Yesterday I read an article that said all pregnant woman would be paid £3,000 for having a home birth. Is that not bribery? There are many things that I would consider doing with the promise of £3,000 being dangled in front of me like the proverbial carrot.
Don’t get me wrong I am all for home births and I think that it should be an option that a woman can choose. The key word in that last sentence being choose. Handing over £3,000 to a woman who has a homebirth doesn’t speak of choice to me, it sounds like shoving her down the path of homebirth with a hefty £3,000 push.
Apparently the funds are part of an overhaul of the maternity services which is designed to urge women to have their babies at home instead of a hospital. Why are they so keen? Well, a major review has called for hospitals to improve safety in maternity units to reduce the needless mistakes that happen. The report makes for scary reading as it blames the ‘mafia’ of midwives who fail to get Drs involved even when a labour is going tragically wrong. Also figures from the Care Quality Commission illustrate that
half of all maternity units still fail to meet basic safety requirements. 41% were deemed as requiring improvement whilst 7% were labeled as inadequate.
This makes for extremely worrying reading so what is the government doing about it? What it does best. It’s not looking into how this can be fixed and it’s not looking into any long term soloutions. No, instead it is throwing money at the problem it, hoping that it will go away. It appears that how they are going to deal with the issues of unsafe maternity units is to have more home births. Makes perfect sense. Not.
If lots of expectant Mums “buy” into this scheme then what will happen to the maternity units? Some smaller maternity units may have to close and that means less choice for any future Mums. Rural hospitals may also see their maternity units closing. This is hardly making a better midwifery service. It just seems another poorly disguised attempt for the government to save money in the long term and in the short term shut-up the problem. But this isn’t a problem that can be shut-up, nor should it be shut-up,
after all we are talking about lives here.
The NHS watchdog NICE claims that homebirths are less dangerous than hospital births for second time Mums. I would like to know how they have worked this out. Critics have said that there is too little evidence to make comparisons. All I know is that if I had opted for a home birth then I may not be here today. You can read more about my experiences here
From next year the government will be launching pilots for the homebirth scheme and I will be very interested to see how this plays out. All I know is that I don’t agree with what Baroness Cumberlege said, in that it is “a driver for change, a driver for choice”. It’s not a choice when you are being bribed with £3,000 which any expectant Mother would find hard to turn down. I agree that our midwifery services need help and that they need support as they deal with an increasing population and older Mothers but I don’t agree that the way to do this is by forcing the issue of homebirths. The government isn’t supporting our midwives, they are burying them.
What do you think of the government’s plans?
I don’t think the maternity review is all about homebirths, the focus I thought was on continuity of care and choice. I think there are many complications such as where the money will come from and why the current system can’t be changed from within and yes I completely agree with your worry about smaller maternity led units…it would be a travesty if some of these core services were closed as a result. But I certainly didn’t read it as bribery or bribing people to give birth at home, but birth is a personal and emotive subject and I guess we come to it, as you have pointed out, with our own experiences behind us #bestandworst
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The article I read didn’t mention about continuity of care and choice so that is good to know. I just worry that they are not focussing enough on supporting midwives in the midwifery units or looking at how these services could be improved and the article I read did read like people would very much be encouraged to have a home birth and one of the reasons for that being that it is cheaper. However, the article obviously didn’t tell us the whole story. Thanks for your comment.
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Definitely…that’s my main worry as well (the existing midwifery care, which…and I love our midwives and volunteer on the ward, but there are too many things that don’t seem to work). To be honest I’m reading lots of conflicting angles on the review…some positive, some negative, some a mixture of both highlighting different concerns and different benefits. I feel a bit (a lot) confused about the whole thing! How it works in practise will be interesting (if it gets to that stage) and how people are helped to decide on how best to focus their choices will also be interesting. x
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Yes, I agree it will be really interesting to see how it works in practice. I am very confused about the whole thing too to be honest-argh! The only I do know is that our midwives and volunteers deserve more support because like you say there are a lot of things that don’t work.
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Oh I didn’t read it this way at all - I read it more that the ‘proposal’ is that pregnant women get a £3,000 ‘budget’ for their antenatal and birth care and that they can choose how best to spend it. To be honest, we already have plenty of choice over our care anyway, so I’m not sure why the monetary ‘budget’ comes from (if anything, surely that limits choice?). For example, what if a Mum decided to spend her ‘allowance’ on a birthing pool, but then after the birth needed some extra breastfeeding instruction/care. What if her £3,000 had been used up beforehand? Would she not be entitled to it?
I really don’t think it’s like you get ‘paid’ to have a home birth - the choice is there for Mums to be, but it’s not being monetarily incentivised. If anything, this sounds like the start of privatising healthcare to me.
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Yes, I think I read a very biased article that didn’t explain the bigger picture. But like you say I still think that the £3,000 allocation is a difficult one and one that makes me feel uncomfortable. I just feel that it doesn’t feel quite right and like you say heading towards privatising healthcare which I think would be a real shame.
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I thought you were being given £3,000 for your birth and then you could decide what you wanted - potentially increasing choice as many may opt for water or home births or specialist mother and baby units. The one thing I’m not sure about is what happens if there’s a difference of opinion between mother and doctor about what birth method is best. (Not everyone who wants a water birth can have one for medical reasons IIRC).
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Ahh really. So if you have to have a hospital birth do you still get the money? Or as I read it, you would only get the money if you didn’t have a hospital birth. I am so confused. I need to go away and find some more articles. I looked yesterday but could only find the one online.
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wow I think that is awful! I totally agree with you that it should be an option that women choose, but are not bribed into. I had a hospital birth with my daughter but am strongly considering a home birth if I have a second baby. I don’t know how I would feel about accepting money for it though!? It just seems so wrong to me! #BestandWorst
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Yes, I think I need to find out more about it but you have hit the nail on the head with the fact that it just seems wrong that they are offering money, especially when I am sure that money could be used elsewhere to improve general maternity care.
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I get the impression that some of these articles are based on a very quick skim of the press release rather than reading the recommendations and findings. Journalists should know better but outrage is a big draw for readers and clicks.
The full review is here:
https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf
and press release summarising the findings:
https://www.england.nhs.uk/2016/02/maternity-review-2/
Annex C covers the recommendation of a pilot of a national maternity care personal budget:
“Women should be able to choose the provider of their antenatal, intrapartum and postnatal care and be in control of exercising those choices through their own NHS Personal Maternity Care Budget. ”
The press release states:
“Every woman should develop a personalised care plan, with their midwife and other health professionals, which sets out her decision about her care reflecting her wider health needs
It also recommends trialling an NHS Personal Maternity Care Budget which would give women more control over their care, whether it is through an existing NHS trust or a fully accredited midwifery practice in the community”
It will take a while to go through it fully and for more detailed analysis to emerge about its recommendations and implications. For those interested in how much it may cost and what may happen to those savings there is an estimate in Chapter 6.
The report is an independent review and not by Government. As far as I can see there hasn’t been a Government response to the recommendations to indicate how much of it will be taken forward. Many of the recommendations are around culture, support, training and data capture which aren’t necessarily the domain of Government but of professionals in the health service.
I’m still working my way through it and doodling in the margins. I’m up to 27/126 so far!
#BloggerClubUK
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Thanks for this. When I was reading the article yesterday I was thinking this can’t just be it. I am concerned about how allocating the money will work and also what will happen to the smaller midwife units so this report will make for interesting reading and hopefully resolve some of those concerns. What you have said from the report sounds really promising, especially the part about the “personalised care plan” as I think at the moment that this can often feel like it isn’t the case. I guess this would also provide consistency of care, with getting the same midwife? Would be interested to know your thoughts once you have finished reading it! Thanks for your comment and the info :-)
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One of the recommendations is exactly on continuity of care bolstered by electronic maternity records so details can be shared across hospital rather than painstakingly having to be transcribed into a new template and other such nonsense! Have a look at the press release to get a feel for the other recommendations. There are definitely questions on funding assumptions and whether they will work but I worry the good stuff is being ignored in knee jerk reactions. I’ll keep an eye on the midwife blogs for their take.
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Well that is good about the continuity of care bolstered by electronic records, it is crazy when you think that this isn’t the case already! I will have a look at the press release, thanks. It will be interesting to see how the midwife blogs react to this too and to get an insiders perspective. Like you say there are lots of positives to be taken from this and I am feeling more reassured after your comments. Thanks.
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I’ve considered a home birth for my second, as my first was ok. However, for so many women this isn’t an option! That 3 grand per woman should be being used to train and support more midwives and improve the standard of maternity care! I think a bit crazy! Thanks for sharing with #bestandworst x
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Thanks for your comment :-) x
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I actually tried for a home birth first time round, I wanted it so much I went 16 days over so I didnt need to get induced. It didnt work I ended up in anyway because I stopped at 7cm. Although the time I did spend at home was very rewarding and to be honest better than being in hospital when it became medicalised very quickly. This time round I have no options, in fact I have very few options in general what will be will be all I do know is that it will be hospital. If I wasn’t high risk then I would definitely consider a home birth again but not because of the £3k but because personally its my choice. I agree the government should be increasing options not limiting them and I can only see that scheme doing just that! Thank you for joining us at #BloggerClubUK hope to see you again next week. x
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Thanks for your comment. I would have given anything for a home birth, would be amazing as like you say it feels less medicalized. I would imagine that you feel much more comfortable and that can only be good for baby. I think what the government is trying to do is good in theory I just worry about the midwife units that are crying out for funding and additional training. What will happen to them?
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