By Caroline Parkinson
Health reporter, BBC News
Pregnant women often feel nervous about labour and birth
Hospitals in parts of England and Wales are reducing or even axing services for pregnant women because of the NHS's financial problems, it has been warned.
Antenatal classes and breastfeeding tuition are being affected, the National Childbirth Trust and Royal College of Midwives told the BBC.
They said women were being deprived of much-needed advice and support.
The Department of Health said it was committed to a maternity service which put women's needs first.
Antenatal classes set out what happens in labour and what options women have about how to give birth, as well as offering breastfeeding advice and information on what to expect in the first few weeks as a parent.
The National Service Framework on maternity services, published in 2004, said good antenatal care should include providing access to parenting education and preparation for birth.
Whether or not services are provided depends on local primary care trusts, who pay the local hospital to provide them.
The NCT, which provides paid-for antenatal classes for women, started to compile reports from members about local cuts last October.
So far it has been told 19 areas across England and Wales have either cut or closed antenatal classes or visits to maternity units - designed to help expectant parents become familiar with the surroundings in which they will have their baby.
Belinda Phipps, chief executive of the NCT, said: "So much of the NHS is closing antenatal classes down. There are a lot of people who would have gone to those classes, but they can't."
Ms Phipps said there were also anecdotal reports that postnatal midwife visits, designed to check on the health of the mother and the baby, were also being reduced.
Mervi Jokinen, of the Royal College of Midwives, said: "The NHS is in grave difficulties financially.
"With maternity services, they have looked at what they can leave out. We understand that a concerning amount of antenatal classes are being cut.
"NCT classes are very good, but women and their partners don't get to know the midwives they will be seeing when they have their babies, like they do with NHS classes."
One of the areas which has been hit is Maidstone in Kent, where antenatal classes were cut from four sessions to one in October last year.
But Tracey Jewsbury, the Maidstone and Tunbridge Wells NCT representative, said that its most recent event was inundated, with 300 parents attending.
She said the new arrangements would penalise those who could not access or afford the £150 charge for NCT classes.
"People are desperate for information. But we are definitely heading for a two-tier system."
A spokesman for Maidstone and Tunbridge Wells NHS Trust said new funding arrangements had led it to reduce antenatal sessions.
He added: "Pregnant women can still access any information they need, from the same midwives as before, but just in a slightly different way."
In Romsey, Hampshire, NHS antenatal classes were cut completely last June.
Instead, midwives go to women's homes for a longer than normal 36-week check and give them information about what to expect during labour and birth then.
Local NCT representative Barbara Wyant said: "It doesn't really seem to be an economy. If they are going out to do longer visits with each woman, they won't be able to see as many people."
Maria Dore, senior midwifery manager at Southampton University Healthcare Trust, said: "We have been very open about the pressure we are under to provide a safe, high-quality maternity service for everyone as the birth rate in this area continues to rise.
"One of the steps we have been forced to take in order to maintain safety is restricting the number of antenatal classes that are offered by our maternity staff."
Deprived hit hardest
Liberal Democrat health spokeswoman and Romsey MP Sandra Gidley has written to ministers about the cuts to classes.
A former NCT teacher, she said it would be the most deprived families who would suffer.
"The people who are most in need are the ones least able to access information."
And Louise Bamfield of the Fabian Society, who has been looking at the health of women and their babies of Indian, Pakistani and Bangladeshi origin.
She said: "Attendance of antenatal classes is a factor in increasing the risk of having a low birth weight baby.
"The government needs to do more to encourage women to attend these classes. It is a particular problem for women whose grasp of English is minimal or non existent."
Jo Webber, deputy director of policy at the NHS Confederation - which represents over 90% of NHS organisations, said: "We would not want women to be going through pregnancy without all of the relevant information.
"It is especially important that women living in deprived areas receive this information and support - as historically it would seem they do not tend to try and access antenatal services.
"PCTs are working hard to provide the best possible antenatal care possible to local patients - this may not always be in the form of an antenatal class."
A Department of Health spokesman said trusts should meet standards laid down by the NSF, and echoed by the National Institute for Health and Clinical Excellence.
"The soon-to-be-published maternity strategy will set out how we will achieve services that provide real choice and support for women in all settings, from antenatal care through to the early child years."
Are you attending antenatal classes? Have you been affected by the cuts?
A selection of your comments:
The nhs has seem to have a negative approach to pregnancy. First of all saying that overweight pregnant women are a burden to the nhs. And now cutting on relevant information that is important to pregnant women, especially first time mums. I found these classes very informaative and useful. My advice would be to stop treating drunks on a saturday. There you go money saved all round. Get rid of time wasters, and treat pregant women with dignity and respect.
amanda jenkinson, uk
Antenatal classes are not only important for gaining much needed information but they are a means of meeting other expectant mums in your area. The mums from my antenatal classes have been getting together regularly for two years now! We are good friends and give each other needed support and advice.
Claire Bleakley, Edinburgh
Prenatal classes and maternity ward visits are vital to familiarizing yourself with the process of what will happen in the hospital. Without them many expectant mothers would be uninformed and lost.
SHELLON BECKFORD, enfield middlesex
I am just hoping that one 2.5 hour class will prepare me for the birth of my first child! Do not quite know how they will cram all the relevant information into such a short space of time.
Liz Johnson, worcester
When I had my last child I was really pleased and grateful for all the help that my antenatal classes gave me I am now having my second child and I think it is disgraceful that I will not be able to get the help and advice that I need, Do the NHS realise what they will be doing? As they are not going to be helping mothers and advising them therefore some mothers may feel they cannot cope and this may have big effects such as post natal depression, more abandoned babies and if women know they can't get the help then they may terminate in the beginning or in extreme cases it may stress women out that they cannot be helped anymore and therefore cause miscarriges. All these are possibilities and the NHS seriously needs to think about things a bit better they are supposed to be improving themselves not letting everyone down
Samantha Crossley, Halifax, UK
I was given 4 days notice to attend a one day antenatal classes. I was unable to attend and I was told that I will not have another chance. This is my first pregancy so I had to pay £150 to pay NCT classes.
Sonia de la Orden, Greenford - Middlesex, UK
The NHS funding cuts have hit my local antenatal and postnatal provision. Before I had my first child the NHS was able to provide an antenatal class just for dads. This was cut before I had my first child (dec '05) I am about to have my second child, and my local surgery used to offer two weighing clinics a week with a health visitor in attendance at both the clinics. This has now been reduced to one clinic a week. With my first child the midwives visited you in your home for the first 10 or so days (or as long as you needed it) This has now changed to a system of post natal clinics where the midwives no longer visit you in your home, but expect you to come to a postnatal clinic in the surgery. Not very practical with a newborn and a toddler. The NCT should not be expected to provide all the antenatal and postnatal support new mothers need - just because the NHS is suffering funding problems.
Heather Townsend, Flitwick, Bedfordshire
I recently attended antenatal classes and they were superb. We had to pay a small donation but it was well worth it. The chance to meet other women in the area in the same situation was invaluable, as was the advice, info and support received from the classes. The first few weeks of a baby's life are trying on both the mother and father and without this education, I don't think I would have coped so well. So the NHS are only going to add to those women feeling depressed, alone and worse if they axe these classes, therefore creating costs in care elsewhere.
Laura Storey, Eastleigh, UK