Protecting human rights in childbirth

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The Labour Party's midwife pledge: what does it mean and can it work?

The Labour Party launched its Health Manifesto today. The announcement it chose to promote? A guarantee of personalised one-to-one care from a midwife for every woman during labour.

Here are the details from the Labour Party’s blog (strangely, the Health Manifesto itself doesn’t set this out):

  • One-to-one care means that a woman in LabourPledgeestablished labour receives care from a designated midwife for the whole of that labour.
  • This means that a midwife will be able to care for mum 100 per cent of the time.
  • The one-to-one care will cover the labour, the birth and the period immediately after giving birth.
  • All the evidence shows this is the best way to improve the quality and safety of care for women and babies.
  • In fact NICE recently found that longer-term benefits of one-to-one may care include increased take-up of breastfeeding and a reduction in post-natal depression.

Currently, women giving birth in hospital may be attended by multiple midwives, depending on how long they are in labour. Shift changes are well-known to compromise women’s safety during childbirth and one-to-one care has repeatedly been shown to improve birth outcomes.

In February this year, NICE released its guideline on ‘Safe midwifery staffing for maternity settings’. It recommended one-to-one care for women in labour by a midwife, but it did not suggest that the women should receive care from the same midwife during labour.

The Labour pledge explicitly guarantees care in labour from a single designated midwife, so they have chosen to go further than the NICE recommendation. But they have not promised continuity of carer throughout pregnancy, labour and the post-natal period.

Milliband announced the pledge saying that he wanted every woman to receive ‘Call the Midwife’ style care. This is disingenuous: the wonder of the care provided by Jennifer Worth and the midwives of the 1950s was that the women received their antenatal care from the midwife who attended them in labour, giving them the chance to build a relationship over the course of pregnancy. If Labour’s pledge is honoured, women will not have met the midwife before their labour begins. While personalised one-to-one care during labour is certainly an improvement on the fractured care that women receive at present, the full benefits of personalised care will not be achieved by this election pledge.

Labour have suggested that the recruitment of 3,000 extra midwives will provide the staffing needed to make the pledge a reality. This might be optimistic. The RCM has said that there is currently a shortage of over 4,000 midwives and that’s without having to provide personalised support from a single midwife.

One-to-one support as envisioned by Labour would also have enormous consequences for shift patterns. There is no way for a hospital to guarantee that the same midwife would remain with a woman for her whole labour and maintain predictable shifts. Perhaps the only practical solution would be to introduce truly personalised care, so that midwives carried a caseload of women who they looked after during pregnancy and birth (as occurs now in Trusts that provide a dedicated home birth service).

It is not clear why the Labour Party did not promise real continuity of carer. It might well be more workable than the promise they chose to make instead.

Elizabeth Prochaska, Birthrights