Making a difference: Bringing birth back into the community
Birth Centre Bristol proposal to the Bristol Primary Care Trusts
February 2004
Executive Summary
Introduction (Section 1)
The Birth Centre Bristol project was established in October 2001, with the aim of setting up a birth centre in the Bristol area. A birth centre is a community-based facility, managed, staffed and run by midwives skilled in supporting women through normal birth. Birth centres have been shown to provide a high level of satisfaction to both the women who give birth and the midwives who work in them.
The project is seeking capital and revenue funding through the Bristol Primary Care Trusts (PCTs), with a view to establishing one or more birth centres that are part of the National Health Service and free to the women who use them. The initial object of this proposal was to open a dialogue with Bristol North PCT. The purpose of this revised edition is to update the document and to widen the scope of the proposal to cover other areas in Bristol.
The benefits (Sections 2 and 3)
This project represents a high profile opportunity to contribute to national and local public health priorities by developing high quality maternity care within the community as part of the new service configuration in Bristol.
Good maternity care has a significant impact on long-term public health outcomes, and primary care trusts are well placed to promote a return to a more balanced model of midwifery services with midwives based in the community and more accessible to women. Birth centres enable key midwifery skills to be preserved and taught, with benefits in terms of reduced intervention rates and the morbidity associated with interventions. Birth centres offer a means of addressing current severe midwife shortages by providing alternative working arrangements for midwives who have become disillusioned with the obstetric model of care.
The Birth Centre Bristol model of care (Section 4)
Midwives at the birth centres will work in a group practice, providing antenatal and postnatal care for local women and attending the births of all those women who give birth at home or in the birth centres. All women will have a named midwife and the emphasis will be on individualised care. Enhanced care will be offered to more vulnerable women, with strong links to other agencies and support groups. Breastfeeding will be encouraged and supported.
Professional issues (Section 5)
There will be robust structures for effective clinical governance at the birth centres, with the aim of ensuring excellent standards of care through a high quality service with active midwifery supervision.
The Royal Colleges of Midwives, General Practitioners and Obstetricians and Gynaecologists have all supported the principle of community-based, midwife-led birth centres. Women meeting the criteria for a home birth will generally be able to give birth at the birth centres. Care pathways will be drawn up for all the key stages from confirmation of pregnancy to discharge from midwifery care and a detailed risk management plan will be in place. Regular audit will monitor adherence to these standards and protocols and provide a basis for quality improvements.
The birth centres will offer training and experience to medical students, midwives and obstetricians in community-based maternity care and the skills needed to support normal birth. They will work closely with the acute obstetric unit.
National and local priorities (Sections 6 and 7)
The birth centres will help to meet many of the national and local priorities with which primary care trusts have been charged: user involvement, addressing the needs of the local population, tackling health inequality, meeting the needs of black and other ethnic minorities, promoting public health and providing high quality care that is both clinically appropriate and cost-effective.
Public health targets (Sections 8 and 9)
The birth centres will meet many public health priorities, including improving access, supporting families, tackling health inequality, and developing high quality services. They will also help to address key public health issues such as mental health, coronary heart disease, smoking, teenage pregnancy and domestic violence. The NHS Plan envisages an expanded role for midwives across health and social care sectors.
An important aim of the birth centres will be to reduce rising caesarean section rates, which are a national cause for concern; surgical deliveries involve health implications for mother and baby and high costs for the NHS. A key factor in caesarean rates is the culture of the maternity unit; the birth centre midwives will be committed to normal birth. The birth centres will provide continuity of care and one to one midwife care in labour, which are rarely possible in obstetric units but have been shown to result in fewer interventions, higher breastfeeding rates and high levels of user satisfaction.
Operational and financial matters (Sections 10 and 11)
A management committee involving user, community and professional representation will determine the philosophy and activities of the birth centres.
Midwifery assistants can be used to staff the building and provide elements of maternity care. The community midwives can be based at the birth centres, use them to run clinics and groups, and attend the births of the women who choose to deliver there. The birth centres will eventually each be able to accommodate 400 to 450 births per year, in addition to offering antenatal and postnatal care.
Most of the running costs of a birth centre are staffing costs, which are transferable. There may be some marginal costs that cannot be transferred and some additional costs during the set up period. These costs must be set against the savings to existing acute unit, GP and community services that can be achieved both immediately and in the longer term. Costs may also be able to be mitigated by other potential sources of funding.
Conclusion (Section 12)
The Birth Centre Bristol proposal envisages the first birth centres in the country to be started from scratch, rather than developing out of the closure or threatened closure of existing facilities. This presents a unique opportunity for the Bristol Primary Care Trusts to establish birth centres that are centres of excellence and a new model for maternity services in Bristol.