notes from JK

Speech: Maternity Services in Brighton & Hove

This speech was presented to the Full Council meeting of Brighton & Hove City Council on 18th March 2010. It was to propose a Green notice of motion on maternity services, which was passed by the meeting:

Amidst much downbeat news on the NHS, it is doubly worth celebrating, as this motion does, the local Primary Care Trust’s plans to introduce a midwife led birthing centre in our city.

For far too long the majority of mothers have had to trek to Crowborough for a midwife led birth or go to the Royal Sussex County hospital for a ‘standard practice’ birth. An increasing number have been wanting to have home births but the resources have not always been available to support this. Furthermore Crowborough birthing centre only has six beds – so the choice has not been a reality for many families.

Of course good, trouble-free births do happen every week at hospitals. I support the good work our local hospital does, this motion is about offering families meaningful choices.

For so-called “normal” pregnancies home and birthing centre births are just as safe, if not safer than the hospital environment. For it is in hospitals, where birth still tends to be overly medicalised, that unnecessary interventions with unintended side-effects still happen too often.

Much obstetrician thinking is still too male dominated. Doctors tend to treat birth as something that happens to a women, in the way disease happens to someone, rather than an incredible thing that women do and have been doing for millennia.

We celebrate the advances in medicine which have dramatically reduced childbirth mortality rates. But traumatic births, due to inconsiderate and inappropriate medical interventions, should be avoided wherever possible. For the trauma of a difficult birth has lasting physical and psychological impacts on mother and child, hence their partners and surrounding family too.

Women being offered epidurals, “because the anaesthetist is around now”, being strapped to monitors which restrict their movement in the critical stages of labour and being given epistomies because mums are made to deliver lying in that most unnatural position, on their backs. These are all examples of unnecessary interventions which still happen in NHS hospitals. These are actions which have a lasting impact on the wellbeing of mothers.   Medical interventions often require additional recovery and healing, hindering mothers from caring for their children in those precious early days.

Such interventions are extremely rare in midwife led-birthing centres. Midwifes have a different, more nurturing model of birth which trusts women in their ability to deliver safely and naturally. Of course they have the training and skills to deal with the complications which can occur, but most births can and do proceed without major intervention.

Birth is a life changing moment for all concerned. The mother in a state of anxiety, pain and intense physical vulnerability and the father trying to make himself useful in one way or another. A midwife is in a unique position of experience and skill to empathise with and support the expectant family.

When my wife was expecting a few short years ago, we started off with different midwives at each checkup. After a few months we were fortunate enough to be assigned to one midwife who stayed with us until a week after the birth. However for the birth itself, none of the midwives or other staff were known to us. This made a difficult situation that much more stressful. A familiar face would have made a world of a difference.

The NHS need to find a way to resource greater continuity of maternity care. This also applies to post-natal care. Midwives generally stop seeing a mother 5 to 10 days after birth. Health visitors pick up the baton from there, yet they are suffering from increasing caseloads where 70% of health visitors in one survey saying that they didn’t have time, due to their caseloads, to help even the families that are most in need. The number of health visitor home visits are in decline as are the number of clinics they run.

This leads to an increased risk that child development problems and post natal depression are less likely to be picked up. Unless parents are proactive in accessing services, they are likely to get only very occasional visits backed by postal surveys. This isn’t enough to form the bond needed to spot problems in the early days of parenting.

A good relationship with a midwife and then health visitor is vital. These are tender, challenging, vulnerable times. For the mother who wants to discuss problems she may be experiencing, for example the physical after-effects of giving birth or during breastfeeding, there must be a level of trust and understanding for them to share these concerns.

That’s why this notice of motion calls on the PCT and the Health Secretary to support greater midwife provision and post natal care. Offering counselling after a traumatic birth received near unanimous support in the PCT’s survey. Such counselling can prove vital in speeding psychological recovery. There is plenty of evidence that when not dealt with birth trauma can have an impact for years, on the mother and her relationship with those around her.

Let’s work to try and eliminate as many unnecessary birth traumas as possible, but where they do happen, let’s support parents with the best services we possibly can.

I urge you to support this motion. Thank you.

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