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  • 11Jan

    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.

Discussion 12 Responses

  1. January 11, 2013 at 1:04 am

    NCT is desperate to get more MSLC reps sitting. In our area, there is an MSLC but it never bothers meeting so the first job for any MSLC rep would be to lobby the powers that be (probably not the Head of Midwifery, she seems impervious) to make sure it starts being a bit more active and actually meets. I think it’s shockingly ignorant and arrogant – especially when our local trust covers 2 hospitals but reduced our nearest hospital to almost nothing by restricting when women can go there to give birth and how they access the place, along with closing the postnatal ward which was a godsend when I had my two.

    • January 12, 2013 at 5:18 pm

      Ours met quite regularly but they all have problems retaining people. Also as the trusts often set the agenda it can become a talking shop for staff a bit. I remember giving detailed feedback about their consultant lead pathway and how it lead to inconsistent care for women and they were very open to discuss it.

  2. January 11, 2013 at 9:21 am

    “even a small number of women leaving the most popular private antenatal education being unprepared is unacceptable” – just to pick up on this: for your next post, can you discuss the difficulty of preparing women for the postnatal period? It’s something I encounter daily. Women who have been in my own antenatal breastfeeding session, in which I am very realistic about the physical, social and emotional challenges of life with a new baby, tell me that *nothing* could have conveyed the reality of it to them.

    • January 12, 2013 at 8:15 pm

      I hear what you’re saying. We have an NCT postnatal class here too (I didn’t go) and hear nothing but praise for it. Also local NHS ones, although reviews more mixed. It isn’t explicitly a maternity related blog, I just happen to feel passionate about this as NCT/NHS have both been big parts of my life. May well return to it again though :)

  3. January 11, 2013 at 9:30 am

    You had me nodding in agreement reading this blog particularly the line about the NCT being ‘the safety net service for the better-off when the NHS fails ALL pregnant women’. Although the service we received from the NHS was better than many it still varied wildly and it was easy to see the impact of lack of funding and direction. As our current government is trying to dismantle the NHS and sell it off in pieces to private providers we need to make sure this doesn’t slip off the political agenda.

    • January 12, 2013 at 8:16 pm

      Sadly I think it will be a case of not knowing what we’ve got until its gone. I have visions of people still picking holes in their private services when there’s nothing left for anyone else :(

  4. January 11, 2013 at 11:21 am

    I was told that as I was lucky enough to afford private sessions (NCT) I was unable to attend NHS sessions. Then there were no NHS session for 2nd time mums and by then I couldn’t afford private sessions. The problem with NCT and elective c-section at that time was that they were not commonly covered in their groups, however, my teacher made a great effort to get me involved. Made some lovely friends too, but it was expensive and I felt quite unprepared for the big event afterwards. I could really have done with more support 2nd time around too. After care differs so much, its a total postcode lottery. I too was dribbling snot bubbles and in uncontrollable tears on day 2 and I felt very alone, especially when my partner was made to leave for 2 hours at lunchtime leaving me dribbling all over new baby who refused to feed! I now offer private antenatal classes, but strongly believe that the NHS should work to provide better services for all to help prepare for labour and motherhood. I am trying to join my MSLC but struggling to find out how to join. I would like to add that on a medical side the NHS did a fantastic job of caring for me and the girls during my pregnancies and c-sections.

    • January 12, 2013 at 8:18 pm

      From my experience (and Trusts may differ) MSLC’s want service users rather than service providers – unless you’re both?

  5. January 12, 2013 at 7:46 pm

    I could not agree more. The current debate is totally misdirected. As well as lack of NHS antenatal classes there is also the problem of postnatal care too (which has been cut and cut) and as Karen has said above there is a lot of information that can’t really be given meaningfully until you actually have the baby.

    • January 12, 2013 at 8:21 pm

      Thanks. The current debate reflects the fact that middle class voices are louder. ‘The squeaky wheel gets oiled’ and all that. The fact that so many people are including as an aside that they received poor NHS care but still focus exclusively on the NCT is a great shame.

  6. February 8, 2013 at 2:19 pm

    […] Fresh from writing about access to maternity services…. […]

  7. April 11, 2013 at 10:16 am

    I am a midwife who has recently retired from the NHS after 37yrs. I love teaching and offer parent education classes. I tailor make them for the individual couples and families. I am concerned that the NHS has not provided enough local parent education. This has left the door of opportunity for the private sector to step in. It is importent that parenting educators give up to date safe and accurate information to our families. If the instructor have the knowledge and skills,along with experience, I believe that this is a recipie for success.

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