News archive 2005
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Bristol Health Services Plan takes on maternity services
October 2005
As a direct result of the delivery of our petition letters to the Bristol Primary Care Trusts in June, we have recently been taking an active role in the Maternity Services Commissioning Programme for Bristol, North Somerset and South Gloucestershire. The aim of the programme is to review maternity provision throughout the region and to develop proposals for appraisal and implementation by the Bristol Health Services Plan as part of the current reconfiguration of health services in the Bristol area.
Two members of the Birth Centre Bristol Steering Group attended a meeting in September of key professionals and decision makers from local NHS and Primary Care Trusts to develop options for birth and newborn care.
Apart from the 'do nothing' option, all the options put forward for appraisal at the meeting include birth centres. These options were presented in a paper to the November board meeting of the Bristol Health Services Plan.
In October, several representatives from our network of local and community groups attended a meeting with the Bristol and South Gloucestershire NHS Public Health Consultant to offer a user perspective on the proposals being put forward to the Bristol Health Services Plan. Their views, together with the evidence from our petition and community survey in Easton, were used to support the case for offering women in Bristol the choice of accessible and individualised midwife-led care in birth centres close to where they live.
Thanks to this input from Birth Centre Bristol and community representatives, Bristol Health Services Plan has agreed to take on maternity services, which up until now has not been part of its remit. A project plan is now being put forward for formal appraisal of the various options for maternity services, all of which include community-based birth centres.
Entering 2006 we can look back positively to the autumn of 2005 as it represents real steps forward for our campaign to promote birth centres as a means to improve public health, maternal choice and midwife recruitment and retention.
MATERNITY SERVICES COMMISSIONING PROGRAMME
Minutes of the User Group Meeting on Maternity Services
Thursday 20 October 2005
1 Welcome and introductions (Pip A’Ness)
This meeting was set up at short notice to give service users a way of contributing to the Maternity Services Commissioning Programme (MSCP) review process before the Birth Group reports to the November board meeting of the Bristol Health Services Plan (BHSP). Birth Centre Bristol had brought together a range of users, both as individuals and as representatives of groups supporting women through pregnancy and birth and of specific communities of women, including Health Links Easton, La Leche League, Mothers for Mothers, NCT, the Home Birth Group, Association for Improvement in Midwifery Services and Neighbourhood Renewal Easton & Lawrence Hill.
Users were welcomed and asked to introduce themselves, say which group they were representing, and give a brief comment on their experiences of the maternity services. All the women present had one or more children, and their experiences included home and hospital births, natural deliveries and caesarean sections. Some examples:
- Traumatic (hospital birth at St Michael’s)
- Amazingly positive experience (home birth)
- Healing (home births)
- Loss of control leading to postnatal depression (hospital births)
- No choice, too busy, no space (hospital birth at St Michael’s)
- Wonderful (caesarean sections at St Michael’s)
- Terrifying, a culture of the abnormal (hospital birth)
- A druggy experience (hospital births at Southmead)
- Problems for refugee women from a culture of traditional delivery forced to give birth with unfamiliar midwives (hospital births)
2 The MSCP, the BHSP and the role of users (Dr Chris Hine, Public Health Consultant, Bristol and South Gloucestershire PCTs)
The primary care trusts (PCTs) commission (buy) health services from the hospital trusts. The MSCP set up a number of working groups to review maternity services and agree on needs and priorities.
The issue of midwife shortages had come out as the most urgent. Staffing levels were too low in comparison with the rest of the country and there were not enough midwives to provide one-to-one care. This problem was exacerbated by the fact that St Michael’s is a local and regional centre of excellence for complex obstetric and neonatal care. Staff shortages meant that the neonatal intensive care unit was often closed to admissions. These pressures had a knock-on effect for providing care for local women.
The BHSP is a joint planning body for the PCTs and hospital trusts. Until recently maternity and newborn services had been left out of the planning process. Although clinical care was good, there was no vision for maternity services for the area. The aim of the board paper is to convince the BHSP to make room for maternity services in its schedule and to appraise the options put forward by the Birth Group of the MSCP. User views would be helpful.
3 Options for maternity care in the Bristol area (Jilly Rosser)
The National Service Framework (NSF) sets out government standards for maternity services. The standard for birth emphasises promoting normality and choice and improving women’s experiences of care. The NSF is mandatory and must be implemented by 2009. The main issue in the options put forward by the Birth Group was the level of care for which women would be eligible. Midwife-led care could be provided at home, in community birth centres handling 500 births a year or in midwife-led units alongside hospital obstetric wards. For these to have a distinct culture they should be physically separated from the obstetric unit.
4 Discussion (facilitated by Pip A’Ness and Jilly Rosser)
Some comments from the discussion on the options:
- Birth is the single most important event for a family and a good start in life is essential
- GPs don’t support home birth
- Home birth is very demanding on midwives’ time
- The culture of intervention in hospitals strips midwives of confidence
- Women are frightened
- We need a culture change to promote normal birth
- In our litigious society, birth is seen as risky – we want healthy babies, but healthy mothers too
- A bad birth experience can cause long-term grief and disempowerment, affecting breastfeeding and the attachment between mother and baby
- Everyone wants more choice
- Babies coming in from outside Bristol bring funding with them – increasing midwife-led care will create more space for specialist care
- Birth centres offer continuity of care through pregnancy, birth and afterwards
- We need to rebuild confidence in women and midwives
- We need to make the profession attractive to recruit and retain more midwives
- There is a big move towards providing neighbourhood-based services
- Communities know themselves best
- Women should know and demand the choices available to them
- Continuity of care is essential
- We can look at and take the best from midwife-led provision elsewhere
- The attitude that mother and baby are set against each other must change – it is insulting for doctors to suggest that they care more about your baby than you do
- The word 'normal' has different meanings for different people –some interventions can now seem normal
6 Achieving consensus (Jilly Rosser)
After the discussion, the users by a large majority (10 out of 12) voted for the option offering the highest level of midwife-led care. It was acknowledged that such a radical change might have to be phased in over a period of time.
7 Summing up – the message from users (Sue Paterson)
The main issues coming out of the discussion were:
- Choice – the cornerstone of government policy but Bristol offers little choice to women
- Capacity – making more space in hospitals by caring for low risk women in the community
- Confidence – women are frightened and midwives are deskilled
- Community – making services accessible and answerable to local people
- Continuity of care – personalised care can be given when women know their midwives
The clear message from users was that change was needed. They asked for this message to be incorporated in the paper to the BHSP board to help inform its decisions.
Birth Centre Bristol Action Group media launch
23 June 2005
On a gloriously sunny morning, a hundred members of the Birth Centre Bristol Action Group (including toddlers, babies and bumps) gathered in the gardens in King Square with representatives from the local press, radio and television, to see over a thousand signed petition letters delivered to the Chairs of the Bristol Primary Care Trusts (PCTs). Hovering above the group and tied to wrists, backpacks and pushchairs were hundreds of pink and blue helium balloons advertising the new website.
Sue Paterson, Chair of the BCB Steering Group, welcomed Arthur Keefe, Chair of Bristol North PCT and Tara Mistry, Acting Chair of Bristol South & West PCT:
"Today we are handing over 1200 petition letters signed by people from all over Bristol. Everyone we spoke to supported our campaign, and we would be giving you ten or twenty times more letters if we had had the time and resources to speak to more people. The NHS says that it now wants to provide the services that people want in the way they want them delivered. The BCB Action Group has given a voice to the people of Bristol and they have told you what they want – the choice for women to have their babies in community birth centres with midwives that they have come to know and trust. Please listen to these women and their families and provide the service that they are asking for."
Pip A’Ness, BCB Action Group Co-ordinator, wheeled on a decorated pram containing the gift-wrapped box of petition letters and an analysis of all the respondents and the comments that people had made. To celebrate the launch of the Action Group, two hundred balloons were released into the sky.
Arthur Keefe responded briefly on behalf of both Primary Care Trusts. He thanked Birth Centre Bristol for the petition letters and acknowledged the hard work and effort that had gone into our campaign. He said that birth centres fitted well with government plans to move all non-acute care out of hospitals and provide it locally, that there was a great deal of sympathy for our cause within the PCTs and that the strategic plan that BCB had recently put forward for a phased introduction of community birth centres merited very serious consideration. However he also said that maternity services had not been seen as a priority because the perception was that there was not a problem in Bristol as feedback from the hospitals was good.
Birth Centre Bristol will now be responding formally to these comments.
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The delivery of the petition letters was featured on local radio, in the regional news programmes on both BBC and ITV West and in the Evening Post. |
Visit to Paulton Birth Centre
15 April 2005
On 15 April 2005, members of the Birth Centre Bristol Action Group visited Paulton Birth Centre near Bath. Paulton was originally a GP unit that was fully refurbished in 1997 and is run and managed by midwives. The setting is rural and beautiful.
There were 230 births at Paulton last year. The unit has two birthing rooms (one with a birth pool) and an eight-bed ward, mainly used for postnatal care.
The midwives who run the birth centre are part of the community midwifery service in the area. A midwife and a maternity assistant staff the centre 24 hours a day, with a second midwife on call for births. The midwives also provide antenatal care, postnatal care and support, and a home birth service. Women can drop in to Paulton for advice both before and after having their babies.
On our visit to Paulton Birth Centre we were made very welcome. Use of the facilities, service provision and organisation were explained. The centre has been very nicely modernised and appeared comfortable with a pleasant atmosphere. They have a lot of water births, and the birth pool is often in use.
Women from South Bristol can now choose to have their babies at Paulton Birth Centre. For more information, or to ask about having your baby there, see the Paulton Birth Centre website.
Birth Centre Bristol Information Event
10 February 2005
On 10 February 2005, Birth Centre Bristol held a public information event at Easton Community Centre to raise awareness about our campaign after setting up the Action Group in January. The hall was almost filled with people, including local women, women who had used the maternity services in Bristol, midwives, hospital managers, NHS representatives, obstetricians and local MP Valerie Davey.
The meeting was chaired and introduced by Sue Paterson, Chair of the Steering Group. Sue welcomed everyone and then handed over to Jane Walker, consultant midwife, who had been project leader of the Edgware Birth Centre in London. Jane gave a lively and interesting presentation, beginning with an overview of what birth centres are, and what they can offer. She reminded the audience that women want a service that is respectful, personalised and kind, that is easily accessible, and that gives women a sense of control over what is happening to them. It is just this service that birth centres can provide, and that is sadly elusive in some big obstetric units. Jane also mentioned the current drivers for change, such as the National Service Framework (NSF) for maternity services, which actively promotes the concept and development of birth centres.
Jane went on to present data from the Edgware Birth Centre, the only NHS birth centre in the UK that has been fully evaluated. The data was impressive, showing that women who give birth at the birth centre are more likely to have a normal birth and less likely to need drugs for pain relief than a comparable group of women giving birth in hospital. In addition, birth centre care costs 30% less than hospital care. Although the women are a self-selecting group and numbers are relatively small, the data is in line with findings from other studies. The women who were interviewed had great trust in their midwives, and valued the fact that they could go through labour at their own speed. Jane ended by referring to Birth Centre Network UK, which has set guidance for establishing birth centres, including the minimum standards required, and the need for ongoing audit and evaluation.
Next the audience were invited to put questions to a panel. This was made up of Jane Walker; Rick Porter, an obstetrician from Bath; Jilly Rosser, a Bristol midwife and member of Birth Centre Network UK; and Nigel Baker, an NHS accountant. Jilly Rosser and Nigel Baker are members of the Steering Group; Jane Walker and Rick Porter are on the Advisory Panel.
The questions posed were interesting and varied. One member of the audience asked what the options would be for a woman who had reached 42 weeks in her pregnancy. Jane Walker said that at Edgware women had access to a range of complementary therapists and that this option might prevent women having such a prolonged pregnancy. However, she also pointed out that birth centres need clear referral criteria, as this is what makes them safe. Rick Porter suggested that a woman in this situation would have much more time to discuss her options, reflecting the increased confidence, competence and experience of midwives working in a birth centre.
Another question was about recruitment, retention and job opportunities for midwives. Jilly Rosser suggested that birth centres were the solution to the current staffing crisis, and that this was backed up by the Edgware experience, where they had 200 applicants for three midwifery posts.
A member of the audience asked the panel why they thought women were still encouraged to have their babies in hospital when, in every other aspect of healthcare, policy makers seem to be trying to keep people out of hospital. The panel all agreed that part of the problem revolved around resources. While no one disputes that birth centre care is cheaper than hospital care, shifting resources from one area to another is complicated. Jane Walker suggested that the recent development of children's centres may help, as birth centres could be incorporated into these. In addition, the government is now moving towards a policy of payment by results and, as home and birth centre births are the cheapest option, NHS managers may be encouraged to provide them as an option.
Sue Paterson closed the meeting by warning that, with all the changes that are taking place to health services in Bristol, we must guard against the result being even more centralisation of our maternity services. She said that bringing birth back into our communities would bring new life into them - literally, socially, spiritually and emotionally - and that with confidence, vision and leadership, we could all work together to make this happen.