In the future clinical commissioners, led by GPs will be looking to ensure that the highest quality and, I'm assuming, the best value for money, maternity services are available.
High quality maternity care following guidelines for supporting women to have a normal straightforward vaginal birth will without a doubt reduce costs. The definition of normal birth excludes caesarean birth, epidurals etc all of which are expensive.
The media picked up the publication of new guidlines by the RCM, RCOG and the NCT and wrote stories saying that caesarean births and epidurals will be withheld from women to save money
The fundamental message is that women should have choice - there are no suggestions that choice should be taken away from women.
Perversely it is the women who are seeking normal births who have less choice. Homebirths, births in midwife led units are not choices that are easily available to many women so not all women are able to make the choices they want.
Doula UK issued a statement that adds to the discussions very well.
Doula UK welcomes the recent increased discussion on how best to support women and babies to achieve increased rates of normal birth and decreased caesarean rates. Doula UK members work with women and their families before, during and after birth, supporting them as they make fully informed choices about place of birth and pain relief.
As Kicki Hansard, Doula UK spokeswoman, explains "there is no correct answer to what kind of birth is right for each woman and baby. However, many of the women our members work with are keen to avoid unnecessary interventions and maximise their chances of a positive birth and breastfeeding experience. For others choosing epidural anaesthesia or a caesarean is the key to this positive experience. There need to be real choices available to all women as well as in-depth information to allow them to understand the impact of these choices."
"The recent report by the NCT, RCM and RCOG provides a crucial opportunity to discuss whether the maternity services currently offer what women and their families need for safe and positive births. However it is vital that, as well as awareness of rising unwanted interventions and rising epidural rates and a desire to reduce those rates, a system is developed that ensures women have the environment, support, information and care that is necessary to do so. If women are to have fewer epidurals they need to be supported to find other ways of coping with labour and birth."
In a recent Doula UK survey women who were supported by a doula experienced a 25% drop in intervention rates compared with the national average, while the 2011 Cochrane Review of the effects of Continuous Support during Labour demonstrated similar findings. In addition it showed that women who had continuous support as they laboured were less likely to request epidurals and more likely to be satisfied with their birth experiences.
"There is increasing evidence that, in addition to a birth partner, having the support of someone outside a woman's circle of friends and relations and outside of the hospital staff makes a significant positive impact on birth," says Kicki Hansard. "As the policy makers, NHS trusts and individuals in the maternity services look at how best to decrease unwanted intervention and epidural rates, while providing real choices and support for women throughout the childbearing year, the positive impact of doulas needs to be a key consideration."