Health Committee

No 38A, Session 2002-03                23 July 2003

Choice in Maternity Services

Report published

Julia Drown MP, Chair of the Maternity Services Sub-committee said:

This report reflects our disappointment that extensive reforms to Government policy on maternity services made ten years ago, have not resulted in a greater degree of choice and control for women and their families. We are concerned that the closure of smaller maternity units and birth centres, midwife shortages and a lack of experienced obstetricians (a problem which will be exacerbated as the European Working Time Directive is implemented), all limit the choices women have. We call for the Government to take steps to rectify these problems and to give women power to make informed and real choices about their maternity care.

A great many of our recommendations echo those made by our predecessor Committee in 1992 which were adopted as Government policy but which have not been implemented throughout the country. Examples include the Committee's conclusion that "the policy of encouraging all women to give birth in hospitals cannot be justified on the grounds of safety", and the recommendation that there should be a presumption against the closure of smaller maternity units. We look forward to the publication of the Children's National Service Framework as an opportunity for maternity services to allow women to negotiate a wider range of options in choosing their maternity care. We urge the Government to consider allocating some one-off resources to maternity units so that staff can plan and implement change without fear of further staffing shortages.

We recommend that maternity units should examine how women are informed about their choices in relation to screening and testing, and intervention in labour. Genuine informed choice on tests and interventions may help avoid the increasingly litigious culture we have had reported to us. We are particularly concerned that some women undergo caesarean section without exercising informed choice. We call for the Government to be more proactive in tackling the rising and variable caesarean rates throughout the country. We believe that the Government should address the more general concern that birth is no longer perceived as a normal physiological process. A great many women currently are not aware that they can make direct contact with maternity services through consultation with a midwife rather than via GP referral, and those who do wish to refer themselves directly to maternity services are sometimes refused this option.

Women who choose to have their babies in maternity units should wherever practical be able to exercise choice over the type and location of the unit, and their length of stay after the birth of their babies. We call on the Government to ensure that trusts do not limit women to a single birth partner. We also call on trusts to ensure that labouring in birth pools can be supported. Our report also highlights the work of independent midwives and recommends that all trusts should arrange for the use of independent midwives where needed.

Currently only 2% of babies are born at home, yet surveys indicate that given the choice 3-10 times as many women would want to have home births if given the choice. We point to the previous Secretary of State's announcement in 2001 that all women should have the choice of a home birth but we are disappointed that no direct action has been taken by the Department to achieve this in the two years since his statement. We heard evidence that women who chose home births had this option withdrawn from them at a late stage in their pregnancies, on the grounds that sufficient staffing could not be guaranteed to support the birth. We find this practice wholly unacceptable. We call on the Government to take action to stop this practice. Women should not be faced with the option of having to have their baby in hospital against their will, or, as has happened, to give birth alone at home.

Throughout our inquiries into maternity services we have been encouraged by evidence of strong partnerships between members of maternity teams, and of their commitment to developing partnerships between the woman and her carers in planning and making decisions but there are significant variations in services across the country and it is clear that not all families are getting the support they need in maternity services. Our report urges the Government to take action to support maternity teams in their efforts so that all pregnant women and new mothers feel that they have control over their care, and that their wishes are respected and supported.

Notes to Editors

The Health Committee will publish its Eighth and Ninth Reports of Session 2002-03 on Inequalities in Access to Maternity Services (HC 696) and Choice in Maternity Services (HC 796) on Wednesday 23 July.


 In December 2002 the Health Committee appointed a Sub-committee to undertake a series of short inquiries in this area. In its first inquiry the Sub-committee set out to look at the services available to women in England today and at the variation in these services across the country. In conducting its second inquiry, into Inequalities in Access to Maternity Services, the Sub-committee chose a range of disadvantaged groups of women in order to explore a number of access problems and solutions, and to attempt to draw together some common factors which might contribute to full access to appropriate care and advocacy services. In its third and final inquiry, into Choice in Maternity Services, the Sub-committee examined the degree of choice and control a woman has over her maternity care.

Copies of the reports will be available for collection on Wednesday 23 July at 11am from the reception desk at Westminster House, 7 Millbank, London SW1. Copies of the report will also be made available to the Press at the Press Gallery, House of Commons.

Following publication, copies of the Report will be on sale from the usual Stationery Office outlets (tel. 0845 702 3473) and the Parliamentary Bookshop (tel. 020 7219 3890). Following publication the Report may also be viewed at

The Health Committee is a Select Committee of the House of Commons. It is appointed under Standing Order No. 152 to examine the expenditure, administration and policy of the Department of Health and associated public bodies. The Committee has power to send for persons, papers and records. The Maternity Services Sub-committee, which was nominated on 12 December 2002, is appointed under Standing Order No. 152 and had the power to send for persons, papers and records.

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