What women want
Was the transient publicity from the announcement about maternity care promises & home births worth the daily debunking it receives?
From the leader in the Guardian:
Eye-catching initiatives that turn out to be rather less than they appear at first are a stock in trade of election campaigns. So only the wildest optimist would be taken aback by the discovery that the promise earlier this week from the health secretary, Patricia Hewitt, to guarantee every expectant mother the option of a home birth by 2009 - a pledge first made in the 2005 Labour manifesto - is deeply flawed.
And, from new research, we also learn that the assumption that choice is the first priority for mothers is wrong. In fact what they want, wherever they give birth, is quality care at the time and extended support afterwards.
The same could be said for every other patient group. Get the basics of safe & effective care right first. Spout nonsense about choice later.
Being a good mother is overwhelmingly more important that having a home birth that might expose the baby to risk. This is a subject that is too important to too many people to be the subject of an electoral gambit.
The Guardian keeps at the maternity story-line with data suggesting that Patricia Hewitt’s “home births” promise is unattainable.
Six out of nine English regions have too few midwives to achieve even the basic level of care for families before, during and after the birth of a child, figures obtained by the Guardian reveal.
The chronic shortage of midwives means that the government’s promise this week to offer all women a choice of a home, hospital, or midwife-led birth by 2009 cannot be met.
The Guardian obtained annual figures for the number of births each midwife has to deal with from detection of pregnancy to postnatal care. The statistics for England in 2005 were calculated from NHS data on the number of midwifery posts and Office for National Statistics numbers for births. The RCM says the maximum should be 28 births to a midwife in a year.
Actual ratios range from 1:38 in the east, to 1:15 in Yorkshire and the Humber. Of the nine English regions, only the north-east, north-west, and Yorkshire and the Humber achieve the RCM’s targets.
Officials at the RCM who have seen more detailed government figures say that in the worst areas midwives are having to care for up to 42 women a year.
The National Childbirth Trust lists 15 threatened or closed midwife-led birthing centres in England and four in Scotland. The centres are the cornerstone to the government’s promise of broadening choice but are also the most staff intensive.
This late in the media cycle, they should really have known better than to punt out an empty headline.
I am not sure that I would be comfortable with the lack of monitoring, though lets face it babies have been coming out for millions of years without them. But we were prepared to let those babies die earlier. Now we are not & every little advance is hard won.
Epidurals and other forms of painkilling are frowned on and rarely administered at hospital births. At home, because of the lack of equipment to monitor the effect on a baby’s heartbeat, they are not allowed. Instead, hot water and breathing exercises are all a woman has to depend on.
“We consider the pain to be essential to ensure that the birth process is normal,” Ms Smulders says. She speaks enthusiastically of the “orgasm of birth” - the final rush of hormones that the woman feels as she gives the often excruciating final push, which an epidural would destroy.
Not to mention the tolerance to pain required.
And in the BBC, cancer care comes under the spotlight:
A senior cancer specialist has told the BBC he is giving patients unnecessary treatments to manipulate radiotherapy waiting lists. The government requires treatment to begin within 31 days of diagnosis.
But Chris Hamilton of Hull’s Princess Royal Hospital says that means some low-risk patients are being treated before more urgent cases.
He said: “You’re caught in a bind. Either you give them unnecessary treatment with hormones and reclassify them or you put them to the front of the queue where they shouldn’t really be.”
Mr Hamilton said he knew other hospitals were doing this and had informed Mike Richards, the national cancer director, about the practice.
A recent survey by the Royal College of Radiologists found that over half of cancer patients were waiting longer than the four week maximum wait it recommended for post operative radiotherapy.
It doesn’t help that some of the hospitals are rather dysfunctional and under so much pressure that targets take on added significance in the eyes of management.
The Daily Mail weighs in too.
Dr Grumble keeps up the pressure on MMC:
MMC has been criticised in terms of its hasty introduction, lack of adequate consultation, lack of a proper educational pilot, poor administration, the non-training grade issue and, of course, the disaster that is the application procedure, MTAS. However, the real ‘elephant in the room’, it seems to me, is the educational value of the programme. I am not at all sure who has been the educational advisor, or advisors, on the MMC project, but I question their educational understanding. The behaviorist principles on which it seems to have been founded have been discredited for many years now.