Excellence andExcellence andExcellence and ChoiceExcellence and Choice

BackgroundBackgroundBackgroundBackground

New Directions (2008)RQIA Review of Intrapartum CareRQIA Review of Intrapartum Care (2009/2010)DHSSPS Regional Review of Maternity Services (2011)Services (2011)DHSSPS Quality 2020 (2011)Transforming Your Care (2011)

Why make changes in the Maternity Service?Why make changes in the Maternity Service?y g yy g y

Safety and Quality

Labour Ward Cover - Consultant Presence

Neonatal Service @ Mater Hospitaleo ata Se ce @ ate osp ta

Middle-grade medical rota @ Mater Hospital

Access to regional specialist services and link to RBHSCAccess to regional specialist services and link to RBHSC

RQIA Report (2010) & DHSSPS Draft Maternity Strategy (2011)

Sustainability and Cost EffectivenessDifficulty in maintaining locum medical cover for neonatal service and middle grade rota at Mater Hospital

Location of Eleven Maternity Hospitals + births in 2010/11 (LVH and Downe have Freestanding Midwife Led Units; Craigavon, Ulster, Altnagelvin have Alongside Midwife Led Unit)Midwife-Led Unit)

The principles which underpin maternity services areThe principles which underpin maternity services are

Women have the right to choose how and where to give birth. This choice should be supported by high quality information and evidence-based clinical advice. Maternity services should be locally accessible and comprehensiveMaternity services should be locally accessible and comprehensive Joint working across multidisciplinary teams and sectors;Specific services for women with poor obstetric or medical history or complications in early pregnancyearly pregnancyA comprehensive antenatal diagnostic and screening service and offered to women in order to detect, where possible, any maternal problems or foetal abnormalities at an early stagey gThe woman and her family’s circumstances should be assessed holistically. Psychological and social need should be identified early and managed appropriatelyOne to one midwifery care to women during labour and childbirthy gPostnatal care should be provided to facilitate the transition to motherhood by making sure ill health is prevented or detected and managed appropriately including a multi professional, multi agency service for women who have, or are at risk of, postnatal d i d th t l illdepression and other mental illness.

Births for 2011Births for 2011Births for 2011 Births for 2011

RJMS

Number Incidence (%)

Delivery Method

Mater

Number Incidence (%)

Delivery Methody

All Breech 27 0.5

Normal 3038 54

All Breech 7 0.6

Normal 744 61Normal 3038 54

Instrumental (Forceps/Vacuum)

726 13 Instrumental (Forceps/Vacuum)

183 15

C 288 23 4Caesarean sections

1813 32.5

TOTAL 5604 100

Caesarean sections

288 23.4

TOTAL 1222 100

Births in Belfast Births in Belfast Place of Residence 10/11Place of Residence 10/11

RJMS MaterBelfastN h 49 8•North

•South•East•West C tl h

497749269892222

5583220

17014•Castlereagh 222 14

South Eastern Trust

1420 396

Northern Trust 1187 27Northern Trust 1187 27

Southern Trust 234 3

Western Trust 64 1

GB/ROI 8 1

TOTAL 5602 1222

Belfast Trust response to the DHSSPS ‘RegionalBelfast Trust response to the DHSSPS ‘RegionalBelfast Trust response to the DHSSPS Regional Review of Maternity Services (2011):- a draft Maternity Strategy for Northern Ireland’

Belfast Trust response to the DHSSPS Regional Review of Maternity Services (2011):- a draft Maternity Strategy for Northern Ireland’gygy

‘Women with high risk pregnancies should continue to be treated within the regional centre for maternity services at the Royal Jubilee Maternity Service; g y y y ;

The regional maternity centre must continue to be located adjacent to the Royal Victoria Hospital which can provide a range of specialist services for

t d th ith f di l d i lpregnant women and new mothers with a range of medical and surgical conditions including access to specialist theatre teams, interventional radiology and intensive care;

Prenatal services at RJMS require the on-site back up from the full range of paediatric specialties based in the Royal Belfast Hospital for Sick Children;

Preterm babies should be looked after in a neonatal unit staffed 24/7 by appropriately qualified consultant Neonatologists.

Options Options pp

Option 1 Maintain Consultant-led Obstetric services at the Royal Jubilee Maternity Service and Mater Hospital, including current models of Midwife-Led Care in both Units (this is the status-quo);

Option 2 Establish one Consultant-led Obstetric service and an Alongside Midwife-Led Unit at the Royal Jubilee Maternity Service only.

Option 3 Establish one Consultant-led Obstetric service including current models of Midwife-Led Care at the Royal Jubilee Maternity Service and a Free-standingMidwife-Led Unit at the Mater HospitalMidwife-Led Unit at the Mater Hospital.

Preferred Option:Preferred Option:Preferred Option:Preferred Option:Option 3 Establish one Consultant-Led Obstetric Service, including current models of Midwife-Led care, at the RJMS and a free-standing Midwife-Led Unit at the Mater Hospital.

RReasons:Choice for women - Right person; Right place;Improved safety by greater consultant presence in Labour ward;M i t i i i l t i li tMaintaining regional access to specialistclinics/services and RBHSCA il bl h i l itAvailable physical capacity;Delivers Trust strategic direction.

P f P t B kl h t t l (D 2011)P f P t B kl h t t l (D 2011)P f P t B kl h t t l (D 2011)P f P t B kl h t t l (D 2011)Professor Peter Brocklehurst et al (Dec 2011)Professor Peter Brocklehurst et al (Dec 2011)((National Perinatal Epidemiology Unit (NPEU) at the University of Oxford) National Perinatal Epidemiology Unit (NPEU) at the University of Oxford)

Professor Peter Brocklehurst et al (Dec 2011)Professor Peter Brocklehurst et al (Dec 2011)((National Perinatal Epidemiology Unit (NPEU) at the University of Oxford) National Perinatal Epidemiology Unit (NPEU) at the University of Oxford)

The Birthplace study is the largest carried out into theThe Birthplace study is the largest carried out into the safety of different maternity settings - comparing births at home, in midwife-led units attached to hospitals,at home, in midwife led units attached to hospitals, those that are stand-alone and doctor-led hospital unitsMidwife-led care was in general much more likely to lead g yto a natural birth.

Excellence andExcellence andExcellence and ChoiceExcellence and Choice