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Private Midwives in the NHS

Private Midwives in the NHS

The Sunday Times published an article recently about private midwives attending births at NHS hospitals: “Mothers Take Own Midwives Into NHS Hospitals”. This is definitely becoming more common, especially now that NHS trusts are inviting it to happen by contracting with companies like Neighbourhood Midwives and Private Midwives:

Ten NHS trusts have signed partnership deals allowing one private company to book rooms in their hospitals and centres for women to give birth helped by a private midwife. The mother then pays the company.

I can understand why this is happening, but I have mixed feelings about it. On the one hand, many trusts are under severe financial pressure, with midwifery shortages and hiring freezes, and literally not enough staff to care for the number of pregnant women in their trust. Creating an option for some of that responsibility of care to be taken up by private midwives helps to ease the burden on their over-stretched service. Renting out rooms and equipment to private midwifery companies also generates more money for cash-strapped trusts, so you can see the appeal. We also know, by overwhelming evidence, that continuity of carer produces better outcomes across the board, from shorter labours to fewer cesareans to better neonatal outcomes, as well as increased satisfaction reported by both women and midwives alike. At the moment, though, continuity of carer is hard to come by in the NHS, but is something that private midwives are much better at providing, so it makes a lot of sense that women who are able to are choosing private midwives because this is the type of care they desire.

In 2016, in response to the Kirkup Report which investigated the tragic failures at the Morecambe Bay NHS Trust, NHS England announced a new scheme to give women more options in choosing their maternity care provider, ostensibly as a way to address the shortfalls which led to the Morecambe Bay tragedies, as well as increasing women’s ability to have a named midwife or case-loading midwife (i.e. to have continuity of care and continuity of carer). This scheme is currently being tested in several NHS trusts, called “Maternity Choice and Personalisation Pioneers”, and basically amounts to women being given a £3000 “birth budget” and then allowing them to choose where and how to spend their money–either on NHS services or private services which contract with the NHS, exactly as described in the Times article above. Which all sounds very good on the surface, but I’m worried that this is just a way to privatise the NHS through the back door. As soon as you begin to allocate personal budgets to women, you’re pulling funds away from the general NHS pot, which is already operating on a shoestring and severely underfunded. If more money is diverted to private midwives and organisations providing private care, there will be less and less available for NHS, which has expenses (such as providing and maintaining actual physical hospitals) not accrued by private companies, who would be using the NHS facilities.  Also, it runs the risk of pulling low risk women (and their funding) out of the NHS pot, which leaves less money available for women with more complicated pregnancies, who would have to rely on NHS services if they weren’t a good candidate for low-risk private midwifery care.  There is a lot of thoughtful commentary out there on why a £3000 birth budget might not be such a good idea. For one thing, in some areas (such as London), £3000 wouldn’t fully cover the costs of hiring a private midwife, and my understanding is that the NHS has put provisions in place which would prevent women from taking the NHS budget and then supplementing it with their own money in order to purchase more expensive care. Also, women using these birth budgets can only use them on private midwives who have been contracted by the NHS, which means that they couldn’t use the budget to help pay for the services of a self-employed independent midwife working outside of the NHS. And in fact, the fate of the self-employed independent midwife (i.e. a private midwife who works outside of the NHS, and works for herself rather than being employed by a private company, such as Neighbourhood Midwives) is very uncertain at the moment anyway, thanks to an incredibly obtuse decision by the NMC (but that’s a conversation for a different day, certainly).

In my mind (and on my wish-list) is the option where the NHS is fully funded, the shortage of 5,000 midwives in the NHS is filled, and women are given true informed choice about the type of care and services they would like to have, including case-loading and one-to-one midwifery care, i.e. continuity of care and carer.  This is something the NHS has struggled to provide, and something that women are clamoring for.  When there is a shortage of midwives and a budget crisis, I suspect there isn’t enough staff to truly provide that kind of care in numbers that aren’t overwhelming to the individual midwife. I’ve already spoken to many NHS midwives in my very brief tenure so far who have discussed how they used to case-load, but over time found it to be too exhausting, so they switched to a different modality. Or about how home birth services that provided case-loading care gradually disappeared when the core midwives who were part of the team became burned out or fed up or too exhausted to continue, and no new midwives wanted to take on the role. Imagine how different a service like that would look if it was staffed in such a way that a midwife could personally attend…I dunno…20-35 births per year, tops, and truly give each woman the fullness of her time and energy and attention through their entire antenatal/ labour/ postnatal journey, while still feeling like she had down-time and time for self-care and time to see her family. Imagine what maternity care in a world like that would look like!

But I know well enough that this is wishful thinking. I’m not sure what the right solution is here. Women want (and absolutely deserve) individualised, unhurried care from the same midwife throughout their pregnancy, birth and postnatal period–and rightly so! If this can’t be provided by the NHS, I understand why women would try to seek out that type of care privately, and also why the beleaguered NHS might think that contracting private midwives to provide it is a good idea. But I also know that there are thousands and thousands of excellent NHS midwives who also long to be able to provide that type of care in the first place, and if they could work in a system that allowed for case-loading and continuity of carer in a humane model that didn’t require each individual midwife to completely drain herself dry, there would be no need to contract private midwives in the first place.  Where do we go from here? It will be very interesting to see how these birth budgets are working out in the pioneer trusts, and whether they can actually create the kind of change their creators are hoping for.

 

 

Breastfeeding News Roundup

Breastfeeding News Roundup

Breastfeeding has been in the news a lot the last few weeks. Here’s a quick roundup of some of the most interesting and exciting new articles regarding our first food, and why it’s so important.

First, a viral post about the microbiology research of a Vicky Green, a Biosciences student at South Devon College, who demonstrated the power of breastmilk by placing it in petri dishes cultured with some of the nastiest bugs around, including MRSA and E. coli. In the picture in the link, you can actually see clear rings surrounding each drop of breastmilk on the petri dish where the bacterial growth was halted by the breastmilk proteins. What’s even more remarkable is that she’s using the breastmilk from a mum nursing a 15 month old and a mum nursing a 3 year old, which just goes to show that breastfeeding DOES continue to play an important and vital role in nourishing our children and providing optimal health for them well past the first 6 months of life. Unfortunately, as an IBCLC, I hear all too often from clients that they were told by a (presumably well-meaning) GP or Health Visitor that there’s no benefit to nursing a baby past 6 months. Absolute nonsense, as this research so clearly demonstrates! And who knows, perhaps the protein in breastmilk will hold the key to defeating bacteria like MRSA in the future.

And speaking of nursing babies beyond infancy, Tamara Ecclestone recently posted a lovely photoshoot of herself nursing her 2 year old daughter Sophia and just about broke the internet in terms of controversial backlash, as people reacted so negatively to the photos that she was actually forced to defend her decision for posting the photos in the first place. Which honestly is just a very sad state of affairs. Also, the BBC article linked above doesn’t provide 100% accurate information. UK guidelines for breastfeeding are in line with WHO guidelines, and state that babies should be breastfed exclusively for six months and then continue to be breastfeed for a minimum of 2 years OR BEYOND, in addition to the food they’re eating. For the record, the right time to wean is whatever feels right for mom and baby, but the biological norm for our mammalian species is to breastfeed for anywhere from 2-3+ years, and as with all phases of growth or development, there’s a huge range of normal in terms of the right time to wean depending on the mother and baby dyad. It’s irresponsible to suggest that the UK guideline only encourages breastfeeding for the first 6 months. As for the controversy, unfortunately that’s nothing new. People are often outraged by the thought of breasts being used for purposes *other* than sexual, and sadly we hear of stories all the time of women being shamed for nursing in public, or told to use the toilet instead. And not surprisingly, most likely due in part to these cultural perceptions, the UK has one of the worst rates of extended breastfeeding of any developed nation in the world–even lower the the US’ rate of extended breastfeeding, which is quite surprising given that women in the UK routinely have 6 months of maternity leave (and often a year) compared to women in the US who often receive a scanty 6 weeks, if they’re lucky enough to receive anything at all. Clearly there’s still A LOT of room for improvement, and personally, as someone who’s still nursing her own two year old, I applaud Tamara Ecclestone’s decision to share her beautiful photos, which is an important part of how we can begin to normalize breastfeeding in the first place. The Milk Meg also has a wonderful article on this entitled: 9 Reasons my child is not “too old” to breastfeed.

And finally, this is a fascinating article by Kathleen Kendall-Tackett, IBCIC (who I saw at the LCGB conference last year, and is a fantastic speaker), discussing all of the ways that breastfeeding doesn’t just provide the optimal food for our babies, but also provides the best emotional and neurological foundation for their mental health. Breastfeeding encourages responsive parenting, promotes sleep (which in turn supports better parenting, as well as lowering the risk of postnatal depression–and breastfeeding is an independent factor for reducing maternal depression as well, regardless of sleep). Breastfeeding also promotes nurturance, attachment and bonding. As I often tell clients, breastfeeding is 10% about the FOOD we’re feeding our babies (and what incredible food it is!) and 90% about THE MANNER in which we’re feeding our babies, setting them up for healthy brain growth, emotional processing and psychological attachment in addition to optimal nutrition.