Over many months I have been thinking a great deal about the importance of one to one midwifery care or personalised care as the Government calls it. Why am I so passionate and committed to seeing one to one midwifery happening in Bradford?
I am passionate about one to one midwifery care because I know what an enormous difference it can make to the experience women have during the childbearing weeks and months. I really don’t think it is good enough for health services to say to a woman: ‘There you are! You and your baby are alive and reasonably well’. And send them off to an unsupported home environment traumatised, exhausted, barely breastfeeding and with the minimum NICE visits to look forward to. Similarly, it is unfair to expect that many women in the deprived areas of our city and district will be able to turn up to hospital to birth a baby, maintaining the best health and wellbeing of themselves and their baby and their wider family, on the minimum and fragmented care offered by the medical led NICE guidelines.
The evidence shows us that women supported by one to one care of a midwife, are more likely to have a normal birth, experience less pain in childbirth, are more likely to breastfeeding and continue to breastfeed and are less likely to have post natal depression. Breastfeeding babies are 5 times less likely to be hospitalised for gastroenteritis, are less likely to be obese, less likley to suffer eczema, less likely to have heart disease or diabetes. Not breastfeeding a baby starts cost the NHS money from 8 weeks old, and new evidence shows that cutting the investment in maternity increases drop off rates for breastfeeding. Moreover, we now know that personalised maternity care significantly reduces the risk of premature labour, miscarriage before 24 weeks and still birth. Having a midwife you know and trust can save your baby’s life.
I would not class myself as a vulnerable woman but I lived for 9 years in the deprived community of Girlington and 10 years on the Allerton council estate, my husband worked away and was on a minuscule salary as an archaeology PhD student(!) and so for most of this period I was having to manage a home, up to three small children, and a baby – all on a very low income. Unsurprisingly I suffered from post natal depression and so I know the difference one to one care made for me.
With my first child, 19 years ago I was not referred to midwifery care by my GP and only found a midwife late in pregnancy. Case loading was in operation then in the local teams and so not only did I have continuity of care from my midwife, it was likely she or a midwife I knew and knew me would be attending my birth at home. My birth was a long and difficult one and although I had a dream baby I was traumatised by the birth, regularly having flashbacks. I remember with gratitude the care I received from this midwifery team – but most of all the couple of hours I was able to spend with my midwife 4 weeks after the birth going through what happened and why – debriefing we would call it today. I had a lot of emotional work to do after that – not least because I was still struggling with loss of a previous child, but it helped move me forward: I did not get stuck at the birth.
Contrast this with another difficult birth – my fourth child. I had a midwife who did not really support my choice of homebirth ( when I saw her which was not often), I had one in sixty midwives on call so had to accept a complete stranger into my home and birth, there was a fiasco because I was having a water birth and she did not know how to deal with this. I was transferred in for bleeding with another set of midwives. I returned home that evening unbelievably exhausted. Within a week my husband was back at work ( no paternity leave in those days) I had 2-3 perfunctory visits from 2 different midwives ( I remember just 2 visits but cannot believe this is all I had but it could have been) I was discharged at 10 days. I had no opportunity to debrief or talk through what had happened with the midwife who attended the birth which I desperately wanted/needed to do. My husband started working away again at 4 weeks. At 8 weeks both he and I were utterly exhausted and depressed.
Because of that experience, with our fifth child we took the advice of the supervisor of midwives to whom I had complained during the pregnancy of my fourth child, when I realised the level of the fragmented care that I was supposed to accept for my fourth child: we booked an independent midwife. Better late than never! My husband was training to be a teacher at the time, the cost represented 20% of our then income and it took us 2 years to pay it off but it was worth every penny. We were given timely information, the birth went smoothly because there was no interference. The difference in postnatal care was enormous: Our independent midwife kept us in check, visiting us daily until I begged her not to because I did not need it. We were not discharged for over 2 months because they wanted to ensure we did not suffer postnatal depression – she had the knack of ringing me on the day I had done too much so she could gently remind me of my priorities and I would go to my bed and leave my job. Michelle always said self employed women were the worst for taking too little time off around the baby!
I tell my story because I want to demonstrate in my own life – as much as others – why personalised care is so important and why I am so passionate and committed to seeing it happen on the NHS before my daughters have children. Not every woman needs the kind of care I needed. Different women have different social and emotional needs. BUT women and babies NEED the investment of one to one midwifery care in order to remain healthy, to care and guide them when they are not, and to help us pick up the pieces and to carry on if it all goes horribly wrong.
Up until now whenever I have raised the possibility of case loading in Bradford I have been told it is impossible, too expensive, too difficult for midwives, women will just have to live with the (unacceptable) levels of care I faced for my fourth child. But now we have a practising NHS midwifery team with a solid business plan who can do it and are doing it to Tariff; and making a difference to the lives of ordinary women living at the rougher end of the Wirral. I want this to happen for women in Bradford, especially for the women living in Girlington, Manningham, Little Horton, Barkerend where rates of infant mortality are high and many women struggle as I did to make ends meet.. It makes such a difference, SUCH A DIFFERENCE.
I know that midwives cannot wave a magic wand and give us the money to fix the car and pay the bills, they could not give my husband paternity leave or bring him home from working away. But what they did was bridge the gaps – of the understanding and skills I needed, give me some social and moral support so I could keep going, get me to a place where my social network could take over.
If we invest in this one mother one midwife project, if the CCGs take the needs of women seriously enough to ensure it happens, we will be investing in the health and wellbeing of not just women and babies but their families and their communities. It makes that much of a difference. 19 years ago I was a young traumatised mum living in Girlington and my midwife was Julie Walker. Julie Walker is head of midwifery. I have just stepped down after four years as chair the MSLC and I own an international birthpool business. It really does make that much of a difference.
Find out what YOU can do to make a difference: http://m4m.org.uk/takeAction.php