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Health: Maternity Services

Volume 703: debated on Wednesday 16 July 2008

asked Her Majesty’s Government:

What is their response to the recent report by the Healthcare Commission on maternity services, Towards Better Births.

My Lords, we welcome the Healthcare Commission’s report, which acknowledges that the majority of women have a positive experience of pregnancy and childbirth. However, we cannot be complacent. Women tell us that they want more choice in their maternity care. That is why, to make that happen, among other things, we announced in January an additional £330 million of funding for maternity care, and in February action to recruit an additional 4,000 midwives by 2012.

My Lords, I thank the Minister for that Answer, but will she reassure me that the Government’s intention to guarantee all women a choice of where to give birth will not mean that women with high-risk pregnancies can choose a home birth? Does she agree that it is unacceptable for women to feel pressurised into considering a home birth, as the Healthcare Commission reported last week, particularly if home birth is regarded as a default choice by women who are worried about understaffed or badly equipped labour wards but who might then expose themselves and their babies to danger should they need the emergency transfer service, which itself might be underfunded and unable to cope?

My Lords, we want to ensure that women have as many choices as possible, and minimise the risks to themselves and their babies. Current evidence supports the fact that when healthy women are offered the option of home birth, there is every indication of success. However, the noble Baroness is correct: it is not, as she put it, a default position. The key to ensuring a safe childbirth is an early assessment of the mother’s and baby’s needs. We are trying to ensure that PCTs will be judged on whether they can increase the number of women who access maternity care by the twelfth week of pregnancy. This early access enables a healthcare professional to assess the mother’s and baby’s needs and, indeed, whether the pregnancy is high-risk. At that stage the mother will be advised about the risks of a home birth. Clearly, part of this equation is that, when things go wrong, PCTs need to have planned the right response to ensure the safety of mother and baby.

My Lords, the Minister will recall the extremely good report Maternity Matters, which listed all that should be done in maternity services, and said that these would be implemented by 2009. Why, then, were there fewer training places for midwives this year than in the three previous years? Why are there not enough jobs in the National Health Service now for qualified midwives to take up?

My Lords, I think we would agree that it is essential that staff providing maternity care are properly trained. We are committed to increasing the number of midwives, and the number of training places has increased by 20 per cent in recent years. We are pushing midwives through that supply chain into those jobs. It is the duty of PCTs to recruit midwives at the right level to provide the right services.

My Lords, have the Government also made a commitment to providing enough bathrooms and bedrooms? The report identified that some hospitals have an inadequate number of both.

My Lords, the report drew attention to this. We are investing £162 million a year in maternity services, and the £330 million I mentioned is in addition to that. There is no excuse for that extra cash not supporting the implementation of Maternity Matters and the modernisation of options for place of birth. We have examples of where the money is being well spent to improve facilities, but clearly there is more work to be done.

My Lords, following the point made by the noble Baroness, Lady Tonge, about student midwives, I was interested to hear the Minister say that she believed there were more student places. That does not coincide with the reply given to one of her honourable friends in the House of Commons, according to the Royal College of Midwives, which states clearly that the number of training places fell last year compared to the previous years. Does the Minister agree that what is critical is not more government policy but implementing present policy and matching the increase in the number of births, which rose by 90,000 in the past six years, with the number of training places? How does the Minister propose to attract students to become potential midwives?

My Lords, we have more midwives than ever before working in the National Health Service. We are committed to training and ensuring that more midwives are recruited, in recognition of the rising birth rate. SHAs are taking a number of actions, such as implementing “return to practice” programmes and providing flexible retirement schemes. We are encouraging more midwives to stay in the workforce and providing support workers’ programmes. I will check the statistics and get back to the noble Baroness, as I was not aware of the one that she mentioned. My brief says that the number of student places is increasing.

My Lords, can the Minister explain what action the Government can take, given that 32 per cent of trusts fail to meet the standard of having a consultant on the labour ward—indeed, there is a national shortfall of consultants—and that 83 per cent of them do not have in place neonatal resuscitation training for midwives and obstetric staff? I declare an interest as I have been asked by both Royal Colleges to chair a working party to look at the learning environment.

My Lords, the noble Baroness points to some important issues. The new RCOG Standards for Maternity Care published last week covers many of these issues and includes standards for obstetrician staffing and consultant presence on maternity wards. It provides that all obstetric units must have a lead obstetrician and a labour ward manager, as well as a minimum of 40 hours’ consultation presence, with 60 hours in larger units. At least twice a day, and during the weekend and bank holidays, there should be a physical round made by the consultant. We are pursuing that standard with great energy.

My Lords, as a happy grandfather, I am very grateful to the NHS at University College, London, where my grandson was born recently. Does my noble friend not agree that the terms “high risk” and “home delivery” together are something of an anathema to obstetricians and that there is a high risk of birth asphyxia, about which we are most concerned, which is quite unpredictable in some home births in high-risk cases? Does she agree that encouraging the wrong patients into that birth scenario is extremely unwise?

My Lords, my noble friend is absolutely right, and his question reflects the aim of the original Question.

My Lords, the report said that recommendations were not adequately adhered to for antenatal care and that women experienced poor communication, care and support after their babies were born. What do the Government have in mind to address those two points?

My Lords, we are aware that sometimes mothers may have had an excellent experience during the birth but find that the postnatal care does not match up to it. That is why we commissioned NICE to undertake work on developing clinical guidelines for routine postnatal care as part of a series of guidelines related to maternity care. As ever, the key is getting the NICE recommendations implemented at the local level.