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‘Women and Midwives.. together we’re strong” Midwifery Led Care

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Presentation on theme: "‘Women and Midwives.. together we’re strong” Midwifery Led Care"— Presentation transcript:

1 ‘Women and Midwives.. together we’re strong” Midwifery Led Care
Astrid Osbourne Consultant Midwife & Supervisor of Midwives SRN,SCM,PG Dip Professional Studies, MSc Advanced Midwifery practice, Post Grad Cert Supervision of Midwives

2 Today we will discuss what Midwives CAN do!
We will look at our global history We will consider where we are now What political influences are pushing maternity care? Look at the innovations that the UK has achieved in the National Health Service Consider how midwife led care does work Look at models of MW led care, home birth and birthing centres

3 Normal birth is different for different people & professionals

4 Midwifery History: UK NHS started in 1948 – more than 50% of women gave birth at home The Peel report in 1970 called for ALL births to be hospitalised on the grounds of safety [no evidence!] 1980’s the DUBLIN study and active management of labour by early ARM, syntocinon from 4cms, continuous EFM & constant support 1993/ 94 Winterton and Changing child birth - call for back to basics 2004 National Service Framework standard 11 maternity 2007 Maternity matters – benchmark for care

5 Childbirth normality WHERE ARE THE MIDWIVES! They burnt us as witches in the 15th century – right across Europe Internationally Midwifery is loosing its position as the MAIN provider of care for well women and their babies Modern midwifery: In some countries care is entirely medically led Caesarean section rates continue to rise The Birth Place Study published Oct 2011 Cost – primigravid cost £2,075 Hospital, £1,912 birth centre, £1,793 home birth Multigravid cost £1,142 Home, £991 Birth Centre, £780 home birth

6 Areas of Midwifery practice that have started to be developed in the UK:
Normality in childbirth – most Consultant Midwives/senior MW practitioners are engaged in this area of care Birth centres with no medical input In the UK a third of pregnant women do not see a Doctor at all during pregnancy and birth NHS maternity hospitals are managed by Midwives Where teams of Drs and Midwives work together the responsibility is shared Normal birth is the forte of the midwife

7 To keep birth normal: Create a homely atmosphere, demedicalise the environment – hide stuff away – make the place homely Create a positive attitude to low intervention Choice of place of birth and carers for women including home, birth centre & hospital birth Women having the opportunity to know their midwife and to trust her/him Education and training for m/w’s and Drs to improve normal birth understanding and confidence Access to parent education and prep for birth

8 What do I do as a Midwife Consultant in the NHS?
I support MWs and Drs in the intrapartum areas – plan as much normality into every birth with them Discourage unnecessary intervention, formulate personal plans Give priority to mobilisation and normal labour behaviours Educate MWs and Drs – bring normality into all aspects of care – teach in the universities Work along side senior Consultant Obstetricians to improve the normal birth rate; including revising policy Encourage normal birth in ALL settings Audit & research [own and others]– dissemination to all

9 Management of pregnancy risk
Essential for the midwife led care model is the separation of high and low risk women [NSF 2004 & Maternity Matters NICE 2008 Midwifery twenty twenty, 2010 ] Acute care in high risk services must be appropriately Dr led and easy to access by MWs Low risk midwife led services across the community in partnership with GPs and social care Easy flows from one process to another where necessary

10 What Changed? The Political, Financial & Medical Revolution
Media pressure to be ‘rescued’ by medical science Modern midwifery: our behaviour & our reaction to pain/discomfort – some women are encouraged to accept pain relief to comfort those around the woman – including midwives! Rising epidural rates – rising CS rates – increased immobilisation during labour – unnecessary intervention during labour Women: are having heavier babies, are fatter, work longer, control their fertility Changing role of Motherhood – youthfulness

11 The CS epidemic: In the USA it is said that CS ‘keeps the vagina honeymoon fresh’ [Kitzinger 2005]
We perpetuate the common belief that vaginal birth is risky and CS is less so Women want CS because they maintain greater control The belief that CS is safe, easy, efficient, desirable & better for the baby The belief that there is less pain, injury & unpleasant emergency procedures “Women’s choice”: ignores the power differential between women & obstetricians [Kitzinger 2005]

12 The rising trend toward global CS
World wide CS has increased from 25% to 70% in developed countries In some developing countries it is higher Austria = 40% Southern Italy = 50 – % Brazil = 75% South Africa [Caucasian population only] = 70%

13 Birth Place Study Results: Outcome
Interventions were less frequent in MW led areas of care There was no difference in adverse outcome for primigravid or multigravid women by place of birth Women in a MW led unit were more likely to have a normal birth Primip women at home did slightly less well 62,036 low risk women were evaluated 27% 0f the home birth group were primigravid Costs: Routine CS costs in excess of £3,000 Savings average for MW led home birth = £310 Savings for stand alone MW unit = £130 Savings for along side MW led unit = £134

14 Standards for Midwifery practice to promote normal birth
NAMED MIDWIFE - contactable Birth choices for all women Women followed through care by known carer/s Follow the National Institute of Clinical Excellence care pathway for A/N and labour care Detailed birth planning Follow up care by known carers Equal governance – the same clinical standards for quality and safety as in all other hospital settings Seamless transition from one setting and carer to another [low to high risk and visa versa]

15 Service design for birth centre & home birth – social approach
What is a Midwifery Team or Group? An autonomous group of midwives who are responsible for a group of pregnant women Geographically based and working from Community Centres and/or large medical centres, any public building has potential Group Practice offers whole care and continuity of carers to women – INCLUDING BIRTH with M/W’s known to the woman Realistic birth planning, managed expectations and a clear plan if risk becomes an issue

16 Setting up Birth Centres and whole care systems that support normal birth
Challenges: Growing birthing population – predicted at approx 3% + across London yr on yr Staffing challenges – shortfalls recognised across Maternity services, Integration of staff – change management & aging workforce Cultural changes, new ways of working To meet government [DoH] drivers for first class care, standards, targets & CNST Resources reduced by recession and historic debt, inefficiencies and failure to modernise

17 A few Facts Electronic fetal monitoring in low risk labour is associated with increased CS rates and has no long term health gains Epidural analgesia – increases the need for instrumental birth Epesiotomy as a routine intervention has no benefits to mother or baby Artificial rupture of membranes – may reduce the length of labour [half an hour average] but causes more pain & increases the uptake of pharmacological pain relief – which influences movement and vomiting

18 Currently only 55% of women in London have a birth attended exclusively by a midwife – Drs don’t do natural, normal birth [they aren’t trained that way & don’t have time]

19 Finally ......Why Midwifery Care Matters to Women
“This has been a dream birth that made this day one of the most beautiful days of my life.” Natalie after her water birth at the Bloomsbury Birth Centre London

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