ABSTRACT
Maternity services have been centralised into large hospitals. Most women can birth well if surrounded by people who value them, listen to them and nurture their self-confidence. The National Health Service is now run on a commercial model: the imperative being to get more for less. Centralisation produces economies of scale, or more output for less input and in maternity care the main input is staffing. Midwifery is rooted in relationships and a tradition of generosity, which research and long experience has shown to have excellent clinical and social outcomes. Standardisation requires care to be defined as a series of tasks to be monitored rather than a continuing supportive relationship. Midwives there do not understand the problems with insurance here because, once liability for the care of a child is removed, the cost of clinical negligence insurance is manageable for them. The chapter describes many of the problems around birth due to a fundamental clash of values.
