Maternity Review: Informed Choice and Personalised Care

Yesterday’s publication of the 2016 Maternity Review, glossily titled “Better Births,” gave rise to a mixed response in the press. The 126 page document is a fascinating compilation of statistics and feedback gathered from parents and health professionals, much of which tells an all-too-familiar tale about disconnected care, conflicting advice, families feeling unsupported, and midwives and other health professionals working within the confines of a complex high-pressure environment.

The main recommendations of the report were:

• Personalised care, with genuine choice, informed by unbiased information;
• Continuity of carer;
• Safer care, with professionals working together across boundaries, and a culture of safety, with rapid and transparent investigation of mistakes;
• Better perinatal mental healthcare;
• Community hubs so that women can access a range of care from different professionals, including local midwifery practices;
• Reform of the payment system for maternity services.

Mainstream media were quick to focus on the proposal that women should have a £3000 budget and a choice of birth places and carers. The Times describes this as women being “handed £3000 by the NHS,” a scenario which seems as unlikely as its tone seems dismissive of women’s abilities to think straight if presented with such quantities of money.

In what I will call the “birth press,” the response was more mixed, with much applause for the focus on personalised care, continuity of carer, and genuine informed choice. Doula and founder of Birthrights Rebecca Schiller wrote in The Guardian of her expectation of “the inevitable barrage of scepticism about whether we can handle the weight of responsibility for our own health.”

Jane Merrick in The Independent immediately obliged:

Do all expectant mothers really want personalised care plans, as proposed by the National Maternity Review? […] Although there is no cost to the individual, placing the burden on mothers, with a price tag attached, is yet more pressure and yet another thing for pregnant women to worry about.

There was a widespread response that, since homebirth is generally cheaper than birth in a hospital, the focus on cost efficiencies would see health professionals encouraging more homebirths, even, according to Kim Thomas, author of Birth Trauma, when this is not clinically appropriate. Many birth workers will be reading this with a raised eyebrow; experience suggests that the interests of the baby always trump the interests of the mother, and it would take a huge change of culture for homebirth to be routinely recommended even when it is clinically appropriate.

Another undercurrent in the response among the birthy people is that the report, and particularly the recommendation of the birth budget, opens up the door to privatisation of maternity care, as well as the use of NHS funds for non-evidenced forms of care. The report itself tells us that parents want to be able to make informed decisions:

Many women expressed frustration over receiving conflicting advice from different healthcare professionals throughout their care. Women and their families told us they need to be able to access
appropriate information to enable them to make genuinely informed decisions about their care and where to give birth. They wanted information to be evidence-based and available to them in a range of
formats, including online.

What this report is calling for is a huge cultural upheaval, as well as a change to the infrastructure of birth in the UK. To be able to offer genuine choice of birth place, we would need more midwife-led birth units and more midwives able to support homebirths. Health professionals across the board would need training to bring about a shared knowledge of the evidence base as well as an understanding of the different perspectives they bring to maternity care. I think perhaps the body of the NHS may be willing, but the purse strings are held too tightly by people who do not have this knowledge or understanding.

Cross-posted from Huffington Post.