“Safe care is personalised care,” says Baroness Julia Cumberlege in a letter to the women of England. Launching the report of her review of maternity services in England, Cumberlege is clear about her vision for the future and catchily suggests £3,000 personal birth budgets. But behind those simple-sounding words lurks an argument that I hope she has the support to win.
Women’s basic humanity – and the autonomy, dignity and respect that this should afford them – is often characterised as the enemy of safety in maternity care. Wherever we place ourselves on the natural to medicalised birth spectrum, the narrative is usually the same. Silly women with their unrealistic and downright irresponsible ideas about birth can’t be the ones who decide what happens to their bodies in pregnancy because it’s just not safe for the baby. This ridiculous argument has left attitudes to women in the maternity system in a state of relentless suspension for years.
That’s why I fully support the report’s conclusion that for maternity services to be truly safe for women and babies they must be set up to provide individualised care that listens and responds to the women they serve and ultimately supports and trusts them as they make decisions that are right for them. It’s a sentiment that Birthrights (the human rights in childbirth charity I lead) set out in our August 2015 letter to the review team, co-signed by the president of the Royal College of Midwives, leading obstetricians and others working in maternity care.
Yet many of the specific changes and innovations that the report advocates are those that women and experts have been requesting for decades. Women being cared for by small teams of midwives they can get to know, increased perinatal mental health provision, improving the way mistakes are investigated and overhauling patchy postnatal services. Some of these ideas featured heavily in Cumberlege’s last review of maternity services more than 20 years ago. I worry about what new power this report will have to stir up the stagnant waters around attitudes towards women’s reproductive health and rights.
Nevertheless there are some radical and ambitious proposals that could really shift the power balance for the better if they could be made real, such as giving women their own personal maternity budgets to spend on their care as they see fit. Despite the inevitable barrage of scepticism about whether we can handle the weight of responsibility for our own health, I think this could work.
Proposals to change the way compensation is offered for birth injuries could offer families financial support without having to go through the trauma of litigation that may be unsuccessful. The proposed “rapid resolution and redress scheme” would also liberate the NHS from the devastating consequences of a litigation culture which has spread fear and defensive practice.
But to make these ideas more than tantalising words on paper we need new tools to put pressure on those with the power to enact these recommendations. Otherwise there is a risk that the phrase “personalised care” could replace “woman-centred care” as a distractingly shiny bow on a system that’s actually quite the opposite.
A key aspiration of the review team is that all women should have access to a choice of where they give birth by 2020. Yet all women should already reasonably expect this choice today based on Department of Health policy that came in to effect in 2009. This isn’t something to aspire to but to demand now, and loudly.
Similarly, women already have existing rights to choice, information, consideration of their individual circumstances and a relationship with their caregivers based on different legal sources. Invoking these, and suggesting simply ways to strengthen and clarify these rights could provide a strong platform to begin to turn some of this theory in to reality.
So while my response to more personalised maternity care is to punch the air, I can’t help but wonder, what now? Because what happens tomorrow to stop this just being a slogan and actually make care both safe and personalised is what really matters for every woman, no matter how complex her needs.
