Birth Manifesto

Birth Manifesto

A 14 point plan to improve maternity, labour and postnatal care  

1. 1.               Provide continuity and consistency of care and carer for pregnant women.
   2.              Enable all women to have the choice of home, birth centre and hospital births, ending the postcode lottery.
   3.              Normalise physiological birth by working to lower the emergency caesarean rates in the UK.
   4.              Fund doula support for vulnerable women, such as those at risk of domestic violence, refugees or women with perinatal depression.
   5.              Support independent midwives to practice, replace or reinstate the abolished Supervisor of Midwives tole and ensure regulation of midwives is fit for purpose.
   6.              Offer specialist perinatal mental healthcare across the country.
   7.             Ensure health professionals receive appropriate training and annual statutory updates on facilitating informed decision making, including an understanding of maternity care in a human rights context.
   8.              Reinstate grant funding of midwifery training.
   9.              Ensure optimal cord clamping is offered for babies, including those needing resuscitation.
   10.           Include the importance of an oxytocin-rich environment in the training of all birth professionals.
   11.           Fund community support for breastfeeding and infant feeding specialists and specialist midwives in hospitals.
   12.           Provide comprehensive antenatal and postnatal education for new parents.
   13.           Work to end the ethnic inequality in maternal and neonatal birth outcomes.
   14.           Celebrate birth as a positive experience to be honoured and respected.

1. National Maternity Survey, recommendation 2.1: 'Every woman should have a midwife, who is part of a small team of 4 to 6 midwives based in the community who know the women and family, and can provide continuity throughout the pregnancy, birth and postnatally.' 
NICE CG190 1.1.19: 'Maternity services should: provide a model of care that supports one‑to‑one care in labour for all women.'

2. National Maternity Survey, recommendation 1.3:  'Women should be able to choose the provider of their antenatal, intrapartum and postnatal care and be in control of exercising those choices through their own NHS Personal Maternity Care Budget.'
NICE Guideline CG190 1.1.2: 'Explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth.'

3. Quality watch: 'Apart from Italy, UK has high and increasing C-section rates relative to the Nordic countries. OCED statistics 2013' ASPH re NICE CG190:
  'Irrespective of population a commitment and belief underpinned by sound understanding of the physiological process of childbirth improves women's' ability to labour and birth normally.' 

4. Cochrane report: 'We conclude that all women should have continuous support during labour. Continuous support from a person who is present solely to provide support, is not a member of the woman's social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial.' Also current project with Social Care in North Cambridge, findings not yet released.

5. IMUK: 'There is legislation in place to require all health professionals to have professional indemnity insurance. Our regulator, the Nursing and Midwifery Council (NMC), ruled in December 2016 that IMUK’s indemnity scheme was no longer sufficient, despite it having been deemed suitable by two independent actuaries. This decision is not based on evidence nor on our previous safety record. We have never received a complaint regarding our indemnity cover from either a client or another midwife. IMUK had chosen to use an indemnity product that mirrors the scheme used by the NHS.'

6.  National Maternity Survey, recommendation 4.1: 'There should be significant investment in perinatal mental health services in the community and in specialist care. '

7. NICE CG 138, 1.5.22: 'openly discuss and provide information about the risks, benefits and consequences of the investigation or treatment options (taking into account factors such as coexisting conditions and the patient's preferences)'

8. NHS:  If your course starts on or after 1 August 2017

You must be accepted for a place on a full or part-time NHS-funded course which will lead to you registering as a:

9. NICE CG190 1.14.14: 'Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heart rate below 60 beats/minute that is not getting faster. If the woman requests that the cord is clamped and cut later than 5 minutes, support her in her choice.'
BASICS: Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support trolley: 'The-state-of-the-art BASICS trolley can be manoeuvred alongside the bed for a normal delivery, as well as next to a caesarean section or assisted forceps delivery. This means that the baby can remain close to the mum at a time when she most wants to keep her newborn within sight. In addition, it means that the baby’s umbilical cord can be left intact, enabling doctors who believe delayed cord clamping offers benefits to babies, especially those who are weak or premature, to employ this technique while resuscitation takes place.'

10. BUCKLEY, S, AIMS JOURNAL 'The full expression of these labouring hormones requires specific conditions: that the labouring mother feels private, safe and unobserved. This basic need is recognised by traditional systems of maternity care, which prioritise the emotional well-being of the labouring woman and ensure that she is cared for in a familiar place with known and trusted helpers. These factors will keep her as calm and relaxed as possible, and her adrenaline levels low.'

11. Infant Feeding Survey, 2.5.6: 'These findings illustrate the fact that the main reason why so few mothers follow the recommendation of feeding exclusively until six months is due to the introduction of formula, either to replace or supplement breastmilk. Given that this is also associated with breastfeeding exclusively for a relatively short period, information and support for mothers in the early weeks to help them to breastfeed exclusively for longer is likely to have an impact.' 
NICE CG 37, 1.3.1: 'Breastfeeding support should be made available regardless of the location of care.' 1.3.3: 'All maternity care providers (whether working in hospital or in primary care) should implement an externally evaluated, structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard.'
1.3.15: 'From the first feed, women should be offered skilled breastfeeding support (from a healthcare professional, mother‑to‑mother or peer support) to enable comfortable positioning of the mother and baby and to ensure that the baby attaches correctly to the breast to establish effective feeding and prevent concerns such as sore nipples.'
UNICEF Babyfriendly Initiative, Step 3: 'Implement evidence-based initiatives that support breastfeeding, including the Unicef UK Baby Friendly Initiative, across all maternity, health visiting, neonatal and children’s centre services.'

12. National Maternity Survey, recommendation 2.3: 'Community hubs should enable them to access care in the community from their midwife and from a range of others services, particularly for antenatal and postnatal care.' 
NICE CG 37, 1.1.5: Women should be offered relevant and timely information to enable them to promote their own and their babies' health and wellbeing and to recognise and respond to problems.

13. ONS: 'Babies born in 2013 had an infant mortality rate of 3.8 deaths per 1,000 live births, compared to 3.9 deaths per 1,000 live births for babies born in 2012. Pakistani, Black Caribbean and Black African babies (6.7, 6.6 and 6.3 deaths per 1,000 live births respectively) had the highest infant mortality rates.'

14. NICE CG190 1.1.12: Providers, senior staff and all healthcare professionals should ensure that in all birth settings there is a culture of respect for each woman as an individual undergoing a significant and emotionally intense life experience, so that the woman is in control, is listened to and is cared for with compassion, and that appropriate informed consent is sought.
1.2.1: 'Treat all women in labour with respect. Ensure that the woman is in control of and involved in what is happening to her, and recognise that the way in which care is given is key to this. To facilitate this, establish a rapport with the woman, ask her about her wants and expectations for labour, and be aware of the importance of tone and demeanour, and of the actual words used.' 

REFERENCES:

BUCKLEY, S, IN AIMS JOURNAL 23, n4: www.aims.org.uk/?Journal/Vol23No4/undisturbedBirth.htm
COCHRANE REPORT: http://www.cochrane.org/CD003766/PREG_continuous-support-for-women-during-childbirth
INDEPENDENT MIDWIVES UK: http://www.imuk.org.uk/news/judicial-review-to-protect-independent-midwifery-begins/
INFANT FEEDING SURVEY 2010: http://content.digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf
NATIONAL MATERNITY SURVEY 2015 : https://www.england.nhs.uk/mat-transformation/mat-review/
NHS: https://www.gov.uk/nhs-bursaries/eligibility
NICE: https://www.nice.org.uk/sharedlearning/providing-a-choice-of-a-midwifery-led-unit-birth-centre-for-women-with-low-risk-pregnancies 
https://www.nice.org.uk/guidance/cg37
https://www.nice.org.uk/guidance/cg138/
https://www.nice.org.uk/guidance/cg190
ONS: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/pregnancyandethnicfactorsinfluencingbirthsandinfantmortality/2015-10-14
QUALITY WATCH: http://www.qualitywatch.org.uk/indicator/international-comparisons-surgical-procedures 
UNICEF: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/call-to-action/