The long awaited Maternity Services Review has been published today! There is lots to welcome in the proposals. A much needed focus on perinatal and postnatal mental health. A recognition of the importance of continuity of care. Appropriate payments for service providers. Better collaborative working between health professionals.
Plans also include a £3000 personal birth budget allocated per woman to spend as she "chooses", be it on midwife care in the community, a home birth or hospital birth and complementary therapies such as hypnobirthing. This figure apparently reflects the average cost of a straightforward pregnancy and birth. But is this genuine choice?
Unfortunately real choice simply isn't reflected in the current reality in maternity services. There is no "choice" without good local provision. A woman would need to have an experienced homebirth team, a birth centre open 24/7 and specialist obstretric led unit within reasonable travelling distance in order to be able to exert her birth preferences.
In the current situation of maternity units closing, stressed out midwives leaving the profession in droves and a liability culture amongst health professionals, women have the opposite. Disempowered and anxious, there really is a postcode lottery in the standards of care available in an NHS pushed to its limits. In my area, the midwife led birth centre was closed. Both the nearest maternity units are often too full to accept labouring women or to perform antenatal scans. Neither hospital employs a lactation consultant.
Birth plans become records of hope, that maybe amongst the myriad of professionals you encounter, someone might have the time to facilitate what you want, rather than simply placing you on a treadmill of protocols and policies. New mums sent home battered, bruised and exhausted with a tiny newborn, to make room for the next one.
So while choice is inevitably limited until universal maternity services are properly funded, the idea of a personal budget with which to "buy" services, is also worryingly capitalist in tone. Is this a gimmick, meant to lead us down the road to privatisation? What happens when your pregnancy or birth isn't straightforward and your personal birth budget runs out?
I hope that this review does lead to some positive and long overdue changes to maternity services. Women deserve to be supported and empowered, as do the staff caring for them and their babies. Birth is not simply a means to an end. It is the start of the parenting journey, starting that path supported and prepared could not be more important for parents and their new babies.
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