From MIDWIFERY MATTERS, Issue No.103, Winter 2004
Sue Paterson
Beginnings
In the autumn of 2001, the first meeting of the Birth Centre Bristol steering group took place around my kitchen table. We had little idea that we were embarking on a journey that, three years later, would find us so far ahead of our starting point and yet still a long way from our goal.
The steering group was initially made up of three midwives, an obstetrician, a general practitioner, a solicitor and an accountant. We knew that to have any chance of achieving our aim of establishing a birth centre in Bristol within the NHS, we would have to be committed, focused and professional. We would have to find out who were the decision makers and engage with them and anyone who might be able to influence them. We would meet and have to deal with ignorance, opposition and vested interests. We would have to show how birth centres offered a way of addressing many of the local and national public health priorities with which the primary care trusts were trying to grapple. We would have to involve the community and demonstrate local demand. We would have to find funding sources to meet the inevitable costs of our campaign.
At its inaugural meeting, the steering group agreed simple terms of reference, confirming that its main purpose was to support the progress of the Birth Centre Bristol project, to develop a strategy for furthering its aims and objectives, and to guide and drive the project in line with this strategy.
The steering group was (and is) supported by an energetic and dedicated group of working midwives and we were already beginning to develop our advisory panel: a network of senior health and business professionals willing to offer guidance, criticism and advice.
The Project
At our second meeting, the steering group fixed on Easton as a site for the first birth centre. Easton is a socially and ethnically diverse area of central Bristol with a vibrant local community but a high degree of deprivation. It was a priority area for Neighbourhood Renewal funding, with some difficult social and public health problems. We felt that a birth centre in Easton would address many of these problems, especially issues of social disadvantage and health inequality, through providing access to appropriate, high quality care within the local community.
On the wider front, we believed that birth centres could help to address national health priorities by promoting breastfeeding, reducing caesarean section rates and improving family life through providing a positive experience of normal birth. We were also convinced that birth centres could offer a real solution to the recruitment and retention crisis in the midwifery profession.
The Next Steps
Over the next few months, Birth Centre Bristol bid successfully for funding from Sure Start for a survey of women in Easton and had positive meetings with the Regional Director of Public Health and several community groups. Birth Centre Bristol representatives joined the Neighbourhood Renewal health task group and the Sure Start partnership.
All of this was happening within the context of plans for a major reconfiguration of health services in Bristol (the Bristol Health Services Plan). It was imperative to get birth centres on the agenda. In response to an encouraging letter from the Chief Executive of Bristol North Primary Care Trust, the steering group began work on a formal proposal. This was an outstanding team effort, and the result was a professional, detailed and well researched document that undoubtedly raised the profile and reputation of Birth Centre Bristol and has since been adapted for use by other birth centre campaigners around the country. The proposal was published in September 2002 with funding from Neighbourhood Renewal.
The response from the Primary Care Trust was positive but cautious. Money was tight and much of it was already committed, but the Chief Executive was keen to keep lines of communication open on a development option which he saw as an interesting and innovative idea that had considerable support within his organisation. The Director of the Bristol Health Services Plan undertook to involve Birth Centre Bristol in the future development of maternity services.
The results from our survey of women in Easton showed overwhelming community support for a birth centre in the area. The most important reason given was the need for local, accessible care, and strong feelings were expressed in many of the responses. Armed with our formal proposal and these impressive results, Birth Centre Bristol began a dialogue with Bristol South & West Primary Care Trust.
We are now working to persuade both Bristol primary care trusts to include birth centres in planned community hospitals or health care facilities in their respective areas. We are also putting much effort into informing and engaging midwives and supervisors of midwives and raising public awareness.
The Roller Coaster Ride
Carrying out a campaign of this nature is a steep learning curve and can feel like a rocky ride.
One of the high spots was when all four Bristol MPs agreed to give public support for our campaign. A low spot was when the local newspaper that had promised to feature this success ignored our press release. We learned the hard way about the pitfalls of offering an exclusive.
Another great moment was when we heard that the Secretary of State for Health, John Reid, had mentioned our campaign in the House of Commons and promised to help midwife-led initiatives to prosper. Less good was his failure to reply to our letters. We learned to be a bit more cynical.
We were encouraged by the positive response from senior levels of the primary care trusts and disappointed by resistance from the acute unit and some GPs. We learned that we have to listen and respond carefully to their concerns, which relate mainly to issues of finance and clinical risk management.
We were delighted when a special public consultation event on maternity services was held in response to our campaign. We were not so happy when this was barely mentioned in a subsequent report. We learned to be philosophical about other people's agendas and to persevere doggedly with our own.
It is a long slow process, with many ups and downs, but very rewarding as we learn more and make each small breakthrough along the way.
The Way Forward
Birth Centre Bristol is now poised to go ahead with a slimmed down steering group. We have been joined by a dynamic young ARM midwife and have strengthened our advisory panel. We have set up the Birth Centre Bristol Community Network, which is identifying local needs and priorities through consultation with interest groups in Easton. We recently published a revised and updated edition of our formal proposal to the Bristol primary care trusts. We received substantial funding last year from Neighbourhood Renewal and have just had our funding renewed for the next two years. The primary care trusts have authorised their staff to work with us on exploring the birth centre option and we are preparing a business case for the inclusion of birth centres in the planned community hospitals. We are arranging a presentation on the Edgware Birth Centre for GPs and a visit to an existing birth centre for primary care trust executives.
We have come a long way since that first meeting at the kitchen table and have still a long way to go, but we hope that our experience so far will be an inspiration to others and that in a future edition of Midwifery Matters we will be able to report that we have succeeded in our aims and that mothers and midwives in Bristol can experience and enjoy a new and different model of care for normal birth.
Sue Paterson is the Chair of the Birth Centre Bristol Steering Group. More information on Birth Centre Bristol and its proposal document is available from Birth Centre Bristol.
The proposal may be adapted for use by other birth centre campaigners, provided that Birth Centre Bristol is acknowledged and credited.
updated 15th December 2004 (IK)