There’s no getting away from it. These are pretty dark times. I steer clear of the mainstream media and its petty, daily calamities, but there is a tide that is rising and it should be causing you concern. It affects us all, you cannot turn a blind eye and assume someone else is dealing with it.
I am not immersed in politics, but I can start by telling you what I can see in the world that I am involved in, which is maternity and families.
The National Maternity Review has published a report that calls for many things that the #MatExp campaign and others have been campaigning for. I am not going to critique the report here, many others have done that admirably and their thoughts can be found under National Maternity Review Report in the #MatExp Links Library. What I want to look at is what is happening right now in maternity and family services, whilst campaigners and leaders call for change and improvement.
“Sweeping, widespread changes to whole areas of midwifery regulation”
The Royal College of Midwives is very concerned about changes proposed by the Department of Health and is urging members and supporters to contact their MPs to challenge the proposals. Stuart Bonar of the RCM explains “The Nursing and Midwifery Council’s proposals would abolish much of the rules and architecture governing the role and scope of a professional midwife. This potentially opens up the provision of women’s care during and after pregnancy to anyone, regardless of training or qualification. This would undermine midwives’ ability to provide women and their newborn babies with the care and support they need and represents a real danger to mothers and babies. We can see no rationale for this.
We are told by the NMC that “protection of title as a midwife” is not under threat. However, the fact remains that a midwife’s role, scope and function are all due to be eroded. The reason given – regulatory simplicity – is unconvincing. Our advice is that proceeding with the existing NMC proposals would present a risk to maternity patient safety.”
You can read more here in Stuart’s blog post of 9 February. Regardless of your views on the subject, this is a potentially huge change to maternity care that is not currently in the public spotlight.
Midwives are struggling enormously……
“I have shed too many tears over a career I could not love more because there is nothing I can do.”
This is a quote from a blog post by a midwife from University Hospital South Manchester, published on Sheena Byrom’s platform back in October. She reports that “5 maternity units in the North West of England have been closed over the weekend. These women need our care. We are literally being worked to the ground. I am watching amazing midwives leave a profession they love because the workload and stress is too high.”
Hayley’s is not a lone voice. The same issues are highlighted time and again on social media, in books and at conferences. Newly qualified midwife Dawn Stone wrote for the #MatExp campaign’s Women’s Voices series (“Your Midwife”) and explained that “Working on a busy 50 bed AN/PN ward can feel like being on a carousel that’s spinning and spinning; there is no slowing down, only jumping on, and trying to stay upright and facing the right way.”
Much has been written in the press about midwives, their failings and limitations, issues of safety and issues of culture. Again, the answers to these issues are above my paygrade if you like, but what I can tell you is that we will not see safe maternity care in this country until we face the current workplace reality for our midwives. For more discussion of what is happening and what can be done please see “Time to Act for Midwives” from #MatExp.
…..and so is everyone else
It is far from only midwives who are struggling in this way. Health Visitors have long been under pressure from all sides, and commissioning for these services have now moved to local authorities as of October 2015. Inevitably we have seen reports that some authorities are considering cutting services or not commissioning them altogether. If you are unsure of what that means, Health Visitors are currently tasked with caring for 100% of families with children under 5. That’s the first five years of children’s lives, in every single family. Interacting with health visiting services is a choice, families are not legally obliged to do so, but the vast majority choose to turn to their HVs for support and advice, and the service focuses on transition to parenthood, maternal mental health, infant feeding, healthy weight for children, accident prevention and school readiness. Important stuff yes? The things that we constantly see people calling for more action on correct? This is what HVs do. And they are understaffed, under-supported, over-stressed and now potentially not commissioned everywhere.
Again, whilst you might not have had a fantastic experience with your HV I hope you would agree that there is no other service that can pick up the slack if health visiting disappears up a local authority flue.
And what of junior doctors? It is reported that two thirds of the general public currently support the continued action of junior doctors in the face of Jeremy Hunt’s determination to crush them. This post from 23WeekSocks back in November explains the issues at stake on the eve of the first strike. Events have now moved on to the point where a contract they bitterly reject is about to be imposed on junior doctors. Are these the conditions under which we want our vital NHS staff working? Conditions which they reject as unsafe?
The pressures under which obstetricians and sonographers work can be glimpsed through another two entries in the #MatExp Women’s Voices series. You will see common themes in all of this, including the threat to the mental health of the very people we rely on to keep us well.
Which brings us to mental health services.
This article from The Guardian describes the postcode lottery of mental health services for new mothers. “More than one in 10 women develop a mental illness while expecting a child or in the first year after giving birth. For about 40,000 women it is severe and in extreme cases necessitates admitting mother and baby to a specialist unit.”
“Mental health problems are the biggest single preventable killer of women in the “late” postpartum period, between six weeks and a year after giving birth, accounting for almost a quarter of maternal deaths in this period, according to University of Oxford researchers. One in seven maternal deaths in this period are by suicide.”
“There are 111 beds across the 15 MBUs, but that is not enough with large areas of south-west, eastern and north-west England without a facility.” There is currently no Mother and Baby Unit in Wales. “Of the 40,000 who have antenatal or postnatal problems, or both, only a quarter get access to specialist perinatal mental health services.”
Another piece in the same newspaper describes the personal experience of a junior doctor confronted with a struggling new mother. “I called social services and relayed the story. It was 4.55pm. “Is she going to kill the baby and then herself?” was the business like question I was asked. I replied no. “Ok then, we can see her tomorrow.” I was left literally holding the baby.”
Anyone who has engaged with mental health services, or who has tried to get support for a friend or loved one, knows that there are staggering gaps. Like many of you I have a store of anecdotes of people in crisis left to struggle alone. Of services not joined up. Of professionals not communicating effectively with one another. Of mothers falling through gaps because they don’t fit a particular model. Of families who have gone through dreadful tragedies being left to fend for themselves. At the most vulnerable time in many people’s lives they are left to try to advocate for themselves, to fight for the services they need, to get their voices heard. When they are in no position to do so.
Where can go to? Where can we find support?
Well the answer used to be Children’s Centres. And in fact I still see this answer given regularly. People suggest new services could be based in Children’s Centres. That is where support could be based, where professionals can come together, where services can be centred. Yet where are these fabled centres? In my area, Trafford, we have lost 14 out of 16 Children’s Centres since 2011. When my eldest son was born I had a centre within walking distance of my house. I volunteered there. I received support there. I gave support there. I got information from there. I met professionals there. So did many other families. By the time my youngest son was born two and a half years later my nearest Children’s Centre was across town. Fine for me, I can drive there. But is that what we want, for crucial services to only be available to those with access to a car? Do we really believe that vulnerable new mothers are going to struggle with public transport to access services? If you believe that you know nothing of early parenthood.
And of course many centres are based in libraries. Which are also under threat. Who need community hubs eh? It’s only where joined up services for families can be based. Let’s close ’em.
Support for Infant Feeding
I have written enormous amounts about infant feeding which I am not going to revisit here. This open letter from the World Breastfeeding Trends Initiatives team signed by a huge number of eminent professionals outlines what needs to be done. Suffice to say that as the evidence mounts for the importance of breastfeeding support and the improved health outcomes of optimum infant feeding, funding for breastfeeding support groups is being consistently cut across the country. Statistics tell us that the vast majority of mothers choose to breastfeed. Yet an enormous number of those women give up breastfeeding early in a baby’s life. Anyone involved in infant feeding or who has tried to breastfeed a baby will tell you that access to good quality support is the pivotal issue. So let’s close down breastfeeding support groups too eh?
Use Your Voice – If You Can
For women and families who have suffered due to any or all of the issues above, when it comes to maternity there is an option for them to provide feedback to their local services. That option is their local Maternity Services Liaison Committee (MSLC). Not every area has one in place, but where an MSLC is available it can be a vital way for services users to come together with staff and commissioners to work for improvements. This blog post from the Chair of Bromley MSLC discusses the importance of these organisations in more detail.
So guess what? I bet you can! Yes, funding for MSLCs is under threat. If we are going to limit the provision of services and support for families we should make sure we limit their ability to talk about that too right?
You can sign this petition to call for better funding for these important services.
What is happening in your world?
The above is a snapshot of the issues happening in the world I inhabit. I know that there are huge struggles in the worlds of other vulnerable people, those with disabilities being a prime example. We all know of the shameful issues surround the “Bedroom Tax”. The Independent has reported the names of the MPs who have recently voted to force through the ESA disability benefit cut. Referrals to food banks are rising by enormous percentages. This is skimming the surface. What of refugees and those fleeing unimaginable horror? What is happening in your world? Please do comment to share your experiences.
Time to cut the budget.
Good news then on the BBC today that George Osborne is warning of further budget cuts. I mean, there’s just so much surplus! So much fat in the system. So many areas where cuts can be made with little impact to families and vulnerable people! Oh…. wait…….
Across the pond……
In some ways this all pales in comparison to the terrifying things happening over the Atlantic in the United States. It is becoming increasingly likely that a vicious, uniformed racist is going to become the Republican nominee for president of the United States. He has called down hatred upon specific religious and racial groups. He is whipping up support by speaking to people’s fears and prejudices. His rallies have been the site of violent clashes. Does any of this sound familiar at all? Have we perhaps seen charismatic leaders whipping up hatred at times in our global history?
Has it ended well?
Like I say, these are dark times.
What is the point?
So what is my point in listing all of this to you? Why start your Sunday on such a note?
My point is that there are different ways that we can respond to all of this. There is less money, less to go around, less for you and less for me. So very tempting then to give in to the rhetoric and believe that there are groups who are not deserving of compassion. Groups whose suffering should be ignored. Groups who are not as compassionate as they say they are. Professions whose funding should be cut. Groups who should be rejected. Because then we can claw back some more for ourselves, because those other people shouldn’t have it.
And even if we do not buy in to the rhetoric of hate it would be easy, so very very easy, to simply despair and do nothing.
Well guess what? This is not the way forward. It never was, it never has been, it never will be. You have heard the phrase “The only thing necessary for the triumph of evil is that good men do nothing.” Perhaps like me you assumed that it referred to apathy? Perhaps it does. But it also refers to despair. When there is so much suffering around us, it feels overwhelming, and being overwhelmed leads to inaction. And inaction lets in those things we fear.
The answer is to do SOMETHING. Anything. Start in your home with what you teach your children. Start on your street with how you care for your neighbours. Start in your community with what you campaign for. Start in your workplace with the compassion you show to your colleagues. Start in your conversations with the rhetoric that you challenge. These are not small things. These are the things that turn the tide.
We all imagine that in dark times in history we would have stood up to be counted. We would not have allowed these things to happen. How could people have stood by? How could they ignore their neighbour’s suffering?
Are you standing up right now? RIGHT NOW? Or are you standing by?
Let’s stand together.