Recent research conducted by Netmums and the Royal College of Midwives exposed real weaknesses in the provision of care for women and babies in the NHS.
Nearly a third of survey participants claimed not to have been offered NHS run ante-natal classes but worryingly, this rose to nearly half of women on low incomes. Almost 75% of women earning less than £15,000 said they had not attended such classes.
Other findings included a shortage of midwives to provide one-to-one care through labour and afterwards, women being left alone while giving birth and worrying gaps in post-natal care, such as regular visits from a community midwife to help establish breastfeeding.
What you put into a service influences what you get out, so do official statistics on outcomes correlate with these findings? Actually yes.
Pre-eclampsia, a potentially life threatening condition, affects just as many women now as it did decades ago. Only recently have the rates of infant mortality started to fall in Scotland. Until 2007, the numbers of babies dying at birth or shortly afterwards actually increased; thereafter they stabilised and in the last year, they have come down slightly.
And on breastfeeding rates – the key improvement target for babies' health since Susan Deacon introduced it as Health Minister at the turn of the century – our record is pitiful. The aim was to increase the number of babies still being exclusively breastfed at six weeks from 26.6% in 2007 to 33.3% in 2011. Did we make it? Eh no. The rate recorded was 26.5%, marginally down on the baseline. Worse, there are wide geographical variations from 18.2% in Lanarkshire to over 30% in Highland.
And having bombarded you with facts and figures and findings, is there a point to it all? Well I rather hope you don't need me to join the dots but in case you do...
For years, experts in the field of obstetrics – that's looking after women and babies to you and me – have railed against the lack of investment and research funding. It's the classic Cinderella service, ignored and unloved, except by a chosen few. This means there is very little research to establish the causes of conditions like pre-eclampsia or find cures. It matters less in Scotland and the UK where high quality clinical care means most women survive but in the developing world, pre-eclampsia is one of the biggest killers of women. If we Westerners were to invest some of our riches, we would not only be helping our own, but saving countless lives needlessly and shamefully wasted elsewhere.
But it's not just about the money, as the dismal breastfeeding rates show. This is one area where investment has occurred, yet still we are failing. The reasons for our low breastfeeding rates in Scotland are complex but there is also evidence of a lack of joined up thinking and working.
Money has been poured into achieving this target, yet at the same time, NHS Boards have streamlined support for families in the early years of a child's life. In Lothians, you get one developmental check when your baby is 20 months old and that is your lot. Community midwives have morphed into community nurses with responsibilities to vulnerable adults and older people in the community. Those who retire are not being replaced. Hence, ante-natal classes, breastfeeding support groups, drop-in weigh clinics are disappearing.
But all of this still does not explain one of the key and disturbing findings explicit in the Netmums' research but also implicit in the official data. Poor women and babies get a worse service from the NHS. The class divide would appear to be alive and well, despite all the targeting that is supposedly going on of scarce resources.
This needs to be explored further and urgently, particularly when we know that it is poorer people who are more likely to be having babies. Are they getting care on a shoestring while wealthier and older parents get a Rolls Royce service?
If so, what does that say about the culture and attitudes at play in our beloved NHS? We all worry about the existence of a supposed underclass in our society: are our public sector institutions and the people who work therein somehow unconsciously buying in, and even worse, reinforcing and contributing to the persistence of poverty?
Whisper it but could there be something very wrong with our much vaunted public sector ethos and values?