"Maternity Services - Poor/no choice in practice"

About: Waltham Forest PCT

(as the patient),

I gave up on the local maternity services and arranged private care as I felt I could not get the type of service I would have liked despite the government's promises in Maternity Matters.

I have read research which shows that women:

- who have continuity of care from a known midwife in the antenatal, labour and post partum periods have faster labours and better health outcomes.

- receiving one to one care from a known midwife in labour cope better and need less drugs than those cared for by a team or midwives attending several women.

- labouring in water need less drugs and therefore have better health outcomes.

- labouring at home halve their chance of a C section, assisted delivery or damage to their pelvic floor and their baby is twice as likely to have high APGAR scores.

- less drugs and intervention is shown to improve breastfeeding rates.

Having read such information, I was therefore keen to have as natural a labour as possible.

So as a 'low risk' woman I assume that when I ask to be able to labour & birth in water in the local birth centre I did not expect this to be problematic because I have experienced:

1) The birth centre is shut a lot of the time due to staff shortages

2) The two pools available are often in use (and anyway I wonder why there are only 2 pools available in a hospital which I have heard delivers over 5000 babies a year?)

3) The midwife leading the tour of the unit said to me that the rules on getting entry to the birth centre are so strict that in practice it might be better to easier to achieve a homebirth

4) Even if I get into one of the two pool rooms, I was told I would also have to get one of the midwives trained in water-birth or I will have to get out of the pool.

So as a 'low tech' natural water birth at the birth centre is not very likely from the points above, then I do not expect to encounter problems in relation to a homebirth because:

1) When I mention a homebirth to my midwife at my booking appointment, she tries to persuade me that a local birth centre would be a good choice (See 3 above - are you as confused as me?).

2) I was told if I call up when I am in labour and there is another homebirth in progress, the trust will not have another midwife team to send to attend me and I will have to go into hospital

3) As 4 above

So I feel like I will not have continuity of care and I must wait until I go into labour to know:

- who will attend me in labour (and even then it seems to me shift changes mean they might leave half way through!)

- if I can get into the local birth centre as in practice the facility is small and too short staffed to deliver service to the majority of women

- not know that I can birth at home as another homebirth may be using the services of the small number of on-call midwives.

- whether at home or in hospital, not know whether water birth will be possible as not all midwives are trained to use the pools.

Although 'choice' was theoretically available to me, I feel as if there seems to be quite high chances of these 'choices' not being available to me in practice.

I think the Maternity Matters proposals are great. From my experience it is just a shame that the services that they promise are only being offered with a huge list of caveats and conditions - which in real terms means to me that the offerings only materialise after a nail biting wait - if at all. I would like to ask, please can the DH stop pretending that they have reached the 2009 target and carry on trying to deliver what they promised - a really excellent standard of care that women deserve.

In the end, I thought that the anxiety of all the unknowns would detrimentally affect my health (my blood pressure might have put me out of the low risk category). I employed 2 independent midwives (despite the difficulties with the insurance) and we got to know each other so well the birth plan only needed to be 6 bullet points long. We had a lovely intervention-free birth in water at home - my baby was born very calmly and quietly, with high apgar scores. I had a relatively short labour for a first baby (7.5 hours) and no tearing.

I believe if all women could have the care I received from my midwives as a result of the Maternity Matters promises (wherever they chose to be) it would be a fine thing indeed.

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