Saturday, 1 May 2010

Are London Maternity Services Really That Bad?

Chris turned my eye to this article in Wednesday’s Evening Standard that showcases the inadequacies of London’s maternity services for birth and suggests growing numbers of average pregnant ladies (i.e. non “new age hippies”) now resort to DIY home births for fear of over-medicalized hospital births.

It’s a long, rambling article so to summarize:
  • Mothers do not get one on one care: Soaring birth rates, a shortage of trained midwives and clinical-minded, controlling consultants result in a lack of support and choice for women (particularly older mothers). 
  • The Association for Improvements in Maternity Services (AIMS) claims London has some of the most interventionist hospitals in Britain.
  • A recent investigation by the Conservatives found that more than four in 10 NHS hospitals have refused to accept expectant mothers at least once last year.
  • Labour’s women-centric vision of childbirth featuring choice and continuity of care have fallen down; parenting charity the NCT claims just over 7% of women in the capital give birth how and where they want.
Wow. On this basis, I’m shocked that we haven’t seen a mass exodus of pregnant women from the capital. Maybe they are all just giving birth at home instead?

I’m no “new age hippie” but I did plan for a home birth, decide to be a natural birthing warrior and criticize the ambiguity around the closure of the home birth providing Albany Midwifery Unit, cited in this article.

Yet I still feel that there is a huge middle ground between a completely natural home birth overseen by an attentive midwife and a completely medicalized and/or clinical hospital birth with little aftercare and support. This article oscillates between the two extremes. I think that’s a bit misleading.

My birth plan didn’t go to plan: I ran overdue and requested daily monitoring rather than induction; was finally induced at 2 weeks 5 days post dd when my blood pressure spiked; I had some “medical intervention” at the hands of a consultant when LLC’s heart rate fluctuated during birth. Yet I delivered a healthy baby; I felt the midwives and doctors considered my wishes; sure, they could have spent a bit more time post-birth helping me learn to breastfeed but overall, I couldn’t fault my care.

I have met many other new mums whose birth plans have not played out in reality (it seems they rarely do), who have some complaints but overall had a positive birth experience. Yet our voice is glaringly absent from this article. Not to mention the voice of the many women that prefer to give birth in a hospital and have no interest in home birth.

The article shows little discretion for how women can proactively improve their birth experience. Women must ask questions and be their own advocate when it comes to maternity care. If I hadn’t asked for daily monitoring, I would have been induced as a matter of course at 42 weeks. I learned in retrospect I could have given birth in a neighboring mid-wife led birthing unit if I had requested this even though this option was not offered to me. There are definite gaps in ante-natal service choice and information, all the more reason why women must ask or they won’t get.

The article also courts political drama. The Conservative report that women have been turned away from certain maternity units is a problem, but would it not be worse if maternity wards took women into care with no staff to accommodate them?

There may be truth in many of this article’s assertions. The issues run deep and I'm not belittling the problems that exist. But does it take it too far? Are London maternity services really that dire? Have you given birth in the capital and if so, what was your experience?
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