MIDWIFERY FOR THE 21ST CENTURY - ACTION NOW

Do Women Want Midwives or Obstetric Nurses?

If you are expecting a baby, or you have had a baby recently, you may have been unable to get the kind of care you want or noticed how few midwives are available. While the government promotes 'choice' and the National Service Framework has developed a 10 year strategy to encourage change, there are many areas where the quality of maternity care has worsened. Far too many fit and healthy women have no choice but to give birth in high technology units. These units may be the best option if you or your baby are likely to have problems, but they are not appropriate for the majority of women. Because they focus on problems and complications, they intervene unnecessarily far too often and as a result have excessively high caesarean section rates, induce or accelerate labours far too soon and offer little support in labour. These units are often short-staffed and as a result the midwives are expected to look after more than one labouring women at the same time thereby denying them the emotional support and encouragement most labouring women need.

To compound this problem we now have a generation of midwives who are not accustomed to supporting women who expect to have a normal birth. As result, far too many women are left alone during labour or, at the earliest moment, are encouraged to have drugs to speed up the labour.

The quality of care would improve if women were enabled to choose the midwife they would like and midwives were enabled to have their own case loads so that they would be able to look after women during pregnancy, birth and for a period post-natally.

What can you do about it?

We have known for over 20 years that the current system of maternity care is far from ideal, but until there is a concerted effort to bring about change nothing will happen.

The proposal for an NHS Community Midwifery Model would offer women real choice and also enable those midwives who trained, or practise, in hospital to regain their lost skills should they choose to do so.

The One Mother One Midwife campaign supports this model and also offers the opportunity to sign the petition for change and gives additional information about their campaign.

Each of us can make a difference, but until we start to act individually, and collectively, and actively do something positive, the system will not change. The following information gives you many options to help change the current unsatisfactory system and you can decide how involved you could become.

Even one act may help. You may do only one thing, or you may be sufficiently fired up to undertake a number of initiatives. The decision is yours. We hope that the following information will give you some ideas of what you could do.

Campaigns are more likely to succeed when people get together to press for change. Find out whether there are other women, and midwives, in your area who want to change the system. The following are some suggestions, they are not in any order of priority:

National Service Framework

The NSF has been developed as a 10 year strategy to encourage change in the maternity services. It makes a number of policy recommendations which can be quoted and used to ask the Trusts and other service providers what they are doing to meet the requirements of the NSF. The following is a selection of some of the recommendations:

The complete NSF document can be viewed on the Dept of Health website.

Message from the authors of The NHS Community Midwifery Model

Proposed by the Independent Midwives Association (IMA) this model is being considered by the Department of Health. Our suggestion is that it sit alongside the current provision and be available to any midwife interested in working in this way and to women who would like to have genuine continuity of care.

The concept is easy, when a woman gets pregnant, she has direct access to a list of midwives local to her, she contacts them, meets one or two and chooses the one she feels most comfortable with. That midwife then enters into a nationally agreed contract with the NHS who pays on a set fee per case basis. This is the start of a relationship between the midwife and the woman which can develop over the months of pregnancy and provide a firm foundation for an equal partnership based on trust. This, as the research shows, makes for good outcomes and positive experiences for everyone involved and it isn't just about home births, the midwife would have full access to NHS facilities so her client could choose the place and type of birth that most suits her needs.

One of the major problems facing the provision of maternity services today is the shortage of midwives. Despite many initiatives to improve recruitment and retention within the midwifery profession, the crisis is deepening. A new approach is needed and we believe our community midwifery model, if made available to those women who want it, no matter where they live or what socio- economic class they come from, would be good for mothers and babies and good for midwives.

You can read about our proposal in more detail on the IMA website www.independentmidwives.org.uk. The results of on-line surveys of midwives and the general public can also be seen on this site.

Please help us to make this a reality. Write to your local MP (or use the writetothem.com website to contact them and/or find their details); copy it to the Minister responsible for maternity services, Liam Byrne, (Parliamentary Under Secretary of State, Department of Health, Richmond House, Whitehall, London SW1A 2NS) and to the Chief Executive of your NHS Trust (details of your local trust can be found on the NHS website telling them you would like this option to be available in your area.

Spread the word to as many people as you can, whoever they are. As a community we should all have a vested interest in a maternity service which genuinely meets the needs of all women who use it, including the next generation.

Thank you.
Annie Francis and Brenda van der Kooy
Independent Midwives Association
www.independentmidwives.org.uk

Message from the One Mother, One Midwife (OMOM) Campaign

We want every UK woman from whatever background and socio-economic status to have the opportunity to choose their lead professional and be provided with a maternity service built upon choice, information and partnership.

Currently:

These extremely high intervention rates, soaring levels of postnatal depression and an ever decreasing percentage of breastfeeding mothers, have huge repercussions for the UK's future health and the NHS.

Under the NHS Community Midwifery Model women will be cared for by the same midwife throughout pregnancy, labour, birth and postnatally, allowing a relationship to be built between the woman and the midwife.

The Benefits of this model:

Will it Work?

This model was introduced throughout New Zealand in the early 1990s and is the basis of all maternity care in N.Z. Over half of all New Zealand women choose a midwife practicing independently as their lead maternity professional for their pregnancy, birth and the postnatal period. A further 21% chose an employed midwife who holds her own caseload.

This model will run alongside existing maternity services, giving women choice about the kind of care they wish to receive and midwives the choice of the way they wish to practice.

Desired Outcome

Government implementation of the 'NHS Community Midwifery Model' and the National Service Framework

Who we need to influence

British Government - Department of Health; Strategic Health Authorities; Primary Care Trusts

Who we need to encourage to join the campaign

What can I do?

Suggested Draft Letters

Selection of suggested letters that could be sent to the minister of health and others

Minister of Health
Liam Byrne MP
Parliamentary Under Secretary of State for Care Services
Richmond House, 79 Whitehall, London, SW1A 2NS

For pregnant women to send

Dear Sir

I am expecting a baby on xxx and I am dissatisfied with the standards of care that are on offer in my area. I am informed that:

* I am unlikely to have the continuous support of a midwife during my labour

* I am unlikely to be offered a home birth because here is a shortage of midwives, and if I decide to have one and there are insufficient midwives on duty when I go into labour I will be advised to go into hospital

* I will be attended by a number of midwives during my pregnancy, none of whom will be enabled to get to know me and they are unlikely to be attending me during my labour.

* Add your own reasons for why you are not satisfied with the present system

This is unacceptable.

I am informed that there is a national shortage of midwives and little is being done seriously to address this problem. Unless midwives are enabled to gain women's confidence, get to know individual women, and provide care within the community this situation will continue and my life and the life of my baby will be unnecessarily put at risk.

I am informed that the NHS Community Midwifery Model will address these issues and provide mothers and midwives with the opportunity to work together to enable a safe and successful birth to occur. What steps are you taking to enable this model (as described by the Independent Midwives Association - www.independentmidwives.org.uk) to be implemented as soon as possible?

Yours sincerely

For women who have recently had babies to send

Dear Sir

My baby was born on xxx and I am dissatisfied with the standards of care that I received in my area.

* I was not provided with continuous support of a midwife during my labour.

* I was not offered a home birth.

* I was not offered the option of a birth centre.

* I was attended by a number of midwives during my pregnancy, none of whom were able to get to know me or attending me during my labour.

* Add your own reasons for why you are not satisfied with the present system.

This is unacceptable.

I am informed that there is a national shortage of midwives and little is being done seriously to address this problem. Unless midwives are enabled to gain women's confidence, get to know individual women, and provide care within the community this situation will continue.

* My care led to xxx problems which I believe may have been avoided if I had had continuous support from a midwife I knew.

* Although there were no problems during my pregnancy and the birth of my baby, I know other women have not been so lucky and I am concerned that the lives of mothers and babies will be unnecessarily put at risk if the current midwifery situation is not addressed.

I am informed that the NHS Community Midwifery Model will address these issues and provide mothers and midwives with the opportunity to work together to enable a safe and successful birth to occur. What steps are you taking to enable this model (as described by the Independent Midwives Association - www.independentmidwives.org.uk) to be implemented as soon as possible?

Yours sincerely

For members of the general public to send

Dear Sir

I am dissatisfied with the standards of care that are on offer to women in my area.

* Women are not being provided with continuous support of a midwife during labour

* Women are not usually being offered a home birth

* Few women have the option of a birth centre

* Women are being attended by a number of midwives during pregnancy, who are unlikely to be the ones attending them during labour.

* Add your own reasons for why you are not satisfied with the present system

This is unacceptable.

I am informed that there is a national shortage of midwives and little is being done seriously to address this problem. Unless midwives are enabled to gain women's confidence, get to know individual women, and provide care within the community this situation will continue and the lives of mothers and babies will be unnecessarily put at risk.

I am informed that the NHS Community Midwifery Model will address these issues and provide mothers and midwives with the opportunity to work together to enable a safe and successful birth to occur. What steps are you taking to enable this model (as described by the Independent Midwives Association - www.independentmidwives.org.uk) to be implemented as soon as possible?

Yours sincerely

For midwives to send

Dear Sir

I am dissatisfied with the standards of care that we are able to offer to women in my area.

* I am not able to provide continuous support to women during labour.

* I am not able offer/provide home births.

* I am not able offer the choice of a birth centre.

* I am not able to work at a birth centre.

* I am not able to provide continuity of care to women during pregnancy, and unlikely to be with those I do meet antenatally during their labours.

* Add your own reasons for why you are not satisfied with the present system.

This is unacceptable.
I am informed that there is a national shortage of midwives and little is being done seriously to address this problem. Unless midwives are enabled to gain women's confidence, get to know individual women, and provide care within the community this situation will continue and will be unable to affectively provide safe care. I believe that this is putting the lives of women and babies at unnecessarily risk.

I am informed that the NHS Community Midwifery Model will address these issues and provide mothers and midwives with the opportunity to work together to enable a safe and successful birth to occur. What steps are you taking to enable this model (as described by the Independent Midwives Association - www.independentmidwives.org.uk) to be implemented as soon as possible?

Yours sincerely

Similar letters could also be sent or copied to:

Contact details for these and others can be found in the section below:

Contact details for those to be Influenced and Challenged

England

Scotland

Wales

Northern Ireland

Local Contacts

If you have any comments or suggestions about the above information do contact AIMS

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