Sunday, 13 April 2014

Bounty Hunters are on the move

Hip hip hooray for Sarah Crown and Mumsnet for their new campaign to get rid of Bounty reps from our maternity wards. I've been banging on about this issue for years since the birth of my baby when I first encountered the astonishing Bounty Pack.

Stuffed full of what I assumed was nonsense, I found my child benefit form, some interesting information about local breast feeding groups and other NHS leaflets about how to keep my baby alive. I could hardly believe that Bounty were entrusted to deliver this vital information to parents and the fact that it came with heavy advertising from Pampers and Sudocrem seemed incongruous at best. Did I have to clad my baby's bum in Pampers and stinky zinc cream to claim my child benefit? Did I have to read all the endless bits of paper to make sure I wasn't missing some instructions on how to avoid cot death?

I read everything in my pack with raised eyebrows, increasing hilarity and finally wild-eyed fury. Who knows when Bounty first got its tentacles into our hospitals (they bear a striking resemblance to the Nestle Nurses of days gone by) but they are fresh from 1954. I found a pamphlet full of quotes from - I kid you not - the Daily Mail and The Sun claiming to offer relationship advice. What?! Yes, I too was unaware of their expertise in this area, they actually recommended 'ring fencing' 20 minutes of your day to not talking about your new bundle of joy and - even more repellent - resuming marital relations as soon as possible. Don't mind the stitches, honey, the only thing your man is interested in after a long, hard day in the episode of Mad Men he comes from is a long, hard ... chat about the golf course and a romantic spin about the sheets.

So, as it's now 2014 and we're all a little bit wiser about the machinations of advertising execs and want our healthcare delivered by midwives and doctors rather than underpaid Bounty reps let's politely ask them to leave and let new mums get on with recovering from childbirth, learning the mysterious art of breast feeding and having some toast and tea. Get the midwife to hand over the child benefit form. After all, far fewer of us are entitled to it these days.

Saturday, 5 April 2014

Just when you thought it was safe to have a baby....

Your new National Health Service starts on the 5th July. What is it? How do you get it?
It will provide you with all medical, dental, and nursing care. Everyone – rich or poor, man, woman or child – can use it or any part of it. There are no charges, except a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in times of illness (National Health Service Leaflet 1948).

There's a revolution in the NHS. No longer shall the NHS be shaped and driven by the health outcomes of everyone - rich or poor, man, woman or child. The NHS of the 21st century is financially driven; it's a market place and there's profit in numbers. So out with the old and in with the new – and that means a new approach to services. Specialist care centres, emergency centres serving wider geographic areas, phlebotomy centres, vasectomy clinics: more specialist, less general medicine is the way of the future. This model is possibly financially superior but is hopeless for the hapless users of the service. Previously, one could nip to one's local surgery to have a blood test, a veruca removed, or the coil fitted; now one has to trek across town to be serviced by a plethora of healthcare professionals in a disparate web of healthcare outlets. We're told that our care has improved and that we should be grateful for what we get because healthcare is draining the economy.

Now here's the nub: we all know that healthcare and the NHS has been re-shaped to operate as a business, and the bottom-line of business is profit. All NHS facilities – that's hospitals, GPs, sexual health clinics etc - have to meet the health needs of their clients while meeting their bottom-line and making a credible profit. At the same time as the move to a private sector model for our public services, we have been sold a myth: specialist services, hubs of care and improved 'customer services' in the NHS improves health outcomes. This is a fabrication sold to the public by the handsomely paid management consultants who populate health think-tanks and NHS England. And these consultants are being increasingly used – and paid for – by the Department of Health and individual Trusts to advise on changes to health services. It's no wonder that we have moved away from health as the focus for care when we no longer use public health professionals and doctors to improve service provision.

So, let's get down and dirty and talk mums and babies. Maternity is unlike any other health service. The users are not patients, they do not need treatment: they need care – sometimes complex care – and they need respect. We know that small maternity units, midwife or obstetric-led give a better and more valued service. So why are so many of these units being downgraded or closed?

Margaret Hodge stated in a recent report: "There is evidence that many maternity services are running at a loss, or at best breaking even, and that the available funding may be insufficient for trusts to employ enough midwives and consultants to provide high quality, safe care." A worrying statement when childbirth is always the end result of pregnancy, and the childbirth rate is rising.

Every day news stories report cases of women giving birth without a midwife and hospitals groaning with over-stretched capacity on labour wards. And yet the government writes and rewrites papers and policy that demands more “choice” for women in maternity and higher ratios of midwives to women. Ministers drone on about woman-centred care, about midwife-led birth centres, case-load midwifery. But the reality is that the service lacks thousands of midwives, and midwives are leaving the profession in their droves: within 10 years of qualifying a third of midwives leave the profession.

In 2013 Jeremy Hunt, Secretary of State for Health, attempted to downgrade Lewisham Hospital's maternity service to leave a stand-alone birth centre with no obstetric-led care – despite the fact that Lewisham sees over 4,000 births per year and houses some of our country's most deprived women, with all the complex healthcare and challenges of that population. Only 12% of women in Lewisham would have been able to use the midwife-led unit. The vast majority would have been forced to use the already burdened units at neighbouring hospitals, stretching their capacity to over 7,000 births per annum. Lewisham Hospital battled Hunt in the courts twice and won both times. Lewisham was a test case for many maternity centres up and down the country. And Hunt was so outraged that he had lost in Lewisham that he is using clause 119 of the Health and Social Care Bill to push through closures and downgrades to service provision more easily and without the hassle of having to go to court. And where are the headlines? Where is the debate? If the Coalition succeed in passing the bill no hospital or maternity service in the country will be safe and that means fewer and fewer women will have access to good, comprehensive local care.

Childbirth is intimate, it requires the mother to feel safe in her environment, confident about the support from her midwives. Women ask for a more personal service. No one wants to be herded into cavernous hospital wards with anonymous carers and a conveyor belt service to give birth in fear or by the surgeon's knife.

Sunday, 12 January 2014

21 Days Later


When I discovered I was expecting our third baby I started to think about how and where the wee tot would be delivered. I had my first daughter at Lewisham Hospital which had been such a traumatising experience that I vowed never to set foot in their labour ward again. Our second daughter shot out in St. Thomas' 'home from home' after a hair raising drive through SE London during which the labour moved swiftly from first to second stage. After that I thought it might be safer to have this one at home.

My only concern was that there wouldn't be enough midwives available to support the home birth; I was supremely confident that as this would be my third labour it would be quick and she would be born at home in the bosom of our family. I knew my dates exactly so when her due date arrived I was secretly disappointed that she hadn't (my second daughter was born, very conveniently, on her due date). The days passed slowly, one week went by and I was faced with that dreaded 41 week appointment.

I decided not to go...after all, the baby would probably turn up in the next couple of days...with a little struggle the midwives agreed to an appointment at 41+3, the days went by and the nights and despite being desperate to go into labour I had a sickening feeling that it wasn't going to happen. Finally at 43 weeks I gave in and went to Lewisham Hospital's Day Assessment Unit. I had a scan which showed a monster baby lurking inside. So, at 21 days late I found myself in the same room in which I had given birth 5.5 years before, I had the CTG (belt monitor) strapped to my tummy and had my waters broken: everything I had desperately wanted to avoid.


But this time was different; this time my midwife supported me wholeheartedly, she got mats for me to use, a birth ball and encouraged me through the contractions without staring constantly at the CTG. I was in control and as a result had the birth I had wanted all along: three hours from start to finish, totally natural and a lovely, beautiful, rather large baby at the end of it. It just wasn't where I had wanted it to be!

Thank you to the community midwives at Lewisham hospital particularly Shirley Peterson, the former Head of Community Midwifery, and thanks to Bola, Nicola and James who supported me during the labour. You made everything wonderful!