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Ms Julia Drown (South Swindon) (Lab): I am delighted to follow the hon. Member for Romsey (Sandra Gidley), with whom I have sat on many Committees discussing issues relating to maternity services. I welcome the children's national service framework. There certainly is a need for joined-up government when it comes to children's services. I know of cases in my own constituencyI am sure it is shared by Members across the Houseof children with severe learning difficulties or challenging behavioural problems, and it is often with those groups that agencies find it hardest to come to some agreement about how services should be set up. That can sometimes lead to delays, resulting in lack of services for the children and parents who most need them. I greatly appreciate the work being done to solve that problem.
I also greatly welcome the emphasis on parenting. It is always a surprise to me that our society creates and provides antenatal classes for parents-to-be and that there is so much intensive work focused on the birth of the child, yet when the baby pops outI hope with the minimum amount of pain and difficultysuddenly we have apparently created two wonderful parents, even though they may have no knowledge or experience of looking after children. We need a whole new emphasis to focus on the fact that it is not the easiest thing in the world to become a natural parent. Parents need all the support that they can get to help them with all the difficulties that they face.
The hon. Lady is making an important point. In my surgery, I often see families that are struggling, particularly with problems relating to controlling their children, and when I talk to them it is apparent that the problem has gone on from generation
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to generation. There is no good parenting model exhibited down the family tree, as it were. How does the hon. Lady envisage these services developing? Does she agree that schools should provide more and teach parenting skills rather than French, for example?
Ms Drown: I would not say "rather than French", but I certainly agree that schools should do more, acknowledge the problems and provide support. Let us face it: some schools have pupils who are parents themselves or who act as parents. I particularly commend the Government on the Sure Start schemes up and down the country. It is easy to see that they help to change generational patterns by providing intensive and very supportive help to parents. I would like to see them spread throughout all our communities.
I chair the all-party maternity group, which was set up about three years ago to campaign for a national service framework for maternity services. With that hat on, I particularly welcome the fact that the maternity module was incorporated into the children's NSF. I would like to thank colleagues in the Housethe hon. Member for Romsey is oneand in the other place for helping me with that work. I would also like to thank the National Childbirth Trust, the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, all of which helped us in many of our meetings along the way.
I also chair the Health Sub-Committee on Maternity Services, which has produced three reports over the last year or so, covering issues such as information on maternity services, staffing problems, choice for women and inequalities in services. We looked particularly at the differences in caesarean rates between units across the country. We tried to establish why those rates were so different when we have pretty similar women across the country and we found that it came down to the leadership within units. With leaders determined to reduce or maintain a low caesarean rate, it led to people challenging whether a caesarean was necessary in certain circumstances and minimising those major operations that would otherwise have happened.
Because of all that work, I particularly welcome aspects of the NSF that deal with maternity and I should like to make a few points about the subject. The maternity framework represents the biggest opportunity to secure a major step forward in maternity services since the publication of the Changing Childbirth report. A number of people told the Health Select Committee that they really appreciated that report, but they felt that not enough had happened. The problem centred on the difficulty of putting theories and Government policies into practice on the ground.
The NSF rightly promotes normal birth, and states that medical interventions should happen only when needed. I am pleased that it goes into detail on this matter, and that it talks about better birth environments and the need for birth pools. It was frustrating to hear midwives tell the Select Committee that there was a time when lack of training meant that no one was able to use the birth pools that they had. It is hard to imagine the frustration felt by parents who had decided to give birth
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in that way when they found that no one was trained to use the pools available in the hospitals. I am sure that the fact that the NSF even mentions birth pools will convince PCTs that they must ensure that the skills are present to support their existing facilities.
Mention has been made already of the need for choice when it comes to the place of birth. This issue continues to come up because of the real problems encountered around the country in implementing the policy but, where possible, parents should be able to choose between midwife-led units and home births. The NSF goes so far as to state that that capacity needs to be developed to meet the needs of parents, and I hope that my hon. Friend the Minister will take action on this matter now. My hon. Friend the Member for Braintree (Mr. Hurst) has told the House about instances in which that would make a real difference for women who are soon to give birth.
Some time ago, the Select Committee on Health, under the chairmanship of the hon. Member for Macclesfield (Sir Nicholas Winterton), compiled a report that stated that there should be a presumption against the closure of midwife-led units. We looked at the matter again, and endorsed that presumption absolutely. The midwife-led unit at Malmesbury, which is used by some of my constituents, has been proposed for closure, even though it is the only one available for use by women in Swindon. It is the jewel in the crown of my neighbouring PCT, and people visit it from across the nation and even from other countries.
I have seen no serious costings about the long-term benefits of midwife-led units, although, as the hon. Member for Romsey noted, their high breastfeeding rates mean that children born in them are less likely to be admitted to hospital. However, there have been no serious attempts to look at alternatives to closure. Although many women and parents use the midwife-led unit at Malmesbury in my patch, I know that many others do not even know that it is an option because it is not mentioned by the midwife or GP who is looking after them. Clearly, however, such units would become more viable economically, according to the crude measure of cost per birth, if more people used them.
The decision about closing midwife-led units is in the hands of my right hon. Friend the Secretary of State. I know that the wish in Government is always to resist interfering in local decisions, but I hope that the launch of the NSF will promote a shift in policy towards re-emphasising the need for midwife-led units, and that there will be a willingness to intervene to save those units.
I am pleased that, after discussions, my own PCT is considering establishing a midwife-led unit in Swindon. I very much support that, so that women throughout the area can have access to such a unit. Swindon is a big and growing place, and there is no doubt that we can support a unit there as well as one in Malmesbury.
In many parts of the country, people also face problems securing home births. As chair of the parliamentary maternity group, I have received some very distressing letters from women. They may be in their 36th week of pregnancy and they may have planned to have a home birth all along, but they discover suddenly that that option is not availablemost often because of a shortage of midwives. I have to
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say that when we write to chief executives I am never quite convinced from their responses that they have done everything possible to try to give women the choice of a home birth. Midwifes would be asked whether they would be willing to do extra hours. Midwifery assistants or bank staff could be used. There are also independent midwives who could be used to give women a real choice.
The underlying worry appears to be that home births use up too much staff time. Everybody now seems to be committed to one-to-one support during labour, but does it make any difference whether that support is given at home or in hospital? After all, because women are more relaxed in their own environmentthey are often so comfortable that they do not call on services until later in labourhome births tend to take much less time. Analysis shows that, on average, home births take up less midwife time than those in hospital.
It is important that we do more to support those women who want home births. I hope that Ministers take action when trusts think about suspending home birth services to ensure that every option is considered.
I share the view of the hon. Member for Romsey that the NSF is a missed opportunity to provide even more support for breastfeeding by creating a strategy for England. Wales and Northern Ireland have strategies, as do many health boards in Scotland. The hon. Lady pointed out the great benefits of breastfeeding for babies, and she also mentioned the benefits for mothers, who reduce their chances of breast cancer and some forms of ovarian cancer, and of developing osteoporosis. I acknowledge that the NSF contains some very good recommendations on breastfeeding, especially on the extra support that women need in the form of access to breastfeeding counsellors. That support does not have to be provided by midwives. For example, the National Childbirth Trust provides support for breastfeeding for many women.
I know from talking to many women in my constituency that they would have liked to breastfeed, but they did not always have the support to do so. Breastfeeding is not always easy to start with, and we must acknowledge that and provide the necessary support. Nine out of 10 women who stopped breastfeeding in the first six weeks would have liked to continue for longer but were not able to do so. That demonstrates a lack of skilled support, which we need to develop.
A breastfeeding strategy could cover such issues as providing proper content for training for midwives, nurses and other professionals. It could also provide for training to update such skills. A breastfeeding strategy could also cover the implementation of the international code of marketing on breastmilk substitutes, which might require some changes in the law. We should also promote legislation to protect breastfeeding mothers from discrimination and harassment, with some supportive employment and guidelines for employers on breastfeeding mothers. Some companies say that women can breastfeed or express milk at work, but the only place provided is the toilet. I do not like that and I am glad to say that I know of only one example of such provision in my constituency. More appropriate and comfortable rooms could be used, for the sake of both the women and the babies.
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Of course, we could do more in the House to promote breastfeeding. We have made progress and we now have some breastfeeding rooms, but we still say to Members, staff and visitors that if they want to breastfeed they must go and hide somewhere.
Breastfeeding is not dirty or unpleasant; it is natural and if we could all be more relaxed about it we would help to promote its great benefits to both babies and mums. It seems strange that, for example, the public are not allowed to breastfeed up there, behind that glass barrier. Would it really be a problem? I hope that even in the House we can do more to support breastfeeding.
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