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Date: Wed, 18 Jun 2003 09:33:56 +0100
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Subject: Health Select Committee, Provision of Maternity Services
report published
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-----Original Message-----
From: BROWNING, Anne [mailto:[log in to unmask]]
Sent: 17 June 2003 16:58
To: HEALTHCOMMEM
Subject: Embargoed publication of report - Provision of Maternity Services
House of Commons
Health Committee
7 Millbank, London SW1P 3JA
Tel: 020 7219 6182
PRESS NOTICE
17 June 2003
No. 31 Session 2002-03
EMBARGO 00.01 am Wednesday 18 June 2003
Provision of Maternity Services
Report published
Julia Drown MP, Chair of the Maternity Services Sub-committee said:
Our inquiry set out to see how maternity services have changed over the last
ten years in response to the Government report Changing Childbirth which
hoped to create women-centred high quality services across the country. This
first stage of our inquiry concentrated on regional variations in services,
staffing, training and information issues in maternity services. In order to
gain a 'snapshot' of the provision of maternity services, and to hear from
those most closely involved, the Sub-committee took evidence from health
professionals and user representatives from maternity units in each of the
eight NHS regions.
Although we found some excellent examples of maternity services we were
disappointed that much of what was expected by the Government ten years ago
has not been created consistently across the country.
There is a huge variation in caesarean sections. For example 11% of births
at the Royal Shrewsbury Hospital are caesareans, 19% at Manchester's St
Mary's, 26% at The Rosie Hospital, Cambridge and 30% at St Mary's
Paddington. The rate is rising overall which means that there are many women
unnecessarily undergoing major operations. Although caesarean section poses
only a small risk, women having caesareans are three times more likely to
die in labour. Caesareans are more likely to lead to infections and future
infertility problems and require a longer recovery time than normal births.
We are confident that there is excellent work going on in all the maternity
units we heard from but it is clear from our inquiry that more needs to be
done to address the variation in practice across the country - for example,
to explain to the public why the caesarean section rate at the Rosie
Hospital, Cambridge compared with that of St Mary's Hospital, Manchester
means that there are 300 more women cared for by the Rosie Hospital, who are
having major surgery each year. In Manchester these women might have had a
normal birth.
We were concerned to hear that basic good practice guidelines for reducing
caesareans are not always put into place - for example mothers of breech
babies are not offered a technique to try and turn the baby around. This
technique is successful in half of the cases but was only offered to one
third of women with breech babies. Keeping to basic good practice guidelines
like these should reduce unnecessary caesareans by at least 5%.
The costs to the NHS of this are significant - a caesarean was costed at
£760 more than a normal birth in 1997. So across the NHS this adds up to a
substantial sum with every 1% rise in the national caesarean section rate
costing the NHS £5 million. The Committee's view is that given the NHS's
response to other treatment choices, elective caesareans made as a
'lifestyle choice' would be difficult to support in the NHS, and that
caesarean sections should only be carried out when medically or
psychologically necessary.
We heard from many units about problems over staffing levels - in some
delivery suites midwives had to care for several women at a time and levels
of on-site consultant cover were low. Midwives are having to spend more time
supporting interventions such as caesarean sections which reduces their time
available to support normal birth. This can create a downward spiral whereby
the lack of support for normal birth means more unnecessary interventions
for mothers. We identified a loss of confidence by staff and parents in
normal birth which is a serious concern - this confidence needs to be built
back up by strengthening the importance of normal birth in training of all
staff. Making the midwife the first point of contact for a discussion on
maternity choices rather than the GP is one of our recommendations to help
this.
Staffing shortages can be self-perpetuating in that they lead to extra
stress on staff and further problems in recruitment and retention, so we
recommend a review and a renewal of government efforts to recruit more
midwives in particular - and to get more who are registered back into work.
We were amazed at the lack of good information available to maternity units
due partly to inadequate systems but also due to a lack of support for
systems and inconsistent data definitions - for example over what is meant
by a 'normal' birth. This is despite government attempts to make such data
consistent. At its worst we heard from maternity unit staff who entered data
to a computer knowing they had no way of getting information out at the end
of it.
Notes to Editors
The Health Committee will publish its Fourth Report of Session 2002-03 on
Provision of Maternity Services in the UK on Wednesday 18 June at 00.01 am.
A press conference will be held at 9.30 am in Committee Room 16 on Wednesday
18 June.
Background
Although childbirth is now safer than ever before, some women still go
without the kind of advice and support that they need, throughout and after
their pregnancies, to secure the best possible health outcomes for
themselves and for their babies. In December 2002 the Health Committee
appointed a Sub-committee to undertake a series of short inquiries in this
area. In its first inquiry the Sub-committee set out to look at the services
available to women in England today, at the variation in these services
across the country, and at four issues of particular concern: the collection
of data from maternity units, caesarean section rates, the staffing
structure of maternity care teams, and the provision of training for health
professionals who advise pregnant women and new mothers.
Confidential advance copies of the report, which will be embargoed until
00.01 am on Wednesday 18 June, will be available for collection on Tuesday
17 June between 12 noon and 1 p.m. from the reception desk at 7 Millbank,
London SW1.
Please present this Press Notice; a signature will also be required.
Advance copies of the report will also be made available to the Press from
the Press Gallery, House of Commons, at 12 noon on Tuesday 17 June.
Witnesses' copies will be posted to them.
Following publication, copies of the Report will be on sale from the usual
Stationery Office outlets (tel. 0845 702 3473) and the Parliamentary
Bookshop (tel. 020 7219 3890). Following publication the Report may also be
viewed at
<http://www.parliament.uk/parliamentary_committees/health_committee>
www.parliament.uk/parliamentary_committees/health_committee
The Health Committee is a Select Committee of the House of Commons. It is
appointed under Standing Order No. 152 to examine the expenditure,
administration and policy of the Department of Health and associated public
bodies. The Committee has power to send for persons, papers and records. The
Maternity Services Sub-committee, which was nominated on 12 December 2002,
is appointed under Standing Order No. 152 and has the power to send for
persons, papers and records.
The text of Committee reports, minutes of evidence and press notices can be
accessed through the Internet at Parliament's website:
www.parliament.uk/parliamentary_committees/health_committee
Current Membership of the Health Committee:
Mr David Hinchliffe MP (Chairman) [L] Wakefield
Mr David Amess MP [C] Southend West
John Austin MP [L] Erith and Thamesmead
Andy Burnham MP [L] Leigh
Mr Simon Burns MP [C] Chelmsford West
Jim Dowd MP [L] Lewisham West
Julia Drown MP [L] South Swindon
Sandra Gidley MP [LD] Romsey
Siobhain McDonagh MP [L] Mitcham and Morden
Dr Doug Naysmith MP [L] Bristol North West
Dr Richard Taylor MP [IND] Wyre Forest
The Maternity Services Sub-committee has the same membership as the Health
Committee. Julia Drown MP was appointed Chair of the Sub-Committee on 12
December 2002.
--- End Forwarded Message ---
----------------------
Dr Jane Sandall
Professor of Midwifery and Women's Health
King's College
57 Waterloo Road
London
SE1 8WA
Tel: 020 7848 3605
Fax: 020 7848 3506
email: [log in to unmask]
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