‘Consultation now closed’

Midwifery led units

Are Midwifery-led Units safe?

Evidence shows that they are. Use National Institute of Clinical Excellence (NICE) guidance advises women with straightforward pregnancies to give birth at midwifery-led units.

National Institute of Clinical Excellence (NICE) guidance published in December 2014 confirms the safety of midwifery-led units for straightforward pregnancies. If a woman needs consultant care during labour, she would be transferred to the nearest consultant-led service.

The Midwifery-led units detailed in our consultation document would be on our district general hospital sites, not out on their own. However, we already have successful home-from-home birth units at Denbigh Infirmary, Bryn Beryl Hospital in Pwllheli and Dolgellau Hospital which account for about 2 per cent of births in North Wales.

You are proposing to take away our right to choose where we give birth.

We would maintain choice for women during any temporary changes. The National Institute of Clinical Excellence ( NICE) say that we should ensure that all four birth settings should be available to all women: home births; midwifery-led unit; alongside midwifery-led unit and consultant-led. This reflects the requirements of Welsh Government for Maternity Services.

Why should high risk mums have to travel further than they are currently used to in order to have their babies?

We would not want to cause additional travel unless we felt it absolutely necessary to make the changes.

However, in other parts of the UK, for example Scotland and Devon, women travel miles away from where they live for obstetric care. It is not unusual for women who need (or choose) to give birth at an obstetric unit to travel for this service.

Indeed, in North Wales we are used to travelling for specialist services e.g. trauma goes to Stoke, very premature babies go to Arrowe Park, and specialist children’s services are at hospitals like Alder Hey.

We have to make the right decision for the whole of our population.

What at the options for mothers using a consultant-led setting who cannot drive? Will they have to get public transport?

Currently a number of women who are unable to get to the hospital independently or with a relative call an ambulance.
In options that will require change, we have already had discussions with Welsh Ambulance Service about how to provide extra cover.

We already support families in hardship who need to travel for services. For example, the families of those undergoing surgery for gynaecological cancer at our centre at Ysbyty Gwynedd have a local hotel provided to support them with visiting their relative. We would be looking to “provides similar support” if a decision was made to change the current service temporarily.

I have to have weekly scans due to complications in late pregnancy with my last child. Would I be expected to travel to Bangor or Wrexham instead of the short journey to Glan Clwyd?

Routine antenatal and postnatal care would be retained at all three hospitals therefore you could continue going to Glan Clwyd each week for scans. The only aspect that would change would be the labour ward cover by consultants and the on-call arrangements.

As you are under a consultant, you would be advised to deliver at an obstetric unit to ensure your and your baby’s safety. Depending on the decision of the Board, in your case this could mean delivering at a different hospital.

What about emergencies? What emergency cover will there for the Midwifery-led Unit?

Midwives are trained to deal with emergencies and will stabilise any mother and baby and transfer them appropriately. Midwives spend their jobs monitoring women and looking out for things that aren’t quite right and will anticipate any problems as best they can.

The safety of the mother and baby is of paramount importance so in the rare cases where problems or complications can’t be foreseen, emergency transport would be ready to transfer women to one of the obstetric units.

Emergency transfer arrangements for midwifery-led units have been agreed at an all-Wales level – a 999 ambulance. These arrangements have been endorsed by the Welsh Risk Pool and Welsh Ambulance Service Trust (WAST).

We are anticipating one to two patients per week needing transfer to an obstetric unit; most of those will be planned moves because of failure to progress.

We would only anticipate one or two patients every couple of months to need to be moved as an emergency. We are working with the Welsh Ambulance Service and other emergency transport services to ensure we reduce the risk of dealing with these situations.

A woman can suffer a placental abruption after a low risk, normal pregnancy and can bleed to death in 30 minutes. What if this happens at a Midwifery-led Unit?

At every hospital there is immediate access to acute medical teams to resuscitate and provide emergency intervention in this example. This will not change in any of the options being considered.

What are the transfer times from a Freestanding Midwifery-led Unit to an Obstetric Unit?

We would expect total transfer time from bed to bed to be a maximum of about 60 minutes. Any woman needing to be transferred by ambulance would be escorted by a midwife to provide one-to-one support throughout the journey.

This is in line with travelling times between similar units in other parts of Wales.

Will ambulances be on constant standby to transfer women? What happens if there is a massive road accident?

We would have dedicated transport initially and would monitor use. 

Blue light ambulances pass through roadworks or accidents on a daily basis in emergencies of all kinds. Traffic delays are taken into consideration by ambulance control and crews.

Does a woman in labour in a Midwifery-led Unit (MLU) who needs rushing to a consultant have to sign consent to be moved?

This is not true. There are no consent forms for this, and such forms are not used elsewhere either. Midwives would discuss with the woman the reasons she needed to be transferred (the majority of transfers are due to a slow labour or delay in labour).

Can women who are in a Midwifery-led Unit (MLU) have an epidural?

Epidurals are not offered to women who choose to give birth in a Freestanding Midwifery-led Unit (FMLU). In labour, if a woman requests an epidural, she would be transferred to an obstetric-led unit.