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Mrs. Brooke: As we are talking about joined-up thinking, does the hon. Lady agree that more could be done in education through child care syllabuses? I was promised a change in a child care syllabus, but because of the recent 14-to-19 proposals, everything is on hold. In the interim, should not we encourage the Government to ensure that the real facts are put before young people?

Ms Drown: I should like more to be done in schools. Sometimes, it seems that schools feel that breastfeeding is embarrassing and do not talk about it, yet it is the most natural and wonderful thing and we should promote it. I should like to see more children's books promote breastfeeding. Often, we see pictures of a baby's bottle in children's books, but only rarely do we see a picture of a breastfeeding baby. I appeal to the publishers of children's books to do their bit to promote breastfeeding as the norm.

Breastfeeding rates in England are among the lowest in Europe; by the age of four months, only about 28 per cent. of babies are breastfed. We certainly need to do more and, through the strategy, I look forward to that.

I am pleased that the NSF focuses on a major issue that we considered in the Health Committee: women who are disadvantaged, whether because they are from ethnic minorities or because they have mental health problems or disabilities, or for other reasons. The Committee heard from a wheelchair-using mum, who had had to argue strongly simply to obtain a height-variable cot. That makes obvious sense, not only for wheelchair users but for everybody. Women are not all the same height.

Such cases often arise when we adapt for people with disabilities. Low-floor buses were introduced so that people in wheelchairs could get on to buses. Then we found that not only those people but everybody—people with buggies, people without buggies—could get on or off buses more quickly and easily, and the buses ran more efficiently. When we adapt services for people with disabilities, it is better not only for them but for everyone. Things such as height-variable cots are better for everyone.

The woman to whom I referred succeeded in her case with the health authority, but it was frustrating to realise that people in neighbouring health authorities would have to undertake similar campaigns and engage in the same debates to obtain height-variable cots because the service was not country-wide. Because the NSF emphasises the needs of disabled women, I hope that such arguments will no longer have to be made, that there will be no more going through the hoops and that change will be implemented quickly.
 
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The Health Committee considered issues relating to translators, who are key to meeting the needs of some people in maternity services. There is sometimes a tendency to rely on the partners of people for whom English is not their first language, which can be a bad idea, especially if domestic violence is involved. I hope that point will be highlighted under the framework. I am pleased that the NSF covered domestic violence, as it can start at pregnancy, so the more that we can address those needs, the better.

The hon. Member for Romsey referred to mental illness. We must ensure that we have enough mother and baby units as soon as possible. We should not separate mentally ill women from their babies; they should not have to choose between taking up mental health services and being separated from their babies and risking not having those services so that they can stay with their babies. That is not acceptable. We must provide those services for people throughout the country when they need them.

I want to emphasise my welcome for antenatal support, the importance of appropriate antenatal visits—the two visits that are required before the 12th week of pregnancy—and, in particular, the options for care. The hon. Member for Braintree drew attention to the fact that GPs were recognised as critical to decisions about where mothers give birth, but midwives are often involved in those decisions as well. I hope that we can ensure that all midwives have not just knowledge of all the different choices that women might have in giving birth locally, but experience of working, and continuing to work, in those different birth environments.

Sandra Gidley: Does the hon. Lady agree that, very often, doctors have not had a positive experience of childbirth? During their training, they are dragged into all the interesting births that are going slightly wrong. They rarely stay with a woman who is having a normal labour and delivery from beginning to end. They do not gain experience of that, whereas midwives are much more familiar with the concept of normal birth. Does she think that it would be a good idea to adapt medical training so that doctors have more idea about normality, rather than abnormality?

Ms Drown: Yes, I do. That is a key issue. There is an underlying feeling in the minds of many people who work in maternity services that a birth is best delivered in the most high-tech unit possible. The logic behind that is, if anything goes wrong, everything is available so that staff can dive in and help the woman and baby, yet the evidence does not support that view. Why? The reason is that, unlike almost all of what happens in the rest of the health service, giving birth is perfectly normal and healthy, so virtually no intervention is needed in most births. Psychology is important: if a woman is feeling more relaxed and in control, she is more likely to have a successful birth.

People talk about a cascade of interventions in maternity services. Women are in the main hospital and lots of things could happen, so an intervention is made because the means to do so are available. That intervention necessitates another intervention and so on, until someone ends up with a caesarean—a major
 
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operation. I am not suggesting that caesareans are not needed. They are absolutely necessary for many women and their babies, and they produce the best results for them. However, on average, too many caesareans take place in this country, so too many people are experiencing interventions. That is why I hope that the national service framework, which tries to emphasise normality and support women in their choices, will help lead to a reduction in such interventions. I would love all GPs to gain experience of home births, so that they can see how normal births work fine without interventions. As the hon. Lady suggests, if doctors gained such experience, it could help in developing maternity care.

I want to finish by referring to antenatal services. It is important that midwives give impartial advice and that they do not work for just one unit. Given that payment by results is being introduced, it could be very dangerous if the midwife who gives the advice works only for the unit that will receive a payment if the birth takes place there. Midwives should either work in all the units in an area or be separate from any unit that will receive money if women decide to give birth there.

I hope that midwives will be trained to give some legal advice, for example, about rights at work. The Union of Shop, Distributive and Allied Workers recently conducted a large survey of 1,200 pregnant women working in retail outlets, which found that 62 per cent. of mums-to-be reported experiencing a negative attitude towards them when they had reported that they were pregnant. I am delighted that 38 per cent. of women felt that their employers were helpful and supportive—well done those employers—but one in four women told USDAW that they felt marginalised and ignored and more than 22 per cent. did not receive paid time off to attend antenatal appointments. Clearly, that is a worry. One of USDAW's members said:

that should have been done—

Clearly, with things like that going on in this country, we need to give women the advice and support that they need when they are going through their pregnancies.

Dr. Pugh: The hon. Lady mentioned the legal profession. What is the extent to which many women's preference against natural birth is related to the medical establishment's fear of litigation? Has she discovered any evidence that people are more prone than before to avoid natural birth, or that doctors are less prone to offer it?

Ms Drown: When the Health Committee examined the matter, we found that there was a lot of anecdotal evidence—but no concrete evidence—to suggest that that might be the case. The more that we can counter the worry of litigation with evidence showing what is best for women, the better.

I welcome the national service framework and ask the Minister to intervene to ensure that the good aims of the policy are implemented on the ground. We need support through funds such as the modernisation fund so that units can change when possible. They should be released
 
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from their day-to-day activities so that they can find out how they can change for the benefit of women, babies and children throughout the country.

6.15 pm


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