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Astrid Osbourne Consultant Midwife & Supervisor of Midwives SRN,SCM,PG Dip Professional Studies, MSc Advanced Midwifery practice, Post Grad Cert Supervision.

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Presentation on theme: "Astrid Osbourne Consultant Midwife & Supervisor of Midwives SRN,SCM,PG Dip Professional Studies, MSc Advanced Midwifery practice, Post Grad Cert Supervision."— Presentation transcript:

1 Astrid Osbourne Consultant Midwife & Supervisor of Midwives SRN,SCM,PG Dip Professional Studies, MSc Advanced Midwifery practice, Post Grad Cert Supervision of Midwives

2  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


4  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  WHERE ARE THE MIDWIVES! They burnt us as witches in the 15 th 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  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  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  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  Essential for the midwife led care model is the separation of high and low risk women [NSF 2004 & Maternity Matters 2007. 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  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  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  World wide CS has increased from 25% to 70% in developed countries  In some developing countries it is higher  Austria = 40%  Southern Italy = 50 – 60%  Brazil = 75%  South Africa [Caucasian population only] = 70%

13  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  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  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  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  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


19  “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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