The first national review of maternity care since Maternity Matters has been announced and is already underway (Department of Health (DH), 2007). The review, which was promised in the Five Year Forward View (NHS, 2014), is headed up by Baroness Julia Cumberlege with some very focused and clear terms of reference. This latest review will assess current maternity care provision and consider how services should be developed to meet the changing needs of women and their babies. Simon Stevens CEO of NHS England said: ‘Most mums say they get great NHS maternity care, but equally we know we can do better in many places. The time is right to take stock, and consider how we can best deliver maternity care safely in every part of the country, while better meeting the high expectations women and their families rightly have.’
While I agree with Stevens, I urge caution not to disregard the good maternity care and positive midwifery practice that is occurring daily. This is despite an ever-challenging NHS where workloads are high and morale is low. In my role as Royal College of Midwifery Director for England, I am extremely fortunate to visit many maternity units and birth centres and meet midwives and women who use services throughout England. I witness outstanding maternity provision and see wonderful examples of how midwives and maternity support workers (MSWs) go the extra mile for mothers and babies in their care, despite their large caseloads and staff shortages. Many are working extra hours in their own time and without meal breaks. This is all in an effort to provide high-quality and safe care with healthy outcomes as well as giving women choice and a positive birth experience.
I would suggest that the NHS review panel nor the professions, can move forward without looking back and critically reflecting on the last 2 decades of maternity provision as well as considering what happened to the Changing Childbirth Report, the National Service Framework for Maternity Services and Maternity Matters (DH, 1993; 2004; 2007) recommendations? Did we actually achieve all that was asked for and if not, why not? I hope that whatever the review panel recommends, we will have further investment in our services and midwives to support the implementation of any changes that may be required. We did not see this investment following Changing Childbirth or Maternity Matters; instead we saw a scramble to implement changes with no increased investment or resources (DH, 2004; 2007). Midwives were asked to deliver continuity of care as a model but we could not deliver this without investment.
We cannot afford to return to a blanket policy where everyone receives obstetric care in hospital settings under the leadership of a doctor. It is important that investment continues for the ongoing development of social models of care. Midwife-led care needs to be the default position for women identified as low-risk or without complications. We need to see more birth centres, both alongside and freestanding, across the country in an effort to give women real choice as well as personalised safe care and healthy outcomes.
We will implement the recommendations from Kirkup (2015) as a profession. We will also continue to use the research that supports the ongoing development of midwifery-led care as we look forward to the report and its recommendations at the end of 2015 (Birthplace in England Collaborative Group, 2011).
Delayed cord clamping
A real success story for mothers and babies in England and wider has been achieved by the BJM's midwife of the year, Amanda Burleigh. It has taken Amanda 10 years to convince midwives, doctors and maternity heads of midwifery to consider the evidence on the advantages of delayed cord clamping (DCC). The National Institute for Health and Care Excellence has also listened and included DCC in its updated guidelines in 2014. The result has been an overwhelming change in implementation across the country for women having normal low-risk births as well as for women having a caesarean section.
Future challenges
The provision of continuity of care and accessing a midwife easily and locally is going to be an ongoing challenge for those in England. Looking for investment and support to develop more homebirth teams and an increase in freestanding and alongside birth centres does not come cheap either financially or from a human resource perspective. Not all midwives and MSWs are able to caseload and provide continuity of care due to their own commitments or responsibilities. The challenge of having midwives and MSWs with the right skills and knowledge to develop models of care that give women time that supports good relationships between women and midwives needs careful planning and commitment. Providing good multidisciplinary team and agency working for the benefits of women who have complex needs is still something we need to work at and improve on.
We all have a real opportunity to support and even influence England's NHS review by sharing our very best midwifery practice. You can email—england.maternityreview@nhs.net
The biggest challenge of all is that there is never, ever a need for another Kirkup report!