Maternity Services: Gloucestershire

Simon Opher Excerpts

Wednesday 9th October 2024 Westminster Hall

[Dr Simon Opher (Stroud) (Lab)]

I thank the hon. Member for Cheltenham (Max Wilkinson) for calling this debate. Maternity care in the Stroud area has been a big issue for the past couple of years in particular. I have been a GP for 30 years, and I have helped with antenatal and post-natal care and, indeed, intrapartum care for six months, which was the hardest work I have ever done in my life. I also delivered my second daughter in a Worcester hospital.

I know and have worked with fabulous midwives, who are the absolute key to maternity services, as we have been discussing. Doctors are occasionally called in for other reasons, but midwives run maternity services; they have to be central, and they have to make their decisions around women. That is one of the reasons I promote Stroud maternity unit: as my hon. Friend the Member for Gloucester (Alex McIntyre) said, midwife-based units have lower levels of intervention and better outcomes for babies.

As many hon. Members have said, the key problem here is the lack of midwives. We should not shy away from that, but I also want to talk about a number of other issues. Something that seems to have been missing from the discussion is women’s choice over where they give birth—we seem to have reduced that choice to just Gloucestershire Royal hospital. Although Stroud maternity unit is open for intrapartum care, it does not have post-natal beds, so women are generally choosing it less often. That is a pity, because it is a fantastic place to give birth and has a low intervention rate. Equity and equality also seem to have been lost from the discussion recently, and we need to get them back into the decision-making process.

Maternity care is actually a longer process than just where someone gives birth. I will outline where those interventions take place. Pre-conception and antenatal care tends to be done in GP surgeries by community midwives with the help of GPs. Intrapartum care can be done at home—a small proportion of people do give birth at home—or in midwife-led units, such as Stroud maternity, or in either midwife-led or consultant-led units, such as in Gloucester Royal and Cheltenham. They are the possibilities. When it comes to post-natal beds, the only choice at the moment is Gloucestershire Royal; there is no other option in Gloucestershire. Either mothers go there for their post-natal care or they have to go home and have a community midwife.

The last part, I always think, of the whole maternity service is the eight-week check of the baby by their GP. I have done thousands of those checks in my life, and it is one of the best things I ever do. The GP can check babies for problems and talk to mums about not sleeping and all the other issues.

That is the whole, rounded nature of maternity care. I now want to talk about Stroud maternity, because that is what I know about most and what we are missing most. First, it is a very much loved and valued service in Stroud and we are missing the six closed post-natal beds. As I have said, it is a stand-alone, midwife-led unit. That is unusual in this country, and it is a shame it is unusual, because it is a really good place to have intrapartum care, so it is something that I am really trying to promote. We have 1,000 live births in Stroud a year, and at the moment only about 300 take place at Stroud maternity unit, but as I have said, there are lower levels of intervention and there is increased maternal satisfaction. For that reason, we must get these beds open again; they have been closed since 2022.

I want to make a few points about post-natal care, because often people say, “Oh, it’s a luxury; we can’t really afford it.” It is not a luxury. There is very good evidence that for certain families, certain mothers, good post-natal care saves a huge amount of money later on. It is about making sure that the baby and the mother bond properly and that breastfeeding starts properly. It is about making sure that they have a couple of days away from, perhaps, a number of other children and properly bond and that mothers learn how to look after babies. A lot of my colleagues say, “Well, post-natal care, we don’t really need that,” but we do need it. If we lose it, it will cost the country more, but it is also part of the whole maternity service. That is the first thing I would say.

Secondly, the people at the CQC have stipulated various things. The CQC is about safety, which none of us can argue about. However, some of its decisions, I feel, do not make sense and all they do is give safety to the organisation and not to the mother. For example, postnatal beds are being closed because it insists on having two midwives on the unit at all times; that makes it safe. However, closing the post-natal beds means that all these mothers have to go home. Are they safer at home or are they safer at hospital, with maternity care assistants and other nursing staff? I would say that the safety of the mother is better served with those post-natal beds open, even if there is just an on-call midwife as a second midwife. I want to slightly question the logic of the CQC—we must go back to it—so one of the things that I will do after this debate is write to the inspectors and arrange a meeting with them, because we must consider the safety of the mother and the child first. This is not about covering the organisation and making that safe; it is about making the mother safe, so I would iterate that as well.

There is something else that we have been doing. The League of Friends at Stroud hospital in general and at the maternity hospital is fabulous and has been providing extra services for post-natal and antenatal mums for some time. We now have an interim plan whereby we are going to open a sort of day hospital in the maternity unit so that at least mothers can come and have a bath while someone else looks after their baby, for example, and they can receive advice from health visitors and midwives. That is an interim plan. I do not want to say that it is a good replacement. We must get those post-natal beds open, so I am also due to meet the maternity and neonatal voices partnership, which is a crucial agent that we must talk to.

In summary, we need to train and, crucially, retain more midwives, because we have trained quite a lot of midwives who have almost immediately left the profession, as the hon. Member for Cheltenham was saying, because of stress. We need to secure a better working arrangement for them, and I look forward to my hon. Friend the Minister outlining plans to train thousands more midwives. We need to review CQC safety and make sure that the stand-alone nature of midwife units is fully understood by the CQC. We also have to make midwife working much more flexible. There could be on-call systems for these stand-alone units, so a second midwife does not need to be present if they are available to be called in. I have talked to midwives about that, and they seem happy to run that type of service. We also need a commitment from the ICB and the Gloucestershire Hospitals NHS foundation trust to reopen all six post-natal beds at Stroud maternity hospital.