Sunday, April 08, 2007

NHS encouraging midwives rather than obstetricians because they are cheaper?

A full range of birthing choices, huh? If only one could simply giggle and chuck the glossy Maternity Matters document in the bin along with Patricia Hewitt. We know the NHS will never be able to provide every mother with her own named midwife to hold her hand throughout what James Naughtie hilariously referred to on the Today programme yesterday as her "confinement" (where do they find these male presenters born so many, many generations ago?).

We know it, because we know about NHS rotas and staff attitudes and the way the patients are made to fit around them. We know pregnant women are not all going to have their own midwife on call, unless that means call back after 9.30am and speak to the answerphone.

Yet we must do more than chuckle, for Maternity Matters is no joke. It is the next stage in a midwife-led campaign to limit the choice available to women giving birth. You only need to read the introduction to see this. "It also emphasises the need for all women to be supported and encouraged to have as normal a pregnancy and birth as possible," writes Ms Hewitt. Her junior "Minister for Care Services", Ivan Lewis, adds: "I believe individualised care offered by a midwife, specialist support provided to those most at risk and normal birth without medical intervention will become a more realistic option for every parent."

A "normal" birth . . . birth without medical intervention: why? Why should we? This is an extraordinary conspiracy against women, a sort of quasi-religious belief in the virtue of pain, which Ms Hewitt is bafflingly encouraging. The more that modern medicine offers, in terms of pain relief and convenience, the more urgent the insistence of this weird sorority that a woman has to give birth "naturally".

Again, why? We are no longer expected these days to die naturally, without the operation that would remove the cancer or the pain relief to help us on our way. We are not expected to have our hips fixed naturally. We are not even expected to endure a mild headache without a paracetamol. Yet somehow the deeply painful and, for some, traumatic experience of giving birth is forced upon woman after woman in the name of some Earth Mother concept.

As a woman interviewed on the radio yesterday said, the worst part of her otherwise excellent treatment on the labour ward was the moment when the midwife gave her "quite a lot of grief" because she chose to have an epidural. She only had the strength to insist upon it because her father, sister and husband were all doctors and she trusted their advice. These midwives trained to help women give birth are for some reason trained only to help them give birth naturally. They are the chief conspirators against us. Please, let us have fewer of them, not more, Ms Hewitt.

I remember when I told my very nice and until then helpful midwife that I was going to have a Caesarean (I, fortunately, had a choice). I might as well have said that after careful thought I had decided I would feed my baby heroin. When she had recovered sufficiently from the shock, Maureen, a large, broad-hipped woman and mother of about eight, suggested I might have been swayed by Posh Spice: "A lot of women want to follow their favourite celebrity." Then she asked whether I was doing it at my husband's request to keep myself perfect for him "down there". There was no way she was going to understand that for me a predictable, pain-free birth (yes, I wanted it in the diary; anything wrong with that?) with a surgeon I had met and trusted, accompanied by lots and lots of drugs, was my choice.

Too many women in their late thirties have too many horror stories of agonising labours followed by emergency Caesareans under general anaesthetic so that, after all that, they miss the actual birth. For the rest of their lives they must live with terrible scars from being slashed wildly across the stomach by the cack-handed doctor on call, and remember the first weeks of their child's life in only a blur of exhausted depression and trauma. Does maternity not "matter" for them, too? Ask a woman who has had a planned Caesarean: awake, calm, pain-free. And no risk of the "down there" issues that Maureen referred to, either.

Yet the whole thrust of government policy is towards making that - the best choice for many - less and less available. They are closing smaller consultant-led maternity units and encouraging women towards natural home births or midwife-led units (no Caesareans), while hoping to use the specialist consultant-led birth centres only for the few expecting complicated births; minimal medical intervention, maximum embrace of the "natural". Ouch!

Perhaps the most insidious effect of these official attitudes is the guilt they can engender in the poor woman who tries and feels she has "failed" to have a "normal" birth as eulogised by NHS midwifery and the equally messianic National Childbirth Trust, progenitors of so many doomed "birth plans". One writer in The Times has been describing the feelings of disappointment and failure she felt after an emergency Caesarean: "Right from the start I felt I had let [the baby, Charlotte] down, not to mention me and my family." So irritated were many "pull yourself together, girl" readers, that she felt compelled to respond, this time less traumatised, a year after the birth (you can see the whole debate on the Alphamummy blog): "In the months leading up to the birth of Charlotte, like any very excited first-time mum, I read lots of books and attended a `natural birthing yoga' class on a weekly basis. In all my teachings I was told over and over again that the best way is the natural drug-free way. I was told that drugs slowed down the labour and could affect the baby. Nowhere was I told the benefits of drugs. I was brainwashed into thinking that natural is right and drugs were wrong."

Quite. It is shocking that a feminist Secretary of State for Health in the 21st century should be colluding with the pious missionaries campaigning to keep women's birth experiences in the 19th. We are modern now. And we are not in the Third World. We do not need to get behind a bush and squat. Let those who want to go natural, choose natural. But let those who don't, choose drugs. Choose a Caesarean. Choose life - any way they want it.


NHS might not even be able to supply a midwife!

Fury at Hewitt's plan to water down promise of one-to-one midwife care for pregnant women

A government pledge to give every mother the right of one-to-one care from a midwife during labour has been watered down to allow hospitals to use lower-paid attendants with fewer skills. Midwives' leaders call the move 'scandalous', arguing that it will increase the risks for those women and babies not supported by a qualified midwife.

The policy shift will be in the government's maternity strategy, due to be announced by Health Secretary Patricia Hewitt this week. The government has come under increasing pressure over the state of maternity wards due to a recent spate of reports showing that standards in Britain are falling, with thousands of women not receiving good antenatal care or enough support during the birth. In its election manifesto in May 2005, Labour promised that by 2009 women would be cared for by a named midwife throughout pregnancy and would receive continuous care throughout the delivery. Instead they could now find themselves in the care of a maternity support worker, a new category of staff without a nursing or midwifery degree who may not be able to deliver a baby safely.

However, Health Minister Ivan Lewis is adamant they would not jeopardise safety. He told The Observer: 'By the end of 2009, we want to see trusts at least giving a commitment to the fact that a skilled professional is present throughout the birth. That could be a midwife or it could be a maternity support worker.' He defended the use of lower-skilled staff: 'What matters is that the mother feels confident that she is well cared for. There are many maternity support workers who are providing an excellent service.'

Lewis also criticised the 'rhetoric and scare-mongering' of recent media reports that have highlighted problems on maternity wards. 'A lot of the media reporting has been very irresponsible because it scares women. There have been two million births over the past three years, and 50 women died in that time due to obstetric complications that could have been dealt with better. One death is too many - but that number doesn't suggest a crisis in terms of safety.'

The Royal College of Midwives is furious that hospital trusts will be able to claim they offer continuous care during labour when they have replaced trained midwives with maternity care assistants, who are paid around 12,000 pounds a year and are not subject to the same regulation. They were originally introduced to help with lighter duties on maternity wards, such as feeding and washing, but many believe hospital trusts see them as a cheap workforce.

RCM adviser Sue Jacob said: 'This change has been quietly slipped in and is nothing short of scandalous. Do we really see childbirth as so unimportant that you de-skill the very people who will be delivering children? Women want nothing less than a midwife by their side when they are in labour. We know from all the research that's been done that continuous care from an experienced professional makes a huge difference to the safety of both the mother and the child.'

Belinda Phipps, chief executive of the National Childbirth Trust, said: 'We would like to see the gold standard being met, which is a qualified midwife being with a woman throughout labour. We know that 10 per cent of women are being left alone during labour, and they don't like it. It's just down to not having enough staff, and the financial situation in the NHS has made that worse.' Phipps pointed out that in Scotland the target of offering continuous care from a midwife is already being met. 'It has to be asked why the rest of the country can't achieve this goal, given that it is so very important for women when they go into labour,' she said.

Under the new strategy, called 'Maternity Matters', from 2009 women will also be offered a choice of whether to receive their antenatal care from a midwife or a GP. They will be able to choose whether to give birth at home, in a midwife-led unit or in a hospital.


Britain: Teacher dangers

The dangers resulting from indiscipline are played down below but the last paragraph lets the cat out of the bag

Teachers were awarded up to 25 million pounds in compensation last year for stress, accidents and violent attacks by parents and pupils. The highest award, of 330,000, was paid to a teacher in Birmingham who was assaulted by an intruder on school premises after hours. A female teacher in her thirties who was raped by a 12-year-old boy with severe learning difficulties received just 11,000. She was attacked in November 2004 while giving a one-to-one tutorial in English and IT at a special needs centre. The boy, who was sexually abused and is one of Britain's youngest convicted rapists, stole her car and crashed it 40 miles away.

The National Association of Schoolmasters and Union of Women Teachers (NASUWT) secured nearly 6.9 million in compensation. The Association of Teachers and Lecturers won nearly 6 million for its members. The National Union of Teachers estimated its overall compensation figure last year at up to 12 million. In 2005, NUT members were awarded 7 million, but these only involved cases pursued by the union's lawyers. Steve Sinnott, general secretary of the NUT, said: "The injuries and injustices suffered by teachers can destroy their careers. It is imperative that employers recognise the positions that they can put teachers into. Teachers have a right to be treated fairly and to be protected from the dangers that can be inherent in the job."

Most of the personal injury cases involved teachers slipping up on wet surfaces, tripping over furniture or suffering other accidents on school property. Several listed involved road accidents. A teacher who was beaten up by two parents at her school received compensation for criminal injuries. Some of the payouts were more controversial. A lesbian teacher in East London, who was dismissed by a Roman Catholic school after asking for paternity leave to assist at the birth of her partner's baby, won 20,000 in compensation. Another teacher in London received 3,000 for unfair dismissal and race discrimination, although the discrimination claim was "extremely weak", according to the NUT. Graham Clayton, the NUT's senior solicitor, said that the compensation it sought was always fair. However, when he was questioned over the award to the rape victim he said that the union was often unhappy with the awards by the Criminal Injuries Compensation Authority. "The criminal justice tariff scheme doesn't always produce justice that it should," he said.

At the National Association of Schoolmasters and Union of Women Teachers, lawyers secured 6,877,197 in compensation for members, which included 330,000 for the assault on the teacher in Birmingham. Chris Keates, general secretary of the NASUWT, said that there had been a steady increase in the number of claims. Stress was a major factor, but she admitted that the cases were often difficult to prove. "My greatest concern is the large amounts of public money being wasted, which could be avoided if schools had proper management issues in place," she said.

Last November the Education and Inspections Act gave schools a statutory right to impose discipline on pupils, ending decades of confusion about teachers' powers. Teachers can use physical restraint, confiscate mobile phones and march an unruly child out of a classroom. An amendment to the Violent Crime Reductions Act also enables them to search children for weapons.


A blunt British bishop

On Wednesday afternoon in Birmingham a young Muslim woman found herself in the wrong place at the wrong time. The doors of St Chad's Cathedral opened and hundreds of men surged out, their yellow robes flapping in the sunshine. She, in black robes, glanced back, alarmed, and broke into a run. She had better keep running. Last out was the Roman Catholic Archbishop of Birmingham, the Most Rev Vincent Nichols, agitator-in-chief and hot tip to be the Church's next leader in Britain. He had just blessed the priests of his diocese, urging them to fight a culture that he said was becoming "aggressively antireligious".

Name a controversy where politics and religion meet and invariably the Archbishop's name pops up. Faith schools? It was he who forced the Government to back down on admissions quotas. Gay adoption? His views made him the liberals' punchbag. So why, we asked as we met after the service, did he think that Britain had become so antireligious? He thought for a moment and his gentle Liverpudlian accent at first beguiled us to the strength of his opinions. It turns out that it is the Muslims' fault, because the unease the West has with them gives other faiths a bad name. "The acts of terrorism have shaken people's perception of the presence of faiths in this country and around the world and I just wish there was a bit more differentiation in the reflection about the role of faiths in society."

Some politicians jumbled all faiths into one. "Sometimes the anxieties that are expressed around faith schools are actually to do with Islamic schools. And when you press a politician they say, `Well of course we don't mean Catholic schools and we don't mean Church of England schools', but they still hesitate to move away from the umbrella phrase of faith schools. "Then there are others who relish this opportunity to say, with aggression, religious faith is a corruption of human nature and we would be better off without it."

The Archbishop thinks that Islamic schools must integrate into the state system. He explains with a provocative thesis on life in Britain today. "The deep roots of our contemporary secular culture lie in Christianity and there is, in Christianity, an instinctive understanding about the notion of the rights of the human person. "There is now a clear understanding that politically democracy is the best way of organising the use of power in this society. There is, devolved from Christianity, a notion of justice and courts, of the police and supervision of society, of hospitals and of education. "All of these things come, if you like, from the root of the Christian heritage of Europe and of this country. But Islam is a newcomer and therefore the whole process of welcoming and integrating and understanding needs to be far more explicit and far more open and far more measured. At the same time, society without its roots will lose some of those qualities."

Did he believe that Islam threatened those deep roots? "I think it remains to be seen." Phew! This bishop is not afraid of controversy, and in Birmingham, too, with its large Muslim population. "There are real signs, I believe, certainly through the central mosque [in Birmingham], of Islam trying to understand what it means to live out of an Islamic society and in a secular, multi-faith society. That is a long process."

Put in the context of the riots provoked when the Pope cited a Byzantine emperor's belief that Islam was evil, it is hard to gauge his intentions. Is he naive? Or braver than politicians who preach the benefits of multiculturalism without admitting its problems?

He is no stranger to politics. He was one of the bishops behind a Catholic preelection manifesto in 1996 that, with its emphasis on social justice and minimum wage, was interpreted as backing Tony Blair. So did Labour deliver? The Church had no political allegiance, the Archbishop said. But ". . . it seems to me it is very difficult to hold together an agenda which is based on a coalition of special interest groups. There is a need in political life to dig deeper and find the foundations, aspirations and values. My sense is that broad fundamental platform, with its moral values, had been neglected." That sounded like a "no" to us, but he had not finished. "To me, one of the most remarkable features of the last ten years is the number of new criminal offences that have been created. I read somewhere that we are talking over 700 new offences. Now that speaks to me of a moral vacuum. "If you're trying to replace some shared moral values, a sense of conscience is something that pulls us together. If you try to replace that with legislation, you run the risk of not building on a strong foundation."

He elegantly declined our invitation to back David Cameron, but suggested that the Tory leader might be on the right track. "Some of the Conservative Party's thinking about the family, about the responsibility of parents, about how we build a community and all the pressures that a family is under have to be responded to."

When he was a boy he wanted to be a long-distance lorry driver, but as a teenager he started to have private, unwanted, urges to become a priest. "I'd gone to watch Liverpool and stand on the Kop at Anfield, and say to God, `Why don't you just leave me alone? Why can't I just be one of a crowd?' " We asked if this gave him any insight into the isolation felt by teenagers wondering whether they were gay. He didn't take offence. "I think there must be some similarities, yeah." But he added that when he confided in a priest he was told that he had a choice. "It's my understanding that somebody who grows into an awareness of their sexual orientation doesn't have a choice," he said.

This idea of gay men being born not made is refreshingly modern, especially after he struggles through a tortuous defence of the Church's position on gay adoption: that if, in extraordinary circumstances, it is better for a child to be in a single-sex household, it would prefer the child to be brought up by a single parent, gay or not, rather than a gay couple.

He said that he had no regrets about the celibate life. Yet he sells God - and there is no other way of putting this - by making him hot. As he had told the congregation that day: "The Almightly awaits our `Yes' just as much as a young bridegroom awaits the yes of his bride . . . He longs to draw us to Himself." They should "be filled" by God, "with the recklessness of lovers". Steamy stuff. The Archbishop insists that faith should be physically passionate. "Why not? The crucifix is pretty physical, a physical expression of love. In that sense religion is not so abstract. It's maybe not physical in a genital way, but sex is more than intercourse, it's the whole thing that says we two belong to each other."

He worked with Cardinal Basil Hume for many years. "He was actually a very good politician. He knew when to keep quiet. I'm not always sure I've learnt that yet." Would he like to be Pope? He laughed. "No thank you!" Would he like to follow Cardinal Hume to become Archbishop of Westminster? "No thank you!" But what if he were asked? "That's a different question. I do what I'm asked." Heaven may not be stuffed with politicians, but Cardinal Hume, looking down, would be proud.


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