Two-tier? Too right

Pregnancy bump.jpg

A guest post from Chrissy D looking at the arguably already two-tiered system of antenatal provision for mothers-to-be that currently exists in the UK

I’m hearing a lot lately about the threat of a two-tier healthcare system, since the government’s announcement that NHS trust hospitals could earn up to 49% of their funding from private treatments. Let’s just be clear: any illusion that a multi-tier health care system doesn’t already exist, particularly where mothers and their children are concerned, is not only naïve, but entirely irresponsible.

Leviathan, from The Economist blog, speaks the obvious on this “somewhat ritual denouncement which shies away from the fact that the real NHS is multi-tiered already, with doctors mixing private and public practice”, although from a woman’s perspective the multi-tiers begin even earlier than in the consulting room; they begin at conception.

For a start, there is no denying the two-tiered system of antenatal provision for mothers-to-be that currently exists in the UK. Here there are two distinct levels: the NHS and the NCT. Sure, the NHS provides (in my area) a half-day birth class and three evening classes about what to do when your baby comes; these mainly focus on the physical process of birth and the practicalities of life with a newborn. If you are giving birth at a hospital, you can go look around the maternity unit beforehand for a sneak peek. If you have a bit of money to spare, however, you can hop on the next tier of antenatal care, otherwise known as the NCT. NCT antenatal courses focus on achieving birth they birth they desire and informing parents about what to expect from labour, delivery and beyond, as well as creating local networks of new mums, and providing members’ babies with ready-made friends for they traverse the birth canal. The former tier is free, the latter costs up to £16.95 per course session and annual membership of £40 (with concessions available). Unsurprisingly, the latter is more often the preferred domain of the middle-class mother to be. The former – on a good day – is populated by the rest of us. The latter’s aims are noble and delivery (pardon the pun) effective, but both show a stunning lack of proper state provision for the health and care of expectant and new mothers.

Further to these existing tiers, the proposed availability of c-section to anyone who wants it is likely to create yet greater disparity.

The first possibility is that if caesarean without medical necessity is to be available to purchase, we risk a division such as middle class parents able to pay for a caesarean, while working class mothers must ‘suffer’ the labour pains with less availability of pain relief and clinical attention during labour (while the obs and midwives are occupied in theatre).

However, the second possibility is that the chasm that currently exists may be widened even further, with middle class mothers striving for a ‘natural’ delivery, comfortably informed by their NCT antenatal teachers, and working class mothers opting – with little or no information offered to them on the matter – for the seemingly easier choice of having their children surgically removed. This would result in the detainment (for recovery) of working class mothers in their homes during the postnatal period and limit their access to community breastfeeding and personal support at the most pivotal time.

The tiers of postnatal healthcare (including babycare) are a little more complex, having been created more through the government’s failure to effectively regulate aggressive marketing of infant formulas by global pharmaceutical brands, under the insulting pretense of helping new mothers find their way, thus causing potential ill effects to new mothers and their infants.

Baby feeding (and NHS professionals) offers a choice between two tiers, almost always dependent on class – to breastfeed or not. Those who breastfeed are predominantly middle class, thus have access to the best education on the matter and are more likely to attend breastfeeding support groups (community run and attended primarily by (in my experience) middle-class mothers). Working class mothers are vulnerable to the relentless marketing by formula milk companies, to the point of being left with less choice; then, the very multi-tiered system that throws them to the hounds of pharmaceutical consumerism judges them on their choices and celebrates those who have the best information and opportunities for support. So the new mothers with the least money are encouraged to spend the most on feeding their infants.

What working class mothers aren’t paying for ante- and post-natal healthcare, they are encouraged to fork out on formula milk and other aggressively-marketed baby healthcare products. They are neglected by the free system set up to ensure their wellbeing and left as carrion for companies who make money out of new parents’ instinct to (spend money and) nurture their child.

The problem with Andrew Lansley’s proposed changes to the private-funding cap isn’t that it will create the greatly feared two-tier system; it’s that the crevasse will be forced even wider. That said, who didn’t see it coming?

Close-up of a pregnancy bump by Emery Co Photo, shared under a creative commons licence