“Maternity Turf Wars” and the promotion of home birth by vouchers

The aim should be a healthy mother and a healthy baby!

Almost everyday of my professional life, I see the very challenging consequences of mistakes made during childbirth and the consequences for the child, the mother, their family and for the health professionals involved.

And so two stories that have broken in the news in the past 24 hours are of particular concern.

The first is that pregnant women are apparently to be handed personal budgets of £3,000 by the NHS to buy the services of private midwives under plans to cut the number of hospital births (a link to the story in the @guardian is here: http://www.theguardian.com/society/2016/feb/23/national-maternity-review-calls-for-personal-care-budgets).

The second story is that half of hospital maternity units are not safe and mistrust between doctors and midwives is harming women and babies. This is according to a nationwide review ordered after 11 babies and a mother died at Morecambe Bay NHS Trust (a link to the Morecambe Bay Investigation reports is here: https://www.gov.uk/government/organisations/morecambe-bay-investigation).

At Morecambe Bay, turf wars between doctors and midwives were said to be promoting an agenda of normal birth “at all costs” and this led to failings being covered up. Dysfunctional relationships among staff are said to be damaging care elsewhere as well.

It is also suggested that pay-outs of compensation will be made on a “no fault” basis to parents in relation to stillbirths.

Shouldn’t there should be some joined up thinking here?

1. The fundamental aim for NHS maternity services must be that there should be a healthy mother and a healthy baby. Other issues should fade into insignificance, including where and how the baby is born.
2. There should be a strong focus on breaking down the turf wars said to exist between midwives and obstetricians. Women are entitled to full information about the relative benefits and risks of hospital and home birth. This advice should not be “contaminated” by mistrust and negative feelings between the two professions as I fear it often is now.  After all, both have the same aim – healthy mothers and healthy babies.
3. I cannot see how providing midwives with a financial incentive to encourage home birth will help ensure mothers are provided with full and objective advice on the risks involved. Of course this must include explaining the likely consequences of delay in getting medical help if there is a need to transfer to hospital with a serious complication for mother or baby. Unlikely but it happens!
4. Payment of compensation for stillbirth on a “no fault” basis is, no doubt, well-intentioned but completely misses the point in my view.

I have yet to meet a bereaved parent whose aim in court proceedings is to obtain damages. Their intentions are to firstly find out exactly why their baby died and secondly that lessons should be learnt as a result.

A civil claim is a means to fully investigate what happened.

Damages are not the point.  Once again, the Government appears to be failing expectant mothers and their babies.