How do budget cuts affect your bump?

Midwife shortages and NHS cuts have been big news recently. Our midwife explains how they’ll affect your care

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Make sure your birth partner offers plenty of support!

What’s the problem?

Before he came into power, David Cameron pledged to increase the number of midwives in England by 3,000, saying: “We are going to make our midwives’ lives a lot easier. They are crucial to making a mum’s experience of birth as good as it can possibly be, but today they are overworked and demoralised.”

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Unfortunately, we have yet to see this promise materialise. Together with England’s increasing birth rate, which has risen 22% in the past two decades, and pregnancies becoming more complex due to problems such as obesity and diabetes, there’s more pressure than ever on maternity services.

It’s normal to feel a little worried about how this will affect you as a mum-to-be, but it’s also important to remember that maternity units will vary hugely around the country, with some in crisis and some not. And no matter where you live, there’s still lots that you can do to get the best out of your maternity care – and help us to help you, too.

Antenatal & postnatal care

How will it affect me? 

If your pregnancy is low-risk, you should have a minimum of 10 antenatal appointments with your midwife, or seven if you’re a second-time mum. If there’s a shortage of midwives, you might find there’s a lack of continuity in your care and a different face each time you go for check up. This isn’t great, as it’s good to build up rapport with your midwife. But ultimately what’s important is that your care is good quality, whether from one midwife or 10.

What can I do?

  • Make sure you have a contact number so you can always speak to a midwife if necessary.
  • Consider employing an independent midwife if you want to see the same face throughout pregnancy and birth.
  • If you feel you’re not getting good care, or enough choices for birth, speak to the labour ward’s on call Supervisor of Midwives (SOM). You could also try your unit’s Head of Midwifery, and the complaints department. You should get a response within an agreed timescale.
  • The Association for Improvements in Maternity Services (aims.org.uk) can help during the complaints process.
  • Contact your local MP about any problems you’re having with your care.
  • For extra help with breastfeeding, contact your local breastfeeding support group or counsellor.

One-to-one care in labour

How will it affect me?

One-to-one care in labour produces better outcomes for both mum and baby. You need to feel safe during labour, and any problems are more likely to be picked up early if you have close and high-quality care. Being supported will also help you relax, which in turn helps the uterus and cervix (both are made of muscle) to work more efficiently. Imagine running a marathon with stiff, straight legs – it just wouldn’t work! Although maternity units aim to provide one-to-one care, this often isn’t possible.

What can I do?

  • Consider having an extra birthing partner with you. A woman who’s gone through labour herself can help reassure you and your partner.
  • Consider employing a doula (a professional birth assistant). They don’t act as midwives, but offer practical and emotional support during pregnancy, birth and beyond. See doula.org.uk
  • Students midwives are usually keen to be involved in the birth and will often stay on past the end of a shift, providing you with continuity.
  • Use your community midwife. Rather than going to hospital too early, ask if you can see her at your home or her clinic. Even a phone call to her will reassure you in early labour.
  • Consider a home birth. If your pregnancy has been straightforward and you’re low risk, the evidence shows this is a safe option. You’ll get one-to-one care and can always change your mind and go to hospital.

Pain relief

How will it affect me?

If a maternity unit is busy then you may not have the option of an epidural. This is because an epidural means you’ll need one-to-one midwifery care and if this can’t be provided, then neither will the epidural. Also, if a busy maternity unit only has one anaesthetist, he or she could be in the operating theatre a lot of the time, providing pain relief to women having a c-section and therefore be unavailable on the labour ward.

What can I do?

  • Women with good birth support are less likely to need an epidural, so again, consider who can best support you.
  • Women who are relaxed and can stay at home in early labour are also less likely to need pain relief, so get the candles and soothing music out.
  • Use alternative methods of pain relief, such as massage, a birthing pool, TENS machine or hypnotherapy.
  • An epidural can increase your chance of intervention, such as forceps, which you may want to try and avoid.
  • Stay upright and mobile so labour is more likely to progress normally.

Where to give birth 

How will it affect me?

According to the Government guidance report Maternity Matters, women should have the choice of a midwife-led birthing unit, a consultant unit or home birth. The reality is that not all women have this choice as some local birthing centres, such as Heatherwood Hospital’s Ascot Birthing Centre in Berkshire, have closed due to staff shortages, and home birth services in some areas are stretched as community midwives get called to the labour ward to support the unit. With the Government aiming to make £20bn of savings in the NHS, the Royal College of Midwives (RCM) has warned that services will be further affected if already short-staffed maternity units are expected to reduce staff numbers even more.

What can I do?

  • You don’t always just have to access the service that’s closest to you, and you’re entitled to see what’s on offer further afield. If it’s your first baby, chances are you’ll have plenty of time to get to a birthing centre that’s a good few miles away.
  • If you’re told that the home birth service is suspended due to a shortage of staff, then contact the Association for Improvements in Maternity Services (aims.org.uk) for advice and support.
  • Consider employing an independent midwife. This way, you know that your midwife will be available to provide a home birth when you go into labour, although the service costs between £2,000 and £4,500. Log on to independentmidwives.org.uk for more information. 
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Did you know…

You can visit nhs.uk to find out what your local maternity unit has to offer, and then contact them to find out the midwife-to-woman ratio, or arrange a look around.

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