Jo Dagustun calls to campaigners to make Better Births a reality
In 2016, the National Maternity Review team, in their Better Births report, recommended a transformational change in the way in which maternity services in England are designed and delivered, with a vision:
‘for maternity services across England […] to become safer, more personalised, kinder, professional and more family friendly; where every woman has access to information to enable her to make decisions about her care; and where she and her baby can access support that is centred around their individual needs and circumstances. And for all staff to be supported to deliver care which is women centred, working in high performing teams, in organisations which are well led and in cultures which promote innovation, continuous learning, and break down organisational and professional boundaries.' (NHS England, 2016, p8).
No-one seriously underestimates the challenges that will be involved in bringing about such transformation. But women and families in every area of England deserve no less. In that context, it is highly worrying that some commissioning areas are seemingly reluctant to sign up in full to the Better Births vision and recommendations. Instead, ongoing discussions suggest that the feasibility, affordability and even the desirability of the Better Births vision and its clear recommendations are up for debate. In this context, I would like to pose the following question: is there any reason why every local area should not adopt the Better Births vision and all its recommendations IN FULL as a minimum to drive local implementation work?
We know that the HOW will be affected by the local context, and in some very specific situations it is possible that agreement might be reached that some limited modifications might be acceptable. But I would like to suggest that it would be a big mistake for us to confuse the need for specific local action plans with moves to undermine local commitment to the Better Births recommendations more generally. If we don’t commission for women to receive meaningful continuity or carer (based on a relational model of care over the antenatal, intrapartum and post-natal period), for example, what chance do we have of providers stepping up with plans to deliver this?
We need to stand firm. We have always known that the agenda for change set out in Better Births would be highly challenging for existing service providers. It is meant to be. It represents an ambitious demand for a shift in the power relations of maternity services, one which has been fully evidenced both by the best available scientific research as well by a careful exercise in which the voices of a huge number of women and families around the country were heard. But we also need to be clear about one more thing: it does not represent an agenda that is infeasible nor unaffordable, and it is important for us to avoid being dragged (or even seduced) into debates which seek to suggest any different. It is important that the vision and recommendations of Better Births is properly reflected in local visions and strategies. Without this, the likelihood of Better Birth- compatible services being commissioned is extremely low.
I would urge AIMS activists across England to play a key role in ensuring that the Better Births vision, and its recommendations, are accepted in full. In full is important, because the Better Births recommendations are designed to work together as a package: each is necessary for the successful delivery of the others.
Now is the time - as each of the 44 sustainability and transformation partnerships (STPs) across England develop their 5-year maternity strategies and action plans - for the united voices of birth activists in every area of the country to be heard loud and clear. Local AIMS activists – in partnership with other service user representatives, doulas, antenatal educators, midwives, and indeed everyone else with a keen interest in improving maternity services – must decide now whether or not they are willing to become the 'guardians' of the Better Birth vision and recommendations. For without our ongoing support, the promise of Better Births is bound to fail.
Implementing Better Births: key actions for AIMS activists now
NHS England (2016) National Maternity Review: Better Births – Improving outcomes of maternity services in England – A Five Year Forward View for maternity care Available at: https://www.england.nhs.uk/wp-content/ uploads/2016/02/national-maternity-reviewreport.pdf
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