To: Secretary of State for Health Jeremy Hunt
Choice for mothers-to-be saves NHS money
Dear Secretary of State,
We are wasting millions of pounds every year by not offering women real choice over where they have their babies. At the same time we are failing women because we are leaving them with only one option - to have their baby in hospital. When they understand the true comparative risks of home, Midwife Led Unit (MLU) or hospital, many women chose homebirth or MLU. Both of which cost less than a hospital birth.
We urge you to look at the facts and to ensure that maternity services in the UK become truly woman-centred, with every woman being given genuine choice over place of birth.
Why is this important?
Every year, as another 700,000 babies are born in the UK, we waste millions of pounds of taxpayers money. Why? Because we are failing to offer many mothers-to-be the choice to have their baby outside the hospital environment in a birth centre or at home. Not only is this an appalling waste of money but many mothers say they would take the choice if only they were given it.
Just over 90% of women currently have their baby in a hospital. It costs almost £600 more for a hospital birth than it does to have a baby at home, over £200 more than having a baby in a Midwife Led Unit. Even if just another 10% of women chose to have their babies in a Midwife Led Unit (MLU) we could save more than £12 million a year, or more than 3 times that if they had their baby at home.
Midwife-led care, particularly caseloading, which gives mothers-to-be the opportunity to build a trusting relationship with their carer has been shown to improve outcomes for mothers and their babies, as well as save money, both in the short term (reduced c-sec rate, reduced interventions, higher rates of breastfeeding) and in the longer term (fewer traumatised mothers dealing with postnatal depression and even post traumatic stress disorder). This type of care tends to go hand in hand with birth centres and homebirths.
Although the NHS can and indeed does in some circumstances provide this type of midwife-led care to mothers-to-be, at the moment the approach is far from uniform. The advent of Clinical Commissioning Groups provides us with the opportunity to make midwife-led care the default option for every low risk mother. Alongside improvements in NHS care, it is also absolutely vital that women are also still able to access an Independent Midwife should they want to. Come September 2013 it shall be illegal for IM’s to operate without Professional Indemnity Insurance – this will leave mothers-to-be with no alternative other than NHS care.
Time and time again mothers are telling us and organisations such as the NCT and RCM that they want an alternative to a hospital obstetrics unit birth because it leads to the birth experience they are looking for; less medicalisation; less intervention. It means that women are listened to rather than being told what to do and it means that after the birth women are left feeling empowered rather than powerless.
Yet mothers are reporting that GPs and even midwives are failing to offer them choice, either because the choices don't exist in their area or because for some reason they are not supportive of these alternative options. We've even been told about health professionals not being aware of alternative options right on their doorstep - "Of the 6 midwives I saw postnatally, only 1 knew of the local birth centre I'd just had my baby in!'
A recent study by the RCM of 1800 pregnant women and mums revealed that 64% of them had not been offered the choice to deliver in a midwife led unit. This failure to talk about options can lead to alternative services being terminated because they are deemed un-wanted, when infact they are simply under-publicised. And so the medicalisation of birth continues to grow.
For healthy low risk mothers-to-be, studies (including the recent Birthplace Study published in the BMJ) have shown there is no reason not to consider the option of a birth centre or home birth. At the very least GP's, midwives and all health practioners working with pregnant women should be both informed themselves but also prepared to furnish the mother-to-be and her partner with all the information they need to make an informed decision about where they will have their baby. And then they should support them in their decision. This kind of care is being delivered in some parts of the UK within the NHS (as well as outside it with Independent Midwives) but it is lacking in most.
Since the publication of the seminal report Changing Childbirth 20 years ago, successive governments have promised woman-centred maternity services. We are yet to see them materialise. In April 2012, the then Sec of State for Health Andrew Lansley made several pledges, promising one-to-one care for every woman and ensuring investment that will mean parents have the best choice about where and how they give birth.
Failing to deliver on these pledges would not only fail every mother-to-be, it would also fail the taxpayer.Clinical Commissioning Groups must hold these pledges at the centre of their plans. They must have the budget to offer hospital birth, birth centre birth and homebirth and they must be held to account if they do not deliver. Every effort should also be made to ensure that should a woman want care outside the NHS, by employing an Independent Midwife, this option is still available to her come September 2013.