Twenty five years ago a groundbreaking publication ‘Changing Childbirth’, written on behalf of the Department of Health, clearly laid out for the first time what women wanted and needed when having babies. This was for their own safety and wellbeing and the safety and wellbeing of their children. It boiled down to choice, continuity and control and NCT began campaigning for these changes.
The Royal College of Midwives marked the 20th anniversary of the publication in 2013 with a report entitled ‘Changing Childbirth: Unfinished business’. Clearly midwives then knew that, in spite of their considerable efforts, women were still not being offered the choices they wanted, were not being cared for with continuity and were not feeling they were in control.
Now 25 years later Jeremy Hunt has set out plans for expectant mothers to be cared for by the same midwives throughout their maternity journey. Certainly the announcement is a big stride in the right direction. More importantly, it is part of a planned expansion of the midwifery workforce and improved pay for midwives and others in the NHS and also part of a major programme of ‘maternity transformation’ within NHS England. Certainly it is something to be celebrated. But why has it taken so long when the evidence has always shown that women both want and need more continuity in order to achieve the best clinical outcomes?
The recommendations in ‘Changing Childbirth’ are backed by other more recent studies. A systematic review of evidence showed that midwife-led continuity is strongly associated with fewer deaths of newborn or unborn babies and far fewer preterm births. One might think that this alone would be enough to change practice more or less overnight, but there is more.
Women in NCT’s ‘Support Overdue’ reported that, when they knew the midwife who cared for them in labour, they felt ‘more relaxed, more confident and safer’. Not having to explain themselves repeatedly is a benefit of the continuity relationship also welcomed by expectant mothers in this report, including women with a history of miscarriage or stillbirth, past or present poor mental health, previous or current abuse, or struggles with addiction. In all these cases, having a midwife they know and trust can turn the worries of pregnancy and fear of being judged, into the pleasure and comfort of a conversation with a knowledgeable and supportive friend; therefore improving the chances of a healthier pregnancy and a good outcome of the birth.
It’s frustrating that it’s taken 25 years of campaigning by NCT and other organisations, but Jeremy Hunt has finally done the right thing with his move to support continuity of midwifery care.
It is now absolutely crucial to make sure the plan gets put into action. The Maternity Transformation Stakeholder Council has the remit to scrutinise and challenge the NHS transformation programme and as a member of this Council I will be scrutinising the progress made as closely as I can. For the sake of the huge associated benefits for mothers and babies of the future, it’s the very least we can do.