Action Now

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:

  • Support the One Mother, One Midwife Campaign by signing their petition or joining their campaign group.
  • Write to the Minister of Health in support of the NHS Community Midwifery Model (see suggested letters, which can also be used as a basis for writing to other officials).
  • Give the One Mother, One Midwife leaflets or postcards to as many people as you can, especially, pregnant women, young parents, new grandparents etc.
  • Start a group.
    • If you are a midwife, gather other like-minded midwives and discuss a local strategy, then make links with local women who would be interested in supporting you.
    • If you are a lay person, gather other lay people to discuss a local strategy. Find out which midwives are supportive and get their support.
  • Contact your local Maternity Services Liaison Committee (MSLC) and ask for their support for the OMOM campaign or the Community Model, or both
  • Local NHS services are controlled by the Primary Care Trust and the hospital Trusts - ask them how they are going to provide an NHS Community Midwifery Model (see attached information).
  • Write to the Chief Executive of your local Trust and your local head of midwifery and ask them how they plan to introduce the NHS Community Midwifery Model
  • Contact your local Royal College of Midwives representative and ask her what she is doing about supporting the Model (you can email: info@rcm.org.uk Tel: +44 (0)20 7312 3535 Fax: +44 (0)20 7312 3535 or write to RCM, 15 Mansfield Street, London, W1G 9NH to find out the contact details of their local RCM union representative.
  • In Wales, ask the local Community Health Council to support the Model (there are no Community Health Councils in any other country).
  • Write to your MP and ask for their support. (They more likely to respond if they have a large number of letters asking the same thing). If you do not know who they are or their contact details these can be found using your full postcode at www.writetothem.com
  • Contact your local press and find a journalist who would be interested in raising the issue.
  • Leave copies of the One Mother, One Midwife leaflets or postcards in your local clinics, GP surgeries, toddler and playgroups, drop in centres, local libraries etc.
  • Contact your local Women's Institute, National Housewives Register and any other local women's group and ask them to support the campaign.
  • Join AIMS and help with our work to improve maternity care.
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:

  • 2.1 This standard recognises that, for the majority of women, pregnancy and childbirth are normal life events; it aims to promote women's experience of having choice and control in giving birth to their baby. The standard seeks to improve equity of access to maternity services, which will increase the survival rates and life chances of children from disadvantaged backgrounds. It also aims to ensure that all mothers and babies receive high quality clinical services.
  • 2.4 For the majority of women, pregnancy and childbirth are normal life events requiring minimal medical intervention. These women may choose to have midwifery-led care, including a home birth.
  • 8.1 Every woman is able to choose the most appropriate place and professional to attend her during childbirth based on her wishes and cultural preferences and any medical and obstetric needs she or her baby may have.

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:

  • Over 20% of births are induced and 23% of births are by caesarean section - more than half of these are emergency caesareans
  • Around 12% of births are instrumental deliveries
  • During labour and birth around 1/3 of women have an epidural, general or spinal anaesthetic 12% of women have an episiotomy.
  • Many women are suffering from Post Traumatic Stress Disorder following births.
  • Women are reporting feeling frightened and alone in labour
  • Only 1 in 6 first time mothers, and 1 in 3 of those expecting subsequent babies, will have a normal birth - if they birth in hospital

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:

  • Improve the birth experience for parents
  • Increase the numbers of normal birth, improving the health of many mothers and babies
  • Reduce the number of unnecessary and unwanted caesarean sections
  • Increase the number of babies being breastfed
  • Reduce the costs of maternity services
  • Reduce the incidence of post natal depression and birth trauma
  • Increase recruitment and retention of midwives
  • Increase job satisfaction for midwives, two thirds of midwives would return to the profession if the conditions were right

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

  • Local midwives
  • Local women
  • Local parents and grandparents
  • Women's groups e.g.: Women's Institute, National Housewives Register
  • Local Press

What can I do?

  • Campaigns have a greater chance of succeeding when people get together to press for change. Find out whether there are other women, and midwives, in your area who would be willing to add their voices to change the system.
  • Write to your MP, Chief Executive of your local Trust, Chair of the Maternity Services Liaison Committee pointing out how the local services are not responding to women's needs and ask them what steps they are taking to implement the proposed NHS Community Midwifery Model.
  • If you are a midwife and would like to work within this model write to your MP, the Chief Executive of your Trust, Chair of the Maternity Services Liaison Committee pointing out that you would prefer a more midwife and mother friendly environment and ask what steps are they taking to implement the proposed NHS Community Midwifery Model. Contact local women and form a support group.
  • Form a group of local people who support the Campaign.
  • Find out if you have a local Maternity Services Liaison Committee (you can get the details of this group from the Chief Executive's Secretary at your local Trust). If so, this group will have lay members, contact them and ask them to support the campaign and ask them what they can do to encourage the NHS Community Midwifery Model.
  • Sign the Petition on the campaign website www.onemotheronemidwife.org.uk
  • Join the campaign egroup
  • Contact your local press and see if they have a journalist who is specifically interested in health issues, see if they would be willing to write an article about local maternity services. Suggest that other local women who are not happy with the quality of care could join your group and press for change.
  • Print copies of the OMOM leaflets or obtain copies of the OMOM postcards from lauraabbott2001@yahoo.com and hand them out, particularly to local women. You could also add your name, phone number, email and/or address to the leaflets for local people to contact you.
  • Leave copies of the leaflet or postcards in your local clinics, GP surgeries, toddler and playgroups, drop in centres, local libraries etc.
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:

  • Your local Member of Parliament (you will find who your local member listed on the web site http://www.parliament.uk/mps-lords-and-offices/mps/)
  • Your local Maternity Services Liaison Committee (which has been established to identify how local maternity services perform and recommend improvements). Its address can be found by contacting the secretary of the Chief Executive of your local maternity unit.
  • The Chief Executive of your local Primary Care Trust (Maternity Unit).
  • Head of Midwifery at your local maternity unit.
  • Maggie Elliott, President, Royal College of Midwives
  • Cathy Warwick, Chair, Midwifery Committee, Nursing and Midwifery Council
  • Association for Improvements in the Maternity Services, 5 Ann's Court, Grove Road, Surbiton, Surrey, KT6 4BE. email: chair@aims.org.uk

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

Contact details for those to be Influenced and Challenged

England

  • The Politicians

    • Tony Blair, Prime Minister, 10 Downing Street, Whitehall, London
    • Rt Hon Patricia Hewitt MP, Secretary of State for Health, Department of Health, Richmond House, 79 Whitehall, London, SW1A 2NS
    • Liam Byrne MP, Parliamentary Under Secretary of State for Care Services Richmond House, Whitehall, London SW1 2NS
    • David Hinchliffe MP, Chair, The Health Committee, House of Commons, London, SW1A OAA
    • Laura Moffatt MP, Chair, All-Party Parliamentary Group on Maternity, House of Commons, London, SW1A 0AA
    • Opposition Spokesmen
    • Tim Yeo MP, Shadow Sec of State for Public Services Health and Education, House of Commons, London, SW1A OAA
    • Julia Goldsworth MP, Shadow Minister of Health
    • Professor Steve Webb MP, Shadow Secretary of State for Health
    • Charles Kennedy MP, Liberal Democrats, House of Commons, London, SW1A OAA
    • Your own MP. If you do not know who they are or their contact details these can be found using your full postcode at www.writetothem.com
  • Strategic Health Authorities

    There are 28 Strategic Health Authorities in England. Strategic Health Authorities claim that they respond to local and national requirements both 'upwards' to the Department of Health and 'downwards' to NHS Trusts and Primary Care Trusts. These bodies are responsible for commissioning care from local Trusts.

    Their details can be found at http://www.nhs.uk/servicedirectories/Pages/StrategicHealthAuthorityListing.aspx

  • NHS Trusts

    There are over 300 Trusts in the UK.

    Their details can be found at http://www.nhs.uk/ServiceDirectories/Pages/AcuteTrustListing.aspx

  • NHS Primary Care Trusts

    There are 301 Primary Care Trusts. According to the Government, PCTs are now at the centre of the NHS and will get 75% of the NHS budget. As they are local organisations, they claim to be in the best position to understand the needs of their community, and are supposed to make sure that the organisations providing health and social care services are working effectively.

    They should, therefore, be asked what action they are going to take to provide a community midwifery service.

    Their details can be found at http://www.nhs.uk/ServiceDirectories/Pages/PrimaryCareTrustListing.aspx

  • Maternity Services Liaison Committees

    MSLCs should exist in every Trust in England, Scotland, Northern Ireland and Wales. Each one should consist of a group of professionals and lay people who meet regularly to discuss how local maternity services could be improved. It is a vehicle for change and improvement, making suggestions about areas for review and monitoring. Find out who the lay people are on these committees and encourage them to support change. You can find out the details of your local MSLC by contacting the local Trust's Chief Executive's secretary.

Scotland

  • The Politicians

    • Andy Kerr MSP, Minister for Health & Community Care, St Andrews House Regent Road Edinburgh EH1 3DG.
      E-mail: scottish.ministers@scotland.gov.uk
    • Carolyn Leckie MSP, Scottish Socialists Health Spokeswoman, the Scottish Parliament, Edinburgh, EH99 1SP
    • Nanette Milne MSP, Tory Party Health Spokeswoman, the Scottish Parliament, Edinburgh, EH99 1SP
    • Nicol Stephen MSP, Deputy First Minister, the Scottish Parliament, Edinburgh, EH99 1SP
    • Your own MP. If you do not know who they are or their contact details these can be found using your full postcode at www.writetothem.com
  • Scottish Executive Health Department

    St Andrew's House
    Regent Road
    Edinburgh
    EH1 3DG

  • Health Boards

    There are 14 Health Boards in Scotland. The Boards have similar responsibilities to the Strategic Health Authorities in England, details of these can be found at: www.scottishhealthcouncil.org

  • Community Health Partnerships

    Since the 1st April 2004 Local Health Care Co-operatives (LHCCs), Acute Hospital Trusts and Primary Care Trusts ceased to exist and were replaced by Community Health Partnerships.

    These new organisations are being developed across Scotland to manage community health services and, with the involvement of local authorities. CHPs have been established to build on the work of the previous Local Health Care Co-operatives (LHCCs), which were responsible for managing community health services, but CHPs will be larger organisations with wider responsibilities and greater influence.

  • Maternity Services Liaison Committees

    Not all areas of Scotland have MSLCs details of individual MSLCs can be found on google.

Wales

  • The Politicians

    The Welsh Assembly Government is responsible for policy direction and for allocating funds to the NHS in Wales.

  • Strategic Health Authorities

    There are no Strategic Health Authorities in Wales

  • NHS Trusts

    There are fourteen Local NHS Trusts, you can find out the address of your local Trust at www.wales.nhs.uk/catorgs.cfm#3

  • Local Health Boards

    There are 22 Local Health Boards, which assess the health services their populations need and then pay hospital trusts, family doctors, dentists and so on to provide those services. Different areas of Wales have different health needs and priorities. For example, heart disease is a greater problem in some areas than others. It is therefore important that health services are planned locally by people who really know the area and what local people need and want.

    Each Local Health Board has a decision-making board which is made up of local doctors, a nurse, other health professionals, members of the local council and voluntary organisations, and others to represent the voice of patients. They also have a small executive team to put the decisions into action and provide services for the public.

    The addresses and phone numbers of the Local Health Boards can be found at http://www.wales.nhs.uk/catorgs.cfm#5

  • Community Health Councils

    There are twenty Community Health Councils (CHCs) in Wales. They are government funded local bodies with statutory powers to assist people who have difficulties with the NHS.

    Details of your local CHC can be found via the Board of Welsh Community Health Councils site at www.patienthelp.wales.nhs.uk or the NHS site http://www.wales.nhs.uk/catorgs.cfm#3

  • Maternity Services Liaison Committees

    Wales has a new system of three regional MSLCs,. South East Wales, mid Wales and west Wales, they have yet to set up an MSLC in north Wales. MSLCs are attached to their local health boards.

    Contact for further information: Gill Boden, Chair, South East Wales MSLC, 75 Conway Rd, Cardiff CF11 9NW

Northern Ireland

  • The Politicians

    • Sean Woodward, Under Secretary to the Secretary of State, Department of Health, Castle Building, Stormont, Belfast, BT4 3SQ
    • Your own MP. If you do not know who they are or their contact details these can be found using your full postcode at www.writetothem.com
  • Health Boards

    There are currently 4 Area Boards in Northern Ireland. They are responsible for assessing the needs of their respective populations and commissioning services to meet those needs. They are charged with the establishment of key objectives to meet the health and social needs of their population and the development of policies and priorities to meet those objectives.

    Details can be found at www.healthandcareni.co.uk

  • NHS Hospitals

    There are nineteen hospitals

    Details can be found at www.healthandcareni.co.uk

  • Health and Social Services Councils

    Independent consumer organisations, these councils have a duty to represent the public's views and interests, to review the work of health and social services and to recommend any improvements needed.

    Details can be found at www.healthandcareni.co.uk

Local Contacts

  • Local Press

    Find out who writes on health issues and approach them and ask them to do an article about the changes that are needed to local services to provide the kind of care women want.

  • Local Women's Groups

    The most common are the Women's Institute and the National Women's Register, if you are a member of any group raise the issues there and ask for their support. If you are not a member find out who is and ask them to raise the issues or invite you to speak to their group and explain the issues.

  • Supervisors of Midwives

    All midwives have a local Supervisor of Midwives. She is responsible for providing a framework of support for local midwives and developing standards of practice.

  • LSA Midwifery Officers

    Promote and facilitate equitable and effective supervision of midwives across England to support competent midwives and a safe service which encourages women- centred care' (LSA for England, 2005) are also found in Northern Ireland, Scotland and Wales. Details of which LSA Officer covers your area can be found on the Nursing and Midwifery Council web site: www.nmc-uk.org

  • Chief Executive of the Trust

    Sometimes when women find that little action is being taken, the administrators in the Trust are completely unaware of the problem. It often helps to write a letter to the Chief Executive telling them of your experience and asking them what they are going to do about it.

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

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