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Crucial Choice Guarantee Missed
Released on 26/10/2009
NCT reveals crucial choice guarantee is set to be missed
Over 95% of women in the UK are not able to choose where to give birth, a new report released today by the NCT (National Childbirth Trust) has found. Offering women choice of where to give birth is government policy across the UK as it is proven to have a positive effect on birth outcomes.
The NCT’s report, ‘Location, location, location’ highlights the benefits of choice to parents and calls for governments and health professionals to act quickly to ensure women have these choices available to them.
Take action and support the NCT Location, location, location campaign here www.nct.org.uk/choice
Read all the latest press coverage on the campaign
The ‘Location, location, location’ results show: ·
95.8% of women do not yet have access to a real choice between the three options of home birth with a midwife, a local midwifery facility (birth centre) either stand-alone or attached to a hospital and an obstetric unit in a hospital (the choices defined in Maternity Matters1)·
89% of women live in areas that realistically do not offer the choice of a home birth with a midwife2·
With greater encouragement of home birth, choice could be offered to many more women without any significant investment or shift in the way maternity services are structured.3 ·
Over 40% of women live in areas without reasonable access to both a birth centre and an obstetric unit in a hospital·
Women are lacking in the information and support needed to make these choices.3
The research for the report was commissioned in light of the Government’s Maternity Matters1 promise that all women in England will have access to choice of place of birth by the end of 2009. NCT wanted to ascertain how many women in the UK actually have access to choice. Scotland, Wales and Northern Ireland have also made similar policies that support the provision of choice for women.
Belinda Phipps, Chief Executive, NCT, says: “There is a huge task ahead for trusts and boards as many are very behind in implementing this policy. For every ten pregnant women, nine are not able to choose where they want to give birth. We know across the UK, government policies support women with this choice. However, in reality this is not even close to being delivered yet.
“We want the governments to act now. Although in a few cases more investment in maternity services will be needed, with a simple re-thinking of the way their maternity services are delivered every trust and board can ensure choice is available to all women. We know there are some financial policy obstacles hindering the achievement of choice the NHS could make much faster progress if it corrected these.
“There are a few trusts and boards in the UK that are succeeding in offering women a real choice and these successes are to be celebrated. We now need the rest of the UK to catch up.”
As part of the ‘Location, location, location’ campaign launched today, the NCT is calling for the commitment to guarantee choice of place of birth by the Department of Health to be implemented fully, and for the governments of Scotland, Wales and Northern Ireland to make a similar commitment to guarantee choice.
To achieve this local and national governments will need to: ·
Review the financial framework surrounding maternity services·
Recognise the importance of midwives in reducing costs and delivering choice·
Make sure that women are aware of the options and understand that for healthy women with a low-risk pregnancy, all three options are equally safe places to give birth·
Ensure all in the maternity services work together and have sufficient training so they are experienced and comfortable in all three settings. ·
Make sure parents are provided with unbiased information to help them make their choice
Sarah Banks from Derby says: “The first thing the midwife asked me was 'which hospital do you want to go to?' There was no discussion about other options and no mention of the birth centre nearby. I told her that I wanted to have my baby at home and she refused to discuss it as she said it was too early and wouldn't be advisable as it was my first baby.”
Both women and maternity services benefit from choice of place of birth being available. For women it leads to better birth outcomes, increased likelihood of straightforward births and improves their satisfaction with the birth. This in turn leads to higher self esteem and can increase parents’ confidence in being able to look after their baby.
For maternity services, offering these choices is likely to lead to reduced costs. Currently most women give birth in an obstetric unit in a hospital which is an expensive option3. With greater choice provided for women, more are likely to give birth in a birth centre or at home with a midwife. Therefore the effort necessary to deliver all three options will be outweighed by the savings made through less women giving birth in hospitals.
- Ends-
Local Authorities that offer the least choice
| Local Authority | % of women of childbearing age who have choice |
| Middlesbrough | 0.0% |
| Boston | 0.0% |
| Copeland | 0.0% |
| Carlisle | 0.0% |
| Coventry | 0.0% |
Local Authorities that offer the most choice
| Local Authorities | % of women of childbearing age who have choice |
| South Cambridgeshire | 100% |
| Southwark | 100% |
| Cambridge | 100% |
| Derbyshire Dales | 91% |
| Bath and North East Somerset | 91% |
Full breakdown of trusts available at www.nct.org.uk/choice
For further press information contact Andrea Shufflebotham or Nicola Ryan, NCT Press Office on 020 8752 2404 or email press@nct.org.uk
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Notes to Editors
‘Location, location, location’ details access to obstetric units, birth centres and home births in the UK and calculates the rate of women of childbearing age in each area with choice. See below for the results of the top and bottom five Trusts.
1. What is Maternity Matters? The Department of Health produced Maternity Matters: choice, access and continuity of care in 2007. This guaranteed that women in England would have choice of place of birth by 2009. For more details see http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073312
2. How is choice measured? There are no Government definitions of what having access to choice means, so to measure access to choice in the UK, NCT used the following parameters: ·
Women being within 30 minutes drive of a birth centre·
Women being within 30 minutes drive of an obstetric unit in a hospital·
The area having a 5% rate for home birth5% home birth rate was set as a realistic target should all women be offered home birth as a matter of course. A lower rate would not demonstrate home birth being offered as PCT policy because this could easily be achieved by women who know they want to have a home birth before being offered any options and who, if necessary have fought to be able to have a midwife present at their home birth.
3. What are the barriers to choice of place of birth? The main factors include:
- Staff shortages – in order to retain staff in the obstetric unit and cut costs, trusts or boards may cut back on community midwives, reducing home birth services and closing birth centres. This is an illogical step, as births in an obstetric unit are less likely to be straightforward. This means there will be more pressure on resources such as surgical, pharmaceutical and anaesthetic budgets and the cost of additional recovery time following interventions such as caesarean section. There are examples of how trusts can make better use of their budget by increasing the number of midwives, introducing caseload midwifery and flexible working hours in the recent King’s Fund paper. Lack of experience and training – the midwife regulatory body expects all midwives to be “competent to support women to give birth normally in a variety of settings including in the home” in reality, not all midwives are currently trained to be able to attend women giving birth without medical procedures. More training is needed for midwives so they are confident in attending all types of birth
- Lack of infrastructure - the main factors limiting choice in the UK are the low home birth rate and a shortage of birth centres. Encouragingly, there are more birth centres planned to be built over the next few years, which will go some way to improving the infrastructure. Unfortunately the financial framework is a strong disincentive to creating new birth centres.
- Lack of provision of information – the Towards Better Births report find that only 51% of women who were given choice felt they had sufficient information to be able to choose between the three options. Providing unbiased information on the advantages and disadvantages of each option will help women to make their choice. In many cases women are not aware that there is an alternative to a hospital birth. Once this choice has been made, in order to ensure choice women need to be supported in the option they have selected.
