Midwife Led Care Belgium

Astrid Osbourne
Consultant Midwife & Supervisor of

Midwives
SRN,SCM,PG Dip Professional Studies, MSc
Advanced Midwifery practice, Post Grad Cert
Supervision of Midwives
[email protected]
[email protected]
 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
 OUR PERCEPTION
OF BIRTH IS
IMPORTANT:
 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
 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
 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
 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
 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
 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
 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
 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]
 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%
 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
 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]
 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
 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
 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
“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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Astrid Osbourne

Consultant Midwife & Supervisor of

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