This policy statement is intended to apply to all parts of the UK. The SHA wants adequate NHS, fully funded, woman-centred maternity care, for all women and their family/support networks, from pre-conception to 6 weeks after birth and beyond. Care needs to focus on long term outcomes. It needs to avoid the ‘business’ approach that concentrates on short term targets. The first 1000 days of life are crucial for the long term health and wellbeing of families and society in general. To achieve this, the following is necessary:
Overall principles
- To address maternal and child poverty to improve outcomes and to relieve stress related damage, with good nutrition accessible to all, before, during and after pregnancy.
- The voice of the woman should be heard and listened to at all stages of planning and evaluation of maternity services.
- There should be high quality physical and mental health care appropriate in a diverse society.
- Pre-conception care must be available to all to achieve the healthiest pregnancy possible. It should cover harmful factors in the wider and personal environment, such as air and industrial pollution, tobacco, alcohol and substance misuse and domestic abuse.
Specific stages of care
- Antenatal care and education should be accessible to women from all backgrounds and cultures.
- All care should aim for a safe and positive birth experience. Women should have a real choice of place of birth (home, midwifery or obstetric unit) having been fully informed about how these will meet their individual medical and personal needs. To achieve this home birth should be backed up when there is an emergency with adequate pre hospital care (provided by community-based midwives and paramedics specifically educated on maternity care). Such pre hospital care should enable safe, timely and appropriate transfer to hospital obstetric and neonatal paediatric services. Midwife –led units should be available to women, and hospital based care should allow women’s decisions to be respected.
- Continuity of care from midwives (and other relevant health care professionals) is crucial. All women should have a named midwife, who works as part of a community-based team of midwives, and who coordinates care with others, such as obstetricians, as necessary. Ideally there should be continuity of carer throughout the antenatal, intrapartum and postnatal periods. All women should have one to one care during established labour.
- Women and their families should be supported emotionally and physically in the early days after birth. There needs to be adequate and realistic help with breast feeding, including midwifery, health visitor and peer support. Community based psychiatric services need to be available to support women as needed, as well as sufficient mother and baby in patient psychiatric provision.
- There should be full funding of neonatal special and intensive (levels 2 and 3) care.
Staffing
- More staff should be recruited to end the use of agency staff. This includes keeping staff from EU countries and making them very welcome. NHS staff should be actively supported and valued in order to relieve work-related stress and burnout and prevent attrition, so that in turn they are able to give the best quality care. The culture of risk, fear and blame should be resolved.
Research and education
- Funding for research into maternity care, preterm birth, still birth, neonatal and perinatal mortality and birth injuries should be increased.
- Investment is required in the education of healthcare professional students involved in maternity care. These students should receive non means tested NHS bursaries while being educated. Where appropriate there should be joint education between students such as midwives, paramedics and doctors (potential future GPs and obstetricians) both before and after qualification.