Cambridge Maternity Services Liaison Committee
We care about your care!
Cambridge Maternity Services Liaison Committee
We care about your care!
In Attendance:
Sue Allen-Mills (Chair); Angela D’Amore; Maddie McMahon; Amy Mokady (guest); Boo Newns; Charlotte Patient; Sharon Shipp; Jo Watt, Alison Wilson
Apologies were received from: Amanda Cahn; Cheryl France; Victoria Frost; Julie Gardiner; Bridget Halnan; Nisrin Marcus; Sarah Ockwell-Smith; Heather Sturman; Shahida Trayling; Annie West
Agreed as a true record.
3 A doula ‘meet and greet’ session for midwives has been arranged for February 2 between 10.00 am and 2.00 pm in Seminar Room 5.
5 SA-M has notified Tina Pollard about the mother who had failed to get any response from NICU about donating breastmilk.
7 SA-M has e-mailed WK several times to find out about the children’s services monthly reviews, but received no response. AD’A will try to get information about them.
ACTION: AD’A
10 NC has provided information about the evaluation of the FNP from other areas. This will be uploaded to the website
13 SA-M reported the problem with the Bradbury couch to the NCT, who have been in touch with ST about it.
It was agreed to approve the current terms of reference for another year.
Two issues were raised: (i) the need to review the membership of those members who have not attended a meeting for a long time (ii) whether user members can get access to the Cochrane Database.
SA-M will look into both of these.
ACTION: SA-M
SA-M has been in touch with Jo Duncan, who is happy to include leaflets in postnatal discharge packs (6000 pa). Julie Gardiner has said that the community midwives could also give out leaflets (3000 pa). It was agreed that if the aim is to get a leaflet into the hands of all women having babies at the Rosie or in the community, routinely including them in discharge packs would be the best way of doing this, with leaflets being available through other routes (e.g. children’s centres/GPs’ surgeries/community midwives/antenatal classes) on a more ad hoc basis. It was also agreed that it would be best to limit the material in other public places (e.g. libraries/cafés/shops) just to posters.
ACTION: SA-M to discuss reprint quantities with the PCT.
SA-M has also been in touch with Helen Morrison about including mention of the MSLC in the virtual tour that is being put together (though is some way from being ready). Helen felt that this wouldn’t really work, and suggested putting information about the MSLC on the Rosie website. SA-M to pursue this as part of updating the Rosie site.
ACTION: SA-M
It was pointed out again that mention of the MSLC had been left out of the ‘Going home with your baby’ booklet. This is due to be remedied on a reprint. SA-M to check on this with Kate Evans.
ACTION: SA-M
The meeting was attended by Amy Mokady, organiser of the Cambridge breech babies support group (www.breechbabiesclub.org) and Alison Wilson, consultant obstetrician, to discuss this issue.
The background to the issue being raised was firstly, members of NCT classes whose babies were breech commonly reporting that they ‘had’ to have a caesarean, without seemingly being aware of other options; secondly, Amy having contacted SA-M in Jan 09 about her own experience of having a breech baby, and the issues this raised about the service provided to women whose babies are breech; and thirdly, the impact of breech babies being born by caesarean on the overall caesarean rate.
Throughout 2009, Amy collected experiences of other women whose babies were breech. (a total of 12 women and 14 breech pregnancies representing most scenarios other than vaginal breech birth at the Rosie). In general, they were extremely positive about the care they received, but some issues of concern did emerge.
(i) Women being given inconsistent advice in pregnancy (i.e. different members of staff giving different information), in particular with regard to ECV or other ways of trying to turn a breech baby (e.g. moxibustion/knee-chest position). AW and CP pointed out that obstetricians could not suggest ways of trying to turn a breech baby for which there is no evidence base, and which are not offered on the NHS. However, they were happy to discuss their views of alternative methods if the woman specifically asked about these, and would often mention trying the knee/chest position since it can do no harm.
When a baby is found on a scan to be breech at 36 weeks, women are counselled about ECV. This is now being done by MFAU midwives as well as obstetricians, to avoid the need for women to wait to see a doctor (there are four consultants who counsel about, and perform, ECV). All women for whom it is appropriate are offered ECV.
Overall success rate for ECV at the Rosie is 37% (27% primips, 66% multips).
Amy reported that not all community midwives are giving consistent advice about ECV or birth options if the baby does not turn (vaginal birth is often not mentioned at all). CP to raise this with Julie Gardiner.
ACTION: CP
MMcM asked if women were given signposts to enable them to research the issues surrounding breech birth. There is a Rosie-produced leaflet about ECV. For information about breech babies, women are referred to the RCOG leaflet on-line http://www.rcog.org.uk/files/rcog-corp/uploaded-files/PIBreechBaby0208.pdf.
(ii) Birth options. Women whose babies remain breech after an ECV are told about the risks of both caesarean and vaginal birth. The risks that are presented to them are the ones defined by the Term Breech Trial (which concluded that caesareans pose less of a risk to the baby, but more of a risk to the mother). Most women choose to have a caesarean.
SA-M pointed out that flaws have been identified in the Term Breech Trial, and referred to another piece of research that found that the risks of vaginal breech birth were lower where it was common for it to be planned, where staff were practised in its management, and where there were strict selection criteria for it.
There was discussion of the issue of how risk is presented and informed choice, with the point being raised that risk is subjective, and individuals differ in terms of what they regard as an acceptable level of risk.
CP pointed out that nearly all the women whom she meets after an unsuccessful ECV ask for an elective caesarean. Most vaginal breech births at the Rosie occur when women present as breech in labour and labour has progressed too far for a caesarean to be a viable option.
If a woman plans a vaginal breech birth, or has an undiagnosed breech in labour, or goes into labour prior to a planned caesarean, there is always an obstetrician available to assist a vaginal breech birth, but because these take place infrequently now, expertise – and staff confidence – is waning. Skills drills are performed regularly, but real-life experience is limited. CP noted that there is an issue around training juniors to counsel women who are in labour with a breech baby, to ensure that vaginal birth is offered as a real option, and that this needs to be addressed.
ACTION: CP
AW reported that cases of EMCS for breech babies in 2008-9 (41% of breech births)) are going to be audited. The hope is that this will improve understanding and lead to an increase in vaginal breech birth management skills among staff.
There was discussion of the procedures for vaginal breech birth, particularly with regard to birthing position. The recommendation in the unit is for a dorsal position, as in this position it is easier to deal with any complications that might arise. There is little evidence on the use of standing or kneeling positions. MMcM had heard about hospitals in London where upright positions were being used, and will see what statistics she can find on this. AW said that the breech skills drills do now include standing and all fours positions, as well as dorsal, but staff are most familiar with the dorsal position.
ACTION: MMcM
(iii) Postnatal follow-up. Amy referred to a case of a mother who reported a lack of support both with regard to her baby being breech and having a caesarean. There are now two postnatal consultant ward rounds a week, so women whose babies were breech who are on Lady Mary after a caesarean will be seen by a consultant if they’re on the ward during these rounds.
In summary, there is a need for all staff to be giving consistent information to women about ECV and other options for trying to turn a breech baby, and about birth options when the baby is breech. The point was also raised about the need for staff skills and confidence at dealing with vaginal breech birth to be maintained at a level such that this is a viable option for women.
The board has given approval for the new build, subject to funding, the amount of which is still to be agreed.
SS reported that interpreting services have ceased to be provided throughout the Hospitals Trust, for financial reasons. Midwives are now asked to use Language Line instead. There is, however, at the moment still some provision of interpreting for women in labour (though not antenatally or postnatally).
A new ‘fresh eyes’ policy has been adopted, providing peer review of CTG traces every hour.
New floor mats have been provided by Friends of the Rosie.
LSA (Local Supervising Authority) will be auditing supervising services at the end of January.
As a measure to counter norovirus, the DU and the RBC are currently only allowing one birth partner.
BN reported that the form she had received for a blood test prior to donating breastmilk was incomplete. AD’A will look into this.
ACTION: AD’A
Sara Ward is currently closed. Transitional care is being provided on Lady Mary, by Sara Ward midwives.
A new HoM, Anna Shasha, has been appointed. She is currently HoM at Queen Elizabeth Hospital, Woolwich. She will be starting on March 15.
Interviews for a new Consultant Midwife have just taken place.
23 February, 12.00 pm – 2.00 pm
Seminar Room 4, Rosie Maternity Hospital
