Implementing A Framework for Maternity ... - Scottish Government

10. The report shows that in 2002, there were 45 healthcare facilities across the country that
include maternity units offering intrapartum care. At present, most of Scotland’s children
are born in consultant-led maternity units. Four regional specialist maternal-fetal units, two
in Glasgow and one each in Edinburgh and Aberdeen, deal with the most complex and high
risk cases. They also provide general maternity services to their local populations. Over 35%
of all babies in Scotland are born in these four units. Of the other units, approximately 20
provide consultant-led services in district general hospitals, some of them quite small, and
the remainder are community facilities – Community Maternity Units (CMUs) – providing
midwifery-managed care, particularly in remote and rural areas.
11. The report considers the sustainability of some consultant-led acute maternity services in
small hospitals. Maternity units with low numbers of deliveries are finding they cannot sustain
children’s (paediatric and neonatal) services for the few babies who might need them. In some
cases, change in the local configuration of other services or shortages in professional staff
have already made it necessary for NHS Boards to reshape their local acute maternity services.
12. Changes in the medical and midwifery workforces are already impacting on maternity
services. A review of the Scottish medical workforce 3 concluded that increasing
specialisation, necessary restrictions on working time and demands to maintain clinical
competence through appropriate training and education for medical trainees, make
traditional patterns of medical staffing for all acute services difficult to sustain.
13. The EGAMS report concludes that the current configuration of acute maternity services is
no longer sustainable. The falling birth rate means that some facilities will not be able to
continue in their present form, as small numbers of births do not allow staff to maintain the
range and level of skills needed to deal with complex cases or emergencies. Acute maternity
services will have to change to reflect sustainable ways of working.
14. To continue to provide childbirth services locally for many women in rural areas and to ensure
continuity of individually-tailored care and support, we need to realise the full potential of
midwives. One-to-one midwifery care should be the norm for all women in Scotland. The
midwife’s role should be extended to lead management of childbirth in maternity facilities
to provide a local service for low-risk births where women are unlikely to need specialist
medical intervention. Such facilities can also provide care for women alongside consultantled
units in hospitals.
15. The complete reference report is readily available to clinicians, NHS strategic and
operational managers and other interested people on the Scotland’s Health on the Web
(SHOW) website – www.show.scot.nhs.uk.
3 Future Practice: a Review of the Scottish Medical Workforce p. 25, para 43
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