Better births, better foundations, brighter futures | Sheena Byrom OBE

Sheena Byrom

With more than 30 years’ experience as a midwife, Sheena Byrom explores why a recent review into NHS maternity services has the potential to catalyse change for expectant families across England.  

I’m frequently asked why I continue to be involved in maternity services; why I travel the country, and elsewhere, to lobby for improvement in maternity care, years after taking early retirement from the NHS. 

Well, I try to make clear my intentions: I believe that some of the well-meaning ‘progress’ I witnessed during my three decades working in NHS maternity services isn’t having the desired effect. 

My children have children, and I care about how they are born. In a nutshell, childbirth matters. The social, physical and physiological implications of birth are significant for both mother and baby, and the impact care givers have on the process potentially resonates for generations. 

We now have an enormous opportunity. This year, following a comprehensive review of maternity services in England, Better births: Improving outcomes of maternity services in England was published.  I was eager to read it and felt uplifted as I moved through each page. I was immediately impressed with the focus on kind, compassionate and respectful care – in fact, there are 50 references to these words.

I remember so well Changing childbirth being published in 1993, and being fortunate enough to work with an inspirational and courageous leader, Pauline Quinn OBE. 

Pauline was the director of midwifery in East Lancashire and she took the recommendations of the maternity strategy document seriously. The changes she implemented back in the early 1990s have enabled maternity services in the same organisation to flourish to this present day. With her team, she made it happen. 

Better births
 gives us another chance, providing evidence and impetus to drive improvements for expectant and new families. Lead by Baroness Cumberledge, the review team gathered a broad range of views and experiences from successful maternity schemes in the UK and overseas. They travelled throughout England and listened to service users from many different backgrounds, as well as compiling and synthesizing relevant research evidence.  

The highest level of evidence was used to formulate recommendations that childbearing women should receive personalised care and be central to all decisions about them. 

One of the key strengths of the report is that it acknowledges the importance of organisations caring for their staff and enabling positive workplace cultures where innovation is encouraged and celebrated: “We also know that when staff work in well led, positive environments and are supported to take pride in their work and to deliver high quality care, outcomes for women and their babies improve.” (p43). 

The report stresses the importance and benefits of continuity of midwifery care, while highlighting the need for careful, supportive leadership of midwives practising this way. 

Better births signposts to key publications like the Green Templeton report and research evidence from Cochrane that provide information on the benefits of continuity models, including how they help to reduce health inequalities and variations in care and outcomes. 

The report also advocates for choice in place of birth: at home, in a midwifery unit or at hospital. Together with esteemed colleagues, I am working closely with the Royal College of Midwives (RCM) to try to promote and support the success of midwifery units nationally. Please take a look and get involved

The publication has been welcomed by health professional organisations such as the RCM and childbirth activists alike. Milli Hill, journalist and founder of The Positive Birth Movement, with over 400 groups worldwide, said of the report:  “It puts power firmly back in the hands of women, and holds up the birth experience to be a vital and important part of women's lives, not just a means to an end.” You can read more on the Positive Birth Movement website

Health service commentator Roy Lilley wrote: “If Waitrose wrote reports, they would probably be like this; it is an elegant production, beautifully reasoned, full of supporting facts and an easy read.”

However, critics have focused mainly on the recommendation for women to hold a personalised budget to help them have greater control of the choices they make. How this will work in practice has yet to be detailed, yet some are speculating negatively. 

It’s worth remembering that the main message in the report is one of safety, promoting openness, reviewing data, and learning and improvement. Better births recommends investment in postnatal and perinatal mental health services, multi-professional working and training, organising care around community hubs and promoting collaboration across professional and organisational boundaries. How can that not be good?

So what’s happening now?

NHS England will move into an implementation stage, which will achieve the 2020 vision for maternity services. There will be various opportunities to get involved in shaping the future of maternity services across England via the Maternity Transformation Programme (MTP). 

Communication and engagement activities will take place regularly – watch out for news bulletins, workshops and regional roadshows, as well as regular updates on Twitter, using the new maternity transformation hashtag #MatImp. Details of the newly established Maternity Transformation Programme Board is available on the NHS England website, as well as information about the Maternity Stakeholder Council, designed to review, scruitnise and challenge decisions made by the board. 

If you’re not directly involved in maternity services but lead other NHS services, take note of Lilley’s words: "This is a must-read report. If maternity is not your thing, read it anyway to see how to write a report.  If it is your thing, don't make do with someone else's slide-deck. Read it for yourself. It is important. You will be rewarded."

For leaders and commissioners of maternity services, Better births is a gift. If we embrace each recommendation carefully, with courage and commitment, and collaborate with organisations such as the RCM and Royal College of Obstetricians and Gynaecologists to help break down some of the barriers we may face, then we will maximise opportunity for improvement. And that means, better births, better foundations, and brighter futures. 

Sheena Byrom OBE is an independent midwifery adviser. Follow her on Twitter @SagefemmeSB 

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