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); Jan Butler; Nicola Clapperton; Callie Copeman-Bryant; Julie Gardiner; Maddie McMahon; Charlotte Patient; Jo Sharman; Anna Shasha; Sharon Shipp; Heather Sturman; Claire Thompson; Jo Watt; Kate Wilson
Jan Butler, Anna Shasha and Claire Thompson were welcomed as new to the committee.
Apologies were received from: Angela D’Amore; Joanne Brown; Cheryl France; Boo Newns
Agreed as a true record.
3.4(i) - JG and SA-M have not yet been able to meet Ben Myer from the Ambulance Service to discuss what guidance community midwives should give to parents about providing information to the ambulance service if they need to call an ambulance when there is no emergency, but a midwife is not expected to arrive in time for the birth, because Ben has been unable to spare the time. It is hoped that the meeting will take place in June.
3.5 - SA-M had a meeting with Sheila Reed in the antenatal screening clinic to discuss trialling the use of Paling Palettes as a tool for discussing risk with parents. Sheila suggested a couple of circumstances in which the tool might be tried out and offered to discuss this at a fetal medicine meeting, but so far SA-M has been unable to get any feedback from her on the outcome of that meeting.
7 - SA-M has got data from Emma Te Braake on the rate of normal birth, as defined by the national Maternity Care Working Party (i.e. excluding women who experienced induction, epidural or spinal, GA, forceps or ventouse, caesarean section or episiotomy). The rate for 2009-10 was 39%. The MCWP recommends that services should aim for a normal birth rate of 60% by 2010.
There was some discussion of the MCWP’s definition, particularly with regard to epidurals being an exclusion criterion, and augmentation of labour not being excluded. SA-M said that there had been a lot of debate, and some contention, in the Working Party about the definition, but that its current form is what was agreed on and it is now being used in the national collection of statistics. It was agreed that data on normal birth should be routinely collected for the Rosie, but that there should be further discussion about the definition of this at another committee meeting
8 - SA-M has been in touch with Jo Goddard and Trisha Nolan about the feedback from young mothers at Romsey Mill who said that they felt they hadn’t been listened to in labour. It was agreed by them that SA-M should continue to monitor young women’s experiences and report back.
SA-M has reported the feedback about young women’s experiences in the scan department to Trish Chudleigh. Trish requested further details, which SA-M has asked the Family Nurse who reported the experience to provide. Her reply is awaited.
11 - KW reported that there is money raised from the NCT Baby Show that is available to put into a project to train breastfeeding peer supporters. KW to liaise with JW on this.
ACTION: KW
12 - SA-M had got data from Emma Te Braake about the numbers of caesareans performed by individual obstetricians, but it was raw numbers, so not very helpful. CP explained that the data did not reflect decision-making, as various obstetricians could be involve in the decision at different points.
SA-M has been in touch with Gill October at the Fields and provisionally booked the Centre for the AGM on October 6. It was agreed that we should invite Andrew Lansley to be the guest speaker. SA-M to approach him
ACTION: SA-M
SA-M said that this was being raised as a topic because of the awareness among user reps of firstly the relatively high incidence of negative birth experiences reported by women who were induced, and secondly, that regardless of what is actually being said to them, there appears to be a strong sense among women with prolonged pregnancies that they ‘had’ to be induced at a particular point.
CP referred to the two separate issues of policy on induction and the quality of the service.
Policy follows the NICE guidelines with induction being offered at 40 weeks+10-14 days. For low-risk women, inductions are organised by community midwives. Induction is presented as a choice, and women are encouraged to wait till 40+13-14. Women who decline induction are offered a scan at 40+14, plus a consultation, followed by CTG monitoring every other day. The point was raised about GPs not counselling women along the same lines that midwives do. GPs are not generally involved in giving women information on induction, but CP asked for any known examples of GPs providing different information from that given by midwives to be brought to her attention (as well as any known examples of midwives not giving the standard information). It is also the case that the counselling given by out-of-area community midwives might not be consistent with that provided in area.
SA-M asked if, in the interest of consistent counselling, any consideration had been given to setting up a post-dates clinic, as exist at other hospitals. It was said that this would not be possible due to lack of space and resources, and because it runs counter to the policy of providing care in the community wherever possible.
It was admitted that the current experience of women in the early stages of induction was less than ideal, because for reasons of space, it takes place in the relatively public environment of the ward. This would be improved if the option of administering prostaglandin at home or on an out-patient basis, which is under consideration, were adopted. The situation will also be better once the new build is in existence, as this will allow for an induction bay near to the DU.
The current information leaflet on induction was discussed. It needs to be revised to make the language simpler and less clinical. KW suggested that the leaflet should include information about what the recommendations are if a woman declines an induction. An alternative would be to have a separate leaflet on this. SS pointed out that this information is included in the Rosie booklet.
Caroline Locke (midwife) is currently undertaking a review of women’s experiences of induction. On the basis of this, CP and JB will consider what revisions need to be made to protocols and leaflets. They will report back to the committee in due course.
The question was raised about whether women should be given a due date ‘window’ rather than a specific due date. It was pointed out that due dates are needed for arranging maternity leave and maternity pay, as well as for the timing of any scans and antenatal screening tests that the woman is having, so they could not be dispensed with. However, the point was made that midwives could make women aware that the length of a normal pregnancy varies, and that their baby is actually quite unlikely to arrive on the EDD.
CP stated that there was auditing of the outcomes of induction. SA-M had got figures from Emma Te Braake about induction in the calendar year Jan-Dec 2009. There were 5508 maternities during this period, with 1252 inductions (a rate of 22.7%), of which 340 were for post-dates (27.2% of all inductions). The outcomes of these 340 inductions were: emergency caesarean: 82 (24%), forceps: 33 (9.7%), ventouse: 39 (11.5%), and SVD: 190 (55.9%).
Summary: it was agreed that women experiencing a prolonged pregnancy should be given clear and consistent information about the options available to them, including explanations of what both induction and expectant management involve in terms of procedures.
The meeting’s discussion was timely in view of the review of induction that is currently underway, and can be taken account of when any revisions to protocol are made.
AS spoke about her experience in her previous hospital, Queen Elizabeth Hospital in Woolwich, and the differences between that and the Rosie in terms of the clientele and their health issues. At the Rosie, she is keen to get the caesarean rate down and to promote breastfeeding. She will also be keeping an eye on the homebirth rate.
Developments in the pipeline include the following:
June 1 – assessing women for their risk of DVT is being introduced. Those who are at high risk will be treated with an anticoagulant postnatally.
July 1 – formula milk is being withdrawn from the unit, so women who wish to formula-feed their babies will be asked to take in their own
July 5 – long shifts (11.5 hours) are being introduced for midwives
Nov 16-17– CNST review. The Trust will be aiming for Level 2 status.
SS added that fibronectin testing for prematurity is about to be introduced
AS said that the Rosie website is going to be revised, and asked user reps for feedback on what information is needed on the site (please mail this to her or SA-M). CC-B mentioned that Harlow hospital have a good website.
ACTION: user reps
The current expectation is that building will begin in November. At the moment, arrangements are being put in place to deal with the impact that the construction will have on the current service.
The next DU meeting is taking place in a couple of days.
SA-M asked anyone who could get publicity material out into the community to take posters and leaflets
CC-B asked for information about GBS screening. As this is a complex issue, it was agreed to add it to an agenda at a future meeting.
MMcM reported further problems with a potential breastmilk donor being given unclear information about procedures and being treated unhelpfully. JW will investigate.
ACTION: JW.
6 July, 12.00 pm – 2.00 pm
Seminar Room 5, Rosie Maternity Hospital
The next meeting will be considering services to fathers/partners. Please try to bring as many men’s/partners’ views on this as possible to the meeting.
