Supporting families through changes in maternity care

Last month the Nursing and Midwifery Council (NMC) decided, what felt like overnight, to effectively ban independent midwives from practising. I won’t go into all of the reasons why this is problematic in this blog post (for a great summary see Birthrights’ post here), but I’m sure you can imagine how worrying and unsettling it would feel to be a pregnant woman who had been planning on utilising the services of an independent midwife. 

Women who were preparing to give birth at home, after establishing trust and rapport with their chosen midwife, were basically left stranded. When you learn more about the reasons behind this sudden change, the plot thickens and I think Milli Hill did a great job in getting her head around it all in her blog.
 
We can’t possibly know each woman’s reason behind choosing an independent midwife, but we can guess that some of these women may have had previous bad experiences within the NHS system. Some might be classed as “high risk” and relying on the care of an independent midwife to give themselves the best chance of a birth with no interventions, or choosing an expert in breech birth or twin birth to attend their labour. Some might have read the research about the benefits which continuity of care can bring. Whatever their reason, we know that thousands of women choose to have an independent midwife - a choice which has currently been abruptly taken away. The future of independent midwifery at the moment in the UK remains unclear and in the meantime, women are robbed of the security and safety they had put in place to ensure that they had a positive birth experience.
 
For me, this issue very much comes down to choice. Choice during labour is vitally important in the experience - perceived and actual - of birth for families.  It is choice which is further being eroded in the scrapping of the Supervisor of Midwives (SOM) role, a role which is set to end next month. You can read more about this issue here but essentially, there will no longer be a statutory SOM role. SOMs are experienced midwives who have undergone extra training and have years of experience in supporting women and families through pregnancy, labour, and birth, as well as supervising other midwives. At the moment, a woman wishing for care which is outside the normal guideline will usually speak to her SOM, and together they will work to put together an individualised care plan which best suits her needs. Very soon, this function will no longer exist as a statutory role. What will happen to families in those cases is now unclear.  As a doula, there have been many times when I have been able to connect my clients with SOMs which meant it was possible for women to find a solution which they didn’t know was available to them.
 
These two major changes have many of us worried about what happens when women lose choices and see no other way than to birth on their own, without a midwife there.  I realise that women don’t choose freebirthing just because of bad experiences in the NHS; it is often because they feel confident in their abilities and that birth is safe.  Again, this is their choice!  However, I would hate to think that a woman would be forced into this choice as she felt there were no other options available to her. No independent midwives and no SOMs that she could speak to about her specific needs and requirements.
 
At the moment, there is a lot of doubt and worry, but what is clear is that there are lots of changes in store for those working in and using maternity services, and these changes will have implications for us doulas who work hard to support and empower women in having the birth that is right for them. Where can we now signpost women when there are no longer truly independent midwives and soon, no SOMs?  How can we as doulas make sure women feel that they are free and have the right to choose what is right for them?
 
My gut feeling is that these changes are likely to make it harder for women to receive the individualised care that they so need, especially women in “out of guidelines” situations or those classified as “high risk”. In a system that is breaking the majority of midwives within it, there is little time or consideration for women centred care.  This will make the role of doulas more vital than ever before.  Supporting the families who choose us with that continuity of care which we know makes such a difference, and building up their confidence so that they feel empowered to ask for what they need and feel informed enough to make strong choices.  This has never been more important. It will mean that we need to ensure that we are up to date with the latest research in birth and maternity, and the possible implications of this for the women we work with. Doulas must stick to giving information that is evidenced based and really be clear with our clients that we do not give advice.  Communication with our clients will become even more important, so picking up that phone should always take priority over a text message or email.
 
As doulas it will also be more important than ever to help families in building a rapport with the teams who will be supporting them during labour, birth, and the postnatal period (for more on this topic see my blog post with tips for doulas to build team). This is especially true for women who might have been hoping for an independent midwife and who feel anxious about using the NHS, or for women who have additional needs within their labour plan. If we project a feeling of calm and trust, this will help those families who may understandably be feeling anxious. Equally, we must not be afraid to speak out if we see something which we are not comfortable with - even if this takes place as a letter after the birth so as not to cause distress to the family we are working with.

As doulas we can make a hugely positive difference to the experiences of families, especially during these turbulent times. Although we may feel anxious about what lies in store for maternity services, we must remember to practice self-care and work hard to remain positive for the families who will be looking to us for reassurance and comfort.