6. Conclusion
198. While the work of the Confidential Enquiries
into Maternal Deaths has drawn attention to the vulnerability
of women from disadvantaged groups to the severest complications
in pregnancy and childbirth, the extent to which women and families
from these groups suffer through lack of access to appropriate
maternity care, has not fully been assessed.
199. A great many of those who contributed to our
inquiry pointed out that an attempt to tackle this very issue
was made 10 years ago. The RCOG reiterated the recommendation
by Changing Childbirth that regular monitoring of uptake
of maternity care should be carried out to identify those women
not seeking care or taking advantage of the services available
so that a strategy for improving access could be developed. In
relation to the work undertaken by Changing Childbirth
on access to maternity services, the RCOG asserted that "had
these recommendations been implemented then it may not have been
necessary to re-visit the issues of access to care again now."[178]
200. We are aware that maternity services in some
areas have striven to make contact with women from groups and
communities for whom access to maternity care is problematic,
and to cater to their needs. Lesley Spires from Queen Charlotte's
and Chelsea Hospital summed up the strategy deployed by maternity
services to tackle inequalities in access to care by means of
identifying needs and forming connections with communities and
their existing support structures:
It is important to understand the groups that we
are providing the service for. That is about networking with organisations
that serve those groups … and to network with the leaders
of that particular society so that you understand their needs
and you are not making assumptions about what you think they need,
because that can be hugely different from what we presume. Each
group has different priorities and different needs.[179]
201. Service providers such as those at Queen Charlotte's
and Chelsea Hospital have found that the best way to make and
maintain contact with women from disadvantaged groups is to reach
out to them in their own communities, and to develop trust and
understanding by providing continuity of care and carer throughout
pregnancy and the postnatal period.
202. There is strong evidence, however, that such
good practice in providing services which are sensitive and responsive
to the particular needs of different groups, is not widespread.
In the context of maternity services for women with disabilities,
the NCT told us that there is often a tendency in a medicalised
system for women with additional needs to be treated as 'high-risk'.
This is true for women from all disadvantaged groups, particularly
if they first make contact with maternity services at a late stage
in their pregnancies and/or they are unable to understand information
given by maternity care staff, or to make themselves understood.
These women are more likely to undergo monitoring and even medical
interventions, which may not be wanted or needed. We endorse the
view of the NCT that women should feel that they are in control
of their own bodies and of decisions about their care, or able
to choose when and to whom to delegate some of that responsibility.[180]
203. The evidence we have heard during this inquiry
suggests that many disadvantaged women do not have this sense
of control. In some cases disadvantaged women feel that owing
to their particular circumstances or status, maternity and social
services focus exclusively on the health of their babies, to the
detriment of their experience of pregnancy and birth. Women may
feel that they are given access to support for smoking cessation
or breastfeeding, that they are given attention, purely for the
benefit of their babies. Women with disabilities may feel that
services pay attention to them, because they see their unborn
babies or new infants as children at risk. In fulfilling a wider
public health role maternity services must retain the goal of
providing women-centred care.
204. It may be that for disadvantaged women a lack
of control over the care that they receive, and a lack of awareness
about their choices, constitute a barrier to access to appropriate
maternity care. The DPN told us that :
Women with disabilities are not always given the
same choices as other parents, for example, decisions about the
type of birth or anaesthesia and mode of delivery are taken by
professionals without adequate discussion with the woman or her
partner. Informed choice is often not an option for women with
disabilities due to assumptions and decisions made by professionals.[181]
205. All that we have heard about the relationship
between the ability (or lack thereof) to make choices and decisions
about aspects of maternity care, and access to appropriate care,
will inform our work as we go on to examine choice in maternity
services.
206. We have seen excellent examples of good practice
in maternity services across the country. The biggest frustration
for the Committee has been in hearing reports that this best practice
is not shared across the NHS. The Department must find ways of
saving maternity services the wasted effort of 'reinventing the
wheel' on each of these issues. Methods must be found to ensure
that best practice can be shared across the country.
178 Ev 57; Department of
Health, Changing Childbirth: report of the Expert Maternity
Group, 1993 Back
179
Q 102 Back
180
Ev 76 Back
181
www.disabledparentsnetwork.org.uk/latest.htm Back
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