APPENDIX 40
Evidence by the Southampton University
Hospitals NHS Trust (MS 49)
1. INTRODUCTION
Southampton University Hospitals Trust cares
for almost 5,000 women giving birth per year. The Princess Anne
provides care targeted at women's needs and aims to provide this
in the most appropriate setting. For those who require specialist
interventions we provide a regional service for fetal, maternal,
and neonatal medicine, and neonatal surgery. In addition to this,
for women with uncomplicated pregnancies we are developing new
models of care. This aims to increase the normal birth rate, increase
the number of women being delivered by a professional they have
met antenally and move care away from hospital into the community.
Within the Princess Anne, there is an integrated midwifery led
birthing unit undertaking 400 births per year. There are also
three stand-alone midwifery led birth centres away from the main
hospital currently undertaking 300 births per year.
A major aim of the department has been to develop
our clinical governance systems to systematically reduce risk.
The issues we have been asked to address are
as follows:
2. THE COLLECTION
OF DATA
FROM MATERNITY
UNITS
2.1 We have recently developed our information
system (HICSS Maternity), which allows us to access information
from four key periods in the maternity care episode, namely:
— Booking (mother and partner) all
women.
— Antenatal (Mother and Baby) only
for non-routine/care investigation episodes.
— Birth (mother and baby) all women.
— Postnatal (mother and baby) all women.
The data collected is a mixture of clinical,
social and public health information. The end user questions facilitate
us to analyse our practise as a Directorate as well as by midwifery/obstetric
teams and as individuals
3. THE STAFFING
STRUCTURE OF
MATERNITY CARE
TEAMS
3.1 The service is split into a high and
low risk team. In terms of midwifery staff, two thirds of them
care for women with low risk pregnancies. By the end of May 2003,
half of the women will be looking after women in a case loading
way by midwives that they know.
3.2 The women with high-risk pregnancies
are looked after by midwives in partnership with the obstetricians.
An important component of the fetal medicine department is the
parental support provided by a dedicated consultant nurse. She
also plays an important role in educating and supporting GPs and
midwives in the management of women with complex issues relating
to prenatal diagnosis. A multiprofessional team looks after women
with endocrine problems, including a dedicated midwife, obstetrician
and physician.
4. THE CAESAREAN
SECTION RATES
4.1 Over the past two years, we produced
a progressive fall in the caesarean section (CS) rate of over
3%, which goes against the still rising national trend.
There have been a number of initiatives that
have been instigated in the past two years that we feel have contributed
our success:
— Low risk women now have realistic
alternatives for birthing outside the conventional labour ward
setting eg Birth centres, Birthing rooms within a Consultant unit
and home. Women are actively encouraged to think about the alternatives.
— A change in culture of the maternity
service with less blame and more open and supportive strategies
in place.
— Admission CTG is not being undertaken
for the vast majority of "low risk" women in labour.
— Less continuous CTG monitoring in
labour.
— Caseload holding Midwifery Group
Practices working in areas of social deprivation in collaboration
with Sure Start.
— Caseload holding offered to women
with obstetric risk factors who are particularly keen to give
birth vaginally with as little intervention as possible.
— Caseload holding offered to women
requesting CS due to fear of childbirth, with the aim of providing
intensive support and achieving vaginal birth.
— Ongoing combined education for Drs
and Midwives on CTG interpretation, daily case reviews and perinatal
mortality meetings.
— A high profile of clinical governance
in the Directorate, including new evidence based guidelines, inter-professional
clinical audit, and patient information and risk management.
— Many of the above are either instigated
or carried out by consultant midwives in collaboration with key
members of the obstetric and midwifery team.
— Clear commitment to collaborative
and supportive working between midwives and obstetricians.
5. THE PROVISION
OF TRAINING
FOR HEALTH
PROFESSIONALS, WHO
ADVISE PREGNANT
WOMEN AND
NEW MOTHERS.
5.1 Undergraduate Education
As maternity services develop and re shape there
is a need to develop a workforce that is flexible and responsive.
Our service has worked collaboratively with Southampton University
to develop a curriculum that facilitates students working across
in both community and hospital practice, moving away from the
largely hospital based practice. Student case-loading equips students
with the confidence to practice independently at the point of
registration. It does however have financial implications for
the Student/Trusts/University in terms of equipment, mobile phone
bills and travelling costs.
5.2 The Practice Educator Role
In the light of the report into senior house
officer training, "Unfinished Business", midwives have
an opportunity to develop and expand their role.
As new roles develop there is an imperative
for support in practice. SUHT with funding from the Hampshire
& Isle of Wight Workforce Development Confederation (H&IOW
WDC) have developed and are currently evaluating the role of the
Practice Educator. This role aims to co-ordinate and provide multiprofessional,
clinically focused education required to support the development
midwives and Doctor's working in new ways and environments.
5.3 Consultant Midwives
Consultant Midwives have four elements to their
role: expert clinical practice, education, service development
and research. Since the development of the consultant midwife
role (2000) there have been a significant number of such posts
advertised, a number of which remain unfilled. The reason for
this is multifactorial but one issue is the lack of preparation
for the role. SUHT in collaboration with the H&IOW WDC are
seeking to develop a structured pathway in collaboration with
other units preparing midwives to take on this role.
5.4 Leadership
The NHS has recognised the need to develop leadership
at all levels but this developing largely in uniprofessional courses.
Within maternity services, we feel there is a need to support
interprofessional teams to work and study together.
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