Closing smaller maternity units

[Asosbabe]

Who is making this decision? Surely this is where tax £s are well spent?

Maternity is one of the few treatments that generally makes money for hospitals. The fee per patient is higher thanany other treatments. Hence why there are so many private providers offering maternity services.

No because hardly anyone is allowed to use them. I always marvel at the monthly stats released on how many women have given birth at our local standalone midwifery centre - sometimes just 1 or 2. Sometimes none. And the MLU which is actually alongside the Labour ward at our local hospital doesn’t fare much better - 6% of births take place there and 90% on the Labour ward.

I think the risk averse attitude in maternity is actually making worse outcomes. They need to relax and let more women use the midwife lead facilities.

Isn’t it the opposite? These smaller maternity units are barely used so keeping it open is expensive.

My local one had something like 17 births in a 12 month period before they closed down.

Isn't it much safer in a bigger unit if something goes wrong? More experienced staff, better facilities and equipment etc?

I disagree OP. Some of them may work well but in general I think tax £ are better spent on larger units that can be run more efficiently and serve more women.

Glad I posted. Very interested to hear the argument for closing them.

I don’t think they should be closed, I think more women should be allowed to use them.

Yes and not just maternity. Patient outcomes are far higher at specialist centres than at other trusts. Hence why if you have a stroke or a heart attack nowadays they will take you to the specialist hospital rather than the nearest one.

It's also more cost effective to centralise particular treatments rather than offering them at all hospitals.

Thats nuts the unit I gave birth in averaged 16 births a day.

I live in North Devon. Our maternity unit has been shut for weeks now because of lack of consultants.

Women have to travel up to 2 hours to Exeter in labour. One baby was stillborn (that we know of). Several others born in ambulances on the A361. Other high risk mums having to live in Exeter away from work and family.

If it had been shut when I went into labour both me and my child would have died.

A place to birth your child shouldn’t be a luxury.

This is why I'm worried

I presume it's harder to safely staff smaller units. They still need 24hr anaesthesia and obstetrics services, a theatre and theatre staff, access to neonatal care and paediatrics.

DD1 was a very uncomplicated pregnancy. Agreed a water birth on the midwife led unit attached to the main hospital. All went well for ages, until during a routine heart rate check there were concerns and the midwife pressed the emergency button. Within 5 minutes I was on the main unit, in the room were an anaesthetist, 2 obstetricians, 2 midwives, a paediatrician and a neonatal nurse with an incubator and they got DD out quick. She needed some support for first hour but thankfully then fine. I ended up in HDU due to massive blood loss.

Had this been a stand alone small midwife unit, things may have ended very differently for me and DD. Even the most routine deliveries can go off plan.

Just googled - it was actually 19 births in its penultimate year. Went up to 28 births in the last year it closed.

And this is a busy area of London so it’s not some rural centre!

Generally larger units have better outcomes and have the all the specialists if things go wrong (an acquaintance of mine had to be airlifted following the birth of her child due to the small hospital not being able to provide the emergency care she needed, extreme but it happens). The exception though is having appropriate arrangements for very rural areas, eg my sil had to stay near the hospital from 38 weeks paid for by the health authority.

Are all births complicated though? Surely straight forward births could be local and ambulance for complications?

But hardly any are deemed straightforward now.

Here are reasons women are denied access to MLUs:
They take antidepressants
The baby is slightly too big
The baby is slightly too small
They have a high BMI
They are over age 40

And so on

That's a lot of staff waiting around not doing very much, when women could really do with those staff in other units, especially in a major city when other units must be much busier.

The smaller unit by us was closed following a maternal death, and the investigation into the standard of care means it's very unlikely to re-open. All births now take place at the county hospital.

My DD is a MW and her take is that is wholly unworkable to staff these smaller units safely when the main units are already understaffed due to budget restraints.

I'm confused by the situation in North Devon, forgive me. This isn't a standalone MLU, is it? Doesn't it form part of a larger hospital that has an A&E, etc? How can it be so hard to staff?

Sounds like a really awful situation for women in the local area, so sorry to hear it.

No, of course many births are not complicated. But it's hard to know which ones will be. In my case they had to get DD out within 15mins, there was apparently a timer which started when midwife hit the buzzer. If an ambulance had to be called or even if waiting outside, the time to transfer, potentially wait for traffic, get into the specialist centre and get her out would be way more, with potentially devastating consequences.

And even if deemed straight forward, they may end up not being. I ticked every box for a textbook pregnancy and delivery. DD had other ideas!

The same thing happened in Somerset last year, Yeovil hospital closed their labour, post natal and Nicu. All of those patients were sent to other hospitals, mainly Musgrove park, which itself is barely fit for purpose. I gave birth there during the Yeovil closure and the care standard for appointments and then birth dropped massively when they received all the extra patients.

Yeovil has now recruited adequate staff and has reopened.

The article I read talked a lot about difficulties recruiting and retaining staff. I’m sure a lot more people would be going into these professions if training were paid and they weren’t faced with massive student debt, then pretty awful working conditions.

Also seems fueled by a push towards planned and elective caesareans. Totally understandable women make that choice (where it is a choice, not necessity), but the WHO says there is no evidence that a caesarean rate of above 15% actually improves maternal and neonatal outcomes.

Afterwards it becomes a cycle doesn’t it? Local specialist care is reduced, both during pregnancy and labour, so it becomes more and more risky to have a vaginal birth. If women are faced with traveling 2 hours to the nearest hospital during labour, of course they’re going to be more likely to choose an “elective” caesarean.

You’re right, the maternity unit is part of the larger hospital. It is on the same site as the A&E and wards etc.
It Is very worrying indeed.

It’s a blatant push further undermining of midwife-led care. They can get away with cost cutting in this area right now because the midwife profession is under attack. Anyone interested - look at the Birthplace UK Study.

It is safer for babies of low risk women to be born in midwife-led care settings. Obstetric led care increases risks. Women need to wake up and claim their rights back. Challenge the rhetoric when people assume that medical doctors are best placed to safely care for women and babies. It is a falsehood and evidence has proven it time and time again.