Maternity care in the United Kingdom for the majority of women is provided by the National Health Service (NHS), which was launched in 1948 based on the premise that good healthcare should be available to all, regardless of wealth. NHS care is provided free at the point of contact for all UK citizens and funded by taxpayers. As part of NHS maternity services, all pregnant women (whether high or low risk) receive care during and after pregnancy from a midwife. A woman who is low risk can receive all of her care from a midwife, while women with a high-risk pregnancy will receive obstetric-led care with midwifery support. Women may also have planned contacts with their family doctor in the community.
Over the last 70 years, there have been enormous changes in the content and provision of maternity care and the profile of women using maternity services. Policy directives to move place of birth from home to hospital from the 1970s onwards, based on the assumption of safety, meant that in 2017 only 2 percent of births took place in a woman’s home. This is despite more recent policy recommendations that women should be able to choose place of birth and that more women should be able to access free standing and alongside midwifery-led birth centers. For the majority of women who give birth in UK obstetric units, intervention rates such as cesarean sections and induction of labor continue to increase year on year.
Debra Bick will reflect the historical context of midwifery and maternity care in the UK and some of the current issues facing NHS services, including poorer health of women who become pregnant. She will consider evidence of the longer-term impacts of pregnancy and birth on women’s life-course health, the importance of care pre- and post-pregnancy, and how research programs are hoping to improve birth outcomes, especially for women in south London.
Bick is a professor of midwifery and maternal health in the Department of Women and Children’s Health, King’s College London. She has represented midwifery on several major policy groups, recommendations of which are helping to re-frame the organization and content of maternity care in the UK. Her research has been used to inform the evidence base for maternity care internationally, and work she has led is informing a number of online learning resources for midwives and obstetricians nationally and internationally.