The Royal College of Obs and Gynae in the UK have put out a new document called High Quality Womens Health Care, a proposal for change. It is a very interesting Document recommending that more women give birth at home.
Too much care is provided within secondary and tertiary care settings, including emergency and diagnostic gynaecology, and too many babies are born in the traditional ‘hospital’ setting. We need to drive this care back into the community, with appropriate provision of facilities and professionals with the appropriate skills. This will mean more midwife-led deliveries, the expansion
of nursing roles and a reduction in the number of hospital units and services. However, there is also an urgent need to focus complicated care, including complex pelvic surgery, within fewer units, thereby guaranteeing the very best multiprofessional and multidisciplinary care possible within the most cost-effective environment.
Idea’s include, less hospitals, Obs adapting with women and providing care closer to their homes if they need it. The gist being that they are over servicing women instead of concentrating on the complications of birth which is their job.
It is expected that there will be a high degree of obstetrics and gynaecology consultant support at this level. Consultants will act as specialist advisors to primary and community care practitioners with clinics in the locality. These consultants will either be employed directly in the community (for example, by a community foundation trust), by the acute trusts or by the network, or will have agreed sessions to support community delivery of services as part of the women’s health network. These arrangements will be determined locally, the important consideration being to ensure that appropriate clinical supervision and governance are in place.
The underlying principles are this:
- women should be at the centre of their own care.
- healthcare standards must be consistent, evidence based and applicable to all providers.
- care must be the right care, at the right time, in the right place and provided by the right person.
- care should be provided closer to home (accepting this principle may require women to travel to access very specialist care)
care should cause minimal disruption for the woman. - care should be personalised, ensuring risk assessment, continuity of care and choice (this may be influenced by safety and availability of services).
the quality of care should be uniform within the UK despite different political and health care systems.
I like these principles. There is also a section on educating women. The media etc set up a fear engendered population. All we know about birth these days is what happens in the media. Birth only ever comes with a drama, with complications and with someone dying. We need to get away from this showing the young population the benefits of birthing quietly and calmly.
I also loved the section on choice
Choice
The way in which women’s services are configured should support choice as a principle. Choice includes:
- choice over whether, where and when to seek care
- choice of care or treatment offered
- choice of appointment (date and time)
- choice of hospital and/or doctor
It is likely that the medical workforce will be required to be more flexible in the settings in which they work to facilitate improvement in care. This will require contractual negotiations across foundation trusts. However, such an excellent model exists within midwifery, with midwives working across different levels of service. This also facilitates continuity of care for the woman. Such a major change needs a culture change among professionals (particularly primary and
secondary care physicians), commissioners and women. A concerted effort will be required to educate all stakeholders.
How different to the Australian model. Private Obs fleecing women with large gaps, a medicare payment AND an insurance payout, controlling women and instilling fear into them so they blindly do whatever they are told because their Dr would never put them at risk. Midwives busily reporting each other and hoping that the out spoken ones will “shut the fuck up and go away”.
WOMEN SHOULD BE THE CENTRE OF CARE. They should be choosing WHETHER, WHEN AND WHERE TO SEEK CARE.
By contrast the Australian headlines around birth this week say that there is a steep rise in the number of inductions for first time mothers. More than half of these were before 41 weeks with no explanation to why they were done (I could easily give them a few, just look at Private Ob per capita ratio). There was no improvement in the mortality rate
“Induction seems to be increasing and that doesn’t seem to be improving the outcomes for babies,” study co-author Jane Ford said.
Jane Ford was also involved with another study that came out in January
Epidemiology and trends for Caesarean section births in New South Wales, Australia: a population-based study.
The conclusion of this was:-
Given that the increased CS rate cannot be explained by known and collected maternal or pregnancy characteristics, the increase may be related to differences in clinical decision making or maternal request. Future efforts to reduce the overall CS rate should be focused on reducing the primary CS rate.
So maybe Obstetricians in Australia could take a leaf out of the UK blokes book and start lifting their game, stop blaming the women, stop bullying the midwives and start doing their job.
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Great statement – happening at a time where the NHS Trust in my area (County Durham) has closed down the one and only MLU in the area and officially suspended it’s homebirth service pending further review in September – due to staff shortages in hospital! In the adjoining region where I am supporting a couple, they have been warned repeatedly they may not get their homebirth due to staff shortages – despite the fact there are a total of two women booked for home births in this period. Oh the irony!
I think the personalised care and, for me, woman centred care is sooo important. If I’m bleeding to death or need a surgery to save my baby then I’m not going to care about some stranger seeing me naked but otherwise I dont want strange men watching me do one of the most intimate things that ever happens in a woman’s life. I get “fight or flight” hormones when I have a papsmear or dental check-up.
Drs the world over just need to get the idea that we actually care more about our babies than they do. So we’re not going to try to kill them. Trust us!!! You trust us with the nappies and vomit!
I’m fully supportive of women who want to homebirth and definitely think there should be less obstacles for them and their caregivers to overcome. However, I also think that not all hospitals and obstertricians are money grabbing, antiquated misogynists, as they are sometimes portrayed in the hospital v home birth debate.
Well homebirthers are portrayed as wild hippies who are only out for the experience and couldn’t really give a shit about their baby. Homebirth midwives as dangerous cowboys.
Unfortunately, that’s true…but they’re not, are they? And trying to fight one stereotype by reinforcing another isn’t going to help things move forward. I would love to see women more educated so they could feel empowered to stand up to medical professionals if they are feeling pressured…I had a medically induced hospital birth (with an active labour, no epidural and minimal intervention after the ARM) with a great ob and okay midwives – but I did have to really stand my ground on a few things during labour which would have the midwife scurrying off to clear it with my ob who was always happy for me to progress how I wanted. But it would have been easy to give in and not have had the experience I wanted. I guess what I’m trying to say is you can have a great hospital birthing experience, with the right mode of care (and carers) and the right attitude. I think it’s a bit insulting to assume that anyone who chooses to have a hospital birth is being controlled, made fearful and “blindly doing whatever they are told because their Dr would never put them at risk”
Disagree People are controlled cause the media, society, groups etc always push “must got to hospital, must go to hospital omg you’re not going to hospital what’s wrong with you? you’re crazy, you’re an idealist, everything will go wrong.” its pumped into us from when we are children ourselves really. People do blindly do what they are told (I’ve worked with the public 6 years a fair few are INCREDIABLY gullible) Do wanna know how many people i’ve heard say ‘doctor knows best? (=control) or how many have been told your baby will die if you don’t….. (=fear)” rolls eyes* it makes me cringe.
Yolanda I’m sorry you were in the situation where you had to stand up to your midwife. If she had to get permission to follow your wishes, then maybe she wasn’t really “with woman” . I guess it is lucky that due to your circumstances you felt able to advocate for yourself. Many women find themselves unable to self-advocate that during labor, that is not their fault. Bad births happen to lots of women regardless of the venue of birth – home or hospital – and often the reason the birth is ‘bad’ is because the needs of the mamababy (one organism) were not put at the centre. I strongly believe women need to be supported well during labour and birth and postpartum and this means having a trusted team who understands and supports the woman’s wishes wholeheartedly and does everything in their power to enable her autonomy. No woman, no matter where she is, should have to fight or stand up for her basic rights at such a vulnerable time.
Put simply . . . induction rates are increasing because doctors are BLINDLY following supposed evidence based, recommendations on inducing women, without any real empathy, knowledge, flexibly toward pregnancy and birth. Perinatal Guide Lines are incorrect, dated, and medically biased, derived from Randomized Controlled Trials which were poor and wrongly designed for humans, pregnancy and gestation.
Coincidently, I’ve just finished my research into IOL practices and its impact on increasing section rates. I can’t express to you my despair when I looked, not only into the evidence but the evidence to which the recommendations were meant to be based on . . . . I just don’t know when this fucking madness will end . . it just seems to be getting worse.
Are you published? I’d love to read it!
Yolanda, its comments like yours that truely piss me off! What you are saying is that as long as I’m tough and firm, I’ll get the birth I ‘deserve’ in hospital. Well, I shouldn’t HAVE to be tough and strong!! I shouldn’t HAVE to fight for my OWN RIGHTS! I shouldn’t HAVE to get the okay from some bloke who’s not even in the bloody room! Seriously, your comment smacks of ‘On My High Horse’ and its people like you who are the reason I had such a struggle to justify my home birth to others. Basically, you had your ‘okay’ midwife scuttle off while you were in labour (for who knows how long), to get the ‘okay’ to ALLOW you to birth as you wanted. I had a fabulous midwife who didn’t leave my side, I didn’t need to seek anyones ‘Permission’ and I birthed the way I NEEDED to. No permission needed – I Own My Own Body and Have My Own Rights. You want to see an empowered woman? You want to see educated women stand up to medical professionals? Here I am, A Survivor of a Hospital Birth and Blessed Woman of a Beautiful Home Birth!
This is why the move to try to get eligible midwives to attend their own patients in hospital would be so wonderful. Many of us CANNOT choose homebirth so the next best thing would be our own midwife for antenatal, intrapartum and postnatal care – even if we need to birth in hospital. There are lots of reasons women choose to birth in hospital, and yes, many of them do not realise that they COULD birth at home but for many of us, hospital IS they safest choice! I would give (almost) anything to have a homebirth – but not my life. My son was born preterm (32 weeks) and I had a retained placenta with a 3000mL haemorrhage and an experimental procedure to narrowly avoid a hysterectomy – I was not going to risk leaving my son an orphan and birthing my second child at home – away from immediate assitance if I did something so stupid again. You can have the most skilled practitioner in the world, but if you have high risk factors then hospital birth MAY need to be considered the safer option.
It is for the woman to decide.
As a midwife (passionate about homebirth) I am all about fully informed choice. No one should be bullied for chosing homebirth anymore than they should be bullied for chosing a homebirth.
As a midwife (passionate about homebirth) I am all about fully informed choice. No one should be bullied for chosing homebirth anymore than they should be bullied for chosing a hospital birth – clearly made a mistake there!
I just happened to find this site trying to find answers to my question whay is midwfiery so shit in australia and you have provided the answer! I am a UK midwife who has moved to victoria and returned to midwifery practice and cannot express how appalled and amazed i am at obstetric care in the 21st century in a westernized country. I first noted that at least 60% of women here have epidurals (this includes multips) and this is because the dr said its best ! and they have to endure cathetrization for 24 hours after!! After thisI cannot get my head around appallingly high c-section rate as high as 50-60% depending on the reg/consultant that is on. This is outragous, these women have no idea of the longer term health risks of unnecessary surgery. Seriously, i took a booking for c section for probable small pelvis WTF! the number of inductions is crazy but worse , is that women have absolutely no idea why they are been induced, having a section or analgesia choices, they are starved, monitored and bullied but sadly because their doctor makes their choices it must be right !! I nearly fainted when a women questioned the need for abx prescribed by the doctor – she asked me based on the fact I am a UK midwife I reassured her that on this occasion I agreed with DR so she accepted treatment – it is the norm in the UK for pateints to question their choices. I had one silly young grad midwife ask me about the rate of complaints in UK LOL I advised her to come work in the NHS in UK !! The midwives i work with think they are promoting women centered care and sticking up for midwives rights if they sign a blood form – seriously distrurbing. My worst experience thus far was witnessing a ventouse delivery by a reg in a bad mood – seriously the woman had no idea why she was having it, and she had an episiotomy so long it required 3 sutures for repair and she was almost knocked off with 60 mls lidocaine , but it was okay because the idiot mother in law thought the doctor was great !! Well needless to say I am heading back home…