Where is the support?

AIMS Journal 2007, Vol 19, No 3

AIMS Journal Editor Vicki Williams wonders how much support women are actually getting and whether it is meeting their needs or those of the professionals involved

What is happening to support for women to birth instinctively and to nurture their babies to the best of their ability? On 18 October 2007 Mother and Baby Magazine and Tesco published a survey of 2000 new mothers, suggesting that many women struggle to adapt to motherhood, two thirds said they lived away from family and felt cut off from friends, family and colleagues.

More than half of the mums who responded felt 'lonely and isolated where they live'. Loss of their pre-baby social life was an issue for a staggering 87% of those surveyed. A quarter said that their relationships with their partner had deteriorated and many were irritated that their partners managed to retain their social lives. The article concludes that 'babies are extremely demanding and life for new mums can be very lonely in our modern anti-social society'.

Yet, as we see on page nine, the number of consultants in maternity units are increasing, the NHS spends a shock-worthy £4.49 billion on negligence cases, the majority of which involve obstetric care. Almost 25% of babies are now born by caesarean, yet improvements in birth outcomes just aren't keeping pace and suicide is still one of the biggest causes of maternal death...

Since 8 times as many avoidable mistakes are made by obstetricians as community midwives, isn't it time to see more midwives in the community, supporting women instead of more consultants and more litigation? With consultant care only one-in-six first-time mums and only one-in-three women expecting subsequent babies will have anything like a normal birth and that is a conservative estimate. On page 14 Michelle Barnes reviews Recorded Delivery, where the true normal birth rate looks more like one-in-ten pregnancies. Myths and mis-information still abound, as we can see in Beverley Beech's review of The Irish Pregnancy Book on page 21.

Add this to the threat to Independent Midwives who are already forced to practice without insurance, and the future of support for women looks increasingly bleak.

Even when resources are produced to help health professionals provide support and information they are open to mis-use, often through a lack of understanding as is so clearly illustrated in the review of the WHO baby growth charts by Magda Sachs (page 6).

We are currently in a huge societal debate on a law on smacking. Opinions are wide ranging, and few are research validated as it would be a hugely unethical experiment as a randomised trial. The debate begins with who has a right to use physical force to ensure compliance, through to what actually constitutes 'a smack' and if there is a boundary somewhere at which point smacking becomes hitting.

Parents retain the right to discipline their children using their own reasonable methods, but who is actually defining reasonable, and what help is being provided to those parents who can see no other way of protecting or controlling their children.

Women don't seem to be getting support, to cope with parenting, and it seems that services are being offered without anyone finding out if that is really what is wanted.

Sure Start programmes are achieving success in many areas, but they vary enormously from centre to centre. Some of that variation is because projects are responding to very specific local societal needs, in other areas it is clear that some Sure Starts are offering better support than others. Sadly, those most in need of services remain the hardest to engage, and the evaluation of Sure Starts on page 12 helps us to understand better where increased support might help.

For many of society's most vulnerable groups, offers of support are rarely welcomed and are often seen as intrusive and paternalistic. In the worst cases these services are received with hostility especially where those services appear to be of a monitoring nature and until steps are taken to re-structure social services many parents will avoid contact with the services and lie about any problems, a situation caused to a great extent by our gradual drift into monitoring and surveillance rather than help and support.

However, there is light on the horizon. On Page 16 Gill Boden, AIMS's Wales Network, reviews a very positive launch of the NICE Intra Partum Care Guideline. It is heartening to see that words such as delivery are being acknowledged as unhelpful and unsupportive in such a medicalised setting. Although there is still much work to be done to make maternity care truly women centred, this is certainly a huge step in the right direction.

Also, on page 18 Michelle Barnes shares some of the success of a home birth support group in Sheffield. It is fantastic to hear of women giving birth to twins at home and shows the power of woman to woman support.