Memorandum by Lisa Cotton, Co-ordinator,
Southern Derbyshire Maternity User Group (MS 68)
The maternity services provided within Southern
Derbyshire are widely accepted to be excellent. We have hardworking
midwives and doctors who are dedicated to their jobs in difficult
circumstances. They are working under great pressure and are often
short staffed. Women who have fed into the Maternity User Group
since its start six years ago have heaped praise on the midwives
often recognising the difficult circumstances they work under.
The Derby City General Hospital is, however,
a medicalised teaching hospital. It has strict policies and procedures
to adhere to, and to deviate from these is often a battle, both
for midwives and women.
The Maternity User Group and Caesarean Group
have been established for approximately six years and has had
numerous women and their families input to meetings, information
giving days, questionnaires, suggestion boxes, research and focus
groups. As a group we liase closely with the Research Midwife,
Audit Department, Consultant Midwife and Head of Maternity Services
and input to various forums and committee meetings. There have
been a lot of opportunities, particularly over the past 12-18
months to input to various forums. The management and staff at
the hospital do not merely pay "lip-service" to the
group but actively seek out our opinions and views.
One of the main points that keeps being muted
by women is their wish to labour naturally, too much intervention
and pressure put on them to labour in a set length of time. Women
understand why policies and procedures are there, that the hospital's
main wish is for a healthy mother and baby but women often wish
that they "could have done it for themselves" and not
have had a caesarean/instrumental birth. I myself have had an
emergency caesarean birth, a forceps delivery and am, as I type,
being induced to have my third baby(!). After my difficult previous
births, I dearly wish to have a natural, active birth and to do
it for myself.
Recently at the hospital there have been moves
in the right direction. Midwives have been expressing their desire
to get back to midwife led care and trusting their instincts again,
as well as relying on machines. I was involved in the recruitment
of a new Consultant Midwife. This has been an enormous step. Helen,
the Consultant Midwife, has done a comprehensive report into what
needs to change in the department.
There are things that are already happening,
or starting to happen, for example:
— women being encouraged to have active
labour to reduce labour length and reduce intervention;
— birth balls in each labour room,
and posters on the wall giving details of active positions;
— promotion of physiological third
stage in normal delivery;
— more women being cared for by the
midwife rather than consultant led.
There is a plan to redesign the Maternity Department
when the Trust moves to one site over the next few years. The
User Group had an input into what the department, wards and clinics
will look like. Some of the ideas put forward were:
— more "homely" rooms with
equipment hidden in cupboards;
Although these things are positive and a step
in the right direction, much more is needed. The old fashioned
maternity homes are long gone and should remain so! However, a
more modern birth centre which is midwife led is required with
a philosophy which supports women who want to labour actively
without intervention, where the woman leads with support from
the midwife, a unit which encourages partners to support women.
To be blunt, in addition to the positive benefits to the women
and their families, it is much cheaper than for a woman to deliver
in hospital with all its additional costs. This will have a direct
benefit to the NHS in these expensive times.
If this shift was to occur for more women to
labour out of the sterile hospital environment who don't need
to be there the midwives and doctors who work in the hospital
environment can concentrate their specialties and skills on those
women who need to be there.
The midwives who support women in the units
can rebuild their own confidence in their own skills to the benefit
of the woman and baby.
As a final point, the technology and skills
of obstetricians is required for those women who need it, but
women have been delivering babies in their own homes and without
the need for expensive equipment for millions of years. If a woman
and baby need the technology and skills it is there, but women
need to be given the chance to labour for themselves using their
own bodies as the tool to deliver their own baby.
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