Harder labour

Maternity services have suffered from NHS cutbacks

"If pregnancy were a book, they would cut the last two chapters," according to Nora Ephron, screenwriter of Sleepless in Seattle. Unfortunately for West Hertfordshire's expectant mothers, it's information about the unavoidable part that has been cut. The West Hertfordshire Hospitals NHS Trust is one of the most indebted in the country, and as part of its cost-cutting measures it has abolished antenatal classes.

First, it was the partners who were told (last December) that they would no longer be able to attend classes. Now pregnant women themselves have had the service removed. Only teenage mothers and women expecting twins are provided with any form of preparatory course.

One woman pregnant with her first child says she was notified that classes had been abolished only three weeks before hers were due to start. She had no time to arrange private sessions, even if she had been able to afford the £170 they would cost.

Several other women say they are having to travel further from home in order to attend an available course. Theirs are not unusual cases. Anne Main, the Conservative MP for St Albans, has received hundreds of letters from other mothers-to-be in similar positions.

"They are uniformly bemused, emotional and scared," Main says. "Although the trust says there will still be access to midwives, that is not the same. Antenatal classes are a vital way of furthering friendship between pregnant women and giving them confidence."

Although financial difficulties have caused cutbacks across many trusts, maternity services have suffered disproportionately, in part encouraged by a government policy suggesting a fewer number of larger centres would be better placed to provide services.

Belinda Phipps, chief executive of the National Childbirth Trust, the voluntary parenting agency, describes the cuts in antenatal care as "very sad".

"It is really important for women to get together, have the opportunity to ask questions and get information," she told me. "Without classes, women feel less confident. The less relaxed a woman is, the more difficult the conditions of birth."

As a result of closures and cutbacks in National Health Service provision, the NCT reports a huge increase in demand for its own subsidised classes, as well as requests for help with finding private practitioners. However, NCT antenatal classes in Hertfordshire are now full to capacity, and the trust says there will be an unavoidable time lag in setting up enough new ones to meet the demand.

The West Hertfordshire Trust, which runs four hospitals, says the removal of antenatal classes is only a "temporary suspension". Midwives are still assigned to expectant families, which can make contact with them to ask questions, says a spokesperson for the trust.

The hospitals report hopes of restarting classes "some time in the new financial year". No date has been set, however.

NHS trusts across the country face the unenviable task of searching for ways to reduce spending as increasing numbers of them confront daunting financial crises. One hospital (St Helier, in Carshalton, Surrey) has resorted to removing one in every three light bulbs - an extreme remedy, but preferable to cutting antenatal classes, according to Phipps.

"There is a huge financial problem," she says, "but maternity has not overspent its budget, so it is unfair to penalise those services. It is not where the problem lies."

Phipps argues that although government funding and central targets are the basic problem, bad management has also played a role in West Hertfordshire.

"Watford has a huge Caesarean rate and Caesareans cost money," the NCT head says. "It is relatively easy to bring down the number by reopening the birth centre, encouraging home births and looking after people properly.

"Antenatal classes are vital and should be freely available on the NHS. After all, we are talking about the very start of human life."

This article first appeared in the 05 March 2007 issue of the New Statesman, The great generational robbery