The new National Maternity Review (NMR, 2016) for England has sparked a range of reactions. As this issue went to press, I read a comment in the New Scientist (Wilson, 2016) which is scathing in its criticism of the review, calling it an ‘insult to [the] memories’ of those who died in the care of the University Hospitals of Morecambe Bay NHS Trust. Wilson attacks the review for calling for ‘less access to medical interventions’ and ‘more control ceded to midwives’—accusations so wide of the mark that she herself immediately concedes that it ‘does not call for such measures explicitly’. She goes on to lambast what she perceives as a ‘crusade against C-sections’ being led by midwives ‘pushing [the] dogma’ of natural birth. It seems she thinks the review is being used to promote a particular agenda, rather than an evidence-based consensus on how to improve England's maternity services.
In the introduction to the review, Baroness Cumberlege emphasises the two ‘fundamental principles’ of maternity care: choice and safety. She acknowledges the debate over whether these two elements are compatible, adding: ‘Of course it is true that birth is not without risk, but every woman wants—and has a right to—the safest possible birth for herself and her baby. Every woman should also be cared for by services which fit around and respect her, and her baby's needs and circumstances. Safe care is personalised care.’ This, to me, seems like common sense, rather than ‘blind veneration of natural birth’ (Wilson, 2016).
The ‘best’ approach to maternity care is a sensitive and extremely personal subject. My own view is that childbearing women are human beings, and should be treated and cared for as such. I believe that a pregnant woman should be informed of all the options available regarding her care, and the potential risks and benefits of those options, and should then be supported in her choices—whether that means homebirth, a midwife-led unit, hospital or an elective caesarean. The NMR, with its focus on women's autonomy, supports this. But now we get to the real problem: not all women are able to make these choices, because the options simply are not available. The recommendations of the NMR are all very well, but from where will we get the funding to implement them? There need to be enough midwives in post to provide full evidence-based information and continuity of care to all women—something that is currently impossible, due to staff shortages. We need enough midwifery-led units to care for all the women who choose them, and enough community midwives to facilitate homebirth for those women who want to give birth at home. There needs to be enough space in hospital maternity wards for all the women who want to give birth there, and also to provide emergency care for those who need unplanned interventions. Right now, not just in England but across the UK, midwifery and maternity services are woefully understaffed, underfunded and undervalued.
Until the Government makes a commitment to funding a sustainable maternity service—and sadly, with the recent cuts to student bursaries (Bhardwa, 2016), it seems to be going the opposite way—the vision of the NMR may never be realised. So when commentators like Wilson dispute whether this vision is even a good idea, they are spectacularly missing the point. We won't be able to argue over women's choice when there is nothing left to choose between.