Thought you might be interested in the following letter from Beverley Beech (chair of AIMS) to Gordon Brown:

Dear Mr Brown

The Association for Improvements in the Maternity Services was established over 40 years ago in response to the poor state of maternity care at the time. We can confidently state, 40 years later, that many crucial aspects of maternity care are far worse than they have ever been. While we applaud the Government’s attempts to ensure quality maternity care, so that every woman will be attended throughout her labour by a midwife who has attended her through most of her pregnancy, we find that women:

The present shortage of midwives is a national disgrace and a serious public health issue. The World Health Organisation declared that there was no health improvement for either mother or baby when caesarean sections exceed 10%, yet many of our hospitals have caesarean section rates that exceed 22%, and in some hospitals it is over 30%, and in private hospitals it is even higher. Clearly, at least half of these women had caesarean sections that with better care could have been avoided. The harmful effects, on both mothers and babies, of caesarean sections has been well documented.

Over the last ten years we have seen a huge increase in the numbers of women suffering from postnatal depression and post traumatic stress disorder. Recently, another woman, suffering from postnatal depression, killed herself. The current climate of monitoring and surveillance, into which midwives and health visitors have been drawn has resulted in many women no longer willing to seek help when they have postnatal depression because of the very real fear of being reported to Social Services and having their newborn babies taken away. The latest appeal for our help is from a woman whose 10 day old baby is now in care because she had depression as a teenager and the social workers have judged that she ‘might’ harm the child in the future. They presented no evidence whatsoever to substantiate that claim.

The centralisation of maternity services continues a pace, despite the government encouraging community based care. As a result, midwives have become deskilled and many of them rarely see a normal birth, fewer than 10% of women admitted to large centralised maternity units will have a normal birth. To facilitate such a birth, at the very least, the woman requires the continuous presence of a skilled, supportive, midwife. Instead, women are left alone for long periods of time, often strapped to a fetal monitor while the midwives rush between three and four other women in labour.

In the 1970s women could expect to stay in hospital for at least five days, if they had a complicated birth they would be in for ten, and during that time they could be given assistance and advice on caring for their baby and breastfeeding. Today, women are ‘encouraged’ to leave hospital as soon as possible, and considering the lack of postnatal care in the hospitals they are keen to do so. Those women who have had caesarean sections often leave after two or three days. In the past, women would be assured of a visit from a midwife every day for ten days, and longer if the woman or baby had problems. Nowadays, women are left to their own devices and postnatal midwifery support is almost non-existent. In some areas women are expected to go to some central location for postnatal care if they require it. This means that the women who are the most ill, poorest and most in need of help are least likely to receive it.

While there is a shortage of midwives the Trusts are exacerbating that shortage by freezing recruitment, cutting senior midwifery posts, replacing midwives with maternity assistants and not offering jobs to newly trained midwives.

The present structure of centralised midwifery care, under the control of obstetricians, has deskilled midwives and dissatisfaction with the focus on medicalised deliveries on the labour wards has resulted in huge numbers of midwives leaving the profession. The establishment of the Independent Midwives Association arose as a result of midwives feeling that they could no longer practise midwifery within the NHS.

Over a three year period ten women died at Northwick Park Hospital, a large centralised obstetric unit. Had this happened in a free-standing midwifery unit or at home births the services would have been withdrawn immediately and a public outcry would have ensued. Yet no large centralised obstetric unit has been closed and the drive to centralise into even bigger obstetric units continues unabated, despite overwhelming evidence that social care, provided by midwives in the community improves outcomes (especially in the most excluded groups of women) and holds many other benefits..

If the Government is to achieve its aim of community based maternity care then a real community based midwifery service has to be established in every Trust so that midwives are supported and encouraged to develop their own case loads and truly act as independent practitioners in their own right. The propaganda claims that midwives are already independent practitioners, the reality is that the majority practise as obstetric nurses carrying out the protocols and procedures laid down by the medical profession, the majority of which are inappropriate for fit and healthy women and babies. As a result, morbidity among women and babies is high, and largely unrecorded.

While obstetrics is a much needed surgical speciality for woman who require help during a complicated pregnancy or birth, midwifery is the profession of expertise for supporting normal pregnancy, childbirth and postnatal care. The difference must be clearly recognised by the policy makers. One profession should not consume the other. Midwifery led care has been shown in this country to improve outcomes for both and babies and facilitating this system of care would help meet the WHO recommendations.

A recent study from the National Perinatal Epidemiology Unit in Oxford found that "If the definition of normal birth is one that excludes induction, the use of instruments, caesarean section, and general, spinal or epidural anaesthesia during delivery, the proportion of women giving birth in this category is 38%. A more limited definition which also excludes augmentation, the use of pethidine for pain relief and episiotomy, results in 13% of the study births being categorised in this way". As 3% of women in this study gave birth at home then it appears from this study that only 10% normal births occur in hospital, a disgraceful statistic.

Highly skilled, competent, and caring midwives have left the profession in droves and they will not be encouraged back into midwifery until there is a radical re-think about the structure of maternity services and the provision of midwifery care. Meanwhile, your Government claims that thousands of midwives have been recruited in recent years, the reality is that most of those midwives are working part time and there has been no real increase in midwifery staffing. The Community Midwifery Model proposed by the Independent Midwives Association will enable the midwifery profession to provide the kind of care that women want and need, yet the Government has turned down funding for this project through the Social Enterprise Unit’s Pathfinder Programme.

I have attached an email, which I received this morning in the hope that you will better understand the effects of current maternity care. It is typical of so many letters we receive from women.

For how much longer must women put up with the current sub-standard medical based maternity care and how many women and babies have to die or struggle with serious long-term health problems as a direct result of the over-medicalised service that is in place at the moment?

We urge your government to:

Yours sincerely

Beverley A Lawrence Beech

Hon Chair, Association for Improvements in the Maternity Services

Brenda van der Kooy

Independent Midwives Association

Professor Wendy Savage

MBBCh FRCOG MSc (Public Health) Hon DSc

Attachment:

Why could I not find your web site sooner?

I had my 1st baby in hospital, which started off well (GP unit and a fantastic midwife), but rapidly went down hill with a change of staff. I was transferred to the consultant unit where I felt that my labour became a medical procedure in which I had no active part. It ended with a ventouse and episiotomy in theatre. I had a beautiful healthy baby but felt really let down by the vast team of medical staff who 'treated me'. Recovery was painful and long, and it spoilt those precious first months with my baby. I will always believe that my labour could have been very different had I been encouraged to be more active and to work with my body.

My second baby was to be born on the consultant unit, but I ended up having an extremely fast spontaneous, and most definitely unplanned home-birth, with my husband luckily being a good catch (the ambulance arrived 15 minutes too late)! The experience left us all in shock, but I felt truly empowered by the way my body naturally did what it was designed for.

From the moment I found out I was pregnant with my 3rd baby, I was determined to have a home birth with minimal intervention. The midwives seemed supportive initially, but by 36 weeks had resorted to 'bully tactics'. I was told that I was ignoring medical advice as a 36 week scan estimated the birth-weight to be 8 1/2 lbs, yet I was  certain I was carrying smaller than previously (7lbs 15oz then 7lbs  6oz babies). I was told that staffing problems combined with "women  like me" meant that the GP unit had to close, I had a midwife crying  during a check up because she was so tired from having to do so many  extra shifts and told me that I was being selfish, I was told that it  was unlikely a midwife would be available as 5 other woman were due  at the same time as me, that a woman was denied her birth on the GP unit because the midwives were attending a home birth etc.......... 

My baby's high heart rate had to be monitored following one of these 'chats', then that was used as a reason why a home confinement would  be unsafe. It was only at the 3rd time this happened, that I was told that if I was upset and stressed then the baby's heart rate would also be high!

I was made to feel like I was being irresponsible and selfish, to my baby, my husband, the midwives, all the other expectant mothers, the NHS........ I dreaded my check ups, and even considered not attending. Eventually, I contacted the Head of Midwifery, who read my notes stated she could see no reason why a home birth would be unsuitable and reassured me that staffing was not a problem, and she fully
supported my decision.  This did not stop the bullying, but at least I felt supported by  someone who had taken the time to read my medical notes not just my  green form!

Two midwives did attend my labour, but continued to discuss (in front of myself, my husband, and my mother) staffing issues, closure of the GP unit due to home births, how little sleep they would get, and the fact that they didn't know what would happen after 9am as there wouldn't be enough staff to attend me then (it was 7:15am)! My
labour was progressing normally, but I felt like a hindrance to their busy day. Despite a clear birth plan stating that I wanted minimal  intervention/monitoring, I felt bullied into agreeing to membrane  sweeps and a suppository to 'speed things along'. Luckily I gave birth (7lbs 3oz) at 8:20am, so never had to refuse transfer to hospital after the 9am deadline. My birth plan was further ignored, as the cord was clamped immediately, then I was encouraged to have an injection to 'speed along the 3rd stage'. The midwives were excellent during the actual delivery but I feel that there was no real 'care'.

I had to fight for my home birth, trusting my instincts. If I had found your website sooner then I would have fought with a lot more confidence, and may not have allowed the midwives in question to ruin what should have been a very positive experience. I feel saddened that a profession that is trained to care for women is under such extreme stress that they are not free to do the wonderful job that  most of them must have loved doing at some point. Whilst a safe birth with a healthy baby must be the ultimate aim, some ways of achieving this are better than others.