Antenatal Education: Are We ‘All In It Together’?
There’s been a big debate about antenatal classes over the past week. It’s hard reading to see people who feel they have been let down and I’m glad some women are finding their voice on an issue which matters. At the same time, having worked in the NHS as well as having sat on a local Maternity Group representing mums, I feel like I’m waiting for the rest of the conversation; it’s teetering on the edge of a much bigger issue…
When I had my first baby, I felt very fortunate that I was able to afford private antenatal classes. Not in a glib nod to being able to afford them, but genuinely, very very fortunate. Because when I had my first daughter, my local NHS Trust weren’t offering antenatal classes at all. Reflecting on why I went to private classes in the first place, I returned to those NHS stats that I used to spend my days hunched over, and they confirmed that this issue runs much, much deeper.
So last night I starting tweeting some facts from the NHS Maternity Services Survey (a detailed survey collating the experiences of over twenty-five thousand women in 2010, conducted by the healthcare regulator ‘CQC’). Shocked twitter responses came back very quickly.
For example, the survey asked “During your pregnancy did you attend any antenatal classes provided by the NHS?” A staggering 38% said they were not offered any classes, and a further 4% found them already booked up. That’s 42% of pregnant women who responded in 2010 unable to access NHS antenatal classes. Not built up and let down, not steered in the wrong direction, but offered no directions at all.
And there’s more. When it came to the postnatal period, the support for women themselves (ie support distinct from the birthing process) seems to taper off again. The survey showed that almost one in five (18%) didn’t feel that they got enough information about their own recovery and 21% felt they weren’t given enough information about emotional changes they might experience following the birth (second day meltdown anyone? Oh the larks! I cried snot bubbles on my husband’s shoulder – thank god for muslin squares.) I digress….
Then there’s the guilt-mine that is feeding – please bring your little violins to my annual bonfire on this one ladies, marshmallows optional… The official NHS policy is ‘Breast is Best’ which I still think should be ‘supporting the mother is best’ but that’s another post entirely…. Anywho! The survey… 17% said that infant feeding was not discussed with them during their pregnancy and 13% said they didn’t receive advice about feeding their baby in the six weeks that followed the birth. That’s nada. No support. For a policy which says you can only be supported one way as it is.
How private classes like NCT impact on this data I don’t know. How much they improve the stats or make people aware of the failings I couldn’t say. They may, I haven’t asked. I’m not claiming to be definitive. But please look at these figures. If even a small number of women leaving the most popular private antenatal education being unprepared is unacceptable, what should we say to this? This isn’t a few rogue providers going off agenda, this is more like systematic denial of essential support for pregnant women. And what’s worse is I know that Trusts will be measuring themselves against a benchmark on this. That there is, administratively, an acceptable level of failure. And it’s way too high.
If shortcomings in private antenatal classes, even for a minority, are a problem; then a countrywide failure to provide antenatal classes should be an absolute scandal. And this survey was before the financial cuts kicked in.
In relation to my last blogs on antenatal classes: the negative feedback about the NCT is worrying. People’s dissatisfaction is alarming. It’s a small proportion and (I can’t say this clearly enough) it DOES matter. However, in my heart of hearts, I feel that for many (like myself) it is also the safety net service for the better-off when the NHS fails ALL pregnant women, and we need to see beyond the traditionally louder voices of the better-off types who generally access private services, and ALSO concentrate on the failings which affect everyone.
I’m all for challenging services which aren’t working for women. Anyone who’s read my blog knows that I have been doing that myself for a long time. Any serious attempt to challenge the difficulties which face pregnant women and new mothers WITHOUT identifying the massive gaps in NHS care as a fundamental problem, won’t be speaking for enough of us. From antenatal care through to those exhausted, emotion-curdling, seismic-readjustment stages of new motherhood, we should all be able to expect an equal service and be in the same boat.
What can we do about it?
Blogging is one thing. ‘Raising awareness’ is a start. But you can also:
- take a look at the stats in more detail and see how your local trust performs.
- You can contact your local maternity unit if you have recently had a poor experience and you can complain.
- You can join Maternity Service Liaison Committees which you can look up on your local trust website (I sat on my local one and they are usually desperate for mothers to get involved – don’t be put off by taking a baby to it – I literally sat chatting while bottle feeding twins and was perfectly welcome).
- You can respond to the next survey if you get it.
- You can lobby your local Commissioning organisation (CCG’s) by emailing them and asking them what they are doing about it.
- You can join your local NCT branch and campaign through them.
- You can suggest more ideas and share them in the comments!!
I sincerely hope that the current interest in private antenatal support progresses quickly into a conversation about support for every pregnant woman; because where it has gone so far is the tip of the maternity inequality iceberg.
NB The Care Quality Commission (CQC – formerly the Healthcare Commission) surveys maternity service users every few years. The responses come from over twenty-five thousand women and cover a range of topics from early pregnancy to post-natal care. A lot of it is great, but there are significant failings reported.