Join our a postcard campaign. We are told PCTs have to respond to local need. One of the problems is you don’t know what you don’t know. These are addressed to the chief executive of PCTs – asking for caseload midwifery, continuinty of care, and for them to contract in independent midwives. Make it clear that this is service we want: PCTs have to respond to that.
Sarah Davies: Now is a good time to go to your PCT and ask where money is. Also the government tasked PCTs with implementing Maternity Matters – there will be a check where up to end of this year. Think why postcard campaign. Get together on streets or have public meetings.
Rowan Pelling – I think this needs public demonstration. Where childbirth comes on agenda it tends to appeal a little more to women than men. Even when I was writing for leftie social conscience newspaper, it was incredibly difficult to get anyone interested in childbirth. They’d say “you’ve written about this already this year”.
You are still talking about four-fifths of women having children, and a majority of men as well are having children. My husband I think suffered very much from birth trauma. He couldn’t phone anyone to say he had a baby he was so traumatised. This has got to be raised up to same level of importance as other media topics such as cancer treatments.
Question: what is the situation in rest of Europe? How do we compare to other countries.? Good examples to follow?
Wendy Savage – The shining example is Holland, where one third of births at home, and midwives have power to look after women. Their system is infinitely better than ours. In Scandinavian countries they have a hospital-based system, but obstetricians became worried about the Caesarean rate and their’s is at least 10pc less than ours.
Apart from Holland, I don’t think any other country has taken on the other emotional aspect. Independent midwives are not very common. Lots of our poor results from perinatal mortality are because of the huge wealth gap and poor initial health of those on the bottom half of the social scale.
Annie Francis – one of things about UK is that I’m very optimistic – there are a lot of strands coming together at the moment. Are a number of drivers really helping us to come into NHS on our terms. We are going to lose the skills if we don’t act now, but we are still in a position to use those midwives we have,
There are now 5,000 not practicing who would come back into practice if could work in more autonomous way with continuity of care.
Wendy – most European countries apart Denmark, Holland, Italy Caesar 30pc, in Spain midwives puillaried for looking after women at home, in Germany obs are so hostile to midwives.
Sarah Davies: things can change quite quickly. In NZ in about 2002 there was a sympathetic government minister. The service there is not perfect, but it has moved things forward – much less as a climate of fear; midwives feel free to practice autonomously.
The thing have to look out for is private medicine: Brazil has an almost 100pc of caesareans among private physicians because of financial issues.
Rowan Pelling – It is notable that places that have sensible sex worker legislation – NZ and Holland – are also doing well with birth. They have a sensible attitude to sex: the two things are profoundly linked.