NEXT STAGE REVIEW MATERNITY AND NEWBORN CLINICAL PATHWAY GROUP

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NEXT STAGE REVIEWMATERNITY AND NEWBORN CLINICAL
PATHWAY GROUP

• Intrapartum Care

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Sub group work areas

• Do all the units in EoE currently meet the NICE
  Guidelines for Intrapartum Care
• Analysis of referral Pathways across EoE and
  location of Specialist Services
• Issues relating to access and availability of
  units that meet the needs of minority groups
• Choice of Services/Units available to women.

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NICE Clinical Care Guideline 55Intrapartum Care

• Does your unit meet the current standards set by
  NICE (2007) for intrapartum Care
• Yes 1
  No 7
• Does your unit provide specialist services for
  women either in your own catchments or women from
  outside
• Yes 6
  No 2
• Approximate number of women accessing the
  services from own catchments 63
• Predominantly data not available

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Standards not met

• 11 care in labour
• Retained Placenta Oxytocin injection into
  umbilical vein, proximal cord clamping
• Delay 2nd stage of labour primigravida 2 hrs
• Do not offer episiotomy to women with H/O 3/4th
  degree tears
• Subcutaneous suturing of episiotomy ( not 100)
• Labouring in water permissible after 2 hours post
  opiate
• Intermittent electronic monitoring post epidural
• Full dilatation for 4 hours (3)
• Half cm per hour progress
• Vaginal examination recommended 4 hours following
  oxytocin commenced ( intervene after 2 hours)

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What could be done to help you achieve the
standard?

• Capacity issue re beds availability
• Review of current establishment with a view to
  increasing funded establishments
• Working in partnership with Supervisors of
  Midwives, Midwives and Medical Colleagues
• Closer working with PCTS with agreement to fund
  to ratio 130 (E of E review recommendations)
• Capital monies

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Specialist Services Provided

• Diabetes/ endocrinology x 2
• Level 3 NICU, paediatric surgery x 2
• Maternal medicine. Cardiac, Renal etc
• Perinatal Mental Health Clinic
• Smoking cessation
• Teenage pregnancy x 2
• Drugs and Substance misuse x 2
• Midwife Led Birthing Centre
• Multiple birth
• Vulnerable women
• Newborn Screening
• Fetal Medicine Unit

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Minority Groups

• Do you have a particular minority group that
  access your service
• YES 4
  NO 3
• Barriers to access for minority groups
• Language x 4
• translation facilities
• transient population
• frequently moving accommodation
• Sexual health problems
• Drug misuse

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Minority Groups
Minority Group Number
Chinese 16
Prisoners Minimal
Eastern European x 3 80
Asian 333
African 82
West Indian/Black 109
Poland 20
Portuguese 20
Economic migrants
Travelling Community
Trafficked women for prostitution
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Services offered by unit
4. Choice of Services. West Herts Bedford Hinching brooke Mid Essex NN Rosie West Suffolk Peter borough
Direct access to a midwife ? ? ? ? ? ? ?
Shared care with GP midwife ? ? ? ? ? ? ? ?
Consultant care at womans request ? ? ? ? ? ? ? ?
Home Birth ? ? ? ? ? ? ? ?
Midwife Led Birth Centre ? ? ? ?
One Stop Diabetic Clinic ? ? ? ? ? ?
Antenatal Screening service as per national guidelines ? ? ? ? ? ?
Nuecal Fold Scanning ? Private only
Early dating scans ? ? ? ? ? ? ?
VBAC clinic ? ?
ECV clinic ? ? ?
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Services offered by unit
4. Choice of Services. West Herts Bedford Hinching brooke Mid Essex NN Rosie West Suffolk Peter borough
Evidence based information for women ? ? ? ? ? ? ?
One one care in labour ? 79 50 ? 76 NO ? Data not available
Normal birth actively supported ? ? ? ? ? ? ?
24hour epidural service ? ? ? ? ? ? ? ?
Water birth ? ? ? ? ? ? ? ?
Consultant Obstetrician involvement in all decisions for caesarean section ? ? ? ? ? ? ? ?
Women carry all of their own maternity Records ? ? ? ? ? ? ? ?
Midwife to birth ratio does not exceed 130 135 137 132 134 138 N N No
Women may eat and drink in labour ? ? ? ? ? ? ?
Neonatal discharge checks undertaken By Midwives ? ? ? ? ? ? ? Some
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Key questions to be addressed by the Intrapartum
Care group
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What does a good care pathway look like, based
on the evidence base?

• Key messages from the NICE guidelines are
• Normality
• no intervention when progress is normal
• Communication
• respect, control, rapport, choice
• Support
• one-to-one care in labour, not left alone
• Choice of place of birth
• - home birth, midwife-led unit or obstetric
  unit

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What already exists in the region that meets the
description of a good care pathway? Where have
changes already been successfully implemented?

• Direct access to a midwife
• Home Birth
• VBAC
• ECV
• Midwife Led Units

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What does not yet exist in the region to
successfully provide a good care pathway?

• Adequate staffing levels.
• Obstetric
• Midwifery
• Adequate capacity
• Managed Maternity Network
• Shared evidence based guidelines
• Robust data collection

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What barriers exist to implementing an improved
pathway in terms of

• Structures?
• Facilities for offering midwife led
  care
• Support and appropriate management
  of a Managed Maternity Network.
• Organisations?
• Clear strategies for staffing and
  recognition of the specific problems
  relating to maternity care. i.e. We cannot
  control the number of women who are likely
  to come through the door on any given day.
• Other Factors?
• Basic facilities such as
  interpreters, language line and
  accommodation for fewer hospital based
  services

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What needs to happen to support implementation

• Locally?
• Better engagement with commissioners of services
  to understand some of the current issues.
• Nationally?
• Development and implementation of evidence based
  guidelines that support women in their birth
  choices and improve outcomes