Questioning Nick Clegg

Just a quick missive to the world and my friends out there!

I managed it! I took my work basket to Idle Parish Church, BRADFORD, today, where, I learned, Nick Clegg, Leader of the Liberal Democrats was going to have a question and answer session. And I challenged him to do something for maternity services in this country.

I wanted my question to be well delivered and have maximum impact so I wrote out my question in advance. My question was the last one and I got a round of applause for asking it. the text is below.

And because questions at a public meeting like that are less about the response and more about raising an issue I have followed up our exchange with a letter reiterating the question. And for your interest and inspiration here it is!

If anyone out there is a Labour or Conservative Party supporter/member. Please go out there and do the same. It is not about changing the men in suits at the top of our country, it is about changing the way the political wind blows!

Ruth Weston
c/o Aquabirths
Unit 3, Carlisle Business Centre
Carlisle Road, BRADFORD
07 824 990 345

Dear Nick,

I am writing to follow up on the question that I raised today regarding maternity issues at Idle’s Parish Church 22nd May 2009 (I was the woman with a purple cardigan!).

First of all, thank you for your time and discussion. I was most impressed. I wished I had brought my 14 year old daughter along who is talking of going into politics and would have enjoyed the exchanges. Another time.

In these sort of settings it is much more about asking the question rather than getting an answer and so I wanted to re-iterate my question so that I might have a fuller response from you (and the party) and that there might be a more comprehensive discussion of the matter.

My question is this:

Although the World Health Organisation recommends an 8-10% Ceaserean Section rate for 1st World countries, the UK figure as I saw it on Monday of this week, was 25% nationally.

Although Ceaserean Sections cost around five times more than a Homebirth, and research ( in UK of 5000 births) shows that a woman is HALF as likely to have a CS if she books for a homebirth (even if she subsequently births in hospital), homebirths are actively discouraged in many parts of the country and women give birth in high risk, high intervention obstetric units.

Although research shows One Mother One Midwife Care reduces length of labour, pain experienced by women, intervention rates, Postnatal Depression, and increases normal birth rates and the likelihood of a woman breastfeeding; midwifery care has deteriorated so much that women in Bradford for instance can see a different midwife at each appointment and receive conveyor belt care in hospital.

Although the only alternative to accepting this kind of care is employing an Independent Midwife (we hired one for our fifth child, the cost was 15% of our small income and worth every penny!) this Government is outlawing them by the back door by insisting they have insurance but not providing the means to obtain it.

Birth and maternity issues are not just a woman’s issue but an issue that effects the whole community – a good or bad birth and good and bad maternity care can have profound effects on the wellbeing of mother and baby, her husband and family. Through the knock on effects of community mental and physical health service provision and social security this issue affects us all.

I am therefore asking what you, Nick, and the Liberal Democrats of which I am a member, are going to do about this.

Obviously this was a complex question for you to answer at the time but I just want to pick up on a couple of points you made to feed into your more considered response:

I do advocate homebirth but the point I am making is not really about homebirth per se but the lack of healthy choices women have when giving birth. It is less healthy for healthy women to give birth in an obstetric unit than to give birth in a stand alone birth centre or at home. Yet most healthy women in our PCT area as well as many parts of the country do not have (in reality) the choice of having either a homebirth or a birth in a midwifery-led or independent ( from the obstetric unit) birthing centre.

You spoke the system not being set up for homebirths – and this will take time to sort. I agree but there are two immediate actions that can take place:
1) The current ‘tariff’ system rewards high CS rates as it is based on the cost of the procedures – rather than being paid on population risk and rewarding higher normal birth rates. This means that Trusts who do fewer CS and more homebirths get paid less, although the Trust is saving us a lot of money and sparing hundreds of women and babies the trauma of an unnecessary major operation. We need to reward Trusts for promoting normal birth.
2) The Independent Midwives Association have put forward the Community Midwifery Model (cf. as a model that can run alongside current NHS provision which enables women to choose midwifery-led, low intervention care from a known midwife. As a user this system is particularly attractive because the money follows the woman – not the procedure putting her at the centre of care rather than where she is now – at the bottom of the hierarchy. I would commend this model to become a central plank of Lib Dem maternity policy. It is not as radical as changing to election by proportional representation!

You spoke of the dangers of homebirths being advocated where the system and training is not in place and implied ‘it would be dangerous to advocate homebirths until the system can bear it’. I would warn that as the system deteriorates further and the option to engage an Independent Midwife is closed, women will take the matter into their own hands and will opt out of the system altogether and free birth (birthing without a trained professional present). The movement is growing in the US and is already in evidence in the UK, masked by I suspect (but I do not have the evidence as yet) a rising rate of ‘Born Before Arrival’s’ where the midwife is called ‘too late’. I know this is happening now. If women cannot choose to have the birth and care they want within the NHS a small but growing number WILL free birth – this is the danger of not providing low tech compassionate care for birthing women where they need/want it.

Finally, in the light of the above, we urgently need YOU to take action to save my fabulous Independent Midwives from being outlawed by a crazy policy which insists they have insurance but makes no provision for it. The current insurance system for midwifery is a mess as it is mixed up with obstetrics (the care of abnormal births) where the highest claims are made. Independent Midwives are poorly paid, highly committed, highly competent professionals and I find it immensely upsetting to see them once again treated in this way whilst consultants continue to work privately and lucratively with NHS insurance. Patriarchy and discrimination are therefore, still in evidence in our maternity services. With this point in particular I would like your urgent attention.

I speak as a mother of five children born in Bradford, and a user of maternity services. I speak also as someone who lives and is active amongst our diverse community in Bradford, is a Bradford Breastfeeding Peer Supporter and Trainer and the Acting Chair of the Maternity Services Liaison Committee. I want answers to my questions (and I raise these regularly with the local Trust and PCT) but I also want to be part of the solution – and offer that to you as someone with an interest and expertise in the subject.

With every good wish and looking forward to being in contact

Ruth Weston
07 824 990 345
Unit 3, Carlisle Business Centre, Carlisle Road, BRADFORD, BD8 8 BD