Holding the baby…

I’ll never have a baby. I’ve helped make a couple over the years but that’s about it.

If I was to have a baby I’d want to have it in a hospital surrounded by machines that go beep with matron, a midwife, a consultant obstetrician and my granny standing by.

Thats coz I’m an old geezer with no idea about what’s what but I do know a bit about policy and what works.

Delivering what mums and dads want has been the subject of goodness knows how many reports, surveys and inquiries.

‘Antenatal continuity’ seems to be the theme of the moment.

The CQC, (why they are involved I dunno) have a survey that paints a confusing picture:

• Seeing the same midwife every time: 1/3 of ladies did, just under 1/3 didn’t and wanted to, 1/3 didn’t but didn’t mind

• Labour and birth continuity: 15% got it, 16% didn’t and wanted it, 79% didn’t and didn’t mind

• Postnatally: 27% got it, of those that didn’t, the majority didn’t mind.

• Of the 60% who did not get postnatal care from a midwife involved in their antenatal and or labour care, 2/3 didn’t and didn’t mind.

Continuity based models of care are being beefed up and I’m wondering if we are busting a gut to provide something that the ‘customers’ are, at best, ambivalent about?

The National Maternity Review, ‘Better Births’, says;

“Every woman should have a midwife, who…can provide continuity throughout the pregnancy, birth and postnatally.”

The LTP goes further;

‘By March 2021, most women [will] receive continuity of the person caring for them during pregnancy, during birth and postnatally.’

Let’s be clear what this means;

…for all women, the majority of their care, including the intrapartum period, should be provided by the same health professional (usually a midwife), regardless of whether care is based in the community or hospital.

It can’t be done… not for unwillingness but for, appositely, mother-wit.

The reasoning is in a report from Birmingham Uni that makes uncomfortable reading.

Not only do these changes mean a considerable bolstering of the workforce but substantial changes to how midwives work… the nub of the problem.

Extreme flexible working is needed, to be ‘on-call’, when ‘your lady’ is doing her thing, night or day.

In the Brum-survey we learn;

64% of midwives couldn’t provide this level of availability because they had personal caring responsibilities, 46% for children, which is a key barrier.

Only a third were willing to work in these models, 37% said they were unable to work any on-call or night shifts.

Midwives will have partners, kids, families, school-runs, shopping and lives. You can’t change the whole basis of their employment in pursuit of policy, how ever admirable.

There’s an interesting ‘Mum’s Net’ thread, here, discussing it.

Can we seriously up-scale this initiative when we know, full well, about the understandable inability and reluctance of most midwives to become flexible workers?

With the best will in the world, midwifery professionals, here and in many countries today, are not prepared to trade off a potentially more fulfilling ways of working, with greater intrusion into personal and family life.

It’s just not doable.

The pilot models have often paid midwives more and in London the very popular ‘Neighbourhood Midwives’ came to an end, mired in questions about how to make the funding work.

Some local models are emerging as bodge-arounds, focussing on low risk women or bits of the pathway but they are not true to the policy because the policy cannot be delivered.

I have no idea who authored this bonkersness but they would do well to remember; for policy to work it should have an eye on the horizon but its feet on the ground.

Aspiration is one thing, but talking to the people, whose perspiration will make it work… quite another.

A policy for which 2/3rds of the key workforce is simply unable to work with, means we will lose the workforce.

Somebody needs to have a serious rethink about who’s going to be left holding the baby.

Contact Roy – please use this e-address – roy.lilley@nhsmanagers.net
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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.