It is time to start valuing maternity care for the women worst affected.
Rosalind Bragg is the director of Maternity Action
The Royal College of Midwives’ e-petition calling for 5 000 more midwives has put the resourcing of maternity services on the Government’s agenda.
At the time of writing, over 70 000 people had signed up. That is a phenomenal expression of concern.
While the baby boom is one factor driving the call for more midwives, the harsh impact of the recession and austerity policies is also playing a role.
There is little argument that women dealing with poverty, domestic violence and other forms of disadvantage face worse maternal health outcomes than other women. In 2006-8, 12% of all maternal deaths were to women who experienced domestic abuse.
The maternal death rate for women whose husbands or partners were not employed was six times higher than those whose husbands or partners were in employment.
The experiences of vulnerable migrants rate a particular mention in the triennial reviews of maternal deaths. Black women have maternal mortality rates three times higher than White women.
In 2003-5, asylum seeking women made up 12% of all women who died during pregnancy and maternity despite comprising less than 0.5% of the population.
All the evidence demonstrates that the number of women with complex social needs is increasing. Unemployment has reached 2.61 million. Housing costs remain unaffordable in London and across the UK, at the same time as Housing Assistance payments have been capped.
There are indications that pregnancy discrimination has increased since the economic downturn, forcing many women out of the workforce.
Cutting the Health in Pregnancy Grant and restricting the Sure Start Maternity Grant to first babies has left low income women with less in their pockets. More restrictive benefit entitlements and a harsh sanctions regime have placed many families in unexpected financial difficulties.
Providing maternity care to women with complex social needs requires time and expertise. To refer women on, midwives need to be informed about the services which are available in their area. Midwives need the time and space to provide letters of support, liaise with services, and attend meetings.
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And above all, midwives need time to sit down with a woman and provide her with sensitive care and support. This can’t be done in the space of standard antenatal appointment.
Austerity policies have increased the pressure on midwives. At the same time as needs have grown, cuts to services have resulted in many key agencies closing down or reducing services. Advice agencies have lost an estimated 100 million per year.
Services supporting migrants and asylum seekers have been cut. The Refugee Council , for example, lost 60% of its funding. Funding for violence against women services has fallen by more than 30%. In the absence of expert support, it is left to the midwife to help the woman resolve her situation.
Surprisingly, women with complex social needs rate very little attention in the recently released commissioning guidance on maternity. As a key document to inform commissioners in the new NHS structures, this is a worrying omission. Commissioners need to be aware that standard antenatal appointments aren’t sufficient to meet the needs of this group of women. Attempting to shoe-horn these women into this service model is likely to result in poor care for these women as well as impacting on the time available for other women.
The marginalisation of these women is reflected in maternity service restructures. Maternity services are under financial pressures as the NHS seeks to produce 20 billion in ‘efficiency savings’ within four years. Maternity Action is aware of maternity services which have sought to reduce costs by cutting senior posts supporting high needs women.
In the laissez faire world of local commissioning, there is a risk that this form of cost cutting will become more widespread. The impact of these decisions will become visible in declining health outcomes, but it will be some years before this is evident.
While there is no question that committed midwives will do their best whatever the environment they are working in, the resources need to be in place to ensure that midwives can provide high quality care to the growing number of women who need additional support.
If the NHS is serious about supporting women with complex social needs, then we need to see more midwives in post across the NHS. We need senior midwives with specialist knowledge and sufficient time to sort out problems as they arise. We also need training for all midwives to give them the skills and knowledge to provide the best possible care to the growing number of women who need more help.
With the decade of pain barely begun, it is time to start valuing maternity care for the women worst affected.
Maternity Action is leading the Valuing Maternity campaign to defend maternity rights and protect maternity services.