"No Room at the Inn" for Mums-to-be in Scotland

Released on 21/12/2005

Expectant parents could find that there's "No Room at the Inn" for them in the New Year because of the closure or threat of closure of community midwifery units in Scotland.

The National Childbirth Trust (NCT) is predicting that mums-to-be who have booked into community midwifery units could be left out in the cold and will be forced to give birth in consultant-led units, often miles away from home.

Community midwifery units in some parts of Scotland are under threat for a number of reasons. A cash strapped Health Service believes that the units are more expensive to run than consultant-led units based in hospitals. This is despite the reality that community midwifery units increase women's chances of having a straightforward birth and reduce the need to use expensive medical facilities such as epidural anaesthetic, caesarean section or the special care baby unit.

Another reason is that because until recently, there has been a lack of focus and drive to support midwives to work in these units and to provide the necessary transport arrangements should women need to transfer to a hospital.

The NCT is warning that the Scottish Executive's Framework for Maternity Services which states that 'women have the right to choose how and where they give birth' will be jeopardised unless the Scottish Executive publicly supports both the retention and development of community midwifery units.

Belinda Phipps, Chief Executive of the NCT said:
"Women value community midwifery units as they are not only local and convenient to get to but they can be less frightening than large hospital units can be. We know that access to community midwifery units helps to increase normal birth rates, giving women with a straightforward pregnancy a better chance of giving birth without drugs, forceps or emergency surgery.

"The Montrose community maternity unit for example is popular with local families, booking more women for care each year and has just been given the Royal College of Midwives Award for Promotion of Normality. However, there seems to be a conspiracy of silence in Scotland about the benefits of birth outside a consultant-led unit. In other areas, notably Grampian, managers are not supporting the development of community-based maternity care. Many women are not being encouraged to consider the full range of choices for birth. As a result, some community midwifery units appear unpopular, underused by women and unsupported by the local community.

"We fully support the Scottish Executive's pledges to increase choices for women over where and how they have their baby. Yet their worthy aims are being undermined by short-term financial difficulties and the lack of support midwives receive to run these units. We are urging the Scottish Executive to consider the needs of the modern day 'Mary and Josephs' and support community midwifery units."

The benefits of community midwifery units are extensive. Research shows that:

• They are managed, staffed and run by midwives skilled in supporting women through normal birth, providing friendly, individualised woman-centred and family-focused care. The philosophy of midwife-led units seeks to put women's needs first.
• Small, midwife-led maternity units can provide cost-effective high quality care¹
• Appropriately selected women who book to give birth in a community unit have reduced rates of interventions, including caesarean section, and higher rates of normal birth, with less perineal trauma and greater maternal satisfaction. Their babies are less likely to be admitted to a neonatal unit, so mother and baby are not separated and breastfeeding is easier to establish²

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¹ Saunders D, Boulton M, Chapple J et al. Evaluation of the Edgware Birth Centre. Edgware: Barnet Health Authority; 2000
² EGAMS Reference Report 2002 - http://www.show.scot.nhs.uk/sehd/publications/egas/egas.pdf; p.135 and
Walsh D. NCT Evidence based briefing: maternity care in birth centres - part 1. New Digest 2005;(29):18-21.

 

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