Better Births Five Years on

by | 3 Apr, 2021 | Better Births | 4 comments

I’m old enough to remember Changing Childbirth five, ten and even fifteen years on (now it’s 28 years – how did that happen?) And now it is Better Births five years on. The two Reports had the same visionary leader, Baroness Julia Cumberlege, who can be proud of what she has achieved since 1993 – because, make no mistake, she has been like a dog with a bone ever since she started this journey with us, she did not allow the central message to be watered down. The greatest achievement of Better Births was to add just one little letter to the central message. The Continuity of Care in CC became Continuity of CareR in Better Births. And now, five years on IT IS HAPPENING.

Monitoring Fetal Wellbeing

I don’t really want to talk too much about the online event because to be honest it was three and a half hours of Powerpoint presentations delivered at speed. My hand still aches and I never want to see another fancy diagram that is far too small to see on a screen anyway. They wanted voices from all round the country, (the voice was usually the chief regional midwife) and they wanted all the workstreams covered (no, I can’t remember exactly either). The result was overwhelming, I couldn’t take it all in at that pace, but 500 people, half of them midwives, struggled on till the end. Only 2% of the audience were obstetricians – make of that what you will, I’ll say no more.

Continuity of Carer

There was one outstanding presentation regarding monitoring fetal wellbeing. I had been expecting the usual ‘midwives need more training in CTG interpretation’, but what we got instead from Tracey Cooper, bless her, was a plea for holistic fetal monitoring (back to my copious notes – luckily I had outlined it in a box!) Monitoring fetal wellbeing is not just looking at the FHR trace – there is poor evidence of efficacy of CTG – traces don’t give black and white answer. No, what we need is the whole picture, listen to the woman or birthing person (yes!); look at the whole picture for that labour. And we also need to consider intermittent auscultation, we need to look at fetal wellbeing in other places of birth – include MLUs. We have to improve the culture to learn how best to escalate problems when we find them. And then we need to share good practice.

The people I really wanted to hear from in this webinar were midwives and women – talking about how it is working out on the ground. And, as we really should know by now, nothing will change unless we can get the women involved and Better Births has done just that. Maternity Voice Partnerships are streets ahead of the old MSLCs many of which only ticked a box or provided a set of eyes to proof read information leaflets or help decide on what colour to paint the birth centre. (Probably one of the most frustrating roles I have ever taken on – it took us six years NOT to get six questions on the back of the Friends and Family feedback form.) Mo Ade who chairs Ashford MVP discovered that she had a voice only after a disempowering first birth in 2014, she was invited on to the MSLC, joining the Better Births initiative to develop improvement. “The more service users get involved, knowing that their voice matters, the better the services are for everyone”. And now they are funding MVPs, yes there are paid roles in MVPs, that is how to value women’s voices. Running through the afternoon was what we could call the Ockenden thread – you can only have these things if we put safety first. But what this attitude forgets is that Continuity of Carer is the surest way to reduce prematurity, increase safety, support breastfeeding. It is not either/or, it is both/and.

A Long Way To Go

My own reflection is that it has been a good start but there is a long way to go. Some parts of ARM’s New Vision have been incorporated; local maternity hubs have not materialised but there is some hope, Prof Lesley Regen ex president of RCOG is talking about having a woman’s hub in every town. The iniquitous tariff system has been used as a way to get rid of private and social enterprise services contracting into the NHS, namely One to One and Neighbourhood midwives. Oh the irony – private provision is fine as long as men can make money off the back of maternity services. Independent midwives have been forced out of practice, except in a few Trusts with enlightened managers who give them bank contracts for insurance cover. We need to recruit and retain as many midwives as possible, it’s not looking good even if there is an extra £95 million (I lost count of the times that sum was mentioned).

The Very Best Births

I’ll give Julia Cumberlege the last word because she deserves it. She had no fancy Powerpoint, she talked straight from the heart. She’s given us a Chief Midwife, Jacqueline Dunkley-Bent, at the Department of Health and Social Care (and she has put social care into midwifery services). She’s still talking about ditching degrading stirrups, giving midwives a better work life balance, trying to replace the negligence and blame culture with rapid resolution and redress. She still wants more midwife units and more home births. Above all she wants to humanise birth. She wants us to match Sweden’s safety record she wants women to have the very best births.

Where will we be in another five years, I wonder?

About the author

Margaret JowittMargaret is a mother of four, childbirth activist and campaigner. She has a special interest in biomechanics of the uterus. Margaret Jowitt has been a member of ARM since 1991 and her ideas about the physiology and biomechanics of birth have developed over that time. She invented a birth chair to support women giving birth in hospital settings and is the author of several books. Her latest book ‘Dynamic Positions in Birth’ is available from our Bookshop.


  1. Lynn Genevieve

    I also attended this (long) seminar and made notes…
    a few stand out points for me: I noted that 2 new services were to be rolled out – Pelvic Health Clinics (for perinatal pelvic issues) and Maternity Outreach Clinics (for mental health issues like tocophobia and PTSD).
    Sounds great, but I couldn’t help but wonder why we are in such great need of these services today more than ever? Is it a case of a sticking plaster mentality – shouldn’t we be concentrating on causes and prevention?
    I was amused by the assertion by Wendy Matthews that the (yes £95 million) funding included money for obstetrician PAs…
    I listened very closely to Helen Williams on Informed Consent – some positives but when she raised the question (but didn’t answer) ‘How do we know women understand?’ I got the distinct impression it was referencing those women who declined recommended options – and I wasn’t alone in this thought as the chat box asserted, others raising this issue too.
    I especially liked the acknowledgment of service users and the Chief Midwifery Officer (for England – are there others?) saying that everything should be ‘evidence based and co-produced’. I could be picky and want ‘evidence informed’ but Mo the mother from the National Maternity Voices’ service users was stunning.
    I’m hoping that my ‘Midwife Voices’ also get heard later this year…

    • Margaret Jowitt

      Many thanks Lynn.
      I felt a bit guilty singling out so few presentations, I’m glad you picked out some more. You are so right about preventing pelvic floor injuries and PTSD. Continuity of Carer should help. The Continuity of Care teams are publishing their statistics now, so perhaps we will be able to compare statistics.
      Please add your own recollections, readers – what you can remember after the event is probably significant.

  2. Ian Kemp

    I also attended this event to be subjected to being powerpointed to death. Speakers boasted of how well theyve done and it was great to hear how women, those that are at the centre, are starting to be included. However, what about those facilitating this care, the midwives on the ground. Many are on their backside, broken or near as dammit, trying to provide this model of care. There are not enough midwives. In my last trust there were caseloads of up to 400 each. Of those that are practising, a number do not want, or simply cannot, work in this way. Many are part of a group named beyond midwifery. In some units I have seen evidence of robbing Peter to pay Paul. That is, in order to achieve the caseload targets of CoC they are creating dangerously high caseloads in other areas. I would rather that the afternoon had acknowledged and addressed these issues.

    • Margaret

      Yes indeed Ian. It is the height of idiocy to lose midwives who actually want to work in this way – in social models of care such as the Albany (best statistics ever with mixed caseload in a deprived multiracial community – little induction, but only one term antepartum death in 12 years. The model speaks for itself) One to One and Neighbourhood Midwives – all prevented through NHS intrangisence and lack of insurance.


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