“One of the great strengths of this country is that we have an NHS that – at its best – is of the people, by the people and for the people…we need to engage with communities and citizens in new ways, involving them directly in decisions about the future of health and care services.” (NHS Five Year Forward View) (1)
Shrewsbury and Telford Hospital NHS Trust (SaTH) are repeatedly closing the Ludlow Birth Centre, as well as the Bridgnorth and Oswestry Birth Centres. The closures – for between 12 hours and several weeks – happen without notice, and seem to be stepping stones towards permanent closure. This is a rural area, with long distances to travel from scattered homes to hospital, meaning that the Shropshire MLUs are essential services for the entire maternity journey, providing antenatal, birth and postnatal support to women and their babies without them having to make long, expensive and stressful journeys.
Maternity services are the most commonly used health (as opposed to illness) services provided by the NHS, and they need to be treated like all heavily used services – easy access in the place where people are living. We are not asked to travel to hospital to see the GP or a dentist, and rightly so, as to do so would lead to stress, costs and hospital acquired infections. Yet pregnant women, whose immunity is already lowered by the natural effects of pregnancy, are being asked to travel for miles for regular midwifery appointments and expose themselves and their babies to dangerous bugs. Public transport is very poor, and in some places non-existent. With no local point of contact for midwives, the other option is for midwives to spend hours driving to women to do home visits. New proposals from Shropshire CCG will resolve this issue by simply cancelling postnatal support at home! Meanwhile, SaTH is already reducing access to antenatal and postnatal care during periods of MLU closure.
For some women, the direct effect of this situation is that they are unable to access care, and this disproportionately affects low income women – a huge irony given that the NHS was created in huge part to ensure that everyone, no matter their financial position, can receive medical attention. “Free at the point of care” is of no use to those who cannot reach the point of care. Some women limit the number of antenatal appointments that they go to, as getting to them is just too hard. Others are unable to travel to hospital during labour, or the midwife is unable to travel to them – so women end up birthing at home without a midwife present. There have been five BBAs in Ludlow alone since May last year. Postnatally, parents who do not have the resources to reach hospital out of hours and who are worried about what may (or may not be) a mild issue with themselves or their baby are waiting until the buses are running again, with the risk that what seems to be minor was actually very serious.
Closing the regional Midwife Led Units means that women and their babies are being put at risk. Women NEED the regional MLUs to be able to access the care that they need. MLUs are safer for women and babies who are at low risk of complications (2) and MLUs are suitable for all women to access routine midwifery care before and after birth.
SaTH claim that they have consulted on some (but not all) of the closures, and claim too that women prefer to birth in hospital, but this is simply untrue. Their strategy has been to regularly close the MLUs, leaving women no choice but to “choose” hospital birth. In fact, engagement carried out by Shropshire CCG found:
“During the engagement work of the CCG, rural women have been adamant that their MLUs are needed and must remain.
Women say they need to reach their intended place of birth quickly and easily. This is to be ended.
Women say they value being cared for by the same midwife, or one of a team of midwives, through antenatal care, birth and postnatal care. This will go, as rural women are to be required to give birth in an unfamiliar setting with staff they do not know.
Women have repeatedly praised the postnatal care available in rural MLUs, and this has been recognised by the CCG as ‘exceptional’. This, too, is to end.” (Shropshire Women Speak Out) (3)
Women and their babies are being put at significant risk of harm, and we call upon the CCG and Trust to implement the directives of Better Births, as well as fulfilling their obligations to providing safe care, by re-opening and supporting the Midwifery Led Units across Shropshire.
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