NCT reveals crucial choice guarantee set to be missed by a mile

Over 95% of women in the UK are not able to choose where to give birth, a new report released today by the NCT (National Childbirth Trust) has found. Offering women choice of where to give birth is government policy across the UK as it is proven to have a positive effect on birth outcomes.

The NCT’s report, ‘Location, location, location’ highlights the benefits of choice to parents and calls for governments and health professionals to act quickly to ensure women have these choices available to them.

The ‘Location, location, location’ results show:

95.8% of women do not yet have access to a real choice between the three options of home birth with a midwife, a local midwifery facility (birth centre) either stand-alone or attached to a hospital and an obstetric unit in a hospital (the choices defined in Maternity Matters1)

89% of women live in areas that realistically do not offer the choice of a home birth with a midwife2

With greater encouragement of home birth, choice could be offered to many more women without any significant investment or shift in the way maternity services are structured.3

Over 40% of women live in areas without reasonable access to both a birth centre and an obstetric unit in a hospital

Women are lacking in the information and support needed to make these choices.3

The research for the report was commissioned in light of the Government’s Maternity Matters1 promise that all women in England will have access to choice of place of birth by the end of 2009. NCT wanted to ascertain how many women in the UK actually have access to choice. Scotland, Wales and Northern Ireland have also made similar policies that support the provision of choice for women.

Belinda Phipps, Chief Executive, NCT, says:

“There is a huge task ahead for trusts and boards as many are very behind in implementing this policy. For every ten pregnant women, nine are not able to choose where they want to give birth. We know across the UK, government policies support women with this choice. However, in reality this is not even close to being delivered yet.

“We want the governments to act now. Although in a few cases more investment in maternity services will be needed, with a simple re-thinking of the way their maternity services are delivered every trust and board can ensure choice is available to all women.

We know there are some financial policy obstacles hindering the achievement of choice the NHS could make much faster progress if it corrected these.

“There are a few trusts and boards in the UK that are succeeding in offering women a real choice and these successes are to be celebrated. We now need the rest of the UK to catch up.”

As part of the ‘Location, location, location’ campaign launched today, the NCT is calling for the commitment to guarantee choice of place of birth by the Department of Health to be implemented fully, and for the governments of Scotland, Wales and Northern Ireland to make a similar commitment to guarantee choice.

To achieve this local and national governments will need to:

Review the financial framework surrounding maternity services

Recognise the importance of midwives in reducing costs and delivering choice

Make sure that women are aware of the options and understand that for healthy women with a low-risk pregnancy, all three options are equally safe places to give birth

Ensure all in the maternity services work together and have sufficient training so they are experienced and comfortable in all three settings.

Make sure parents are provided with unbiased information to help them make their choice

Sarah Banks from Derby says:

“The first thing the midwife asked me was ‘which hospital do you want to go to?’  There was no discussion about other options and no mention of the birth centre nearby.  I told her that I wanted to have my baby at home and she refused to discuss it as she said it was too early and wouldn’t be advisable as it was my first baby.”

Both women and maternity services benefit from choice of place of birth being available. For women it leads to better birth outcomes, increased likelihood of straightforward births and improves their satisfaction with the birth. This in turn leads to higher self esteem and can increase parents’ confidence in being able to look after their baby.

For maternity services, offering these choices is likely to lead to reduced costs. Currently most women give birth in an obstetric unit in a hospital which is an expensive option3. With greater choice provided for women, more are likely to give birth in a birth centre or at home with a midwife. Therefore the effort necessary to deliver all three options will be outweighed by the savings made through less women giving birth in hospitals.

Note:

Please follow link to access: Location, Location, Location report

http://www.dodsmonitoring.com/downloads/PlaceofBirthFINALFORWEB%5B1%5D.pdf

Please ofllow link to access: Research report

http://www.dodsmonitoring.com/downloads/Investigation%20into%20choice%20of%20place%20of%20birth.pdf

Location, location, location’ details access to obstetric units, birth centres and home births in the UK and calculates the rate of women of childbearing age in each area with choice. See below for the results of the top and bottom five Trusts.

Local Authorities that offer the least choice

Local Authority	% of women of childbearing age who have choice
Middlesborough	0.0%
Boston	0.0%
Copeland	0.0%
Carlisle	0.0%
Coventry	0.0%

 

Local Authorities that offer the most choice

Local Authorities	% of women of childbearing age who have choice
South Cambridgeshire	100%
Southwark	100%
Cambridge	100%
Derbyshire Dales	91%
Bath and North East Somerset	91%

NHS Maternity Statistics, England: 2008/09

The new NHS maternity statistics for England 2008-9 were released today.

Belinda Phipps, Chief Executive, NCT, says;
“Again we have a release of figures that show the situation for women and babies is getting worse – high caesarean section rates, increased medical interventions, and fewer women giving birth in a place appropriate to them.

“This clearly demonstrates the effect of the lack of progress on Maternity Matters, the governments choice of place of birth promise, which was highlighted in the NCT’s  Location, location, location research report this week. Choice of place of birth leads to better birth outcomes for women, increased likelihood of a straightforward birth and improved satisfaction with the birth. “

Key Points

The caesarean rate has remained the same at 24.6%, with a rise in the numbers of elective caesareans (0.1%) and a decrease in the number of emergency caesareans (0.1%).  This shows a halt in the trend of increasing caesarean rates.
The instrumental delivery rate has increased by 0.1% to 12.2%, with a rise in the forceps rate from 5.0% to 5.5% and a decrease in the use of ventouse of 0.4%.  This continues the trend of increasing instrumental rates.
The induction rate is down 0.2% to 20.2%.  This reverses the recent upward trend.  Since 1999-2000 there had been an overall downward trend, with a low in 2005 but the rate has subsequently risen again.
Normal delivery rates are not available at the moment.  It is hoped the Information Centre will make these available in due course.

68.8% of women had a spontaneous onset of labour, similar to the previous year which was 68.6%.  [Note: this calculation uses a different source for caesarean as method of onset of labour, which is shown as 11%, rather than the 9.8% shown in Table 32, and does not reflect the rise of 0.1% in elective rates over the year]

62.9% of women had a spontaneous delivery, the same as from 2007-08.  This is at an all-time low.

	2006/07	2007/08	2008/09
Caesarean Rate	24.3%	24.6%	24.6%
Elective	9.5%	9.7%	9.8%
Emergency	14.7%	14.9%	14.8%
Instrumental Delivery Rate	11.5%	12.1%	12.2%
Forceps	4.5%	5.0%	5.5%
Ventouse	7.0%	7.0%	6.6%
Induction Rate	20.3%	20.4%	20.2%
Care on GP/Midwife Ward	10.6	11.7	10.8%
Normal Delivery Rate	n/a	n/a

 

Highs and Lows

There are 8 trusts/maternity units with caesarean rates above 30%:

 

Chelsea and Westminster Hospital	33.3%
Imperial College Healthcare NHS Trust (St Mary’s Paddington and Queen Charlotte’s)	33.1%
East Surrey Hospital	30.9%
Barnet Hospital	30.8%
University Hospital, Lewisham	30.6%
University College Hospital, London	30.6%
Royal Sussex County Hospital, Brighton	30.5%
Royal Free Hospital, Hampstead	30.4%

 

There are 5 trusts/maternity units with caesarean rates below 19%.

Kings Mill Hospital, Sutton-in-Ashfield, Notts	15.8%
Royal Shrewsbury Hospital	16.9%
Pontefract Hospital (part of Mid Yorkshire Hospitals NHS Trust)	17.8%
Barnsley Hospital	18.1%
Salford Royal Hospital	18.8%%

Midwife led care

Data for the current years show no increases in births in NHS midwifery facilities – 9.5% in the current year compared to 9.6% in 2007-08.  Care on consultant wards has increased from 44.7% to 48.8%.

Background – Since 1989-90, data have been collected on the place of delivery.  This uses the following categories:

1. NHS consultant ward
2. NHS GP ward
3. NHS combined consultant/GMP/midwife ward
4. NHS midwife ward/other ward or with delivery facilities associated with midwife ward or unit without delivery facilities

These categories are historical and do not necessarily represent current configurations of alongside birth centres, standalone birth centres, midwife led care beds in an obstetric.  Nonetheless, they can indicate changes in patterns of care.

Year	Total deliveries	Total with known place of delivery	Record completeness	Consultant Ward	Consultant / Midwife / GP Ward	GP ward	Midwife ward / Other ward	Total of midwife plus GP led care
2005-06	611,337	360,273	59%	49.4	41.5	1.6	7.4	9.0
2006-07	629,207	378,439	60%	45.9	43.5	2.3	8.3	10.6
2007-08	649,837	305,930	47%	44.7	43.6	2.1	9.6	11.7
2008-09	652,638	495,535	76%	48.8	40.4	1.3	9.5	10.8

 

This shows a decrease in GP/midwife led care in the previous year, and an increase consultant led care. However, record completeness is much higher than in previous years and changes may reflect a more representative sample than in previous years rather than changes in configurations.

Should dads be at the birth?

Leading obstetrician, Michel Odent, says the father’s presence at the birth can lead to his partner needing a caesarean delivery, marriage break-up or mental illness in this weekend’s Observer (18 October).

Michel Odent, a childbirth specialist, also believes the mother-to-be’s labour can be longer, more painful and more complicated because she senses his anxiety and becomes nervous. Next month, Odent will discuss his views at the Royal College of Midwives’ annual conference.

Mary Newburn, Head of Research and Information, NCT, says,

“The NCT believes it’s important that women in labour are given support throughout so they can feel calm, relaxed and reassured. For most women, this means they would like to have some sort of birth companion with them, whether it’s the father, doula, friend or all three.

“Many women feel that having their partner or father of the child present at the birth will enable them to feel calm, secure and supported during the birth.

“However, some women feel that having their partner at the birth will not lead to a calm atmosphere and would prefer them not to be present. Or some partners will not feel comfortable themselves in providing physical and emotional support during labour.

“So, if both parents agree, it can be great for women if their partners are present. For many fathers being present at the birth allows them the opportunity to bond with their new baby and to feel a part of the new baby’s life from the start. Otherwise mothers-to-be should talk about who they would like as their birth companion during labour.”

NCT response to BMJ cot death research

A report out today in the British Medical Journal (BMJ) regarding cot death has found that there is a possible link between cot death and socio-economic deprivation.

A team of researchers at the Bristol and Warwick universities studied all unexpected infant deaths – aged from birth to two years old. Of the 80 cot deaths analysed, more than half (54%) occurred while co-sleeping compared to one-fifth (20%) co-sleeping rate among both control groups. Much of this risk may be explained by the combination of parental alcohol or drug use prior to co-sleeping (31% compared with 3% random controls), and the high proportion of co-sleeping deaths on a sofa (17% compared with 1% random controls).

Quote

Rose Dodds, Senior Public Policy Officer says:

“While this study reaffirms the risks of falling asleep with a baby on a sofa, or if you have been drinking or taking drugs that affect arousal. The risks for babies whose parents had not drunk alcohol, taken drugs, fallen asleep on the sofa with their baby and did not smoke but who did sleep with their baby were not different from that for babies in a separate cot.

“However, it is not appropriate to tell all parents not to sleep with their babies. It is clear from many surveys that around half of parents sleep with their babies at some point in the first six months, and around a quarter do so routinely, so we need to help them to do this in the safest way possible. If we demonise the parents’ bed we may be in danger of the sofa being chosen. A better approach may be to warn parents of the specific circumstances that put babies at risk.

“Parents need to be advised never to put themselves in a situation where they might fall asleep with a young infant on a sofa and that they should never co-sleep with an infant if they have consumed alcohol or drugs.

“Mothers who breastfeed and bed share with their baby, are more likely to continue breastfeeding and there is good evidence that breastfeeding helps to protect against cot death.”

For the NCT position statement on co-sleeping, please visit http://www.nct.org.uk/press-office/position-statements/transitionparenthood

NCT response to Belfast health trust sending new mothers home early

The Belfast Health and Social Care Trust plans to send new mothers home between six and twelve hours after giving birth.

It is understood mothers would only be sent home early from the Royal Jubilee Hospital, Belfast, if their birth was straightforward. Plans by the Department of Health, Social Services and Public Safety to save money means every department within the Royal Victoria Hospital has to make cuts.

Chief Executive of NCT, National Childbirth Trust responds below.

Quote:

Belinda Phipps, Chief Executive, NCT – National Childbirth Trust, said;

“This news is very worrying for new mothers in Belfast, especially for first time parents. Support for parents should be responsive to the parents’ needs. Some women will be keen to go home as soon as possible after a straightforward birth. However many new mums feel they need support and assistance from midwives to help them cope with those first few hours or days to bond with their baby. Mums who do not choose to leave hospital so soon after the birth should be offered the chance to stay longer. No woman should be sent home before she feels ready.

“The savings made by such a proposal can prove a false economy, as the majority of costs in maternity units are fixed costs of the staff. Sending women home early will only have a minor impact on the trust’s budget. Women going home at this stage will need frequent midwife visits.

“As such, if these plans are to come into force, the trust needs to ensure that community services are functioning well and home visits are made by midwives and health visitors, so new mums are not left at home alone without support.

“If the Department of Health is looking to save money, they should consider increasing provision for home birth and midwife-led birth centres. Women at low risk of complications do not always need medical assistance in a hospital environment, and can benefit from a home or community birth setting.”

NCT response to Swansea University research relating to drugs in labour and breastfeeding

A study published in the British Journal of Obstetrics and Gynaecology suggests that there may be an association between drugs used during the third stage of labour and a reduction in breastfeeding at 48 hours after birth.*

This study suggests that injected synthetic oxytoxin alone or with ergometrine (e.g. Syntometrine), which is given to speed the delivery of the placenta and prevent haemorrhage after the birth, could also make breastfeeding more difficult. It is already known that pethidine and similar opioid drugs can have an impact on babies’ ability to start breastfeeding in the early days.

For more information about oxytocin, the third stage of labour or drugs that may be offered to women during labour, please visit the NCT info centre

Press Coverage 29th September – 3rd October

Eparenting. Return to work survey: http://www.eparenting.co.uk/news/national_survey_on_women_who_return_to_work_launched.shtml

Redhill Life. New birthing unit opens: http://www.redhillandreigatelife.co.uk/display.var.2455048.0.new_unit_opens_at_east_surrey_hospital.php

AllmediaScotland. Money raised for NCT mentioned: http://www.allmediascotland.com/allnewswire/3369/Five_Go_on_a_Highland_Adventure_%85_and_Come_Back_Veterans

Content Corner. Hypnosis for labour pain: http://www.thecontentcorner.com/Article/Hypnosis-for-Childbirth/138751

Swindon Gazette & Herald. NCT classes: http://www.gazetteandherald.co.uk/news/3714688.More_help_for_new_parents/

Fife Today. NCT classes: http://www.fifetoday.co.uk/herald/More-courses-will-help-mums.4551459.jp

Daily Echo, Southampton. Mothers turned away from labour ward due to high demand: http://www.dailyecho.co.uk/news/3724805.Baby_boom_/

Malvern Gazette. Breastfeeding group: http://events.malverngazette.co.uk/m6/disp.asp?i=150860

Press Coverage 22nd – 28th September

Worcester News. Toddler group: http://www.worcesternews.co.uk/news/3688599.More_on_offer_at_Evesham_toddler_group/

Redhill & Reigate Life. Nearly new sale: http://events.redhillandreigatelife.co.uk/disp.asp?i=163424

Wiltshire Gazette & Herald. Nearly new sale: http://events.gazetteandherald.co.uk/disp.asp?i=159807

Harrow Times. Nearly new sale: http://events.harrowtimes.co.uk/m6/disp.asp?i=166809

Salisbury Journal. Nearly new sale: http://www.thisissalisbury.co.uk/display.var.2453363.0.recycle_and_reuse_with_nct.php

Kenilworth Weekly News. Nearly new sale: http://www.kenilworthweeklynews.co.uk/news/Childrens-items.4526645.jp

West Sussex Gazette. Nearly new sale: http://www.westsussextoday.co.uk/whats-on/Sale-of-nearly-new-clothes.4531657.jp

Broxbourne.gov Baby show. NCT mentioned: http://www2.broxbourne.gov.uk/press/News1.aspx?PressID=6466

Coventry Telegraph. Doula training: http://cv5.coventrytelegraph.net/2008/09/doula-training-course-at-alles.html

Times Online. Working mums shouldn’t feel guilty: http://women.timesonline.co.uk/tol/life_and_style/women/families/article4830969.ece

EDP24. Choice for mums to be: http://new.edp24.co.uk/content/commentary/story.aspx?brand=EDPOnline&category=Commentary&tBrand=EDPOnline&tCategory=Commentary&itemid=NOED26%20Sep%202008%2008%3A47%3A29%3A547

Press Coverage 15th – 21st September

Community Newswire. NCT classes (Creating Confidence) : http://www.communitynewswire.press.net/article.jsp?id=5084816

Medical News Today. NCT classes (Creating Confidence): http://www.medicalnewstoday.com/articles/121145.php

Q103 Cambridge. Breastfeeding classes: http://www.q103.co.uk/Article.asp?id=889061

Eparenting. NCT classes: http://www.eparenting.co.uk/news/nct_to_increase_number_of_classes.shtml

Bounty. NCT classes: http://www.bounty.com/Parenting-class-numbers-set-to-increase-.news/18781712

Midirs. NCT classes: http://www.midirs.org/midirs/midweb1.nsf/Z45/CDAD86EAFFF4F5C7802574C7003749BB

Children and Young People Now. NCT classes: http://www.cypnow.co.uk/news/ByDiscipline/Health/login/846471/

Medilexicon. NCT classes: http://www.medilexicon.com/medicalnews.php?newsid=121145

Guardian. Penny Wade: http://www.guardian.co.uk/society/2008/sep/17/health.socialcare?gusrc=rss&feed=society

The Sun. Bisphenol A in plastics, NCT mentioned: http://rss.precise-media.co.uk/email/79391/40080631.pdf

The Advertiser. New exhibition on childbirth opens in Manchester: http://www.prestwichadvertiser.co.uk/entertainment/magazine/s/1066919_show_is_a_labour_of_love

Henley Standard. Fete raises money: http://www.henleystandard.co.uk/news/news.php?id=484352

Press Coverage 8th – 14th September

Chronicle Live. Baby worries – Tommy’s poll: http://www.chroniclelive.co.uk/lifestyle/your-health/2008/09/08/baby-worries-72703-21692900/

Red Orbit. Breastfeeding stats in Capital: http://www.redorbit.com/news/health/1546287/capital_babies_get_head_start_to_good_health/index.html?source=r_health

Banbury Guardian. Nearly new sale: http://www.banburyguardian.co.uk/news/Nearlynew-sale-.4466147.jp

Families Online. Mums the Word: http://www.familiesonline.co.uk/article/articleview/4057/1/229

The Scotsman. Wet nursing: http://news.scotsman.com/opinion/Wetnursing-is–a-valid.4468009.jp

Sunday Express. NCT nearly new sales mentioned: http://www.express.co.uk/money/view/60751

UK Parenting Lounge. Creating Confidence media drive: http://www.ukparentslounge.com/index.php?pg=189&utwkstoryid=1705&title=NCT+boosts+number+of+its+antenatal+courses&ind=0