Memorandum by Worcestershire Acute Hospitals
NHS Trust (MS 36)
This evidence is a collective response from
supervisors of midwives appointed for Bromsgrove and Redditch
district and senior midwifery managers of Worcestershire Acute
Hospitals NHS Trust. The Trust comprises of three maternity units,
two consultant led units and one midwifery led unit:
Alexandra Hospital
Worcestershire Royal Hospital
Wyre Forest Birth Centre.
Collection of data from Maternity Units
Collection of data is very difficult, as a maternity
information system is currently unavailable to our Trust (consisting
of three maternity units) County delivery numbers 4,994. Basic
data has to be prepared manually, which is very time consuming,
not cost effective and very basic. This deficiency has been highlighted
since 1992 (and possibly longer). Everyone concerned agrees that
a maternity information system is required, however, funding is
not forthcoming and we continue to highlight this deficit at every
opportunity.
No common data set exists in the UK which can
be very misleading when comparing unit with unit, Trust with Trust.
Any information collected is very basic and dependency needs and
local variations are not considered and are not taken into account.
Unfortunately, the services we provide are benchmarked against
the very basic data collected, eg number of deliveries recorded
used as main benchmarker, with no consideration given to geographical
areas and ethnographic variations within catchment areas, dependency
of patients, provision of neonatal intensive care services, etc.
Birth-rate Plus would capture this information.
Recommendations
i. Development of common data collection
(WMPI are attempting to introduce this as a minimum data set for
the West Midlands region (keme@wmpi.net).
ii. Necessary resources to purchase an adequate
information system for the collection of relevant data.
Staffing Structure of Maternity Care Teams
As already noted, Birth-rate Plus would assist
considerably with staffing ratios in maternity care. This system
is supported by the Department of Health, however, a project manager
is required in order to undertake this system, which is not possible
to fund from within maternity establishment or otherwise.
Continual changes and innovations within maternity
services have impacted on the workload of the staff within maternity
services, eg additional skills acquired, reduction in junior doctors
hours, patient involvement and expectation and improved standards
of maternity care, embracing the Public Health agenda.
An increasing trend of flattening of maternity
management structures with the loss of heads of midwifery and
senior midwife posts has ensued. This has become easier to impose
since the introduction of clinical supervisors of midwives.
Recommendations
i. The professional heads of maternity services
should be allowed to lead the formulation of staffing structures,
applying common principles with allowance for relevant geographical
differences and changes in practise.
ii. Central funding to provide the resources
required to undertake Birth-rate Plus (project manager and administrative
support).
Caesarean Section Rates
As within many consultant led units, our caesarean
section rates are high. Aware of the high rate of caesarean sections,
the supervisors of midwives undertook a retrospective audit project
in relation to emergency caesarean sections and midwives practise.
The most noticeable findings are increased use
of epidural anaesthesia which results in continuous cardiotocograph
monitoring and immobilisation. Further work and effort is required
to address the findings of the project which will increase the
need for training. We are currently preparing to bid for monetary
resources from the Local Supervising Authority to carry this project
forward.
Trusts where the caesarean section rate is low
have a common approach and established team ethos of working with
successful midwifery led units, encouraged and supported by obstetricians.
The stability of staff and population are also noticeable in these
units.
The introduction of clinical risk management
is undoubtedly a positive and necessary move but, without the
necessary resources an increase in litigation claims must also
have impacted on the rising number of caesarean sections.
The culture of modern woman is very different
to that of twenty years ago, their lifestyles and independence
effect the expectation of pregnancy but especially labour and
ultimately analgesia and/or mode of delivery.
Recommendations
i. Improvement and resourcing of midwifery
led units, through:
— Appropriate "grading" and
training of midwives
— Increase confidence of midwives through
education and training
— Team work—obstetricians and
GP's.
ii. Increase midwifery led care in obstetric
units.
iii. Provide one to one care in labour
— Audit standard of one to one care
in labour.
Provision of Training for Healthcare Professionals
advising pregnant women and new Mothers
Training for healthcare professionals involved
in the provision of maternity services should be multidisciplinary
wherever possible. Basic training alone is not adequate, degree
and above should be resourced with the allowance to "back
fill" the clinical posts. Learning that is related to the
working environment should be funded. Midwives are penalised when
wishing to continue further education, both financially and time
factor. Again, there is no equality between Trusts, large teaching/regional
units are able to fund further education for their midwives.
Appropriate, relevant posts need to be available.
Following further education, consultant midwife posts are a tiny
minority and have had very little impact (on the career structure
for midwives).
Recommendations
i. Funding for further education, including
resources to back fill to clinical posts.
ii. Equality of study leave and resources.
iii. Midwifery posts created, relevant to
skills obtained in further education, eg research midwives.
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