Proposal For Midwifery Led Services Approved

14 December 2017 3:06pm

The proposal for a new service model for Midwifery Led Services across the County has been approved for consultation at Shropshire Clinical Commissioning Group’s Governing Body Meeting. It will now need to go to Telford and Wrekin CCG Governing Body for similar approval, before consultation on the proposal can begin.

The proposal is the product of a detailed review and engagement programme carried out by Shropshire, Telford & Wrekin CCGs after Shrewsbury and Telford Hospital NHS Trust raised concerns about staffing levels.

The review looked at how the current system worked and the views of service users, staff and those interested in midwifery services, and what the future provision could look like.

Findings from the review demonstrated a mismatch between staffing and activity. Under the existing system it is not possible to guarantee one-to-one care during delivery, as there is a shortfall of midwifery cover at the Consultant unit where 85% of women have their babies, and an excess of midwifery cover at the three smallest freestanding MLUs. The review found, through talking to staff and service users, that this was negatively impacting on patient and staff experience, as well as potentially failing to provide the one-to-one care in labour that women need.

The way each MLU has developed over time means they all have a different service offer for women.  For example, women accessing one MLU may have access to scanning but those accessing another may not. The proposed new service model aims to change this so that women using any of the maternity hubs have access to the same type of services closer to home. The range of services on offer through the maternity hubs will be much broader than the service currently available through MLUs and will include (but not limited to):

  • Antenatal and postnatal care from a midwife and support from women’s support assistants
  • Planned appointments with an obstetrician
  • Scanning and fetal monitoring
  • Antenatal day assessment, including CTG (where a baby’s heart rate and movements are monitored)
  • Drop in service or planned access during a 12 hour period
  • Support with confidence building and bonding
  • Support with feeding and practical baby care 
  • A space for women and their families to reflect on the birth experience
  • Newborn checks and screening
  • Support with emotional wellbeing and mental health 
  • Support with long term conditions during pregnancy
  • Healthy lifestyle services - including smoking cessation and weight management services
  • Information and advice about pregnancy and parenthood
  • Information and advice about birth options
  • Peer support

Under the proposal, inpatient births at Ludlow, Bridgnorth and Oswestry MLUs would cease, but the new model would continue to offer a full range of birth options within the county. This is good practice and currently only happens in 22% of health trusts and health boards across England, Wales and Scotland.  In Shropshire, Telford and Wrekin, there will continue to be the full range of births at:

  • A Consultant Led Unit
  • An Alongside Midwife Led Unit (on the same site as the consultant led unit)
  • A Freestanding Midwife Led Unit (not on the same site as the consultant led unit)
  • Home 

In addition, it is proposed that midwives and women’s support assistants will be available 24/7 for advice and support either over the phone, in person, or through video call.  This will include a really responsive triage service to assess women in labour and to judge progress as accurately as possible so they get to their chosen place of birth on time.

Dr Jess Sokolov, Shropshire CCG’s Clinical Lead for the midwife led services review speaking on behalf of both Shropshire and Telford & Wrekin CCGs, said: “The current system cannot remain as it is because the midwives are not based in the places where they are actually needed. This means that one-to-one support cannot be guaranteed for women in the consultant led unit. There are also inconsistencies in which services are offered and where, as well as access issues for women across the County. 

“I understand people may have concerns about change but this proposal is a change for the better where services are actually being enhanced to offer more support for more women close to home. 

 “Whilst the proposed new model will continue to offer a full range of birthing options, it also introduces a new concept of maternity hubs across the County to bring together a whole range of maternity related services. We listened to mums who said the current focus was too much on just giving birth so we have worked with them to help devise a whole range of specialist antenatal and postnatal support and services.

“It has been developed with an expert midwife and also meets national guidelines and practices.”

The proposed model will also go before Telford & Wrekin CCG for consideration before it goes forward for consultation.