A Midwife for Me and My Baby

Given the choice would any woman opt to have her baby in the presence of people she doesn't know? Common sense and research would suggest not. Yet of the 2000 women giving birth today, 81% will not be attended at any point in their labour by a midwife they have met before.

Despite it being widely evidenced and widely acknowledged that having a known and trusted midwife with them through pregnancy, birth and beyond produces the best outcomes for mothers, babies and their families (and can save the NHS money) our NHS maternity services are providing far from this kind of care for the vast majority of women.

This is failing women and their families, as well as midwives. And it does not need to be this way.

A Midwife for Me and My Baby (http://www.m4m.org.uk) is a new campaign set up by NCT (National Childbirth Trust), AIMS (Association for Improvements in Maternity Services), IMUK (Independent Midwives UK), ARM (Association of Radical Midwives) and The Birth I Want. The campaign is gathering momentum with support from a growing number of organisations.

Our goal is:

We want every woman to have a midwife that she can get to know and trust, who can support her through pregnancy, birth and beyond, regardless of her circumstances or where her baby is to be born.

There is a factory system of maternity care in the NHS right now. Most women meet many different midwives during the course of their maternity care, most of whom they will meet only once or twice. Their labour and birth will be watched over by strangers.

The current NHS system is working against women and it is working against the midwives providing the care. Maternity care has evolved into its current shape, not because the women using the service ask for it or because the midwives providing the care want it, but because policy makers – government have not created the environment in which a truly woman-centred system can exist, let alone flourish.

Why doesn't the factory system work for women and their babies?

Numerous studies have shown that a woman who has continuity of care from a midwife she knows and trusts is more likely to have a 'normal' birth, is less likely to be induced, less likely to have an episiotomy, an instrumental delivery or an epidural and is more likely to have a homebirth and to breastfeed than a woman who doesn't know her midwife.

This can only be changed by policy makers removing the barriers in the system.

The maternity landscape must change so that continuity of care is encouraged, incentivised and nurtured rather than fought against or not even considered a possibility. Only once barriers are removed can models of care that deliver true continuity and a known and trusted midwife for many more women start to flourish within the NHS. The system as is, drives care into hospital, out of the community, incentivises the wrong things and without enough midwives to cope with the rising birth rate, midwives are stretched and pressured to the max with no time to form relationships let alone provide continuity.

Provision of continuity also fails to grow because midwives providing this level of commitment are not paid to do so. In the NHS they receive the same level of remuneration as those working shift patterns. They are also often lacking the management support to provide continuity and are often expected (on top of their caseload commitments) to provide cover when the acute unit is short staffed.

So that every woman can have a known and trusted midwife caring for her when she has her baby the government need to:

1. Remove the barriers to the provision of true continuity of carer within the NHS
2. Create a woman-centred maternity care system that provides incentives for continuity
3. Properly remunerate midwives who deliver this kind of care

The devil is in the detail, but first the scene must be set. And that is where A Midwife for Me and My Baby comes in.

But to succeed, the campaign needs your support. Please visit our website http://www.m4m.org.uk and sign up to support the campaign. Visit us on facebook: http://www.facebook.com/Midwife4Me and follow us on twitter @midwife4me. You can also sign our petition calling for a known and trusted midwife for every woman at http://you.38degrees.org.uk/petitions/for-every-woman-to-have-a-known-and-trusted-midwife-caring-for-her-during-birth-1

Did you know the midwife at your baby's birth? Let us know by commenting below.

Danone and Nestle increased marketing in UK and Ireland

Since Nestle bought the SMA formula brand in UK and Ireland in December 2012, there has been increasingly aggressive marketing action in the region by both Nestle and Danone, their main competitor.
Baby Milk Action set out the details in their Campaign Blog on 15 May 2013. Particularly interesting, and shocking, is this graph comparing formula sales under highly regulated advertising laws with under loose regulation:

Graph showing the impact of India's tight regulation versus China's loose regulation

UK 23rd best place to become a mother

The UK has failed to make the top 20 in a list of the best places to be a mother - falling behind its neighbours Ireland and other European countries such as Germany and France. In a list of 176 countries in the Mother’s Index, contained in Save the Children’s State of the World’s Mothers report, the UK is ranked at number 23. Finland, Sweden and Norway take the top three slots respectively while for the first time, countries in sub-Saharan Africa - where 10% to 20% of mothers are underweight due to poor nutrition or under-age pregnancy - take up each of the bottom ten places in the annual index.
The detailed and thorough report also looks at what can be done to save newborn lives in industrialised countries. Increased access to family planning and better sexual health education for youth are among the recommendations, as unplanned and teenage pregnancies are high risk factors for newborn mortality. Also wider use of kangaroo care and better breastfeeding support including Baby Friendly hospitals.
State of the World's Mothers 2013 - Save the Children 

Shortage of midwives means some women get more postnatal visits than others

Almost two-thirds of new mothers feel let down by the NHS after giving birth, according to a report. In some places women get three postnatal visits at home, while in neighbouring areas new mothers will see a midwife just once. The report from the National Federation of Women’s Institutes and NCT said the vast majority of maternity units are having to cope with shortages of midwives.
Belinda Phipps, chief executive of the NCT, said ‘We are extremely concerned about the shockingly high number of women who have been let down by their maternity care.
‘It is equally worrying to see that the level of care given to parents varies so significantly by postcode.’
Cathy Warwick, chief executive of the Royal College of Midwives, said ‘We are 5000 midwives short in England. Without enough midwives to cope with the increasing demands on maternity services I fear that we will not see the situation depicted in this report improving.
‘Postnatal care has been an area of concern for some time. This is a vitally important period for women who need support, guidance and advice when they return home after giving birth. Too often resources are taken away from this key area leading to fewer visits by midwives and less contact with them for women."
2 May 2013 The Daily Mail

What is the NCT Campaigning For?

NCT has been campaigning for over 50 years - achieving change for new parents. Our national campaigning work is based around three campaign areas and our three policies on:

• Pregnancy and Birth;
• Babyfeeding; and 
• Parenthood.

In the run up to the 2015 General Election, NCT has produced a Manifesto setting out the actions needed by the next Government to help support parents during their First 1,000 Days of parenthood. We want the main political parties to include these solutions in their own manifestos. You can help by taking the Manifesto to your local MP. 

NCT's 2015 Manifesto

The NCT campaigns in three areas: pregnancy and birth; baby feeding and parenthood and on these objectives

Pregnancy & Birth

1. One-to-one support in labour
2. Birth environments designed around women's needs
3. Easily accessible, individualised services for all
4. Choice of place of birth
5. Well-informed parents and professionals
6. Protection and promotion of the normality of birth

Babyfeeding

1. The Baby Friendly Initiative being fully implemented
2. Informed, individualised support
3. Integrated government breastfeeding strategies
4. Peer and specialist supporters
5. Well informed and supportive communities

NCT supports and campaigns for all parents regardless of how they choose to feed their babies.We want all parents to feel supported in their decision regarding how they feed their baby. We know that most parents make the decision to breastfeed their babies but there are barriers to being able to do this for as long as they wish. Breastfeeding provides babies with the healthiest possible start in life in terms of growth and development. We aim to raise awareness of the barriers faced by those who want to breastfeed and we campaign for more supports to allow women to overcome these barriers.The 2005 UK Infant Feeding Survey found that 73 per cent of mothers stopped breastfeeding before they wanted to.

Early parenthood

1. Information on parenting approaches to be evidence-based
2. Continuous parent-centred, empowering services
3. Improved postnatal care
4. High quality, affordable childcare
5. Improved maternity and paternity pay and leave

NCT aims for all parents to have a positive start to family life. We want all women and men to feel prepared and supported to become confident and caring parents. We value and promote high quality social, financial and emotional support for all parents, as well as opportunities for men and women to prepare for the transition to parenthood.

• For more information on each of the campaigning areas please click on the links above. 
• For access to resources you can use to help you campaign for change where you live click here. 
• To become an NCT member and support the work of the NCT, click here.

Delayed cord clamping may become standard practice

After years of lobbying by the NCT, medical bodies and senior doctors, the National Institute for Health and Care Excellence (NICE), which advises the NHS in England what medical practice it should follow, is now reviewing its cord-clamping guidance, which it originally published in 2007. Doctors hope its new advice, due in June 2014, will lead to delayed clamping replacing immediate clamping as the NHS's standard procedure.

It is thought that infants may be at risk of becoming anaemic by being denied the chance to receive as much as a third of their blood volume from the placenta through the cord. Anaemia can later be associated with brain development and can affect cognitive ability.


Influential bodies such as the World Health Organisation now urge delay, while research published by medical journals such as the British Medical Journal (BMJ) and the Cochrane Collaboration has also helped prompt a move away from immediate clamping.

A Swedish study published in the BMJ in 2011, which found that infants who had had delayed cord-clamping at birth had larger than usual iron stores at four months and were less likely to be anaemic, has proved influential.


The Guardian 25 April 2013

Independent Midwifery Under Threat

As of October 2013, it will become illegal for midwives to practice without insurance, due to an EU directive. Because there are too few Independent Midwives – around 200 – and just one claim could stretch into the millions, the premiums on offer would be prohibitively expensive. Currently IMs work without insurance and their clients sign a form in acceptance of this. IMs argue that insurance is a profit-making industry, and that it is good standards of practice that make midwifery safe, not insurance policies. They also point out that by making insurance a compulsory prerequisite of registration, there are implications for the freedom of all midwives, not just independent ones. Potentially, the legislation could further erode birth freedom for women too, with insurance companies gaining a say in where and how they might be happy for births to take place.

There is a petition asking for government help in securing workable and affordable commercial insurance to find a way forward.

The Telegraph 25 March 2013

Independent Midwives – Crisis in Maternity Care

by Emma Ashworth

Last week, we published Emma Ashworth’s birth story. She gave birth at home with an independent midwife. As it will effectively become illegal for independent midwives to practice from September 2013, she is campaigning to save independent midwives.

What are Independent Midwives (IMs)

IMs work outside the NHS, caring for women and their partners throughout pregnancy, birth and the post natal period. Usually IMs support women who are delivering their babies at home, although they will stay with their clients if a hospital transfer is required.

Why are IMs important?

Despite the Government’s targets, it is not common for mothers to see the same midwife throughout her pregnancy, and usually she will have a different midwife (or multiple midwives) for the birth, even if she chooses a home birth. Antenatal appointments may be just 10 minutes long, which does not allow either the midwife or the mother to really discuss any issues or questions properly. IM appointments can be however long the IM and the mother agree – usually an hour or longer – giving plenty of time to really develop a deep relationship between the IM and the parents, as well as to give time to get really in-depth clinical support. The trust that can build up between an IM can make a huge difference to a labouring mother, allowing her to relax better in labour, making it more likely that the mother will experience a safe, positive birth.

During labour a mother will know who will be with her, and her midwife will usually stay with her throughout the labour, giving 1:1 care rather than 1:4 or so in a hospital. That continuity of care is very important to many parents and has been shown to give a better birth outcome.

IMs have skills which in many cases have been lost within the NHS. Many IMs will be skilled in assisting women who are delivering multiples or breech babies (bottom first) vaginally. Because they are able to really get to know each and every pregnant woman that they work with as individuals they are able to really evaluate the risk of anything which deviates from straightforward in a person by person way, rather than solely on the basis of risk across the whole community. Using the relationship then built up with the parents, mutual respect and understanding, a very personal care plan can be implemented giving the best chance of the very best outcome for mother and baby. A healthy mother and baby and a positive, enjoyable and empowering birth experience.

Some women choose IMs because they recognise that they are more likely to have a positive, natural birth. Others choose IMs because they have had a traumatic experience within the NHS (in a previous birth or for other reasons) and they are afraid that their experience may be repeated. There is a serious risk that without the option of IMs, these women will be forced to risk delivering their babies in fear (which is much more likely to lead to problems with the labour), and some women have indicated that they would rather deliver alone, without medical care, than engage with the NHS again.

No IMs = No Choice of care leaving the NHS as the only option for maternity care within the UK, a situation not found in virtually any other area of health care in the UK.

Independent Midwifery is in Crisis!

In September 2013 it will no longer be legal for IMs to practice. For years IMs have had no choice but to practice without insurance. This is because there were not enough IMs in the country for any insurance company to believe it worthwhile to put together a specialist insurance package. Parents have had to accept this situation for the past 10 years, reassured by the statistics showing the excellent outcomes with IMs. Tragically, in September 2013 a European Directive comes into force which makes it illegal for a whole range of practitioners – which just happens to include IMs – to practice without insurance. This essentially makes Independent Midwifery illegal and takes away any choice in maternity care in the UK.

What can be done?

The situation is now desperate because once we get to early 2013 IMs will no longer be able to take on clients if they are due from September onwards. Various supporters of Independent Midwifery including NCT, AIMS (Association for the Improvement in Maternity Services), Independent Midwifery UK and many passionate individuals have been trying to work out solutions, both through legal channels and the Government but the problem has been that not enough parents have been aware of the problem and that’s where we need you.

Could you:

• Write to your MP and MEP stating your concerns and asking them to get involved with finding a solution (see letter template below)

• Contact Independent Midwifery UK to offer any skills or time you may have (http://www.independentmidwives.org.uk/)

• Tell as many people as possible! Spread the word, talk about what’s happening and try to encourage other people to write letters, too

• Check out Facebook Groups like http://www.facebook.com/groups/fightingforims/

We cannot lose our Independent Midwives. We must find a solution, for ourselves, our daughters and our grand daughters we need choice, and most importantly we need those skills that, once lost, can never be recovered.

See: http://www.nct.org.uk/sites/default/files/Independent%20midwives.pdf for the NCT statement on Independent Midwifery

MP Letter Template  

You can find details of your MP here, your MSP here, your AM here or your MLA here. Many MPs, MSPs, AMs and MLAs also have websites which give their contact details including email address. You can also attend a constituency surgery to discuss your concerns with your representative – again their website usually explains how to arrange an appointment. He or she may also be on Twitter (you can check here for MPs and here for MLAs), in which case you can remind them about the fight to save independent midwifery publicly too.

[YOUR ADDRESS]

[DATE]

[NAME OF MP/MSP/AM/MLA]
[House of Commons
London
SW1A 0AA]

[Scottish Parliament
Edinburgh
EH99 1SP]

[The National Assembly for Wales
Cardiff Bay
Cardiff
CF99 1NA]

[Northern Ireland Assembly
Parliament Buildings
Ballymiscaw
Stormont
Belfast
County Down
BT4 3XX]

[By email to [MP’S/MSP’s/AM’s/MLA/s EMAIL ADDRESS]]

Dear [NAME OF MP/MSP/AM/MLA]

INDEPENDENT MIDWIFERY

I am one of your constituents and I am writing to draw your attention to the imminent threat to independent midwifery in the UK. This threat comes against a background of an increasing birth rate and a shortage of midwives within the NHS, leading to a higher demand for independent midwifery services. Currently, women have the option to opt out of the NHS system of maternity care by using an independent midwife. The reasons why women may wish to do this are many and varied but the key benefit to them of using an independent midwife is continuity of care throughout their pregnancy and labour. You can find further information from the professional association for independent midwives, Independent Midwives UK: www.independentmidwives.org.uk. The UK Government heralds independent midwifery care as the gold standard towards which the NHS should strive.

However, by October 2013 it will become illegal for independent midwives to practise as they do now. EU Directive 2011/24 on patients’ rights in cross-border healthcare, once implemented in the UK, will require all healthcare professionals to have professional indemnity insurance or an equivalent guarantee or other scheme to be in place. The legislative proposals for implementation of this Directive have not yet been published for consultation but it is assumed that insurance cover will be made a condition of registration as a midwife with the Nursing and Midwifery Council. In 2002 the last commercial insurer offering insurance to independent midwives withdrew from the market as it was not commercially viable given the small numbers of independent midwives in the UK. As a result professional indemnity insurance is no longer commercially available for self-employed independent midwives. 

The Government in England has worked with Independent Midwives UK to provide a solution whereby independent midwifery-style care can be commissioned into the NHS (through schemes such as Neighbourhood Midwives and One-to-One). It is not yet clear whether all women will be able to access this care or what areas it will cover. Independent Midwives UK has invested a colossal amount of time and energy in looking for a solution and continues to explore options with commercial insurance brokers to make professional indemnity cover available to independent midwives who continue to work entirely outside the NHS, but there is no guarantee that this will be available by October 2013. The situation at the present time is that women will lose the option to have their maternity care with an independent midwife outside the NHS from next year. Many independent midwives will of course lose their employment. [It is not clear what action is being taken by the healthcare administration in [Scotland/Wales/Northern Ireland] and I should be grateful if you would investigate this and report back to me on what is currently being done.]

[ADD A COUPLE OF SENTENCES ABOUT HOW THIS ISSUE AFFECTS YOU PERSONALLY E.G. IM FACED WITH LOSING LIVELIHOOD, USED A IM FOR PREVIOUS BIRTHS, WOULD LIKE TO USE A IM FOR FUTURE BIRTHS, PREVIOUS EXPERIENCE OF POOR CARE OR TRAUMATIC BIRTH]

There is growing support for real choice in maternity care from women and their families, evidenced by campaigns such as Freedom for Birth (www.freedomforbirth.com) and The Birth I Want (www.thebirthiwant.org.uk). The loss of independent midwifery would be a further limitation on a woman’s fundamental human right, recognised at the European Court of Human Rights in Strasbourg in the case of Ternovsky vs. Hungary in 2010, to determine the circumstances in which she gives birth.

In its response to the Finlay-Scott Review of the requirement to have insurance or indemnity as a condition of registration, the [Department of Health/Scottish Government/Welsh Assembly Government/Department of Health, Social Services and Public Safety] has pledged to take forward work on a case-by-case basis to facilitate a solution to enable the continued availability of services provided by groups for whom the market does not provide affordable insurance or indemnity. Please would you write to the [Secretary of State for Health, Jeremy Hunt MP/Cabinet Secretary for Health and Wellbeing, Alex Neil MSP/Minister for Health and Social Services, Lesley Griffiths AM][Minister for Health, Social Services and Public Safety, Edwin Poots MLA], asking [him/her] to:

*set up a guarantee or other scheme equivalent to professional indemnity insurance to satisfy the requirements of Directive 2011/24; or

*delay implementation of the professional indemnity insurance requirement under Directive 2011/24, if necessary seeking a derogation from the European Union, to give more time for a solution to be found from the commercial insurance market.

Thank you for your attention to this matter and, I hope, for your support in saving independent midwifery.

Yours sincerely

[NAME]

 

Save the Children Lobby UK Government to Prioritise Breastfeeding for G8

The lives of 95 babies could be saved every hour if mothers started breastfeeding their newborns in the hour after their birth, according to a new report by charity Save the Children.  Receiving a mother's first milk within an hour will kickstart the child's immune system, making a newborn three times more likely to survive.


If the mother continues feeding for the next six months, then a child growing up in the developing world is up to 15 times less likely to die from killer diseases such as pneumonia and diarrhoea, the report said. According to the charity, there has been enormous progress in reducing child mortality, but more could be done if mothers were encouraged to breastfeed.
"Despite the benefits of breastfeeding being widely known in the developed world, and it being a free, natural way to protect a newborn baby, too little attention is being paid to help mums breastfeed in poorer countries," said Justin Forsyth, Save the Children's chief executive.


Save The Children is calling on the UK Government to use its G8 presidency to fund nutrition work with breastfeeding and on other donor countries to step up their funding.
"This year's G8 - with the UK in the driving seat - is a once in a lifetime opportunity to focus effort on a final push to end hunger," said Mr Forsyth.

Sky News report 18 February 2013

This Week is 'Nestle-Free Week'

Nestlé- Free Week, taking place on 29 October - 4 November, is a time for supporters of the Nestlé boycott to do more to spread the word and for those who don't boycott to give it a go- at least for a week!

Nestlé continues to push its breastmilk substitutes in ways that break internationally agreed marketing standards in order to make company profits. Nestlé refuses to bring its instructions on how to prepare formula into line with World Health Organisation guidance, so endangering babies who have to be fed on formula. This boycott gives executives a financial reason to think again and helps to force changes. 

Check out the Nestlé- Free Week website here for more information on how you can get involved including posters, labels and logos you can share!

http://info.babymilkaction.org/nestlefree