Caseloading costs significantly less than standard hospital care!
A ground-breaking study published today in The Lancet has found that caseloading is both significantly cheaper and just as safe as standard hospital care.
The University of Sydney Study, led by Sally Tracy, Professor of Midwifery at the University showed caseloading produced a saving of AUS $566 for each woman who gave birth in the public hospital.
Professor Tracy: "Caseload midwifery care has largely been overlooked because of the incorrect belief that the service will be too expensive and that the model is not safe for complex pregnancies. Our randomised trial showed that caseload care can achieve similar outcomes to standard care - and it costs the public purse significantly less".."Our study found that caseload midwifery appeared to alter some of the pathways that recurrently contribute to increased obstetric intervention".
"Caseload midwifery works on the assumption that women will labour more effectively, need to stay in hospital less time and feel a stronger sense of satisfaction and personal control if they have the opportunity to get to know their midwife at the beginning of pregnancy".
Professor Alec Welsh, Director of the Australian Centre for Perinatal Science at UNSW said "Policy makers should not view one-to-one midwife care as an expensive, boutique service and pregnant women should be made aware of the benefits of such schemes".
As Midwife 4 Me turns its attentions to the CCG's and the services they are commissioning, this latest piece of research will provide us with powerful ammunition!
A summary of the article can be found here:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61406-3/abstract?rss=yes
Posted on 17 September 2013 | 5:59 pm
We've got the evidence base. Now we want maternity services that reflect it.
Unashamedly
stealing the introductory paragraph from an e-petition set up by campaigners in
Bradford and Airedale to retain the choice of one-to-one midwifery care for
women in their area:
“The evidence base for one to one midwifery is clear.
Women who have the same midwife to support them throughout their pregnancy,
birth and postnatally have better clinical, emotional and social outcomes”.
Despite
the outstandingly clear and extensive evidence base, across the country the models of midwifery
care that deliver the best outcomes for women are glaringly lacking. This is not, I hasten to add, the fault of midwives. And indeed some small pockets of brilliance exist. But on the whole, the
willingness of CCG’s to commission midwife-led continuity models of care appears
so far at least, to be minimal.
As President of the RCM Lesley Page said in her
article in Women and Birth,
September 2013 entitled Midwifery
in the UK: How do we move midwifery led care from fringe to mainstream?Top of Form
“..the
provision of midwife led care remains small scale with limited access.
Midwifery led care will need to move from the fringes to the mainstream with
wide access to all women if we are to bring our maternity services into
balance, offering women and their babies the genuine opportunity of a normal
birth, reducing the intervention rate and unleashing the potential of
midwifery”. http://www.womenandbirth.org/article/S1871-5192(13)00075-9/fulltext
The latest
Cochrane Review makes a clear case for continuity of midwifery carer; Midwife-led continuity models versus other
models of care for childbearing women (Review) published in August 2013
and available here:
The aim of
the review was to compare midwife-led continuity models of care with other
models of care for childbearing women and their infants. It included 13 trials
involving 16,242 women.
Midwife-led continuity of care
was associated with several benefits for mothers and babies, and had no
identified adverse effects compared with models of medical-led care and shared
care.
The majority of included studies
reported a higher rate of maternal satisfaction in the midwifery-led continuity
care model. Similarly there was a trend towards a cost-saving effect for
midwife-led continuity of care compared to other care models.
The review concludes that most
women should be offered midwife-led continuity models of care and the authors
suggest that “Policy makers who wish to
achieve clinically important improvements in maternity care, particularly
around normalising and humanising birth, and preventing preterm birth should
consider midwife-led continuity models of care and consider how financing of
midwife-led services can be reviewed to support this”.
Over the coming months the M4M campaign will focus our
attention on the 211 CCG’s commissioning maternity services across the country
and we will need your help. Keep your eyes peeled for the next action. In the
meantime if you haven’t already signed and shared these two petitions please do
so:
For every woman to have a known and trusted midwife
caring for her during pregnancy, birth and in the weeks afterwards: http://you.38degrees.org.uk/petitions/for-every-woman-to-have-a-known-and-trusted-midwife-caring-for-her-during-birth-1
Posted on 10 September 2013 | 12:22 pm
We are powerful when we come together
"There are so many petitions flying around at the moment I've got petition fatigue" said a good friend of mine the other day. "And anyway, what use is a petition?"
It's a good question. What use is a petition?
The success of a petition is directly proportional to the number of people who sign it. The more signatures, the harder it is to ignore. Petitions are a useful finger in the wind indicator of issues that are of concern to the general public, and therefore, petitions with a significant number of signatures do truly have the power to raise the profile of an issue with decision makers.
We've all got busy lives, it's never easy to find the time to get behind a campaign, no matter how strongly you believe in it. It's hard to get to a demo in London, goodness knows it can be hard to find the time to print out and post a card to your MP. But a petition is something you can do from your chair. Right now!
So don't believe in the fatigue. Believe in the power. We might just make a difference.
And whilst you are in the mood. Here are two petitions to sign and SHARE:
The first has been set up by M4M and is calling for every woman to have a known and trusted midwife caring for her when she has her baby:
http://you.38degrees.org.uk/petitions/for-every-woman-to-have-a-known-and-trusted-midwife-caring-for-her-during-birth-1
The second has been set up by campaigners in Bradford and Airedale because CCGs are trying to remove the choice of 1-2-1 midwifery care for women in the area, claiming that it is not a priority:
http://www.thepetitionsite.com/593/491/398/support-one-to-one-midwifery-care-for-the-women-of-bradford-and-airedale/
Thank you
Posted on 25 June 2013 | 2:56 pm
If we don't appear to care. The policitians think it doesn't matter. Simple but true.
This week
Guardian Professional featured a piece by Dick Vinegar about how we, the
service user can influence the shape of healthcare http://www.guardian.co.uk/healthcare-network/2013/may/29/will-healthwatch-give-patients-better-deal.
His message is
clear, to affect change you need to make a noise and you need to do it in the
right way. Taking a few lines from his article..
“Julie Bailey is
an example of how to get things done in the NHS: be passionate, never take no
for an answer, gather people round you, and have an eye for publicity, local
and national. With no government funding, she and CURE have become household
names, which is more than LINk ever was. Gaining a high profile is essential
for any patient representative group, to stop doctors patronising them”.
For 8 years,
through the 90’s, I was part of a grassroots environmental pressure group. It
was started by a bunch of surfers down in Cornwall and within a year we’d had
national TV and newspaper coverage, met with Ministers, demo’d outside Water
Company AGM’s and had a growing membership base. I can’t agree more with Dick
Vinegar's assertion that to get things done you need to be passionate and you
need to have the right people around you. And having an eye for publicity –
well we took our surfboards and wetsuits to Westminster and Brussels and it
certainly gave us an advantage when it came to photo opportunities.
But the most
important thing of all is to demonstrate, without question, that we, the people
care about an issue. If we don’t appear to care, the politicians think it doesn’t
matter. It’s as simple as that. Which is why we are so pleased this week that
we have a guest blogger writing for us – a woman who knows a great deal about getting
things happening in maternity care. Who’s passion and ideas really did make
change happen in Yorkshire and who continues to push hard for change today.
Ruth Weston
is the mother of five children and the co-owner of Aquabirths the waterbirth
specialists. A community organiser and activist by background and training, she
turned her energies to campaigning and working towards changing the UK birth
culture when, on impulse, 8 weeks before the birth of her 4th child, she took
over a local birth poolhire company to ensure women in Yorkshire could continue
to have the choice of a waterbirth. Eleven years on Aquabirths builds installed
birth pools for the NHS as well as hiring out high quality pools, and Ruth
chairs the local MSLC and campaigns with all her considerable energy to ensure
that her children will have the maternity care that she had to pay for. Look
out for her blog Bornstroppy at http://bornstroppy.wordpress.com/
The most
important thing about being an activist is to understand that you won 't be
able to do everything but this does not mean you cannot do SOMETHING of
significance for your campaign. Especially as mums of young children when time
is constantly fragmented by the demands of parenting it is very easy to believe
that you can have little impact on the world beyond your home. There are so
many things you cannot do! And of course when it comes to CCG Commissioners
this is what works against us because women with young children are rarely seen
at their consultation events on local priorities . . .
But the
thing is to focus on what you CAN do and what is your leverage and use them
strategically to best effect. For instance as Mums of young children we may be
tied up in many ways BUT we have authenticity on our side and we make very good
photos which the media love. Airedale Mums discovered this to the cost of the
local NHS Trust - a group of Mums with babies campaigning to be able to have
homebirth as a choice, or extreme breastfeeding at Ilkley's Cow and Calf or
setting up a birth pool scheme - the media loved the pictures. Learn to write a
press release, get three Mums and their small families together, each with a
little story about the difference a M4M would have made or did make to your
birth or early parenting, and you have a story that will get into the local and
regional media.
Being in the
lime light may not be your thing - and some of Airedale Mums were willing to
support but did not want to speak or be in the photos, but then there is the
letter writing and the MP visits. There is nothing like writing a letter beginning
with the words 'I am the mother of three children . . .' or 'I am the
grandmother of x grandchildren and I am writing regarding my concern over the
maternity care my children are receiving . . . The thing about this kind of
letter writing is that you don't write it necessarily for the response you get,
but the effect of writing your letter. So the letter does not have to be long,
it needs to be the point ie, state in 2 paragraphs what your problem is, tell
him/her what you want them to do about it and sign off - bullet points are
perfectly fine. This works for the Minister of Health Dan Poulter as well. Your
MP is usually more helpful than the Minister but always remember it is the
letter not their response that is important.
Once one
letter is written then you can follow up with a quick email asking about
progress, you can follow up with an email asking for a meeting, you can send a
letter updating him/her on what is changing. I make a point of contacting my MP
about every 8 weeks, and as a Lib Dem member I make a point of contacting my
nearest Lib Dem MP about once a quarter - bless him, he does his best but he
know he cannot get away! Think of it like writing to your Granny, you always
have to make sure there is something to write about, but if you think about it
there is always something you can write about. The M4M Deliver a Baby printable
baby is just brilliant for this - send one to MP and one to Dan Poulter - short
and pithy and picturesque. And if you can draw or paint - or children can - do
not be embarrassed about sending along pictures and photos – it’s the same
message and is more fun! Share your letters and ideas with friends so they can
have a go too, posting on Facebook is a fab idea. We need to make the facebook
and twitter networks live with our call for one to one midwifery care.
One very
effective way of gaining your MPs attention is to invite him/her to meet a
group of you and each share your story end with 'and this why we want one to
one midwifery care and are supporting the M4M campaign - could (s)he help them
to lobby local CCG commissioners and the Government to make this happen for the
benefit of other women like us?’ Remember that all politicians are wet fingered
- they hold their fingers up to see which way the political wind is blowing,
Mums are linchpins of family networks and very photogenic, and an election is
not that far away . . . use your power!
The thing
is, if you can only do one thing like a postcard or letter, or a visit to an MP
or whatever - then make it as worthwhile as possible by posting it far and
wide, copy in the Chair of AIMS or the Chair of the NCT or both, copy in local
newspaper, post what you have done on facebook, on Linked In on yahoo groups
with a photo perhaps. Tell your friends and see if they may not send 'your'
letter too.
My husband
is an archaeologist and he says that in the stone age, human weaponry was not
effective enough to kill large prey like mammoth and bison in one go, so what
they did was not make arrow heads that penetrated the beast but arrow
heads that made messy surface wounds. They would shoot arrow after arrow to
make such a bloody mess that the beast would finally bleed to death: they just
followed it until it dropped. Few of us ahve the status and power to make a big
enough difference to ensure we get one to one midwifery care in our area in one
go. However, if we can do what we can but make it as effective and messy as
possible by making sure every small action we take from a postcard upwards
makes as big a mess as possible - then we are doing something significant to
make change happen. We may have one child at the breast and a toddler by the
hand but we still have a voice a vote and a passion to see a better world for
our children - with this we CAN change the world.
Posted on 1 June 2013 | 3:30 pm
Genuinely personal care - ultimately, a cost-effective strategy!
Dr Angela Davis, Warwick University very recently published a paper entitled 'Choice, policy and practice in maternity care since 1948'. (May 2013)
http://www.historyandpolicy.org/papers/policy-paper-146.html#S5
She looks at how campaigns by those such as AIMS and NCT have shaped maternity care over the decades and reflects on where we are today. It makes for an interesting read.
In her executive summary she concludes:
"This debate does not reflect how mothers have viewed their own birth experiences. Oral history interviews reveal that women recall the quality of their relationships with medical professionals as the most important aspect of their care, rather than place of birth or the level of medical intervention".
Our combined experience as a group of organisations would back this up. Women rate their relationship with their midwife extremely highly. They want a relationship and they want it to be a good one built on trust. It can be the difference between a positive and a not so positive birth experience.
Dr Davis concludes:
"Empowering women, maintaining safety and pursuing cost effectiveness need not be seen in opposition to one another. The history of post-war maternity care and mothers' own past experiences indicate that investing in the maternity services... in the short-term, and directing resources to provide genuinely personal care will ensure the long-term wellbeing of mothers and babies, ultimately a cost effective strategy. While current, controversial moves to reconfigure maternity services, closing smaller units and consolidating provision into a smaller number of large centres, is unlikely either to meet mothers' needs, promote safety or prove cost effective".
'Directing resources to provide genuinely personal care will ensure the long-term wellbeing of mothers and babies, ultimately a cost effective strategy'.
Exactly what the Midwife 4 Me campaign is about.
Posted on 24 May 2013 | 10:46 am
Spreading the word
The number of organisations, groups and individuals supporting the campaign is growing daily. Many of you are blogging, tweeting, face-booking about what we are up to and this is exactly what we need to get the campaign out there - please continue!
This great blog from campaign supporters Mama Baby Bliss. Perfect for sharing.
http://www.mamababybliss.com/blog/amidwifeformeandmybaby.php
ps Midwife 4 Me facebook page will shortly go live. We'll keep you posted.
Posted on 22 May 2013 | 9:44 am
There's weight in numbers
It's just over a week since we launched the Midwife 4 Me website and already 18 organisations and dozens of individuals have signed up to support the campaign. Thank you.
Every name adds more weight to the cause. If you are part of an organisation you think is allied well with the campaign, please do suggest they take a look at the Manifesto - http://www.m4m.org.uk/manifesto.php
It is because we all know how vital the relationship between woman and midwife is that this campaign was launched. It is also why so many people are getting behind it.
But knowing is only a part of the equation. The fact is that the government knows the huge benefits a known and trusted midwife can bring. It has just failed to do anything more meaningful than pledge to sort out the problems midwifery care is currently facing. Until we see action rather than just promises, both midwife and woman are being failed; with the vast majority of women giving birth with a midwife unknown to them and seeing a number of different midwives throughout their care.
How can knowing, trusting relationships develop under such circumstances, irrespective of how hard midwives are working to make the best of an extremely pressured situation?
I can use this weeks announcement that pregnant women are to be offered a smoking test as a very current example to illustrate what is absurd about the situation we are now in. If a woman had a chance to build up a relationship with her midwife, would there really be the need for a smoking test? Certainly the results from the lastest report on the activities and outcomes of One to One Midwives on the Wirral would suggest not - 30% women smoking at booking. 10% at birth. Something about the care they are providing seems to be working.
We need action, not just promises. And we need some strategic thinking from policy makers.
Every one of us can play our part in pushing government to take on the mantle of creating an environment in which woman-centred care can flourish. By spreading the word about this campaign to friends, family, twitter followers, facebook likers, organisation members you are doing just that.
And by 'Delivering a Baby' to your MP http://www.m4m.org.uk/takeActionDeliver.php you are taking the issue to the people who really could, if minded, make a big difference to lives.
We will shortly be launching our FB page. You can already follow us on twitter @midwife4me (please use hashtag #m4m). We would be delighted to write for or provide info for blogs and newsletters too, so do just ask.
And don't worry, we haven't forgotten the Commissioning Groups. We will come back to them at a later date.
I shall leave you with some words from Davina McCall. Mother of 3, TV presenter and advocate of midwives. Do watch until the end, else you won't get why I've flagged it up.
http://t.co/maAGOLnjsM
Posted on 17 May 2013 | 1:07 pm
How you can support A Midwife for Me and My Baby
If you tweet, blog or facebook and agree with us that having a known and trusted midwife can make a world of difference to a woman and her family then please do spread the word about the campaign any way you can.
If you do none of the above but would like to support the campaign, whether an organisation or an individual you can sign up via the website. And please don't forget to send a baby to your MP.
This is about making our voice so loud we can't be ignored. We know that true continuity of care makes sense. Now we need policy makers to create an environment in which it can thrive.
Thank you to @dorkymum for the fab blog .
http://dorkymum.wordpress.com/2013/05/10/a-midwife-for-me/
If you feature the campaign in your blog do let us know and we can flag it up!
Posted on 14 May 2013 | 12:12 pm
Scissors and glue at the ready? Deliver your baby.
Hot off the pasting table, 4 babies sent to 3 MPs from members of my family living across Cornwall. It took less than half an hour to print, cut out and paste and it was surprisingly therapeutic even assisted by two small helpers!
We need dozens of these babies to be landing on MPs desks over the next few weeks. So please do deliver your baby. And encourage friends and family to do the same. Thanks
http://www.m4m.org.uk/takeActionDeliver.php)
Posted on 9 May 2013 | 10:28 pm
Given the choice would any woman opt to have her baby in the presence of people she doesn’t know?
Whether in a hospital, a birth centre or at home, it’s hard
to imagine any mum-to-be choosing to have someone she hasn’t met before support
her through one of the most significant and most personal events of her life.
Yet of the 2000 women giving birth the day you read this
blog, 1620 will not be attended at any point in their labour by a midwife they
have met before.
Despite it being widely evidenced and widely acknowledged that
having a known and trusted midwife with them through pregnancy, birth and
beyond is best for mothers, babies and their families (and can save the NHS
money), somehow our maternity service is delivering far from this kind of care
for the vast majority of women.
The current system is working against women and it is
working against the midwives providing the care. In fact it is hard to see who
exactly it is working for. And that is what is so jaw-dropping about the
situation. Maternity care has evolved into its current shape not because the
women using the service want it or because the midwives delivering the care
want it, but because policy makers – government, have not created the
environment in which a truly woman-centred system can actually be delivered.
With the advent of clinical commissioning every user of maternity
services has an opportunity to have a real say about how the service should
look. There should be a genuine chance to influence and shape. But our ability
to shape and influence will continue to be limited just as it has been for
years if the barriers that are currently standing in the way of the kind of
care women want and deserve and the kind of care that many midwives want to
give are not taken down. We have to
change the maternity landscape so that women-centred care is encouraged,
incentivised and nurtured rather than fought against, squashed or written off.
So that an environment is created in which care that delivers a known and
trusted midwife for any woman who wants it can fit neatly and easily into the
system rather than being squeezed and pressured out of it.
The existing barriers to genuine continuity of care are
large and cumbersome – hence it has struggled to flourish, but they are certainly
not insurmountable. And the first step on the way has to be the start of the
conversation. This is what the Midwife for Me and my Baby campaign is all about.
We need to make some noise and we hope you will join us..
..You can start by signing up to the campaign and Delivering
a Baby to your MP (find out how at http://www.m4m.org.uk/takeActionDeliver.php)
Posted on 7 May 2013 | 9:21 pm
A Midwife for Me
In October 2012, a group of organisations with a long running history of campaigning on maternity issues
- the NCT, AIMS,
IMUK, ARM
got together with The Birth I Want
and Birthrights to discuss why,
despite wanting it, most women don’t receive true continuity of care
from a midwife they know and trust, and to look at ways to overcome
the obstacles that currently stand in the way of this kind of care.
A few meetings on, a single, clear, shared aim had emerged, one
that the group believe is the only way to deliver the woman-centred care
that women,
their babies and their families want, need and deserve:
We want every woman to have a midwife that she can get to know and
trust, who can support her through pregnancy, birth and beyond,
regardless of her
circumstances or where her baby is to be born.
Posted on 10 April 2013 | 4:37 pm
