PREGNANT women will give birth at home or in “community hubs” run by midwives under a radical shake-up of maternity services being introduced next year.
The far-reaching changes to childbirth in Scotland – piloted across five health boards – will ultimately create a service where, for the most part, expectant mothers should only deliver their babies in a hospital ward with doctor supervision if they face a higher risk of complications.
A key finding of a two-year review conducted by medical and midwifery experts reported in January that less than three per cent of women gave birth at home or in “freestanding midwifery units”.
But many more could safely deliver their babies outwith hospitals because the vast majority do not require that level of specialist medical care.
The Best Start review recommended a new model of care for healthy mothers-to-be which should be midwife led and centred around community hubs which could be “freestanding” or alongside hospitals.
Revealing the plans to The Herald, Health Secretary Shona Robison said they would transform patient care.
“The new model is a fundamentally different way of delivering maternity services that is focused on individualised, person centred care and continuity of carer,” she said.
“The community hub model will see most midwives working in the community, however there will always be women who require to be in hospital during their pregnancy or after birth and therefore maternity wards will remain.”
Ms Robison’s department said the hubs would provide teams in antenatal and postnatal care, which would include midwife, obstetrician, and other health professionals.
Community hubs may have birthing facilities but will not include maternity theatres.
Midwives believe the new model will offer mothers more choice but the changes may prove controversial given that women delivered in doctor-led wards since the 1960s.
Mary Ross-Davie, director for Scotland of the Royal College of Midwives (RCM), said one major study looking at the outcomes of 64,000 births found that midwife-led units was the “best option” and let to “fewer medical interventions”.
She said: “We have midwives who have very good training and education and can pick up on problems as they emerge and respond to them.
“Sometimes if someone is in labour you get early warning signs that things aren’t going quite to plan and in that case the decision would be made to transfer the patient to a consultant led unit.”
Doctors would not normally be present when women were giving birth at the midwife centres but would visit the facilities to provide clinics.
If complications arose requiring a C-section, the mother would be transferred to a hospital, said Ms Ross-Davie.
Outlining the current situation, the Best Start review said: “Those women with a previous vaginal birth and without complications, should be encouraged to consider home birth as an option… It is expected that, over time, this will lead to an increasing number of women being supported to have midwife-only care and a decreasing rate of intervention.”
Asked about the inevitable resistance to the plans, Ms Ross-Davie said: “Giving birth is very culturally defined and if women only see and hear about births in hospitals they believe that is the normal place to be.
“So midwives will be helping women look at what giving birth in different care settings means. We know there are many women who would like to give birth at home and they haven’t felt supported to do that.”
She added that studies have found that given the option around 40 per cent of women would like to give birth in a midwife care setting.
The five health boards piloting the maternity changes – NHS Forth Valley, Highland, Lanarkshire, Lothian and the Clyde area within NHS Greater Glasgow and Clyde – will begin to roll out the new model of service next year and they will assess whether it can be implemented in existing facilities.
Scottish Conservative shadow health secretary Miles Briggs cautiously welcomed the plan.
“If a woman would prefer to give birth in a community setting, and the health board can make that work safely, then it is worth pursuing,” he said.
But he added: “What can’t be allowed to happen is for this to be a cost-cutting exercise which puts the wellbeing of mother and baby in jeopardy."
“We know money and resources are tight and that some maternity units are overstretched.
“But this is not an area where corners can be cut.”
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