Implementing A Framework for Maternity ... - Scottish Government

Introduction
1. Scotland’s mix of urban and very remote communities, with some areas of concentrated
poverty and disadvantage in our cities and a very dispersed population in some rural areas,
presents real challenges to the delivery of maternity services. Women across Scotland have
a wide range of needs in pregnancy and childbirth which services must strive to meet.
2. And those needs are changing. Like many other nations in the developed world, Scotland’s
birth rate is falling. Many women are now waiting longer to have their first baby, and medical
and technological advances mean that women with health problems can now be helped to
become pregnant and give birth. Over the last 25 years, the length of women’s stay in hospital
to have their babies has more than halved. Alongside this, infant deaths in childbirth have
now become very rare. 1
3. These trends seem set to continue. Our maternity services are likely to be dealing with fewer
pregnancies and births, but a higher proportion will be more complex, heightening the risk
to the mother and/or baby and the potential need for medical intervention. While many
women and obstetric professionals believe that the natural process of pregnancy and
childbirth has become too ‘medicalised’, the percentage of women requiring or opting for
caesarean section has increased dramatically across the UK, and it is now the chosen
method in almost one in five deliveries. These factors all have significant implications for
the pattern and nature of acute maternity services across the country.
The Expert Group on Acute Maternity Services (EGAMS)
4. The Scottish Executive Health Department published A Framework for Maternity Services in
Scotland in February 2001. The document sets out a vision for maternity services in Scotland,
and provides a ‘template’ for best practice in maternity care for use by NHS service planners
and the clinical professionals who are responsible for delivering these services. It aims to
ensure that pregnant women receive care that is not only comprehensive and clinically
effective, but is also family-centred, locally accessible, midwife-managed, and based on
joint working between primary, secondary and tertiary services. 2
5. Following representation from the Royal Colleges of Midwives and of Obstetrics and
Gynaecology, the Minister for Health and Community Care set up the Expert Group on
Acute Maternity Services (EGAMS), a short-life working group of professionals and other
stakeholders in maternity services in February 2002 (see Appendix 1). This Group was
asked to consider how the principles in the Framework should be applied to care during
childbirth, and the services in the acute health care sector which deliver that care.
1 Mean stay in maternity units: 1976 – 9.4 days; 1998 – 3.9 days
Caesarean Section rate increase: 1976 – 9%; 1999 – 19.7%
Neonatal Mortality Rate: 1971 – 19.1 per 1000; 1998 – 5.6 per 1000
2 A Framework for Maternity Services in Scotland – Principle 4
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