I remember everything about my midwife - her name, her face, the things she told me. She saw me at my GP's practice throughout my pregnancy and visited every day for 10 days after I returned home with my new daughter. She made my first days with my first born a joy.
That was eight years ago and the midwife has moved on. Three weeks ago, I gave birth to twins in the same London teaching hospital, under the same practice. But this second tale of maternity care is not so happy. In less than a decade, the service I took for granted for my first born had collapsed. There is a severe shortage of midwives; two out of three maternity units are understaffed and London hospitals in particular have problems with recruitment.
Last week, a survey of 2,000 recent mothers by the online magazine Mother & Baby revealed that most were dissatisfied with the care they received, less than half would be happy to return to the same hospital due to lack of support, and half said they received poor post-natal care at home. Only 4% had the same midwife for antenatal appointments and the birth. "Chronically overstretched maternity staff simply don't have the time to provide the sort of quality care pregnant women expect," says Sarah Stone, editor of Mother & Baby. "Many women feel as if they have gone through a conveyor-belt birth experience."
My experience in the labour ward was exemplary. But the moment I was wheeled out of the delivery room and into the packed post-natal ward, it was as if I was being taken from a place where I was the centre of attention to a place where I had to be processed and moved on. The conveyor belt had begun to roll.
It began with my inability to get breakfast. I had been in the ward for less than two hours and my legs were still dead from the epidural. I was awake (I had no choice - the fluorescent lights were on and the curtains around my bed drawn back) and very, very hungry. I had not eaten since breakfast the previous day.
Breakfast was self-service. I watched as the trolley of catering- sized cereal boxes, sliced white bread and mini packets of Flora was wheeled up the centre of the ward. Legless, I called out from my metal-barred bed, "Can I have some cornflakes please?" My cries were drowned out by the baby opposite, who had an infection which wouldn't let him (or us) sleep. The trolley wheeled on past. My thirst was terrible. When a cleaner with a giant mop started wiping under my bed, I asked her if she could kindly get me some water. She took the empty plastic jug from my bedside cabinet, and trotted off to fill it. I never saw her or the jug again.
I was later told it was all to do with the shift change, which coincided with breakfast in the morning and a busy visiting time in the evening. I learned to dread the shift change. If both babies started crying uncontrollably, if I developed a raging thirst while trying to breastfeed, if I needed to go to the toilet, and it happened to coincide with the shift change, then there was no help at hand. The midwives were swapping notes about us somewhere but could not be found on the ward.
The continual change of staff was confusing. When one of my babies wouldn't breastfeed, I was told to feed him from a cup. The next day, a different midwife recommended a bottle or he would lose too much weight. The next day, another midwife said if I gave him a bottle he would never take the breast, so I had to starve him into submission. The following day, that decision was overturned by the next change of staff.
Midwives themselves are not to blame (80% of those surveyed found them "sympathetic and kind"). They are given an unenviable number of roles to play in the postnatal ward. As well as carrying out rigorous medical checks of mother and child, they are expected to inform and educate.
During my three days in hospital, I accumulated no less than six copies of the same full-colour glossy brochure on breastfeeding. Midwives are instructed to promote this method of feeding above all others. The only problem was, through no choice of my own, one of the twins was being bottlefed. It wasn't until two weeks later, when the health visitor (a former midwife who left because of the horrendous hours) came to my home, that I received my first bottle-feeding brochure.
In black and white, it looked like something from the 50s, dated and unattractive. Yet it contained vital information on sterilisation of feeding equipment - information that I should have surely received far earlier. And not only me; despite the emphasis on "breast is best", the vast majority of women in my ward pulled out their ready-made bottles, handing their new-born over to a visiting grandmother. Half of the women in the survey said that, despite trying, breast-feeding didn't work out for them either.
But perhaps, lying behind the disillusionment with maternity care, is a relationship that is inevitably and unavoidably one sided. You never forget the face or name of the woman who helped to deliver your child. Yet, within hours, she will have forgotten yours. It is, therefore, a relationship in which the mother is bound to feel abandoned. For us, it's a time of overpowering importance, when our emotions are at their most raw. For the midwife, it's just a job.
In my ward, the conflict between the expectations of the women in the beds and those pacing the wards was acute. One midwife kept complaining about being tired from working 12-hour shifts. This is not an unreasonable complaint. But we mothers showed no sympathy. What was this midwife moaning on about, when we had been up all night, and would count three hours sleep at a time as a luxury? When the ward manager unplugged the patients' phone, saying staff didn't have time to keep answering it, mutters rippled through the mothers, stranded in bed by caesarean sections and catheters. Calls from family and friends were vital to us. It was as if we were being punished for not rising sooner from our post-natal rest.
At home, the care was no less cursory. My GP practice's midwife no longer makes post-natal home visits; she has too many other clinics to cover. I saw three different midwives over two weeks. They came every four to five days, and it was only so frequently because the baby girl was a bit jaundiced. One weighed the babies with their clothes on; a week later, another weighed them naked, so comparing the weights became meaningless. Another asked me if I had been back for my hospital appointment yet, confusing me with someone else. It is hardly surprising. She had never met me before, and never would again. I was just another mother and baby to visit that day.
"Pressures on the health service mean there is little consistency in antenatal, birth and postnatal care, and some mums-to-be are lucky to see the same midwife twice," says Stone. "The majority of pregnant women do not have the opportunity to build a trusting relationship with a midwife. Instead, most are filtered through a sea of different faces."
Midwives are no happier than mothers with the system. On my post natal ward, they complained of impossibly long and erratic hours, making parenting impossible. Ironically, many midwives change profession when they have children. The government is promising to address this haemorrhaging with a recruitment drive. By 2004, the NHS plans to have 20,000 more nursing staff, although it is not clear how many of those will be midwives.
If I did not have such strong, fond memories of my first child's birth, perhaps this time around would not seem such a cold, cynical encounter. But it does. I did not feel cared for; I felt as if having a baby was burden too much for the health service to bear. I know it can and has been otherwise. To restore a service to what it was almost a decade ago does not seem an exorbitant demand. After all, where better to get it right than from birth.
