Implementing A Framework for Maternity ... - Scottish Government

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Entry examples for Level III Maternal Renal failure, impairment or dialysis Transplant surgery: Heart Lung Liver Kidney Genetic disorders: Marfan’s syndrome Ehlers Danlos syndrome Fetal Suspected or proven fetal abnormality including, cardiac, metabolic disorders, CNS or facial abnormality Neonate Need for assisted ventilation beyond initial resuscitation Congenital diaphragmatic hernia Persistent central cyanosis Abdominal wall defect Congenital abnormality needing urgent surgical intervention Ultrasound identified twin-twin transfusion Necrotising enterocolitis (discretion of the consultant paediatrician) Viral infection Neonate less than 28 weeks gestation Skeletal malformations Need for specialist investigation and treatment e.g. metabolic problem which may require extraordinary therapies such as dialysis Urogenital malformations (genital malformations, posterior uretheral valves) page 43
Appendix 3 Core Competencies for Health Professionals in Acute Maternity Services The EGAMS identified core competencies necessary for all staff providing intrapartum care in a CMU or low-risk setting. A team approach was considered crucial to the delivery of maternity services in each unit. Once competencies are achieved it is vital that the level of skill and expertise is maintained. All competencies correlate to established good practice; implicit in this is maintaining patient safety and clinical governance. It is important that all professionals working in these environments have the confidence, clinical governance, skills and professional judgement to provide a consistently high standard of care for the woman and her baby. This appendix describes the core competencies required by obstetric professionals working in any maternity facility and then identify additional competencies required by practitioners working in specific types of maternity unit, according to the levels of care set out in A Framework for Maternity Services in Scotland. Promoting Normality – supporting normal labour and childbirth This includes providing psychosocial and physical support to women in labour and the majority of existing skills inventories include technical skills and competencies necessary in an emergency. The identification and prioritisation of these skills is central to a quality midwifery service, ensuring that midwives will have the confidence to work in these environments and make clinical decisions about care (Downe, 2001). The range of core skills required mainly by midwives but relevant to all staff in order to keep birth normal are as follows (Hunter, 2000): • Being confident to provide intrapartum care in a low technology setting • Being comfortable to use embodied knowledge and skills to assess a woman and her baby as opposed to using technology • Being able to let labour ‘be’ and not interfere unnecessarily • Being confident to avert or manage problems that might arise • Being willing to employ other options to manage pain without access to epidurals • Being solely responsible for outcomes without access to on site specialist assistance • Being confident to trust the process of labour and be flexible with respect to time • Being a midwife who enjoys practising what the participants call ‘real midwifery’. Promoting normality also includes the use of available evidence to support care (one-to-one care in labour). There are a variety of ways of ensuring that midwives have and maintain these essential skills – but implicit in this must be the use of evidenced based care. Central to this is team working and peer and multi-professional support. page 44
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 10 and 11: Introduction 1. Scotland’s mix of
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 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

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