Given the choice would any woman opt to have her baby in the presence of people she doesn’t know? Common sense and research would suggest not. Yet of the 2000 women giving birth today, 81% will not be attended at any point in their labour by a midwife they have met before (Redshaw & Heikkila 2010).
Despite it being widely evidenced (Milan 2005, NHS Institute for Innovation and Improvement 2006, Hodnett et al 2007, Hatem et al 2008, McCourt & Stevens 2009, McLachlan et al 2012) and widely acknowledged that having a known and trusted midwife with them through pregnancy, birth and beyond produces the best outcomes for mothers, babies and their families (and can save the NHS money) our NHS maternity services are providing far from this kind of care for the vast majority of women.
This is failing women and their families, as well as midwives. And it does not need to be this way.
A Midwife for Me and my Baby is a new campaign set up by NCT (National Childbirth Trust), AIMS (Association for Improvements in Maternity Services), IMUK (Independent Midwives UK), ARM (Association of Radical Midwives) and The Birth I Want. The campaign is gathering momentum, with support from a growing number of maternity related organisations including MIDIRS.
Our goal is: We want every woman to have a midwife that she can get to know and trust, who can support her through pregnancy, birth and beyond, regardless of her circumstances or where her baby is to be born.
There is a factory system of maternity care in the NHS right now.
Most women come into contact with many different midwives during the course of their maternity care, most of whom they will meet only once or twice. Their labour and birth will be watched over by strangers.
The current NHS system is working against women and it is working against the midwives providing the care. Maternity care has evolved into its current shape, not because the women using the service ask for it or because the midwives providing the care want it, but because policy makers – government – have not created the environment in which a truly woman-centred system can exist, let alone flourish.
Why doesn’t the factory system work for women and their babies?
Numerous studies have shown that a woman who has continuity of care from a midwife she knows and trusts is more likely to have a ‘normal’ birth, is less likely to be induced, less likely to have an episiotomy, an instrumental delivery or an epidural and is more likely to have a home birth and to breastfeed than a woman who doesn’t know her midwife.
This can only be changed by policy makers removing the barriers in the system.
The maternity landscape must change so that continuity of care is encouraged, incentivised and nurtured rather than fought against or not even considered a possibility. Only once barriers are removed can models of care that deliver true continuity, and a known and trusted midwife for many more women, start to flourish within the NHS. The system as it is drives care into hospital, out of the community, incentivises the wrong things and without enough midwives to cope with the rising birth rate, midwives are stretched and pressured to the max. No time to form relationships let alone provide continuity.
Provision of continuity also fails to grow because midwives providing this level of commitment are not paid to do so (Van der Kooy 2013). In the NHS they receive the same level of remuneration as those working shift patterns. They are also often lacking the management support to provide continuity and are often expected (on top of their caseload commitments) to provide cover when the acute unit is short staffed.
So that every woman can have a known and trusted midwife caring for her when she has her baby the government needs to:
1. Remove the barriers to the provision of true continuity of carer within the NHS
2. Create a woman-centred maternity care system that provides incentives for continuity
3. Properly remunerate midwives who deliver this kind of care.
The devil is in the detail, but first the scene must be set. And that is where A Midwife for Me and My Baby comes in.
But to succeed, the campaign needs your support. Please visit our website www.m4m.org.uk and sign up to support the campaign.
You can also sign our petition calling for a known and trusted midwife for every woman at http://you.38degrees.org.uk/petitions/for-every-woman-to-have-a-known-and-trusted-midwife-caring-for-her-during-birth-1
Photo credit: Becky Reed, Alex Worley and Freya.
Hatem M, Sandall J, Devane D et al (2008). Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, issue 4.
Hodnett ED, Gates S, Hofmyr GJ et al (2007). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, issue 3.
McCourt C, Stevens T (2009). Relationship and reciprocity in caseload midwifery. In: Hunter B, Deery R eds. Emotions in midwifery and reproduction. Basingstoke: Palgrave Macmillan.
McLachlan HL, Forster DA, Davey MA et al (2012). Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG 119(11):1483-92.
Milan M (2005). Independent midwifery compared with other caseload practice. MIDIRS Midwifery Digest 15(4):439-49.
NHS Institute for Innovation and Improvement (2006). Delivering quality and value. Focus on: caesarean section. Coventry: NHS Institute for Innovation and Improvement.
Redshaw M, Heikkila K (2010). Delivered with care: a national survey of women’s experience of maternity care 2010. Oxford: National Perinatal Epidemiology Unit, University of Oxford. Available from:
Van der Kooy B (2013). Continuity of care: the elusive key to improved maternity outcomes. Practising Midwife 16(4):16-17.