‘Women and Midwives.. together we’re strong” - PowerPoint Presentation

Slide1

‘Women and Midwives.. together we’re strong” Midwifery Led Care 

Astrid Osbourne

Consultant Midwife & Supervisor of Midwives

SRN,SCM,PG Dip Professional Studies, MSc Advanced Midwifery practice, Post Grad Cert Supervision of Midwives

Astrid.osbourne@uclh.nhs.uk

AOsbo15084@aol.com

Slide2

Today we will discuss what Midwives CAN do!We will look at our global historyWe will consider where we are nowWhat political influences are pushing maternity care?Look at the innovations that the UK has achieved in the National Health ServiceConsider how midwife led care does workLook at models of MW led care, home birth and birthing centresSlide3

Normal birth is different for different people & professionalsOUR PERCEPTION OF BIRTH IS IMPORTANT:Slide4

Midwifery History: UKNHS started in 1948 – more than 50% of women gave birth at homeThe Peel report in 1970 called for ALL births to be hospitalised on the grounds of safety [no evidence!]1980’s the DUBLIN study and active management of labour by early ARM, syntocinon from 4cms, continuous EFM & constant support1993/ 94 Winterton and Changing child birth - call for back to

basics

2004 National Service Framework standard 11 maternity

2007 Maternity matters – benchmark for careSlide5

Childbirth normalityWHERE ARE THE MIDWIVES! They burnt us as witches in the 15th century – right across EuropeInternationally Midwifery is loosing its position as the MAIN provider of care for well women and their babiesModern midwifery: In some countries care is entirely medically led

Caesarean section rates continue to rise

The Birth Place

Study published

Oct 2011

Cost – primigravid cost £2,075 Hospital, £1,912 birth centre, £1,793 home birth

Multigravid cost £1,142 Home, £991 Birth Centre, £780 home birthSlide6

Areas of Midwifery practice that have started to be developed in the UK:Normality in childbirth – most Consultant Midwives/senior MW practitioners are engaged in this area of careBirth centres with no medical inputIn the UK a third of pregnant women do not see a Doctor at all during pregnancy and birth

NHS maternity hospitals are managed by Midwives

Where teams of Drs and Midwives work together the responsibility is shared

Normal birth is the forte of the midwifeSlide7

To keep birth normal:Create a homely atmosphere, demedicalise the environment – hide stuff away – make the place homelyCreate a positive attitude to low interventionChoice of place of birth and carers for women including home, birth centre & hospital birth

Women having the opportunity to know their midwife and to trust her/him

Education and training for

m/w’s

and Drs to improve normal birth understanding and confidence

Access to parent education and prep for birth Slide8

What do I do as a Midwife Consultant in the NHS?I support MWs and Drs in the intrapartum areas – plan as much normality into every birth with themDiscourage unnecessary intervention, formulate personal plansGive priority to mobilisation and normal labour behaviours

Educate MWs and Drs – bring normality into all aspects of care – teach in the universities

Work along side senior Consultant Obstetricians to improve the normal birth rate; including revising policy

Encourage normal birth in ALL settings

Audit & research [own and others]– dissemination to allSlide9

Management of pregnancy riskEssential for the midwife led care model is the separation of high and low risk women [NSF 2004 & Maternity Matters 2007. NICE 2008 Midwifery twenty twenty, 2010 ]Acute care in high risk services must be appropriately Dr led and easy to access by MWs

Low risk midwife led services across the community in partnership with GPs and social care

Easy flows from one process to another where necessary Slide10

What Changed? The Political, Financial & Medical RevolutionMedia pressure to be ‘rescued’ by medical scienceModern midwifery: our behaviour & our reaction to pain/discomfort – some women are encouraged to accept pain relief to comfort those around the woman – including midwives!Rising epidural rates – rising CS rates – increased immobilisation during labour – unnecessary intervention during

labour

Women: are having heavier babies, are fatter, work longer, control their fertility

Changing role of Motherhood – youthfulness Slide11

The CS epidemic: In the USA it is said that CS ‘keeps the vagina honeymoon fresh’ [Kitzinger 2005]We perpetuate the common belief that vaginal birth is risky and CS is less so Women want CS because they maintain greater controlThe belief that CS is safe, easy, efficient, desirable & better for the baby

The belief that there is less pain, injury & unpleasant emergency procedures

“Women’s choice”: ignores the power differential between women & obstetricians [Kitzinger 2005] Slide12

The rising trend toward global CSWorld wide CS has increased from 25% to 70% in developed countriesIn some developing countries it is higher Austria = 40% Southern Italy = 50 – 60% Brazil

= 75%

South

Africa [Caucasian

population

only] = 70%Slide13

Birth Place Study Results: OutcomeInterventions were less frequent in MW led areas of careThere was no difference in adverse outcome for primigravid or multigravid women by place of birthWomen in a MW led unit were more likely to have a normal birth

Primip women at home did

slightly less

well

62,036 low risk women were evaluated

27% 0f the home birth group were

primigravidCosts: Routine CS costs in excess of £3,000

Savings average for MW led home birth = £310Savings for stand alone MW unit = £130Savings for along side MW led

unit = £134Slide14

Standards for Midwifery practice to promote normal birthNAMED MIDWIFE - contactableBirth choices for all womenWomen followed through care by known carer/sFollow the National Institute of Clinical Excellence

care pathway for A/N

and labour care

Detailed birth planning

Follow up care by known carers

Equal governance – the same clinical standards for quality and safety as in all other hospital settings

Seamless transition from one setting and carer to another [low to high risk and visa versa]Slide15

Service design for birth centre & home birth – social approachWhat is a Midwifery Team or Group?An autonomous group of midwives who are responsible for a group of pregnant womenGeographically based and working from Community Centres and/or large medical centres, any public building has potential

Group Practice offers

whole care

and continuity of carers to women – INCLUDING BIRTH with M/W’s known to the

woman

Realistic birth planning, managed expectations and a clear plan if risk becomes an issueSlide16

Setting up Birth Centres and whole care systems that support normal birth Challenges: Growing birthing population – predicted at approx 3% + across London yr on yrStaffing challenges – shortfalls recognised across Maternity services, Integration of staff – change management & aging workforceCultural changes, new ways of workingTo meet government [DoH] drivers for first class care, standards, targets & CNST

Resources reduced by recession and historic debt, inefficiencies and failure to moderniseSlide17

A few FactsElectronic fetal monitoring in low risk labour is associated with increased CS rates and has no long term health gainsEpidural analgesia – increases the need for instrumental birthEpesiotomy as a routine intervention has no benefits to mother or babyArtificial rupture of membranes – may reduce the length of labour [half an hour average] but causes more pain & increases the uptake of pharmacological pain relief – which influences movement and vomitingSlide18

Currently only 55% of women in London have a birth attended exclusively by a midwife – Drs don’t do natural, normal birth [they aren’t trained that way & don’t have time] Slide19

Finally ......Why Midwifery Care Matters to Women“This has been a dream birth that made this day one of the most beautiful days of my life.”Natalie after her water birth at the Bloomsbury Birth Centre London