National Maternity Review: Explained

Pregnant mothers to be given £3,000 to spend on having a baby – sounds too good to be true, doesn’t it?

Not necessarily as the NHS in England is to trial a scheme later this year which will do just that.  If all goes to plan it will be rolled out nationally in 2017.

The money won’t, however, go to pregnant women directly, but they will be able to choose how their ‘personal budget’ is spent – using it on a home-birth, a private midwife or extra breastfeeding support, for example.   They’ll be able to access care from a wide range of NHS accredited providers, but before you get too excited, mums-to-be won’t be able to use it on things like massages, acupuncture or aromatherapy.  And crucially, anyone needing urgent care would still get it, regardless of whether their personal budget had already been spent.

The idea is to give women more control and allow more continuity of care, which is the thing expectant mothers say they most want.  Experts say having the same midwife or midwifery team before, during and after birth would not only improve respect and trust, it would also make childbirth safer.

This new scheme comes off the back of an independent review into NHS maternity services, led by Baroness Julia Cumberlege, whose vision is to create a world class system by “putting the woman, baby and her family at the very centre of care…. she makes the decisions, she decides what really matters to her and it’s up to the NHS to wrap the care around her,” she said.

To achieve this, the review recommends that, in addition to having the option of using the Personal Maternity Care Budget, every woman should have a midwife who is part of a small community team. These midwives should help expectant mothers develop a personalised care plan which sets out decisions and is based on unbiased information which can be easily accessed online.  Currently, around 90% of women give birth in hospital even though only one in four say they want to and the review concluded that it should no longer be assumed that hospital care is the preferred option.

There are also calls to fund more mental health provision to help the one in five mothers who suffer problems during pregnancy or in the first year after childbirth and for better funding of postnatal care with women across the country saying they found the current provision to be ‘inadequate.’ Many said they felt ‘abandoned’ after the birth and as a consequence 90% stopped breastfeeding before they wanted to.

Of course, none of this can be achieved without changes to the way midwives, obstetricians and other health care professionals work and the review says barriers need to be “broken down” and services “joined up”.    The Chief Executive of The Royal College of Midwives, Cathy Warwick said she was “delighted” that women were to be given more control, but stressed that “there would be big challenges for midwives as the recommendations are implemented,” adding, “maternity services need to be well staffed if continuity of care is to become a reality.”  There are currently 29,900 midwives working in the NHS but the RCM says 2,600 more are needed.

Whilst the recommendations have been widely welcomed, concerns have been voiced by some including the Birth Trauma Association who warn that putting a price on care could push women into using cheaper options such as homebirth, rather than doing what’s right for them.  The National Childbirth Trust, however, disputes this claiming the opposite to be true, “it’s about enabling women to have a pathway of care that doesn’t take them into hospital and will actually make it easier for women to give birth at home or in a midwife-led unit, but only if they want to.”  They accept that these forms of care are cheaper, but say that the money saved can be channelled into areas of greater need.

The funding of this scheme is of course a big issue and one that is yet to be fully ironed out.  Only time will tell whether these recommendations can be adequately implemented in a system that is already under pressure from increasing birth rates and more complex births.


Author: Rhiane Kirkby.