October 16, 2002

Are St Thomas' Hospital duping women?

Yesterday I had a look around the St Thomas Maternity Unit, or “Birth Centre” as they call it. There are two corridors in the labour ward area - one is the regular labour ward (which they now call the “Birth Centre”) and the other houses the “Home from Home Centre”. It all looked very pretty in an institutional kind of way and that the hospital has lost the plot.

First, they have no idea what a Birth Centre really is. What they have built (and moved into 6 weeks ago) is a regular hospital. Yes, it is painted and bright (primary colours!) and that is certainly a change from the tired, dreary, worn out facilities most women in Britain have to put up with when they have baby in hospital. Apparently other hospitals in London that are being renovated are also calling their maternity units “birth centres” and while I agree they are centres for birth, by debasing the accepted definition used by the rest of the world it seems they are trying to hoodwink British women into thinking they are getting low tech, woman centred care, when in fact it will be “business as usual”.

The “Home from Home” unit is also another con job. It too looks just like a hospital - 12 birth rooms opening off the long corridor, 2 pool rooms, and a yet to be established “common area”that will have lounge chairs and murals on the walls. The decor is “hospital functional”and the only concession in the labour rooms is a sofa bed. The Health and Safety people decreed that women could not use that for either the birth or a post-partum cuddle with the father and baby because it “couldn’t be cleaned” (the mattress is not covered in plastic) so the women must use a regular hospital bed with its electronic controls. Each room has an ensuite, with a small bath and toilet and the shower is over the bath. No way women can move about in the shower and impossible to get the father in comfortably for support. Yes, they are reasonably low tech - no CTG machines, epidurals or forceps etc, but there are Entonox points in the bathroom and beside the bed and the rooms are fitted with scavenger units to suck out the Entonox so that he staff don’t get over exposed to the nitrous oxide. Would you believe that they use Entonox for women in the bath, almost routinely? Pethidine is also available if requested/required. They do have big windows and the view of the Houses of Parliament and Big Ben a few metres away across the Thames would be fantastic on a fine day.

This area is very far removed from most people’s idea of “home”. Belinda Ackerman, the Clinical Midwife Specialist in charge told me that they are hoping to get lots more home births happening and are aiming for 17 community based teams of midwives to provide this service. They can only staff 8 teams at the present time, so home births are likely to be few and far between,. Meanwhile women will come in and have a fairly standard hospital stay in this “Home from Home” area. Belinda said that the whole unit had been designed by administrators/architects who did not consult the staff about what was wanted (nothing changes, does it?) and there are a lot of furniture and some decorating they want to make. I will be interested to see how they are getting on next time I visit.

Some of the midwives at St Thomas will not, of course, welcome any criticism of their wonderful unit. There is a distinct culture amongst the staff there - and they believe that they are definitely the best. I was surprised at the closed minds of many of them and the almost violent reactions I got on some of their workshop evaluations - they don’t like being challenged! The “God syndrome” is alive and well amongst these midwives! I think they should get out more, and have a look at how care is provided in the smaller units and real Birth Centres, both in Britain and overseas. Are they scared they won’t measure up, I wonder? Everyone else in the workshop group were very positive in their feedback and welcomed the chance to review their own practice and consider new ways of looking at things. I fear that you can change the decor in a hospital but unless you change the staff attitudes, women will get the same old care and end up with the same old rates of intervention as ever. St Thomas is certainly a midwife centred, not a woman centred unit.

Posted by andrea at October 16, 2002 09:10 PM

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Andrea,

I have been a patient at St. Thomas' and I agree with your comments regarding the staff 110% - more if that's possible.

(Can't put my real name here though. World is too small.)

Jane

Posted by: Jane Smith on June 26, 2003 08:09 AM

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dear Andrea, I'm trying to research the use of fibre optic displays for use in our waterbirth room at the Wyre Forest Birth Centre in Worcestershire, and I am finding it incredibly difficult to come up with anything that would help our room look like anything different from an over sized bath in a pretilly painted sunny room. Although our clients say that they like it, it is a very sunny room and, very bright and there is nothing to look at apart from a wall. I know that women generally close their eyes in labour, but wanted them to get into themselves by creating an environment that enabled them to do just that. After reading lots about Leboyer and work by Odent I still can@t come up with anything that my managers will go for, thanks in anticipation.

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