What kind of maternity service do we want?

[mulberrybush]

I need your advice.

I live in Stafford. Yesterday I was part of the group which delivered a 50,000 signature petition to the house of commons to protest against the threat to downgrade our hospital services. We are waiting for the recommendations of the Administrator which will come through at the end of this month.

The threat is that we could lose A&E, the intensive care unit, Maternity services and Paediatrics, and that our hospital could become a "step up, step down" outpost for a "Centre of Excellence" 17 miles up the road.

With maternity services, I think that we want to have a service that is near to home - so that we do not have the fear of travelling long distances to an unfamiliar place when we are in labour. Most of us probably want delivery to be as natural as possible. We also want to be safe.

When things do go wrong in labour, which is hopefully rare, then the pay outs can be massive. The rate of litigation against health professionals has been increasing steeply for the last few years, and consultants may sometimes risk of over intervention in childbirth rather than risk litigation and complaints. This means that for consultants "the best place" may be large maternity units in centres of excellence, with lots of equipment.

Is that what midwifes and the women who are planning their births want too, or would people prefer to take the risk of a local midwife led birth in a smaller friendly hospital, with the back up provision of being transported to a specialist unit if there were complications.

Or should we insist that there needs to be Consultant led maternity units within easy reach of most communities - and if so how do we pay for this?

I am aware that when the administrator reports at the end of this month I am going to have to make a decision, on whether to support the recommendations they make. I am also aware that Stafford is being used as the "thin end of the wedge". If Stafford is downgraded, then I would confidently predict that many more maternity units across the country will close or be downgraded too.

I need the advice of women from across the country. What should I do?

[PrincessScrumpy]

What's the multiple birth rate in your area? Just from experience, having Id twins, I had fortnightly appointments and would have struggled to get further than or local hospital. I would have thought, the people who need consultant care are the ones who may struggle to drive distances etc.
Just a thought. :)

[bearleftmonkeyright]

I live very near to Stafford hospital and was admitted there when I had a miscarriage 11 years ago. Knowing the area well, I would say that local provision is important, I travelled 15 miles to hospital in Burton on Trent for my three. That was distance enough. Also more options for home delivery. My second labour was very quick, I only just made it to hospital to deliver.

On a separate note it will be disastrous for Stafford if the hospital is downgraded.

[mulberrybush]

Thanks for the thought on this PrincessScrumpy I do not know about the multiple birth rate - will try to find out.

[CloudsAndTrees]

I don't think consultant lad maternity units are a priority. All women need access to one, but it doesn't have to be local.

Local A&E departments and paediatric departments are a far higher priority IMO.

I feel this way because in the majority of cases, high risk pregnancies and births are known about with enough time for people to make plans to travel to a 'centre of excellence', and where there is not time to plan for it, good provision can be put in place to enable safe transfers.

The same cannot be said of accidents and emergencies where it is essential for good care to be in place quickly. Often families that need paediatric services have a need for ongoing appointments, and it can be very disruptive for family life if these appointments have to take place a long way away from home each time. A persons birth only happens once, so I think the inconvenience of having to travel a longer distance is more acceptable when it's a one off.

[ifyourehoppyandyouknowit]

I think want women want is a choice. There's been loads of changes to maternity service in North Manchester and there is now a range of midwife led units in hospital, midwife led units that stand away from the hospitals and consultant led units plus the option of home birth.

I personally chose to go out of area for DS birth because I wanted 1:1 midwife care, and that wasn't available at my local unit. DH was uncomfortable with the idea of homebirth or a stand alone midwife unit as he was scared about emergencies. It made it slightly more awkward getting to scans etc, but the weekly midwife care and general antenatal stuff was done through the community midwife at my GP.

So I think a variety of services is what I would want, so I could choose accordingly.

[iamadoozermum]

Clouds I see your point and to a certain extent I agree, however for all my pregnancies I have had consultant led care which has meant regular trips to the hospital for my appointments. With DC4, I was in hospital every 2 days for various monitorings etc and unable to drive towards the end because I didn't fit behind my steering wheel! If I had to travel such a distance, as the OP suggests, I just couldn't do it.

[Mum2five79]

With delivery, it is also worth bearing in mind that it is not necessarily a one off journey ie go to the hospital, be admitted and let nature take it's course. With two of my labours, once my waters broke I followed procedure and called the hospital who advised I went in to be checked, even though labour was not established. Having confirmed that my waters were indeed broken, but labour not in it's active stage - I was then sent home again. Fine if it's a local hospital (well not fine fine, but only mildly inconvenient to pop back home to the inlaws who have been woken up at 2am and called in for babysitting duties), but it would be a disaster waiting to happen if it was a 40 mile round trip each time.

I also agree with an earlier poster that it would be worth considering the possibility of easier access to homebirths. Indeed taking into account the costs of an increased incidence of requested homebirths is something the TSA should certainly consider when attempting to balance the books with regard to Mid-Staffs.

[MrsMook]

I don't know the details but there is a threat to the provision of independent MWs due to insurance- this undermines access for homebirth, especially for those who are not encouraged by a blanket protocol in a risk adverse culture.

My babies were born in a hospital that has MW led services alongside Cons care and theatres. This worked well for me- DS1 started in MW care, but we became transferred for monitoring and ended up with an emergency CS. DS2 was cons care for our VBAC, but the difference in the environment was minimal which helped me a lot with my anxiety from the first birth. The key difference was continual staffing (which I was happy with) and the monitoring.


I was unable to drive for 3 weeks prior to DC1, and couldn't walk 300m to the bus stop let alone walk through town to connect to a bus for the hospital (which I did for a DS's app at 6wks). Local provision is important. The 15-20min drive when I was in labour was agony as he was back to back and sitting was intolerable pressure. More remote services would probably put additional pressure on the ambulance service. The drive there was the most painful part of the birth! For people who live in more remote areas, that is a significant concern.

[HorryIsUpduffed]

More MLUs and better HB teams will give women more choices and (cynic) be cheaper in the long run, as they appear to reduce intervention and shorten stays for low-risk women.

[BooMeowson]

I went to the 3rd closest hospital, had consultant led care and gave birth in the high risk ward. I was happy to travel for this.

My main problem is the stories of women who need an epidural and who can't get one as they're busy. It's a fucking outrage - you wouldn't expect someone to get their tooth extracted without pain relief!!

[2brumboys]

There is some evidence from a study in the Netherlands that if you have to travel a long way in labour there is a (small) increased risk that the baby could die, however, there is also evidence (from Norway) that smaller units (with

[AlphaBetaOoda]

MWLU certainly have their place but high risk people shouldn't be sent further due to the high risk !

They want to downgrade out local (20 mins away) consultant led unit to a MWLU but our next nearest is 45 miles.
I had approx 25 hospital appts in my last pregnancy and they would all have been 45 mins away. The current hospital covers even further away( think it was another 30 mins)
Lots of women are telling stories of emergency treatment and some of those would have resulted in air ambulance especially during winter as the road (yes ONE) got blocked due to accidents.

[NomDeClavier]

I think actually we need to keep MLUs but for those who need consultant led care throughout pregnancy, or to see a consultant once for whatever reason, the consultants should go to the MLU (who will presumably have an ultrasound machine and any other bulky equipment) which means services needed locally can stay local but more complex pregnancies aren't shut out of local services completely, even if they will probably need to go elsewhere for the birth.

A&E and paeds services must stay local.

[NomDeClavier]

Sorry that wasn't brilliantly clear, the ideals would be not downgrading, but if they have to then consultants ought to maintain a presence in that MLU with a very specific remit.

[mulberrybush]

Thank you for all the posts on this. A lot of useful information co0ming through already. I do feel that Stafford is fighting this battle for the rest of the country and we really do need your help and advice.

The Downgrade - if it goes ahead - will threaten A&E, ICU, Paediatrics as well as maternity. The ICU is the key to this. If the ICU goes or is downgraded then all the rest of the acute services are at risk.

Interested to see the comments on the litigation threat to independent midwifes. The more I think of it the more I think that litigation is starting to skew many of the choices that are being made about Health provision.

Interesting to see Hopalongons comments - I wonder if it is often the case that what women want from a maternity service is not really the same as what men are looking for. perhaps our partners - with the best possible reasons, can be more fearful about what could happen.

It would be interesting to know more about the incidence of high risk births, and the stage of the pregnancy at which people find out that it is high risk. The scare stories - and the one that are maybe driving this whole issue of centralisation are the ones which seemed normal or low risk, and then suddenly become more complicated at the last minute. I do not know how common this is.

It would also be useful to know more about the experience of being transported some distance in labour. I guess now that most people come into hospital in the back of partners car. If we are talking distances does that mean that there would be much greater use of ambulances for ordinary labour? What are people experiences of being in labour in ambulances?

[CloudsAndTrees]

I do appreciate that having consultant led maternity units further from home will be problematic for some families, and in an ideal world, we would have all services locally. But it basically all comes back to funding, and when there is a finite amount of money, we have to decide which is a higher priority.

Personally, I think someone being able to quickly access an A&E department after a heart attack, stroke or RTA is a higher priority than someone in the early stages of labour being able to get to a maternity unit quickly, especially when it's only going to be a minority of people in labour.

I don't think it's unreasonable to expect pregnant women to travel a bit to receive the care they need, and people can generally take these things into account when TTC.

[CloudsAndTrees]

X posted, but it just so happens that I gave birth in an ambulance. It wasn't comfortable, but it wasn't that bad either. They had gas and air which was all I needed, but then I was lucky to have a standard delivery.

[bearleftmonkeyright]

My last labour third child, he kind of got stuck and I couldnt deliver. He was emcs. I am forever grateful for the provision at Burton Hospital. If I had been moved elsewhere, we could have lost him as he was not breathing after delivery and I was under GA.

[SarahAndFuck]

I do think access to a local maternity unit is vital. Not everyone has a straightforward labour and birth.

For example my first child was stillborn. We found out he had died at a scan and were sent home about an hour later, but had to return the next day for medication and the day after that to be induced.

We were only ten minutes away from the hospital but had we been much further away I'm not sure how we would have coped with the journey. As it is, neither of us can remember how we got home on the day we found out our son had died.

In my next pregnancy we were involved in a car accident that led to a four day stay in hospital for me before our daughter was born too prematurely to survive and DH was warned that I had a serious infection and was also fighting for my life. He was not allowed to stay at the hospital but three times he was called back because they thought the birth was imminent or that my life was in danger.

Again, a longer drive to reach me would have made a terrible experience that little bit worse.

And when I gave birth to DS, I had been told that I needed to get to hospital ASAP as I had tested positive for GBS and needed antibiotics. I then went on to have a traumatic labour that was just seconds away from being an emergency c-section when the doctor agreed to try an episiotomy and forceps birth instead. I was kept in for a few days and was glad that I was close enough to home that DH and my parents could easily visit.

I'd been left feeling battered and stressed by everything and felt vulnerable and upset in the hospital. It did make a difference to have relatives nearby and able to get to me quickly.

My friends newborn died at Staffordshire, they missed the fact that she had a heart problem and even though my friend raised concerns numerous times, they sent her home while she was still blue, having been born not breathing properly. During her labour they had also tried to inject her with something she is allergic to, despite that being in her notes and her wearing an allergy wristband.

She doesn't want Staffordshire to close or lose services, she wants them to be improved so that people get the care they deserve.

[janey68]

Women want choice

The majority of pregnancies are normal and there is the potential for a normal delivery. Whether or not a normal delivery is the outcome, depends a lot I believe on how well the woman is supported in labour. I think MLUs are fabulous- I birthed both my children naturally in one and cannot recommend them highly enough for women who want natural births. They are cost effective too.

Obviously there is a place for consultant led care: women who have high risk pregnancies. Also some women choose to have epidurals which necessitate an anaesthetist, high level of monitoring etc and which can in some cases lead to the cascade of intervention which means an instrumental birth or c section.

There is no one size fits all.

[mulberrybush]

Thank you again for all these thoughtful posts. CloudsAndTrees - I am sure that the cost argument will carry a great deal of weight. I think that people are going to be required to travel for elective care, and that many will see maternity as "elective".
I think we are being told that a lot of the pre birth appointments would continue to be local - but that would mean that the women would not have the time to build up the relationship with the people who will deliver the baby - a bit more of a production line approach perhaps.

SarahAndFuck - thank you for sharing a powerful and difficult story. You rightly emphasise the importance of support from family and friends when going through something so difficult. - for me this makes me feel that health care is in a way something that is delivered by the whole community - it is not just about technical procedure.

There is a lot of discussion going on at the moment about "Zero harm" which borrows ideas from the aviation industry. I am not sure that giving birth is very much like aviation.

Janey68 I think that if I had had the choice I would have wanted a midwife led unit too, but as I was 40 when I had first baby I would probably have been told that I was far to high a risk for this! > our fear is that if we do go down the route of Midwife led then because people are fearful, they will opt for the inconvenience of going further, and the midwife led unit could therefore become "unsustainable".

[mulberrybush]

The report from NHS England this morning www.england.nhs.uk/wp-content/uploads/2013/07/nhs-belongs.pdf now makes it very clear that there is a national plan to change the shape of our health service. I think that the national debate is beginning.

We do all really need to try an understand what is happening.