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The Face of Maternity Services: Then and Now
Words Jadesola Oginni
The face of maternity services has changed drastically over the last century and it will continue to change. Innovations within technology have advanced the process of maternity services and have made the most difference. Let’s go through a historical time-lapse on the development of maternity services since the 1900’s.
Entonox also known as gas and air is widely used now within the delivery room and is known to provide short-term pain relief during the height of contractions (Young A et al, 2012). Would you believe that Entonox was only introduced in the year 1935! Entonox not only transformed women’s experiences of childbirth but also helped individuals within other emergency departments within the National Health Service (NHS), which was founded in 1948.
In addition, the use of an epidural during labour has been proven to alleviate the majority of pain and an epidural ‘top-up” is used commonly for caesarean deliveries. For centuries an epidural has been used and trialled on various individuals with various conditions such as rheumatic heart disease, varicose vein removal amongst many. The first use of an epidural was used in 1942 on the wife of a US coast guard who was to have an emergency caesarean section (Ainsworth, 2014).
Trends in home births since the early 1930’s have changed drastically and are still changing. Home births were common during the 1930’s and many women were surrounded by their midwife, female relatives, friends and sometimes young children. Overtime, as analgesia was widely used and accepted, women and their families were aware that there were medications that could provide pain relief and hospital births increased rapidly. Since the beginning of the decade, the percentage of home births have decreased by 0.4 percent, despite the notion that more women want to revert from hospital-based births to home births. (ONS, 2019).
The term midwife is to be with a woman, the idea of a male birthing partner was unheard of up until the 1960’s. In the 1950’s The Sunday Express Baby Book (Wallis, 2013) discussed a scene for a hospital birth:
“In the delivery room, white with bright lights, you will be taken from a hospital trolley to the delivery table. The nurses will be standing by with the doctor and with their gentle help and encouragement, aided by the science they have studied so long, your baby will be born.” There is no mention of a birthing partner and the scenery is not inviting for the love hormone oxytocin to do it’s thing! Today, midwives encourage the support of birthing partners during the antenatal, labour and postnatal period. Unfortunately, due to Covid-19 many birthing partners have had restricted access to antenatal appointments and many Hospital Trust’s permit only one birthing partner during delivery however this is temporary and hopefully this will change soon.
An episiotomy, an incision between your perineum (vaginal opening) and your anus, during the 1970’s and 1980’s was routinely performed during delivery. Nonetheless, midwives and obstetricians noted that unnecessary episiotomies caused issues such as incontinence and infections and are now only used in emergency situations such as shoulder dystocia or when there’s signs of fetal distress (Ghulmiyyah et al, 2020).
The first time an ultrasound was used within obstetrics was in the late 1950’s with ‘crude, bistable and static’ images (Campbell, 2013). However, slowly the images have become clearer. For most pregnant women today, not having an ultrasound scan to confirm their pregnancy, date their pregnancy, examine any concerns and determine the gender of their baby or babies would be extremely uncommon. In fact, almost a third of women pay for private scans during their pregnancy aside from their routine nuchal and anomaly scans.
Observing the trends within maternity services are interesting and sometimes shocking moreover it is amazing to see the changes that have taken place. There is much more that can be discussed such as research, maternity wear, It’s important to note that changes within the maternity services are based on pioneers within healthcare researching, trialling and disseminating evidence-based findings within the services. It’ll be exciting to see the face of maternity services in the next century and the ways all healthcare professionals can work together to make better changes. The better birth (2016) campaign was created to improve the outcomes of maternity services in England, highlighting the points below to provide quality services for all women and their families.
BETTER BIRTH (2016):
Personalised care: Care centred around the woman and her family.
Safer care: Professional working across departments.
Better postnatal and perinatal mental health: Investments in perinatal mental health services. Smooth transitions between midwives and community care.
Multi-professional working: Breaking down barriers within healthcare professionals to deliver safe and personalised care.
Working across boundaries: Providers and commissioners should take clear responsibilities for improving outcomes and reducing health inequalities.
A payment system: Payment services to be reformed for maternity services to cater to a 24 hour period.