On 29th January 2025 AIMS hosted an engagement workshop to gather feedback on what people would like to see included in the Government’s 10 year Health Plan, with a specific focus on the maternity services. The workshop was attended by a mix of midwives or former midwives, birth workers, birth activists and representatives of charities in the maternity sector. AIMS has also submitted an organisational response to the Government's Change NHS consultation, see details here
Below is the feedback that we submitted.
The workshop was for people with an interest in improving the maternity services, so all the answers below refer specifically to maternity care.
Top choices were personalised, respected and compassionate.
There were also several mentions of dignified, empowering and safe.
Existing pockets of excellence (e.g. homebirth teams, midwifery-led care and caseloading teams) are maintained and expanded, building on best practice.
Midwives continue to be autonomous professionals, not obstetric nurses.
Multidisciplinary teams work together to provide care.
Care is free at the point of access.
Everyone has relationship-based care (Continuity of Carer), with a midwife they know and trust, who has time to listen and discuss options fully. “Stop looking at the clock and start looking at the woman in front of you!”
Maternity services are physiology-led, trauma-informed and research-based. The focus is on holistic care, avoiding normalisation of induction and other medical interventions. There is less reliance on the machine at the expense of listening to the woman. Rates of birth trauma are reduced.
There is genuine respect for human rights and informed consent. Informed decision making is supported with nothing considered “out of guidance.” Women are not persuaded to accept interventions through scaremongering talk of risks or threats of referral to Children’s Services.
Choice of birthplace (home, birth centre or hospital ward) is supported for all.
There is adequate staffing across the maternity services and the wellness of staff is prioritised.
Postnatal care is adequately resourced to support mental and emotional health, and also inclusive of birth partners and other immediate family. This includes regular supportive visits to prevent crisis and wider and less restrictive referrals to support services such as perinatal mental health support. “Make sure women are back to 'well'.”
Prenatal care and trauma-informed antenatal education or group antenatal care are offered to all.
That technology is developed in consultation with the people who will use it - staff and women - to meet their needs.
That systems are flexible enough to be adapted easily according to changing needs and do not create an administrative burden. “Must free up people's time, not take up people's time.”
That we get the basic, low cost, low-tech care right first then look at how technology can enhance this by supporting good care.
The current systems that are time-consuming, inflexible and not joined up are replaced with a national maternity system that allows for information sharing when women attend different Trusts or locations within a Trust. This system also allows women to access their own notes and test results.
Technology supports personalised care e.g. a woman can text or speak directly to her named midwife, and check that her notes accurately reflect her views and choices.
Staff can use smartphones to record notes rather than having to spend time away from the woman to input data.
Technology improves access to care, including arranging appointments, ordering prescriptions, remote access/remote monitoring, including for ‘high risk’ pregnancies.
Option of virtual appointments for the benefit especially of those in rural areas and anyone who would be traumatised by being in a hospital environment.
Staff and service users have access to a central library of research evidence and information.
The technology that is provided actually works reliably, and support staff are available including to train both staff and service-users.
Concerns about data protection and privacy, whether there would be sufficient security, and who would have access to your records.
Cyber attacks - there needs to be a back-up for technology if something goes wrong.
AI should not replace human checks as it may not be reliable. There is a risk of discrimination depending what material is used to train it. Women already suffer discrimination in health research, education and information and there’s a worry that AI would further cement that.
Concern about failure to recognise the limits of technology, for example the inaccuracy of ultrasound scans, which women are often not told about.
Over-reliance on technology with staff being overconfident in it at the expense of physiology and “believing that the machine knows best”, not recognising that technology "can make mistakes".
Fear that technology will become even more overused and take time away from caring for people and from person-centred, compassionate care. “Spending time in front of a monitor instead of building relationships”.
Issue of who makes decisions about investing in and using different technology - avoiding “toys for the boys”.
Not everyone has access to technology and not everyone is technology literate, causing inequity of care. “Women we support struggle with technology - access, using English, etc., understanding the purpose of the technology. They just want to speak to someone!”
Up to date basic technology for all staff, including mobile phones and access to WiFi. This would enable midwives to take digital notes rapidly whilst remaining with the woman (especially in labour), improve communication between staff and women and enable immediate access to research and information.
One efficient digital record system giving all health care providers access to the same notes. This would reduce the administrative workload of midwives and doctors and enable joined-up working between primary and secondary care.
The main concerns, as noted above, are:
Over-use and over reliance on technology such as ultrasound and centralised monitoring in maternity care, at the expense of personalised, woman-centred care, and without recognition of the limits and possible inaccuracy of technical solutions.
Use of AI without adequate human checks, as AI may be unreliable and discriminate against certain groups.
For maternity care it would be more person/family centred, and enable holistic care including for women with complex needs. This would increase satisfaction and help reduce birth trauma.
It would make it easier for people to access the services, without having to go to different places for different parts of their care. It would be a game-changer for rural communities, and would be better for the environment too.
Integrating maternity care with social care and community support groups would empower women, improve their mental health and social support networks, with benefits for the whole family.
Greater knowledge of the local community and collaboration with community groups and charities could help staff to understand and address inequalities.
It would reduce the stress on the hospital system and save money.
More births out of hospital (homebirths and community-based birth centres) would reduce intervention rates and lead to better health outcomes.
Working in this way would increase job satisfaction for community midwives.
Enabling women to have antenatal scans and tests in their local area would save time and money, make it easier for them to access these services, and be better for the environment.
For maternity it would not be appropriate just to offer tests in a shopping centre or similar location without any support should, for example, a scan reveal a baby loss or disability. It would be important for the diagnostic service to be combined with midwifery support if needed. It would therefore be better to have this as part of a community hub along with other maternity care, rather than as a stand-alone centre.
As we were discussing maternity care we decided it was more appropriate to consider “Promoting wellbeing not just managing problems in pregnancy, birth and after”.
Pregnancy is currently treated as a medical problem with lots of testing and monitoring, and the focus is only on physical and not mental health. The constant focus on risks creates anxiety. A holistic approach that includes promoting mental and physical wellbeing throughout the maternity journey rather than only detecting and managing risks would have benefits for the mother, her baby and her family in the short and long term.
Promoting wellbeing requires more focus on public health issues, such as ensuring good housing and nutrition for all mothers. “If the government wants to promote wellbeing for families they need to tackle poverty, nutrition, mental health care, deprivation. People don't have baby in a vacuum.”
Relational care (Continuity of Carer) that treats women as individuals and allows time for discussion and information-sharing could reduce mental health problems and birth trauma as well as improving outcomes.
This approach would also lead to more efficient use of resources, focussing high tech care for those who need it and reducing the iatrogenic effects of unneeded care.
Again, we considered this in the context of 'promoting wellbeing' rather than 'preventing sickness'.
Move away from a solely medical model to a social model of maternity care, with as much care as possible based in the community and Continuity of Carer for all as standard. Healthy women would have low tech care in the community where evidence shows they have good outcomes. High tech care and staffing could be focussed on those who need it. This would improve short-term outcomes and the long-term wellbeing of mothers and staff. It also would improve equity of access.
Treating the mother’s emotional and mental health as equal in importance with the physical health of her and her baby, and resourcing mental health support appropriately. This would reduce the incidence of mental health problems and birth trauma.
Staff trained and supported to provide holistic care that is empathic, trauma-informed and culturally-informed. Staff also need to be looked after and supported in reflective practice, with time and opportunities to share and process experiences. “...need a place to talk things through. We cannot rely on cups of tea and cake. The labour ward is a vortex of cupcakes and bitterness". Staff need to be well looked after themselves in order to look after others.
Community led care is very hard to maintain when it's attached to hospitals, and money saved is redirected to the hospital rather than used for maternity care. There can also be issues of power dynamics and cultures around health. There needs to be a restructuring of maternity services, with accountability and control of funding brought back from Trusts to the community. “Not just making changes, but actually redesigning the system.”
Adequate staffing is essential to underpin all of the above. The shortage of midwives needs to be addressed urgently to enable the implementation of new ways of working, including Continuity of Carer, in a way that enables midwives to maintain their work/life balance. Midwives should be given opportunities to specialise, as doctors are, for example with pathways for working in the community or in hospital.
Regulation of midwives needs to be separated from that of nurses and run by midwives - either in a separate body or a separate section of the NMC (Nursing and Midwifery Council).
We hope that this page is of interest, especially to our colleagues in the maternity services improvement community.
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AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.