Health: Deliver us from hospital cutbacks

The crisis in midwifery means mothers are being discharged from hospital hours after giving birth. But that can be good. By Sarah Lonsdale
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Olivia, now three weeks old, was born at 3.13am. An hour and a half later, I was discharged into the chill of an October morning, the sun yet to rise, clutching my little bundle tightly to my chest as I walked to the car. The reason for this unseemly early discharge from hospital? Just another hard-pressed maternity unit, suffering from both bed and staffing shortages. There were not enough postnatal beds available, I was informed, and they were saving the few they had for first-time mothers and women who had had complicated deliveries.

There was no question of my resting for a few hours in the delivery room; as I was being wheeled out, a midwife dashed round the corner and yelled "Room Two is free!", and another panting woman was helped on to the bed - they barely had time to change the sheets. I have never felt so much like part of a conveyor- belt production line. So, this being my second baby, and having had a straightforward labour, I was dispatched into the night.

Fortunately, thanks to the unstinting care of my two midwives, who had made sure that not only the baby, but I, too, enjoyed a safe delivery, I was able to walk from the hospital entrance to the car with only a slight degree of pain. Not a huge fan of hospitals, I had only wanted the briefest of stays anyway; perhaps no more than the six-hour "minimum" just to ensure that there was no risk of my daughter developing breathing difficulties or myself suffering haemorrhage somewhere en route between hospital and home. But an hour and a half did feel a mite too brief to me.

So I viewed last week's protest by the nation's midwives with more than a little interest. A thousand midwives from all over the UK lobbied Parliament to protest at the dramatic decline in the numbers of practising midwives, and the hopeless understaffing of many of the nation's labour wards. Latest figures show we now have the lowest number of practising midwives ever recorded, with more than 1,000 vacancies nationwide; London - where Olivia was born - is the worst, with a 10 per cent vacancy rate.

At least I had two lovely and competent midwives with me from start to finish, who gave me all the courage and strength I needed. In the same week, and at the same hospital my daughter was born in, one woman labouring to give birth to a baby she knew was already dead was left on her own for 12 hours, and another gave birth in the labour ward staff kitchenette. Only last week, a national review of all stillbirths in this country revealed that two-thirds of all deaths in healthy babies were caused by overworked and under-trained staff. Also last week, two nurses were suspended from Princess Alexandra Hospital in Harlow, Essex, after a premature baby suffered a broken leg.

The length of stay in hospital after childbirth has steadily decreased since the Fifties, which marked the start of the mass hospitalisation of women in labour. Back then, the average length of stay after childbirth was around a fortnight, during which time, apart from recovering their strength, new mothers would be taught useful skills such as how to bath the baby without drowning it, and how to change a nappy without accidentally sticking a pin into its bottom. By the Seventies, the average length of stay was down to about seven to 10 days.

Today, however, after normal delivery, most hospital postnatal units attempt to get new mothers out of their beds within 24 to 48 hours. Small wonder that new parents find themselves desperately wondering which way round the baby's nappy should go, and load up with massive child-care manuals. The reduced length of stay in hospitals - caused by a shortage of midwives and the closure of dozens of maternity units throughout the country - would not matter so much if we all had the support of relatives who could show us what to do. But so often the midwife, and later the health visitor, are the only people many women can turn to for practical advice.

There have been moves by some hospitals to reduce the standard 48-hour stay even further. Bristol Health Care Trust, which has been uncomfortably in the spotlight over its record on children's heart surgery, hit the headlines again this autumn when the closure of one of its maternity units resulted in women being allowed to stay in hospital for just six hours after delivery. At last week's lobby of Parliament, Karlene Davis, the Royal College of Midwives' general secretary, warned that what is happening in Bristol could be repeated throughout the country unless midwives are given better pay.

I spent 24 hours in hospital following the birth of my first child, and am eternally grateful for the handy bleeper beside my bed, so when it came to my second I was only too glad to give up my postnatal bed for a more deserving first-timer.

It turned out that my enforced early return home did have major advantages. For a start, I was not sharing a room with five other women and their newborn babies: just me, my husband and our own little bundle snuffling beside us. Then there were the clean sheets and bath waiting for me, rather than hospital bedlinen and baths of dubious cleanliness. It does not surprise me that in two recent studies of neonatal infection, carried out here and in the Netherlands, healthy babies who were either born at home or returned home within a few hours of delivery contracted up to 40 per cent fewer illnesses in their first 28 days of life than those babies whose mothers had stayed in hospital for more than two days.

But for me, the greatest benefit of our speedy return home was that when our two-year-old woke in the morning and came into our bedroom, I was there, as usual, to give him his milk and morning story. According to many child-care practitioners and health visitors, the reaction of the older child to the new baby can be affected by a mother's lengthy absence from the family home for the birth. If she has been the oldest child's main carer for much of his or her life and is suddenly absent for several days, only to return with a new baby in her arms, it can be very damaging.

So, despite having been somewhat distracted and busy over the last three weeks, with my two-year-old being both sad and uncomprehending at times, at least I have always been there, at home, even from that very first morning after giving birth.