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; Penny Brett; Jo Brown; Kate Evans (for Birte Harlev-Lam); Sarah Lumley; Fiona Mortlock; Sue Prytherch; Anna Richardson; Jo Sharman; Sharon Shipp; Shahida Trayling
Apologies were received from: Angela D’Amore; Bob Dawson; Helen Fairchild; Cheryl France; Victoria Frost; Birte Harlev-Lam; Wilf Kelsall; Maddie McMahon; Jo Watt
In attendance: Maddie McMahon chaired the meeting, not Nicola Clapperton.
PB reported that the cs rate peaked at 30.4% in 2007, and averaged 24.9% in 2008. In 2009 so far, the average rate is 27%.
Following a national audit of cs in 2002, there is government pressure to reduce the cs rate because of the effects of cs on women and their future pregnancies, as well as the implications in terms of cost and length of hospital stay. Attempts are being made to identify key features present in hospitals with low rates.
Areas being addressed at the Rosie include organisational issues, such as improving one-to-one care, and carrying out more professional discussions reviewing the occurrence of cs. The intention is to achieve midwifery staffing levels of 1:30.8. SS reported that weekly meetings to reflect on practice with regard to cs are occurring on the DU. It was also reported that Kings College Hospital in London have doctors starting their shifts at the same time as midwives, which seems to be having an effect.
Also being addressed is practice with regard to women who’ve had a previous cs, elective cs, and the achievement of normal birth. The aim is to reduce the cs rate to 23.9% (the national average), and to have 20% of births taking place outside the DU (i.e. at home and in the Birth Centre).
In 2009 so far, the incidence of emergency cs has declined month on month, while there as been an increase in instrumental deliveries. This figure may be linked to the presence of a consultant on the DU in ‘hot weeks’. Elective cs rates are staying static. Common reasons for electives are: previous cs, maternal request, breech and multiple births. VBAC uptake for 2008 was 31.2 % (up from 21.9% in 2006), with a success rate of 80.8%.
VBAC clinic Initially, the pilot VBAC clinic run by PB was attended with clients selected by consultants, following a discussion with the women concerned. She reported a large increase in women wanting a VBAC following consultation with her. Also, staff feedback on women following appointments at the VBAC clinic was that the women felt very informed. Positive feedback was also received from the women seen by PB in the clinic. Following an audit of the pilot, the VBAC clinic, led by midwives without the need for consultant referral, was introduced. PB needs to increase these clinics, to be able to see more eligible women.
There has also been the introduction of a new Women’s Health Counsellor, who will meet with women who request a cs, to try and lower rates. How to deal sensitively but effectively with these women is currently under consideration.
More work needs to be carried out to look at the cs rates as a whole, and to establish where to go next.
JS asked if anywhere specialises in vaginal birth for breech babies. KE replied that the number of breech births is small and does not have a major impact on the overall cs rate.
It was said that it is easier to recruit student and Band 5 midwives into the Rosie, but harder to get more experienced new staff. There is a need to look at how staff are modelled. It was also mentioned that a higher cost of living allowance might attract more staff, given that the living costs in this area are so high.
Birth Centre There is a new website for the Rosie Birth Centre www.rosiebirthcentre.org.uk. This is its first phase; the second is to follow.
The intention is to encourage all first-time mothers who are low risk to default to the Birth Centre.
There was a 9% closure rate in May, with 62 births in total in the Birth Centre. The transfer rate is 11%-17%.
Work is being done on promoting the Birth Centre, with new literature, which was brought to the meeting, having been produced. This will be sent to clinics, GPs’ surgeries and Children’s Centres.
Staffing levels are currently being assessed.
The new build Birth Centre will aim to encourage natural labour/birth, and will include features that help to promote oxytocin production (for example, a private garden that women can walk round in).
KE showed current plans for the new build.
On the ground floor, there is the new Birth Centre on one side, and NICU parent accommodation (as many special care babies will be coming from out of area) on the other. Both will have 10 rooms, with en suite facilities.
Fetal Medicine will be located on the first floor, above the new Birth Centre. The other side of the building will house seminar rooms and offices.
On the top floor (above Fetal Medicine), there will be the new Neonatal Unit, with 58 cots.
In the ‘old build’, there will be an increase in ‘normal’ beds, including an increase in numbers of single rooms and improvements made to facilities. Money has been set aside to improve the theatres, and increase to the number to three.
After the sign-off has been completed, how to promote the new unit needs to be considered. Promotion of the facilities may also serve as a staff recruitment opportunity.
KE reported that the next midwife training courses are full.
JB asked if there would be any increase in parking facilities. KE felt it was not planned, but the new guided bus service may help transport issues.
The statistics for June 2009 were presented.
Predicted births are 492-472 for July; 487-432 for August; 532-451 for September; 529-465 for October. (1st figure is booked women, 2nd figure is going by scan dates)
The number of births has increased from 447 in April 2007 to 507 in April 2009, and from 414 in June 2007 to 463 in June 2009
SS reported that there has been an increase in difficult deliveries.
SA-M said that there has been increased interest in homebirths among the couples she teaches. She asked if there was a target for homebirths. KE said this was included in the target of 20% of births outside the DU. PB mentioned that there had been a decrease in homebirths, but an increase in births in the RBC, although these are not necessarily related.
There was a 1:35.7 midwife to birth ratio (target is 1:30.8).
PPH rate was 0.8% (no target set as yet).
There was a smoking rate of 8.4% (target is 8%).
There are to be interviews for staff on 23rd July, for posts to commence in October. The majority of applicants are newly qualified.
The following day, there will be interviews held for Maternity Care Assistants, where there have been 14 applicants. These are currently being short listed to make numbers more manageable.
It had not proved possible to obtain figures for this in BH-L’s absence on annual leave. ST requested that this agenda item be changed to Complaints/Compliments, to encourage more positive feedback. This was felt to be appropriate by the meeting.
ST said that meetings have just changed format, and that no meeting had yet been held, so nothing to report.
The AGM will be held at The Fields Centre on October 7, with the topic being the new build. Presentations will be given by Kevin Brennan (the project lead) and Penny Brett, Gerry Hackett and Edile Murdoch (the User Group leads).
At the last AGM (when the theme was normal births), other organisations providing services to pregnant women and new parents were invited to attend and promote these services. It was agreed that this should be done again. Suggestions for people/organisations to be approached included hypnobirthing practitioners (Sarah Ockwell-Smith); doulas (Maddie McMahon), birthing pool rentals (Pool in a Box); someone involved with benefits etc; Opportunity Links (childcare options and help, etc).
ST suggested finding a sponsor for the evening.
It was suggested that a map be added to the invitation. These will be mailed out at the beginning of September.
JS had been in a Children’s Centres meeting, where the issue of the availability of interpreters (specifically for a Polish woman) had been raised. It was stated that Addenbrooke’s holds a contract with an interpreters company called Cintra. The procedure is usually that the community midwife would make telephone contact, then allow the client to speak over the phone. It is, however, difficult to get interpreters at short notice for labour.
SA-M had been contacted by Philippa Bennett, chair of West Essex MSLC (based in Harlow), asking if she could sit in on one of our meetings. SA-M queried whether it would be useful to discuss with her issues arising from women from her area birthing at the Rosie. PB mentioned the problem of in some cases arranging for out of area babies who require neonatal care to be transferred to their local neonatal units. ST said that this issue was being addressed by the neonatal department. SA-M will therefore suggest that Philippa comes along to just sit in on a meeting.
Promotional Materials – VF was not present at the meeting, but SA-M reported that the printing of the material has been held up as a result of the PCT move (their contact details are given on the material). Print quantities also need to be decided on.
September 8th
12.00pm – 2.00pm
Seminar Room 4, Rosie Maternity Hospital.
At the next meeting there will be a review of the past year and feedback of progress achieved. SA-M will contact people who have had action points over the year to check on the progress
