There is a real problem throughout health and social services which is particularly evident in maternity services and that is the issue of care.
Care happens between people and is the response of one person to the needs of another. It must therefore always be appropriate to the particular needs of the individual which that person may not be easily able to express or used to expressing. This requires time, trust and flexibility in the response of the carer. Care is worthwhile because it is transformative for the person receiving care and for the job satisfaction of the carer. We know that continuity of care from a known midwife has impressive clinical outcomes (Sandall et al 2016, Homer et al 2017) and relationships with their clients are of great importance to midwives (Ball et al 2002, Kirkham et al 2006).
Efforts to standardise maternity services in the interests of efficiency have taken the flexibility away (Kirkham 2018). The reduction of each contact with maternity services to a series of tasks which must be carried out with little time, squeezes out care. The fragmentation of care makes it very difficult to build trust. NHS maternity services are now really monitoring services which is why I find it more honest to talk about maternity services rather than maternity care. This is frustrating for all concerned and so limiting of what can be achieved with real care.
This squeezing out of care has happened throughout health services and social care and practitioners in many fields mourn its passing. Whenever I have spoken about midwives leaving because they cannot give the care they wish to give, I have met people afterwards who say it is the same in their field of work: nursing, teaching at all levels, general practice, psychology services, probation services, care of the elderly and disabled and many more. Wouldn’t it be wonderful if we could form a multi-professional organisation just called CARE, to bring back the care. With a big enough membership and backing from professional organisations, trades unions and service users groups, such an organisation could have a degree of influence no one group can have. Could any politician really say they were opposed to care? “Time to care” would be a really unifying campaign.
Could we do it or am I dreaming?
Ball L, Curtis P and Kirkham M (2002) Why Do Midwives Leave? Royal College of Midwives, London.
Homer C S E, Leap N, Edwards N and Sandall J (2017) Midwifery continuity of care in an area of high socio-economic disadvantage in London. A retrospective analysis of Albany Midwifery Practice outcomes using routine data (1997-2009). 48, 1-10
Kirkham M (2018) Standardisation of care: a contradiction in terms. Midwifery Matters 157, 4-7
Kirkham M, Morgan RM and Davies C (2006) Why Midwives Stay London, Department of Health and University of Sheffield.
Sandall J, Soltani H et al (2016) Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews Issue 9. Art. No CDOO4667.