My birth story is like most other women’s, nothing went to plan- but we got there in the end. I went from having a home birth, to the Birth Centre, to the labour ward, and finally I was rushed into theatre. I got my money’s worth. In the end, Freddie was too big (9 lb 10), too posterior and too stuck. I slept through his birth and felt like I was getting this motherhood thing off to a terrible start. After the ordeal, one of the first questions I asked my midwife was ‘will I be able to have other children.’ Her response was, well if Posh Becks can have 4 through C-section, I don’t know why you couldn’t.
When I came back to work after Maternity leave – I was surprisingly seconded to the NHS to help with Maternity services in east London. I had been commissioning domestic and sexual violence services, services for survivors of FGM and sex workers for the previous 6 years so while not in healthcare, I welcomed a change and a break from violence. I went right back to the labour ward, this time with excel spreadsheets comparing targets and policies in hand.
I loved my time in Maternity and would love to go back to this one day. Most midwives are such gentle, grounded and caring people, I think it is in the job description. And most of the time things go well, and there is a happy story at the end. But there is much more to it. What I quickly discovered being on the business end of maternity (perhaps a poor choice of words when referring to maternity) is the issues that run deep through the maternity team; those of staffing, capacity and staff morale. It is no news that there are not enough midwives in the UK to meet capacity, but how this plays out across the UK varies, with some areas having almost 50% agency staff to meet capacity and staff morale at a startling low due to sheer exhaustion.
Maternity services are the heart of the NHS. It is the most used service in our hospitals, and the area of the NHS that most women will access. It’s also our lasting impression of the NHS, most women with dementia can still remember their birth story. But it is often the least well-funded and resourced area in a hospital (and commissioning bodies). Speaking from my own experience, despite the big budget that goes through Maternity (in my area it was £35 million a year) Maternity feels like it’s left to get on, on its own, not integrated into the rest of the hospital structure. Where most of the NHS is male dominated, Maternity is mostly women in the room, working late nights and trying to make things work on very limited resource. Despite budget cuts and an increase in women accessing the services, your midwife is normally still there- making you feel like the most important person in the room. She is there to give you that first cup of tea and toast (which is still the best meal of my life).
There are exciting changes in Maternity services, all influenced by women’s voices. I sat on a board that piloted some of these transformation changes and am eager to see these rolled out. Continuity of care is something you will keep hearing, and what it means in practice is that your neighbourhood midwife should be in a small team, and you should be on a first name basis with your midwife. Another one is choice, something not spoken about often, but you have the right to choose your antenatal care and hospital provider (including home birth). So, shop around and speak to friends. Just because a hospital is in a ‘posh’ area does not mean they have the right maternity care for you. Know that behind the scenes hospitals are campaigning for your care and in constant review looking at where local women are going and why. These are all changes that have come from focus groups, consultations and local maternity voice partnerships. If you want to get involved in supporting your local hospital make these changes and others, click here to join your local Maternity Voices Partnership.
There are so many pieces in the puzzle and not every pregnancy is the same. Women who do not have anyone to come to the birth with them, whose husbands are not able to attend the birth because they do not have childcare, those alone because they’ve fled an abusive partner, women who are pregnant in prison or homeless are all supported by the caring midwives. There are also a couple of incredible charities that support vulnerable women and always looking for volunteers. I worked with Maternity Mates, who act as doula’s for vulnerable women in East London and am constantly amazed at how much they do as a team mostly ran on volunteers. Finally, while 99.5% everything goes well and at the end you have a healthy baby and mother … sometimes things don’t go well. I was originally naïve to this , and I know my next (hopeful) pregnancy I will hold on to the miracle of my body and birth just a little closer. I have sat on maternal death reviews, where beautiful lives are lost. The incredible sadness that also goes across the team after any death, child or mother, is extreme and something you constantly dread, that is always sitting in the back of your mind.
Pregnancy is the most beautiful thing in the world, and maternity is where the NHS absolutely shines. I am from America, where midwives are banned in some states and practicing midwives can be arrested, which I can’t help but think is related to why America has the highest maternal death rate in the developing world. What I learned most during my time as a Maternity commissioner is that the success of a maternity ward is 100% down to the care of each individual midwife, holding one woman’s hand at a time. Every cup of tea and toast given after birth by your midwife is the end of one story, and the beginning of the next.