Letter to Secretary of State for Health about free-standing midwifery units and home birth services

5 Ann's Court
Grove Road

16th February, 2012

Tel: 020 8390 9534
email: chair@aims.org.uk

Andrew Lansley
Secretary of State for Health
Department of Health
79 Whitehall

Are they completely mad?

Dear Mr Lansley

In the last month three Trusts have announced closures of their free-standing midwifery units and home birth services. What is the point of your government, and previous governments, funding research into maternity care and making supportive statements about women’s right to choice when the Trusts ignore it all?

Over the years, various worthy bodies have made statements, supposedly to support improved maternity care:

The Birthplace study found that fewer women gave birth in free-standing midwifery units than gave birth at home (2.85% gave birth at home but just under 2% gave birth in a free-standing midwifery unit). Few of the free-standing midwifery units are supported by the Trusts as their management ensures that the numbers using these units are kept artificially low by restricting the booking of those women who would be eligible and by ensuring that few women know of the units anyway.

The Birthplace study (Brocklehurst et al, 2012) shows that free-standing midwifery units have better outcomes than the obstetric units, the perinatal mortalilty rates are similar but those women and babies are fitter and healthier. They have:

In contrast the women booked into the obstetric units have more:

83% of women had normal births in free-standing midwifery units but only 58% achieved this in the obstetric units. Unfortunately outcomes are currently measured only in terms of physical morbidity and mortality. However from our busy national helpline we know how strongly PTSD and severe postnatal depression follow women's experience of birth in centralised units, even when they are "normal", and how rarely they follow midwifery unit or home births

Enormous savings could be made were free-standing midwifery units provided in every district. The Birthplace Cohort Study published the average costs of birth in the settings available in the UK. It shows that:

It is clear that the standards of midwifery care in our large, centralised, obstetric units have plummeted and they are failing to provide student midwives with the skills they need to attend normal, straightforward, births. Centralised obstetric units are grossly understaffed and midwives stressed at levels that would not be acceptable in any other profession. This has a damaging and potentially long-term effect on the women and their babies.

We call upon the Government to stop sitting on the fence and claiming that the Trusts will be acting in the best interests of their local population. They are doing nothing of the sort, they are continuing with their policies of centralisation and the health of women and babies is a secondary consideration.

Those free-standing midwifery units that are scheduled for closure, Darley Dale, Corbar, in Buxton and the Jubilee in Hull should not only be kept open, but they should be developed so that the majority of women have the choice of birthing in an environment that is conducive and supportive of normal, straightforward, births. At the moment, the majority of maternity care is inappropriate and damaging.

On behalf of AIMS’ members I appeal to you to intervene and take the positive action that is needed to provide a maternity service that is truly responsive to women’s and babies’ needs which will provide the quality maternity care that research clearly shows to be possible. It will not, however, be achieved by further centralisation of obstetric care into larger, and larger, obstetric units.

Yours sincerely

Beverley A Lawrence Beech
Hon Chair

Reference: Brocklehurst P. et al (2011) ‘Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study’ BMJ 343:bmj.d7400.

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