Trust Board Febuary 2010 - Sandwell & West Birmingham Hospitals

SWBTB (2/10) 045 (a)
• Shorter labours
• Lower rates of intra-partum analgesia
• Greater continuity of care and greater satisfaction with care
• Women are more likely to breastfeed their babies
• Higher personal satisfaction and self-esteem
• Women experience fewer problems in infant/maternal attachment processes.
The risks associated with birth centres relate to the need to transfer women in labour to a Consultant led
delivery suite if complications arise. There are a number of mitigating actions including clear risk
assessment throughout pregnancy and labour, clear exclusion criteria, robust transfer policies and
arrangements, appropriately experienced and skilled midwives. Transfer from a stand alone birth centre
will require an ambulance with paramedic crew and midwife escort. The evidence is that transfer rates
are higher in stand alone (20-30%) birth centres (compared to transfer rates of 18-20% from a colocated
birth centre) and the decision to transfer will be made at an earlier stage.
The proposal in Option 3 is for a stand alone birth centre in a community location in Sandwell but not on
the Sandwell Hospital site. This is felt necessary to ensure that women understand that this is a stand
alone birth centre without the back up and support of an onsite consultant led delivery suite and so any
complications will require an ambulance transfer to another hospital. There is a risk that if the stand
alone Birth Centre was on an Acute Hospital site women may perceive there to be emergency back up
on site because there are operating theatres and doctors from other specialities when in reality this is
not the case because there is not a consultant led Delivery Suite on site. It is important to ensure that
only women who meet the clinical criteria are booked to the stand alone Birth Centre and that other
women with high risk pregnancies don’t present to the stand alone Birth Centre assuming a full range of
emergency back up and support and thereby increase the risk to themselves and their babies of
complications and the need for emergency transfer to a consultant led Delivery Suite in another hospital.
The Project Steering Group are identifying potential locations in Sandwell for the stand alone Birth
Centre and in the meantime have used a potential location in Wednesbury for the purposes of
developing some financial planning assumptions.
It is proposed that the stand alone Birth Centre should provide 3 birthing rooms and one birthing pool.
The model is based on an average length of stay post birth of 6 hours with this taking place in the birth
room. There will be no ‘inpatient beds’ in the Birth Centre and no plans to undertake any antenatal
outpatient activity in the Birth Centre (this will take place either at home or in other community locations).
The development of a stand alone Birth Centre in Sandwell is in line with national guidance in terms of
choices offered to women and with the Right Care Right Here Strategic Model of Care for Maternity
services. The stand alone Birth Centre if financially and clinically viable would therefore be a longer term
development and could remain in place once the new Acute Hospital is open.
The proposed staffing model is an integrated team across the community and Birth Centre but with a
minimum of one trained midwife and one HCA on duty in the Birth Centre at all times. This requires an
additional 5.5wte (whole time equivalent) midwives and 5.5wte Health Care Assistants.
The number of anticipated births for the first year of operation is approximately 100-300 with an estimate
for future years of 400 births. The initial work undertaken on the financial analysis suggests that a stand
alone Birth Centre in Sandwell would need the proposed 400 births to break even (see below).
Option 3 recognises that the stand alone Birth Centre would require a period of planning and
development over 18 months to 2 years in order that staff development, leadership, and training can be
put in place to support the new service model of care and for further public engagement to take place
which would be essential to increase public understanding about the nature of a stand alone Birth
Centre.
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