Implementing A Framework for Maternity ... - Scottish Government

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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 page 5
6. The big question for the EGAMS was how NHS resources, including the obstetric workforce, with all its skills, knowledge and experience, should be deployed to achieve the best balance between: • ensuring choice for women on where, how and by whom their care is provided • reducing risk, as far as possible, to the pregnant woman and her baby • ensuring high quality services that offer value for money. 7. It is not always possible to meet women’s first choice in relation to their care at childbirth, particularly in some of Scotland’s very remote areas. This may also present challenges for services in more populous areas where the pattern of maternity services sometimes reflects past practices, rather than current clinical priorities. EGAMS nevertheless wanted to find means of ensuring that, as far as possible, care delivered to women meets their needs and is close to their home and family, without compromising safety. The EGAMS’ findings 8. The EGAMS prepared a comprehensive reference report which describes the shape of current acute maternity services in Scotland. This reference report describes the challenges and constraints facing NHSScotland in reforming and further developing the service, and sets out a service model to meet current and future needs. The reference report includes: • risk assessment criteria to support clinicians in identifying the appropriate level and location for childbirth according to best evidence about outcomes • advice on the development of midwife-managed care • analysis of the workforce skills and competencies needed to provide acute maternity services in future within the context of a changing environment • staff training needs • a detailed list of existing maternity facilities providing care in childbirth. 9. This overview report summarises the content of the reference report and sets out the strategic vision for developing acute maternity services in Scotland for all relevant stakeholders, including the public, health professionals, health service planners, and political decision makers. page 6
Page 1 and 2: Implementing A Framework for Matern
Page 3 and 4: Foreword Our National Health Servic
Page 6 and 7: Contents Key Messages from the Expe
Page 8 and 9: 8. There is no such thing as ‘zer
Page 12 and 13: 10. The report shows that in 2002,
Page 14 and 15: Principles 1.1 Acute maternity serv
Page 16 and 17: Assessing and Managing Risk 1. Risk
Page 18 and 19: Risk assessment and management 6. T
Page 20 and 21: Table 1 Levels of intrapartum care
Page 22 and 23: Education, Training and Workforce I
Page 24 and 25: Principles 3.7 A national, post-reg
Page 26 and 27: Developing the maternity workforce
Page 28 and 29: Stakeholder Engagement 1. The Scott
Page 30 and 31: Information Management and Technolo
Page 32 and 33: Transport in Acute Maternity Servic
Page 34 and 35: Appendix 1 Membership of Short Life
Page 36 and 37: Miss Eleanor Stenhouse Senior Midwi
Page 38 and 39: Exit examples for Level Ia-d: mater
Page 40 and 41: Exit examples Level Ia-d: present p
Page 42 and 43: Exit examples Level IIa: past histo
Page 44 and 45: Exit examples Level IIa: intrapartu
Page 46 and 47: Exit examples for Level IIb: presen
Page 48 and 49: Entry examples for Level III Matern
Page 50 and 51: Clinical judgement and decision-mak
Page 52 and 53: Additional competency which will be
Page 54 and 55: Glossary Accredited Certified as be
Page 56 and 57: Named Midwife A named, qualified mi
Page 58: Further copies are available from T

Implementing A Framework for Maternity ... - Scottish Government

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