Newsletter number 9
July 2023
We have to consider the future - the maternity Services are in crisis. Maternal Mortality and Morbidity is rising, the stillbirth rate is rising, as a nation we are spending £8 billion in compensation claims even though the actual cost of the service is only £3 billion. Midwives are leaving the profession in droves and even though we have plenty of qualified midwives available - they are off doing something else
Here is my two pennyworth for what it’s worth
I think we need to go back to two streams of maternity care. Like when Community Midwives were employed by the local Authority. Hospitals are like voracious bottomless pits and when everyone belongs to them the quieter and gentler people get ignored.
So, Hospital Based Care as it is now. Preceptorship for newly qualified midwives teaching them how to function in a high tech Obstetric Unit. These midwives don’t wish for autonomy, they are happy to abrogate responsibility to the Obstetricians. Any woman who wants to can access this care. She can give birth in the Obstetric Unit or the MLU/Birth Centre. She will be triaged there.
Community Based Care. Preceptorship is different – how to arrange inco pads all over the floor. What to set up in the home if a woman has had a previous PPH. How to access different areas efficiently in the Community, the underlying assumption is that a newly qualified midwife will be taught by women as to what they want and expect. All care is provided in a continuity of carer model. Women give birth at home, in the MLU or in the Obstetric Unit if the labour becomes complicated or too painful and an epidural is needed. Women decide on where they are going to give birth once they are in labour (not before) and they have ascertained (with the midwife) what the labour is like. They are visited in labour by a midwife – they do not go to Triage.
Students coming to the end of their training begin to take on a Caseload ready for the next stage. Usual Caseload is 36 per year but newly qualified only have 18 per year during the first year and 27 during their second year. An experienced and supportive older midwife supports and helps these Albany Type Teams to function. (Teams of 4 – 6 midwives), these Teams are set up in the students final year. They choose a supportive Obstetrician whose philosophy they admire to work with when necessary.
Thus we will retain enthusiastic and committed newly qualified midwives and hopefully the system will gently recover.
