Examination of Witnesses (Questions 580-599)
TUESDAY 1 APRIL 2003
MRS DONNA
OCKENDEN, MR
CHRISTOPHER GUYER,
MS SUE
CREEGAN, MS
PEGGY HAND,
MS MARGARET
WHEATCROFT AND
MRS MANDY
GRANT
Dr Taylor
580. Bournemouth, because you do have obstetricians
on hand you do this low number of emergency caesars. Does that
mean you do not transfer anybody in labour to the unit at Poole?
(Ms Wheatcroft) It will depend on the situation. The
emergency caesareans that have been done at Bournemouth would
be done on the basis that it was not appropriate to transfer,
but if it is okay to transfer then they are transferred.
581. Similar units have given us the percentage
that they transfer. Have I missed that in yours or did you not
give us that?
(Ms Wheatcroft) We have got the transfer rate but
are you talking about transfers for caesarean, or intra partum
transfers?
582. Intra partum transfers to Poole, yes.
(Ms Wheatcroft) We have got the intra partum transfers
to Poole which are about 18.6%, but of those very few go on to
have caesareans.
Dr Taylor: I have to make a comment about our
own experience because our midwife centre turned into a birthing
centre and I thought there was more to it than just the loss of
the doctor—I thought it was the fittings as well that went
into it! Our selection criteria tightened up immediately, however,
because before that we were able to do caesars in the emergency.
But that is only a comment.
Mr Hinchliffe
583. Can I ask about the induction rates at
Portsmouth because although your caesarean rate is average the
induction rate is somewhat higher than average. Is there a particular
reason for that?
(Mr Guyer) The simple answer is we do not know and,
funnily enough, that is the subject of a current audit in Portsmouth
because we are concerned that our induction rates are too high,
and this may well have an impact on what is happening with our
instrumental delivery and caesarean section rates. So we are in
the process of looking at why induction is done and our hope is
that, on the basis of the results we get, we will be able to put
in place something that will reduce the inductions that are done
there.
584. So the procedures for audit are similar
to the ones you have outlined on caesareans, presumably?
(Mr Guyer) Absolutely.
585. I think we have touched on the issue of
the user perspective on intervention but I am not sure whether
we got an answer relating to how informed you felt or not about
the options available prior to giving birth, and I would be interested
from the user perspective whether you feel you are adequately
prepared and involved and if you were made aware in the process
of preparation for your births, what options were available and
what may or may not happen, and whether your choices were included
at that stage, and your views?
(Ms Grant) I would say broadly the view of the women
who use Bournemouth unit is they are more satisfied with the small
unit and they feel they get more continuity, although that has
changed a little recently, I have to tell you. There have been
some changes, and the women who had babies a year or two ago and
who are now having another baby have told me it has changed slightly
and they have not been getting quite such good continuity, so
I think that needs looking at. They would say that especially
women who have used other services, who have been to Poole maybe
for their first babies and subsequently to Bournemouth, feel a
lot better informed at Bournemouth.
586. Going back to time that my children were
being born we had parent classes and so on. Was there something
like this available to you and was it available within the unit
you were going to go to? How was it offered in your area?
(Ms Grant) In the area for the Bournemouth maternity
unit there are ante natal classes that go on in the community.
Obviously ante natal classes are only as good as the person doing
them, so they vary greatly depending on the teaching skills of
the person doing them and there is not much continuity.
Chairman
587. Where are they carried out?
(Ms Grant) They are all outbased in the community.
Mr Hinchliffe
588. Ms Creegan, did you feel that the preparation
from your point of view was adequate in terms of the options that
were available? My own experience with my first child was that
it was a forceps delivery. There is no preparation in the parent
craft classes for that and it would have been very helpful for
me and my wife to have had some experience of what was likely
to happen. What were your views on the classes you were offered
at that stage?
(Ms Creegan) The choices that women in Portsmouth
are made aware of early on in their pregnancy are quite poor.
I do not think the whole range of what is available to them is
necessarily given to all women—it is very selective. Whoever
their first point of contact is, whether it be a GP, a midwife
or whatever, certain women will be told, "There is A, B and
C available to you" and others may be only told about A and
B, for what reason I am not sure.
589. So what do you think could be done better?
Where do you see the problem? Obviously we are looking at what
we can recommend and we see various practices in different parts
of the country, so what would be ideal from your perspective?
(Ms Creegan) I think the ideal would be for a woman
to see a midwife as her first point of contact, someone who does
see—hopefully—birth as a normal process, rather than
a GP who is much more aware of the problems that may arise.
(Ms Grant) I would agree with that, definitely.
(Ms Wheatcroft) Can I say that, whilst this issue
of continuity is extremely important for the women, the midwives
feel very strongly about it as well. They really do want to provide
continuity but sometimes it is difficult for them because there
are many other demands on their time. I know we have not touched
on staffing yet but I think that is something that is very important
when looking at appropriate staffing levels. If we really want
to offer continuity to enable the midwives to give the women time
to be able to make choices, there have to be appropriate staffing
levels, and I think that is extremely important.
(Ms Grant) Also it is extremely important that this
is seen as the midwives and the women working together, because
the midwives get a lot more satisfaction out of the service than
women are enjoying, so it works both ways.
Dr Taylor
590. Moving on to staffing, we have certainly
got the message of continuity of care from the ladies who have
received it and the midwives who want to give it. Really I would
like to touch on staffing issues, both from the midwife point
of view and the medical point of view. Starting from the midwife
point of view, what is your recruitment and retention like? Are
you going to be affected by the European Working Time Directive?
(Ms Wheatcroft) I think it would be foolish for any
of us to think we are not going to have difficulties in staffing
in the future. It is across all the professions and, therefore,
it is an issue that we are all looking at in trying to find ways
of ensuring that there are always appropriate levels. We have
had had a fairly static workforce for some while. Recently, however,
we have had a lot more changes which has created some difficulty,
and I think one cannot underestimate the importance, therefore,
of retention and on-going training for staff in order not only
to keep their skills up but so they want to stay.
591. When you say there have been changes that
have affected it, what changes do you mean? I think you said there
have been some changes recently.
(Ms Wheatcroft) Yes. We have had a stable workforce
and therefore we have been able to offer the continuity, but when
you get changes staff have to be orientated and they have to get
to know the patch, et cetera, and it takes more time to support
them doing that, so if you have a high turnover or have changes
in the service it will affect that and certainly we can see it.
It is important to try to plan well ahead, and I think we would
all like to be able to have some flexibility within a system that
would enable those sorts of things to be addressed.
Chairman
592. I think you have more midwives per delivery
than many other units in that you have 45 midwives for around
700, which is about 1:15. Do you get accused of being overstaffed
because you are so much better than nationally, and how do you
counter that?
(Ms Wheatcroft) We do. We get criticised that we are
overstaffed and that we are expensive, and it is a battle that
we have with our local health authority in being able to defend
our situation, and our outcome demonstrates the value of the ratio
of midwives we have to women. But we live in the real world and
it continues to be a threat, and we are having to be very imaginative
in our staffing and recruitment.
593. One of those outcomes is you were the first
ever NHS maternity unit to get baby friendly status, and I presume
that reflects in quite good breast feeding rates?
(Ms Wheatcroft) We have maintained high average breast
feeding, yes.
594. So what are those rates? Do you know them?
(Ms Hand) 89%.
595. At—?
(Ms Wheatcroft) That has been consistent for about
the last six years.
596. And that is measured at what point? 89%
at—
(Ms Hand) From initiation until the time the mums
go home, which is roughly between 4-5 days.
597. And would you have been able to do that
if you had been working on the midwife levels of some of the other
units?
(Ms Hand) No.
598. So why is that? What is important there?
(Ms Grant) There is no doubt that after giving birth
women often need quite a lot of support with breast feeding. I
run three breast feeding support groups so we pick up the pieces
of what often happens in hospital, but the women in Bournemouth
get more midwife time and the midwives are on the whole much more
well-informed about breast feeding, so they are helping women
with information and it just makes a huge difference.
599. So what more needs to be done? What do
we need to think about as a Committee to get more units up to
the rates you have?
(Ms Wheatcroft) They have to be able to have the time
and the environment as well. We are fortunate in that we can provide
a very relaxed, friendly, non threatening, non clinical type environment
which is very important. Post delivery, one is trying to establish
breast feeding.
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