Keeping Childbirth Natural and Dynamic KCND

1
Keeping Childbirth Natural and Dynamic (KCND)

• Scottish Government Health Directorates

2
Maternity policy context

• Framework for maternity services / EGAMS
• Endorse pregnancy childbirth as normal life
  events
• Recommend care packages tailored to need
• Ongoing medical care by GP
• Community based, midwife led care for healthy
  women
• Obstetric led, maternity team care for complex
  cases
• Significant progress made in implementing
• Variance across NHS Scotland
• Key aspects still to be achieved in some areas

3
KCND

• Purpose
• Support implementation of policy at Board level
• Promote multidisciplinary working care tailored
  to need
• Multiprofessional programme of work
• Aims
• Maximise opportunities for women to have as
  natural birth experience as possible through
• Evidence based care, reducing unnecessary
  intervention, ensuring informed choice
• Introducing multiprofessional antenatal,
  intrapartum and postnatal care pathways

4
Objectives

• Implement national referral criteria and care
  pathways
• Green
• Midwife lead professional
• Amber
• Further assessment required
• Red
• Maternity team care recommended
• Flow between care streams as risk alters

5
Objectives

• Implement lead professional by risk
• Maternity team roles
• Midwifery lead, healthy women
• Obstetric lead, complex cases
• Neonatology lead, sick baby
• Named on SWHMR, ISD
• Primary care team roles
• GP ongoing responsibility for medical care of
  mother baby
• Health visitor ongoing care of well mother baby
• Womens choice

6
Objectives

• Implement midwife 1st point professional contact
• Initial risk assessment
• Against national criteria
• Social circumstances
• Health promotion
• Stream woman to midwifery or maternity team care
  to book
• Prior to 10 weeks?
• GP opinion on stream
• Additional relevant history?

7
Objectives

• Implement normal birth pathways
• For healthy women
• Regardless of setting
• 1st, 2nd 3rd stage labour
• Evidence based
• No admission CTG
• Guidance for monitoring and care
• Flow between midwifery and maternity team care as
  risk alters

8
Summary

• Focus on implementing current policy
• Nothing new
• Robust foundations
• Wider maternity team works
• GP well established role for ongoing medical care
• Evidence on efficacy of midwifery led care
• Enough work to go round
• Stakeholder engagement
• All Royal Colleges, users
• Outcome efficient and effective services
• Appropriate care packages for women based on need