Wednesday, 24 April 2013

Dan Poulter MP: Hear Women's Voices, Respect Women's Choices, Meet with IMUK!

UPDATE: 26th April - IMUK have received word from Dan Poulter's office that he will meet with them on 7th May. IMUK are grateful to everyone who helped them campaign for this.

OK, before we start, well Dan Poulter, he's the Health Minister for Women's Health. There are several different Health Ministers, all of whom report to Jeremy Hunt, the Secretary of State for Health. You knew all that, right? Yup, me too, me too, just checking.

So - Independent Midwives, who as we know, face becoming illegal and extinct from October 2013, have been trying to get a meeting with Dan Poulter for several months to discuss their demise and gain his help and support.

Meeting with Dan Poulter is key to the IM's campaign. And yet, not only is he refusing to meet with them, he seems to be actively avoiding them.

For example, IM's and their supporters have sent Christmas cards, Valentines cards, and hundreds of letters explaining their situation and the barriers they face in careful detail. Dan Poulter did not acknowledge the contents of a single letter in a personal way and instead sent out standard replies.

About 600 supporters demonstrated outside parliament on 25th March and several MP's came outside to meet with them. Dan Poulter did not meet with any of his constituents. 

Nicky Garret, Independent Midwife and one of Dan Poulter's constituents has asked to meet with him at his MP surgery. Dan Poulter has tried to discourage this meeting saying that he can only talk in his surgery about constituency issues. Nicky Garret intends to attend the appointment anyway, later this week.

There are several possible reasons why Dan Poulter is behaving in this way.

Firstly, it's possible that he feels that a solution has been found for IM's in the form of social enterprise companies - the suggestion is basically that they band together to form one formally constituted legal entity - however, IM's feel (and they have told Dan Poulter such), that this is not a solution they are happy with, as, above all, their work would then cease to be 'independent midwifery'. They also point out that a similar project, Neighbourhood Midwives, has had £260k of public money invested in it and yet has not so far been able to secure a contract from NHS commissioners.

Secondly, Dan Poulter seems reluctant to acknowledge and respond to Recommendation 20 in the Finlay Scott Review (an independent report on the requirement to have insurance as a condition of registration for health professionals):

"In respect of independent midwifery, the review recommended that for groups for whom the market does not provide affordable insurance or indemnity, the four health departments should consider whether it is necessary to enable the continued availability of the services provided by those groups; and, if so, the health departments should seek to facilitate a solution.” 

And thirdly, we could speculate that Dan Poulter's own life experience is getting in the way of his judgement. He's a medical doctor who specialises in Obstetrics, and as a Senior Health Officer, he would have spent six months working in the area of complicated birth. It's unlikely he would have ever seen a normal birth, and certainly almost out of the question that he would have attended the sort of blissful home birth that IM's specialise in.

Perhaps someone who has such a tainted view of birth is the wrong person to be appealing to for help in this instance? However, Dan is the man, IM's need him to meet, listen and help, and they are now calling on him in an Open Letter (see below), which has also been sent to senior Ministers, the Cabinet, and the national press.

IMUK requests an urgent meeting with Dan Poulter, Jeremy Hunt and David Cameron before the 10th May. A Department of Health consultation on this matter ends on 17th May. Time is running out.

It seems extraordinary that the plight of Independent Midwives is being ignored by the government - effectively they seem willing to stand by and watch them disappear, in spite of their offering a standard of midwifery which currently meets the Governments own targets, as set out in documents like Maternity Matters, for example:
  • choice in maternity care 
  • continuity of care 
  • increased home birth rates 
  • increased normal birth rates
  • increased breastfeeding rates
  • increased satisfaction 
And they say money talks, especially when you are trying to get a politician's attention, so how's this: Independent Midwives care for approximately 3000 women a year, an estimated saving of £12 million for the NHS. This figure could increase as thousands more midwives would work self-employed if insurance was available. At a time of a rising birth rate of 22% and a deficit of 5000 midwives, the Government are ignoring part of the solution to the plight of childbearing women and the national midwifery shortage.

As some of you know, this issue is personal for me. I was attended by IM's Chrissy Hustler and Caroline Baddiley for my second daughter's birth nearly three years ago, and together they gave me the most priceless gifts - confidence, courage, fortitude, strength, and a completely incredible birth experience that I will never forget. Pregnant again at the moment I'm working with Tara Windmill Robson, who comes to see me every two or three weeks, usually with her armfuls of books, fun craft ideas for my girls, love and inspiration. I can't wait to give birth in her inspiring presence.

However, due in September, I deeply fear that I may become one of the last UK women to give birth with an IM and experience this amazing standard of care. Losing IM's will be a great loss to the entire midwifery profession, leaving no alternative choice to the NHS in this country.

So finally Dan Poulter, a personal plea from me: do these wonderful women the respect and courtesy of meeting with them, and help to keep birth choice, and normal unmedicalised birth, alive in the UK. For whilst you might be an expert in obstetrics, I doubt you've ever been present at a birth moment like this one, and if you don't help save IM's, it might become even rarer and harder to come by than it is already.

A copy of the Open Letter to Dan Poulter from IMUK is pasted below.

Please sign the petition to support Independent Midwives, click here.

Please write to your MP, join the facebook page Choose Your Midwife, Choose Your Birth, get tweeting, blogging and sharing.

Contact Dan Poulter himself and DEMAND that he meets with IMUK before 10th May. 

Thank you.

To Dan Poulter, Health Minister 

Cc Jeremy Hunt, David Cameron, Stephen Dorrell, Margaret Hodges, Members of the Cabinet, National Press

Open letter to Dan Poulter and the Government from Independent Midwives UK 

Further to your standard issue letter dated 16th April 2013, in response to Independent Midwives UK (IM UK) correspondence, public campaigning, petitioning and public rallying regarding the issue of finding workable, affordable insurance for Independent Midwives to comply with EU Directive (2011/24/EU). We publicly state how extremely frustrated and concerned IM UK are by both your complete refusal to meet with board members of the organisation, and the obscene inertia in firing off standard responses to letters, Christmas cards and Valentine cards sent by members of the public over the last few months.

IM UK represents the only health professionals who will be outlawed in October as a result of the linking insurance to registration; it is not only short sighted to refuse to meet with us, but is insulting and unprofessional to do so in such a manner. You have agreed meetings with The Royal College of Midwives and Neighbourhood Midwives – organisations who support IM UK, but whom are not directly affected by the legislation and have their own campaigns to fight. We believe that you are unwilling to meet with IM UK, because acknowledging support for Independent Midwives from the public and maternity stake holder organisations in the UK would entail you having to recognise and respond to Recommendation 20 in the Finley Scott review: 

"In respect of independent midwifery, the review recommended that for groups for whom the market does not provide affordable insurance or indemnity, the four health departments should consider whether it is necessary to enable the continued availability of the services provided by those groups; and, if so, the health departments should seek to facilitate a solution.” 

The independent review by Finlay Scott states that it is through no fault of our own that indemnity insurance is not available - lack of availability is due to commercial reasons and not for clinical risk. We see no evidence of you honouring the recommendation Mr Poulter; indeed there is mounting evidence that you are actively trying to avoid it! Independent Midwives will no longer be able to register, simply because insurance is not available, and women will lose the choice of a safe alternative to the NHS. 

The DoH continually claims that a solution has been found in social enterprise companies; £260,000 of public money was invested in the Neighbourhood Midwives project, which whilst a potential alternative to the NHS, it is not independent midwifery and to date it has not been able to secure a contract from NHS commissioners.

Independent Midwives are fully qualified and regulated; they are the midwives who provide the maternity care you promised your voters in Maternity Matters and other documents. This includes:

· Choice in maternity care
· continuity of carer
· increased home birth rates
· increased normal birth rates
· increased breastfeeding rates
· increased satisfaction

The Government are making illegal the only midwifery service which fully meets these criteria. Independent Midwives save the NHS an estimated £12 million a year by providing a high standard of care for women outside the system. There is a rising birth rate in the UK of 22% and a deficit of 5000 midwives; losing Independent Midwives will only compound the problem. Does the government that supposedly supports choice want to be responsible for women losing this choice and for increasing further burden on the NHS?

In summary, IM UK and its supporters have informed you of the barriers facing Independent Midwives in accessing insurance many times. Our requests for meetings have been refused; you are avoiding the voice of the thousands of voters who have pledged support and engaged in this campaign; it is disrespectful that you ignore these concerns and respond with ill thought -out standard replies - replies which ignore specific questions and only waste more taxpayers’ money.

IM UK again requests an urgent meeting with you, Jeremy Hunt and David Cameron to discuss this issue before 10th May.

Jacqui Tomkins (Chair IMUK)

How Men Can Play Their Part in the Birth Revolution

I was extremely delighted to have my second article published by the Telegraph on the 18th April. It looked at the recent research that has made the news, suggesting that fathers are getting post traumatic stress disorder after witnessing their partners giving birth. Reading some of the coverage, I couldn't help but notice how readily the world seemed to accept that birth is a traumatic event, and wondered, as well as supporting fathers during and after difficult births, shouldn't we also be trying to make birth less traumatising for everyone - fathers, mothers and babies too?

Read the full article here.

Writing for the Telegraph, running The Positive Birth Movement, editing my book about water birth, trying to help in the campaign to Save Independent Midwifery, and gestating baby number three whilst looking out for one and two - well, I'm spread pretty thin, so apologies to all for my lack of blog posts at the moment.

Somehow in between now and Christmas I've got to finish Water Birth: Stories to Inspire and Inform, take The Positive Birth Movement to the next level, write some more articles worth reading, and bring another human being into the world. Oh, and we might move house too.

All this and I can't drink. Wish me luck.

Wednesday, 10 April 2013

Overdue? Desperate to Avoid Induction? This Method Really WORKS!

On average around 20% of UK women have their labours induced, some for medical reasons, others because they are 'post dates', that is, they have gone a certain number of days past their EDD (Estimated Due Date). How many days your care providers will 'let you' go past your EDD before pressuring for induction varies from trust to trust, but often women find that conversations about induction start on or even before their EDD, with 'sweeps' being routinely offered to encourage labour to start, and difficult to navigate meetings arranged with Obstetricians in which women are talked to about 'increasing risk'.

Getting to the bottom of the actual reality of the risk of going past 41 or 42 weeks is tricky, mostly because so many women don't actually get this far. Midwife Thinking has a great article here about the balance of risks a woman contemplating agreeing to induction must consider. Many women feel under enormous pressure once the conversations about risk have begun, and not surprisingly, many agree to induction even before they reach 42 weeks (considered by the W.H.O and others to be 'term').

In between getting to their due date and accepting that induction is their fate, women often engage in a frantic catalogue of activities in an attempt to avoid a medical start to their labours. I was one such woman, and have already written an account of this fortnight of utter lunacy in the post 'They Let Me' Go Overdue. Read it and weep, as I did, on an hourly basis. Thanks to google, the list of ideas for 'overdue' women to send themselves bonkers with is endless, from eating pineapple (utter nonsense by the way), to drinking castor oil (cheaper than a colonic, and twice as effective).

The methods are all described as 'natural', although many of them may not feel this way at the time. Take for example this suggestion from Sheila Kitzinger, not normally partial to encouraging women to lie in the lithotomy position and allow men to save them with their magic wands, but in the race to avoid induction, she makes an exception:

"Lie on your back, head and shoulders well supported by as many pillows as you like for comfort, your partner facing you and kneeling between your parted legs. Lift one leg so that your foot is over his shoulder. Then the other. Though this position is not comfortable, it allows the deepest penetration so that the tip of the penis can touch the cervix...When he has ejaculated he should stay inside you for five minutes or so while you stay in the same position, with legs raised for 10 to 15 minutes, so that the cervix is bathed in semen."

Then there's the 'sweeps'. They seem friendly enough - no sinister drugs - just a midwife and her finger, and many of us accept them without question. Do they work? How could we ever really know? Most women who have them are due to start labouring any day, so anyone who does begin after being 'swept' surely can't be sure that it was this that actually got things moving. Nor are they without risk -  your midwife may accidentally rupture your membranes meaning you face induction anyway - see here for some research on this.

Whether it works and whatever the risks may be, what really concerns me about not just the sweeps, but every other mad method on the post-dates bucket list, is that they smack of desperation, and betray a complete lack of confidence in a woman's body. As innocent and natural as they may seem, they are nevertheless the tiny tiny tip of a bloody big iceberg of mistrust in the process of birth, which many many women find themselves running aground on at some point between 38 weeks and the moment they first hold their baby.

We have to ask ourselves, do we trust our bodies to do this thing or not? If we do, if we really believe that we were made to birth normally and naturally and hopefully joyfully, then why are we engaging with any of this stuff? Why would we need our membranes swept or our cervix's bathed in semem or fifty quids worth of reflexology? Surely, we will just go into labour when our bodies and our babies are ready? And if we don't believe this, if we really feel we need 'intervention' to even get started, why then, let's book ourselves in for every medical procedure on offer and welcome this modern salvation of our frail and dysfunctional female bodies with open arms!

The stress caused by the desperation of trying to induce yourself to a deadline will probably do more harm than good, making it less likely that you can relax and get in the zone required to start spontaneously anyway. So here's my method, and damn I hope it makes me rich. If you are getting near your due date, or just past it, and are coming under any pressure, either from yourself or others, to begin your 'attempts to avoid induction', try this: Do nothing. Yes. You heard me. Do absolutely nothing. Try it. It's harder than you think. It takes a cool resolve, a mindfulness, and a deep and strong belief in yourself and your baby and mother nature herself. Exactly the mindset you need when you go into labour, funnily enough.

Don't let your confidence be undermined. You were made to birth. Just believe. Wait.
And do nothing.