1. Keeping Childbirth Natural and Dynamic (KCND) Scottish Government Health Directorates

2. Scottish Government policy context Framework for maternity services / EGAMS Reports – Endorse pregnancy & childbirth as normal life events – Recommend care packages based on need Community based, midwife led care for healthy women Obstetric led, maternity team care for complex cases Ongoing medical care by GP – Significant progress made in implementing Variance across NHS Scotland – Key aspects still to be achieved in some areas

3. KCND Purpose – Support implementation of policy at Board level – Promote multidisciplinary working & care tailored to need Multiprofessional programme of work Aims – Maximise opportunities for women to have as natural birth experience as possible through Evidence based care, reducing unnecessary intervention, ensuring informed choice Introducing multiprofessional antenatal, intrapartum and postnatal care pathways

4. Objectives Implement national referral criteria and care pathways – Green Midwife lead professional – Amber Further assessment required – Red Obstetric team care recommended – Flow between care streams as risk alters

5. Objectives Implement lead professional by risk – Maternity team roles Midwifery lead, healthy women Obstetric lead, complex cases Neonatology lead, sick baby Named on SWHMR, ISD – Primary care team roles GP ongoing responsibility for medical care of mother & baby Health visitor ongoing care of well mother & baby – Women’s choice

6. Objectives Implement normal birth pathways – For healthy women – Regardless of setting – 1 st, 2 nd 3 rd stage labour Evidence based – No admission CTG – Guidance for monitoring and care – Flow between midwifery and obstetric team care as risk alters

7. Objectives Implement midwife 1 st point professional contact – Initial risk assessment Against national criteria Social circumstances Health promotion – Stream woman to midwifery or obstetric team care to book Prior to 12 weeks GP opinion on stream – Additional relevant history?

8. Workstreams Led by Scottish Government Health Directorates – National steering group, stakeholders engaged Reports to MSAG NHS Boards – Funding allocations Consultant Midwives to support local implementation Chief Scientist NMAHP Research Unit – Literature review to support programme – Evaluation lead – partnership working Multi-strand approach – quantitative and qualitative

9. Workstreams NHS Education Scotland – Leadership and change management support Leadership programme for new Consultant Midwives Multiprofessional work 2008 – Challenges for implementation, strategies for change NHS Health Scotland – Support change management Literature for women, publications NHS Quality Improvement Scotland – Antenatal, intrapartum, postnatal criteria and pathways 1st drafts for consultation May, launch Dec 08

10. Wider context Rising birthrate trend – Economic and social migration Increased case complexity – Rising maternal age, improvements in the management of longterm medical conditions Career framework changes - MMC, GMS, EWTD – Pregnancy & childbirth normal for many but – Need to ensure specialist services readily available as required Need to direct resources appropriately – Right professional, right women, right place, right time

11. Summary Focus on implementing current policy – Nothing new Robust foundations – Wider maternity team works GP well established role for ongoing medical care Evidence on efficacy of midwifery led care Enough work to go round Stakeholder engagement – All Royal Colleges, users Outcome efficient and effective services – Appropriate care packages for women based on need