27 / 3 / 2013 8.15am
As a midwife, I was interested to learn that the impact of the negative culture and poor standards at Mid Staffs extended to the maternity service.
Highlighting the woeful prioritising of cost over care, the report brought to mind the marvels and frustrations I've encountered during the course of my 35 years working in the NHS.
These frustrations, I believe, have been a consequence of continuous 're-disorganisation', institutionalised bureaucracy, the introduction of competition, and managing the NHS as a product.
And although I understand that financial balance in the NHS is crucial – as it is in any business – the rationale and process of how this is maintained needs further fine-tuning.
I remember the pressure I faced when working in a senior position at a highly respected maternity service. In order to achieve financial balance throughout the trust, the number of beds were reduced, staffing levels decreased, and training opportunities halted.
This caused enormous pressure on the system. I juggled numbers, trying to make sense of suggested staffing ratios in the absence of clear guidance. My seniors were incredibly supportive and always keen to maintain safe staffing levels, but as with most other maternity services throughout the country, it was never enough.
Midwives from all parts of England tell me this situation continues.
And workloads are further burdened by excessive bureaucracy and medical interventions carried out ‘just in case.'
A study I was involved in on the impact of paperwork on workload for midwives and obstetricians in maternity services in north west England revealed a sense of overburden and stress due to the increased focus on documentation and tick boxes, mainly to reduce risk or ‘getting into trouble’. The general feeling was that maternity care was ‘record-centred’ instead of ‘patient-centred’.
This focus on risk aversion and risk management processes appears to dominate the system and certainly impacts on the culture in the working environment. In maternity services, this risk aversion culture is actually exacerbating risk in many ways. This is a widely shared view.
For maternity, the highest risk is of the cost of claims for the NHS Litigation Authority – ‘risk’ and ‘fear’ prevail hand-in-hand. This fear is deflected to childbearing women who are increasingly fearful of childbirth. Many women are reporting feeling traumatised by childbirth, while others feel they have had their human rights violated.
So how can we make a change?
The International Confederation of Midwives and the Royal College of Midwives supported the production of a short film to deliver a global message about the importance of midwives and the impact they have on positive birthing and family health.
But it's not enough.
The way that maternity care is delivered needs to improve, and midwives need the help of women and families to push for change, and many women in England are actively taking their future into their own hands.
Individuals and pressure groups are emerging at a pace and challenging the maternity system in England to change. Birthrights for example, is a new powerful organisation headed up by Matrix Chamber Barrister Elizabeth Prochaska, working to protect women’s human rights in childbirth and to promote dignity and respect in maternity care. Toni Harman and her partner Alex are informing the world of the need for improvements worldwide, with their incredible collaborative and filmmaking skills.
The Birth I Want, for example, campaign for women to receive one-to-one care by a midwife throughout their childbirth experience.
And midwives and mothers are coming together to influence the future, too. A group of individuals and organisations including the National Childbirth Trust Association for Improvement in the Maternity Services, Independent Midwives UK and Association of Radical Midwives are campaigning for 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. Watch this space.
Lastly, there are several active, high profile blogs from mothers and birth attendants (doulas) who want to see improved maternity care: Hackney Doula;The Mule; Doula-lly and Lonely Scribe.
Safety hinges on the delivery of individualised compassionate and respectful care, because if that doesn’t happen, patient experience is likely to be at best negative, and at worst, harmful. Compassionate care doesn’t take more time, in fact it saves time and money and is actually advocated as a priority within our healthcare system.
So midwives and mothers, let’s use the Francis report to continue building momentum to improve the healthcare services that support new parents and the first moments of life for generations to come. What can be more important than that?
Sheena Byrom OBE is an independent midwifery adviser. Follow Sheena on Twitter @SagefemmeSB