Development of Women Led Maternity Services

1. Development of Women Led Maternity Services Helen Wallace Midwifery Ward Manager Home from Home, Ulster Hospital And Downpatrick MLU Coordinator

2. My Role as Ward Manager in the Development of a Midwifery Led Unit within Existing Maternity Services at the Ulster Hospital.

3. Background Reports Changing Childbirth (1993) Promoted Choice Continuity of care and care giver Control for all women. These ideals were echoed in all subsequent reports

4. Reports (cont) • NSF Children, Young People and Maternity Services Standard 11 (2004) • Maternity Matters (2007) • NICE guidelines (2007) Intrapartum Care • Safer Childbirth (2007) • Making Normal Birth a Reality (2007) • Towards Better Births (2008)

5. ‘A less clinical, non threatening and more home like environment is less stressful for most women and this helps to create an atmosphere more conducive to the progress of the normal physiological birth process’ Safer Childbirth (2007)

6. Information……suggests that among women who plan to give at home or in a midwife-led unit there is a higher likelihood of a normal birth, with less intervention’ ‘Women should be offered the choice of planning birth at home, in a midwife-led unit or in an obstetric unit NICE Intrapartum care guidelines (2007)

8. Getting Started The catalyst An inspirational study day on water birth with Dr Elizabeth Cluett Education for midwives I negotiated study leave for midwives with water birth expert Dianne Garland Which led to: A placement for myself and a colleague to up skill in water birth and cascade that training to other midwives Hosting study days/conferences at the Ulster Hospital with prestigious authors researchers in Normality and Active Birth

9. Developing Practice Started in the old labour ward • I developed guidelines on using water for labour and birth • I met with women and gave them information on water birth • I commenced a limited water birth service In preparation for moving to the new unit • I led the development of guidelines and protocols • I completed a new Normal Birth Pathway

10. Developing Home from Home • Good communication with Architects Builders Capital team • Good relationships with our maternity services Liason group ‘One Voice’ • Good Community links: Community midwives Health centres and GP surgeries • Good Media Links

14. Active Birth Workshop • All women are invited • Women only • Exclusion criteria explained • Normality and Water birth is discussed • Practise exercises to help cope with labour and birth • Try out the equipment • DVD,leaflets and written information is given to back up the class

17. Outcomes Home from Home surpassed the initial target of 300 births in the first year achieving 580 700 births achieved in the 2nd year Home from Home is on target for 1000 births in the 3rd financial year which will account for almost 1/3 of births at the Ulster Hospital Water birth rate is maintained at 40% Transfer rate is approx 35 % However further breakdown shows • 18% request further pain relief – choice • 17% medical reasons

18. Outcomes (cont) Of our transfers out in labour approx 8% have required a caesarean section 1.8% are postnatal transfers with: • 0.8%postpartum haemorrhage • 0.8% suturing • 0.2 % retained placenta Home from Home statistics are audited regularly and presented twice yearly at directorate meetings

19. Achievements • The first purpose built midwifery led unit in NI • True choice for women within South Eastern Trust • Water birth accessible to all low risk women • Impact on caesarean section rate within the Trust • The success of the Home from Home supported the opening of a stand alone midwifery led unit in Downpatrick whose midwifery staff trained in water birth at Home from Home • We are seen as a centre of excellence

20. Further Development Global Links • England Scotland Wales • Southern Ireland • Denmark (University of Copenhagen) • Russia • Malawi Extension of inclusion criteria • Induction of labour for post maturity with prostaglandin pesaries • Women with history of group B Streptococcus • 2 successful vaginal births following previous caesarean section Research I am in the process of completing a service evaluation on water birth with the practice development midwife which is the first step in a research project with University of Ulster

21. The Secret of Success The ability to motivate others to share my vision of both promoting normality and providing choice for women Building a team of midwives who supported me in the development of guidelines and the pathway before the move to our new premises Support from the Head of Midwifery and Assistant Director WACH The ability to collaborate with a very vocal Maternity Services Liaison group and utilise their support A growing band of women who have achieved the birth they wanted in a safe and happy environment and are keen to tell others that they can do it too

22. Some comments from the last consumer satisfaction survey : Improved Care: ‘The treatment and care were very positive - Home from Home made the experience relaxed and the midwives were supportive and informative. The water birth was very good and I really found this experience much better than the first birth here’ Accessibility: ‘Home from Home was fantastic. I would never have dreamt of a water birth only it was in my room’

24. Thank you for Listening.