Over the last few days I have thought a lot about the Ockenden report and my experience as a mother, doula and antenatal teacher for the last 25 years.
Since I had my first baby 25 years ago, followed by starting to work in antenatal teaching 6 months later, the birth world has changed. There were fewer medical births and waterbirths/birthing centres were starting to emerge. I had a homebirth with a birthing pool and this felt very unusual – we had to hire and construct a fibre glass pool, it was long before inflatable options.
With both of my girls, I saw my community midwife at my house. By time I was pregnant with my son, 19 years ago, women had to go to the GP surgery for appointments. It was the first time I experienced a disconnect with my community midwife, as well as hostility towards my planned homebirth, and absolute glee when that plan needed to change.
I was lucky with the care I received in my first two pregnancies because the community midwives gave me both consistency and confidence. By contrast, when I gave birth in hospital with my third baby, I was mocked by a midwife, and then again by doctors when I was in theatre having my placenta removed.
This experience informed my work as an antenatal teacher and it prompted me to work as a birth doula.
I have heard, seen and experienced excellent care and I have heard, seen and experienced questionable care from midwives and doctors. On labour wards there can be chat and gossip, women can be dismissed and ignored, care can be rushed and options can be reduced with little or no explanation. I have attended births where the focus was normality over safety, along with births where interventions were constantly suggested without cause.
My focus as an antenatal teacher was to encourage expectant parents to think beyond their ideal birth plan, to think about what they might need to manage the challenges and the unpredictability of labour and birth, how to gather information and make decisions. My focus as a postnatal practitioner was to talk to parents about their birth, to help some of them make sense of it when they were left feeling lost and unsure about what happened.
As a doula I have worked closely with expectant parents, some of whom had complex mental health conditions and previous birth trauma. The majority of midwives have been supportive and helpful, providing 1:1 care with excellent communication but I have also witnessed mis-communication, conflicting communication, a denial of options, pressure to make decisions, inappropriate tone and comments.
There are many failings documented in the Ockenden report but there are clear themes about lack of communication and consistency, with staffing issues and a problem with team dynamics.
It’s really important for all staff within maternity to listen to parents, to acknowledge any fears and anxieties, to make them feel safe and informed, to connect with them and to work out the next steps. That was my focus as a practitioner – without the medical work and team dynamics – but what’s missing is the time for this connection to happen.
Midwives are very skilled professionals and their knowledge and experience of all births can make a difference to labouring women. This is a system that is failing and the changes need to better support midwives to do the job they can do so brilliantly.
Unmedicated birth is important, interventions are important, midwifery care and obstetric care are both vital and personalised care, which focuses on pregnant and labouring women as individuals, is crucial to tailoring care that is safe and effective.
If there aren’t enough midwives, the ones we have are overwhelmed and exhausted. And with a rise in interventions, midwives are seeing fewer normal births and this can’t be safe.
Student midwives are struggling to experience normal, especially with the increase in inductions. Labour and birth can look different when it is unmedicated, when women move as they need to, when their instincts can guide – if midwives (and doctors) largely see women on a bed with epidurals and drips and assisted births then that becomes the normal.
And more interventions don’t mean safe.
And with all the talk of safety in maternity services and how things need to improve, I’m aware of what this could mean for expectant parents – how do they navigate maternity services to get the care they need and deserve?
If you are an expectant or new baby, I would love your thoughts and experience of maternity services.
