Doctors’ fears over midwife birth centres – “higher transfer distances (times) increase perinatal mortality”

Sarah-Kate Templeton in The Sunday Times 30th November 2014 reports: Doctors’ fears over midwife birth centres

The promise of more money for roads and infrastructure in marginal seats such as my own is helpful. Lets hope it really happens, and before there are too many deaths on the road between rural District General Hospital and specialised unit.

If Pembrokeshire was “labour” and Mr Drakeford did not come from Carmarthen, I suspect a different decision would have been made about where to concentrate services. Carmarthen is only 20 minutes from Swansea, but we are over an hour away, until a new road is built, and then it will  still be 40 minutes. On the other hand, 6 years ago, the people of Pembrokeshire and Carmarthen rejected the compromise deal of a new build at approximately half way… which would have been 20-30 minutes travel time on today’s roads.

IT IS safe for women to give birth in midwifery units miles from the nearest hospital, controversial new guidelines will say this week.

The National Institute for Health and Care Excellence (Nice) is expected to recommend that even first-time mothers can safely use the centres, which are staffed only by midwives.

The guidelines are supported by the Royal College of Midwives (RCM), which says they will encourage women to give birth without medical intervention such as an epidural or forceps delivery.

But some doctors fear babies will die when mothers get into difficulty during labour and have to be transferred sometimes long distances to hospital by ambulance.

Dr Peter Milewski, a retired surgeon who has campaigned against the closure of maternity hospitals, said: “I would disagree with any advice to first-time mothers that it is safe to deliver in freestanding midwifery units. In my opinion, that is not safe.

“There is good evidence that higher transfer distances increase perinatal mortality. That is why I shall not be willing for my daughter, who is due her first baby shortly, to be persuaded to use a free- standing midwifery unit.”

Milewski said that in Pembrokeshire, west Wales, where he lives, transferring a mother from a midwifery unit to a hospital could take up to an hour.

Nice will make the recommendation despite objections from the Royal College of Obstetricians and Gynaecologists (RCOG). The professional body says first-time mothers, who are at higher risk of suffering problems, should give birth either in hospitals where they can be treated by consultants if they require medical help or at midwifery units alongside hospitals.

In a letter to the British Medical Journal (BMJ) in 2011, the RCOG wrote: “Transfer for [first-time mothers] was up to 45% for mothers delivering at home or in midwifery units into obstetric units. Based on these findings, the RCOG advocates that first-time mothers should be advised of the benefits of delivering in obstetric units or alongside midwifery units.”

Nice will base its recommendations on the Birthplace study, (BMJ 2011;343:d7400) which analysed data from all freestanding midwifery units. It was published in the BMJ in 2011 and concluded there was no significant increased risk when a baby was delivered in a midwifery unit.

However, an analysis of only those units that had submitted at least 85% of the required data — about three quarters of the total — found a baby had more than double the risk of suffering serious harm or death if born in a freestanding midwifery unit rather than a hospital staffed by obstetricians.

Maureen Treadwell, cofounder of the Birth Trauma Association, which campaigns for women to be given the choice of a hospital birth, said: “There is no robust evidence for this [recommendation] whatsoever. If it is deemed to be both ‘safer’ and ‘cheaper’, health commissioners will only commission places [in hospitals] for high-risk women.”

Many maternity hospitals that were previously staffed by consultant obstetricians have been closed or downgraded to freestanding midwifery units. Many of the consultants have been moved to larger specialised maternity hospitals.

Louise Silverton, director for midwifery for the RCM, defended the validity of the research. “For many women, what had been their local obstetric unit has now become midwife-led but they want to have their baby in their own town,” she said.

“I do not see any reason why, if they have no complications, they should not have their baby at that same unit but under midwife care. If things don’t work out, she transfers.”

Kate Stanton-Davies died six hours after she was born at a freestanding midwifery unit in Shropshire in March 2009. An inquest ruled she could have survived had she been born at a hospital and that being born at the midwife-led unit had contributed to her death.

Her mother, Rhiannon Davies, had suffered complications and her daughter fell ill soon after birth. By the time she was transferred the 40 miles by air ambulance from the midwife-led unit at Ludlow Community Hospital in Shropshire to Birmingham Heartlands Hospital, it was too late.

Davies said: “Absolutely, categorically, no first-time mother should go anywhere near a stand-alone unit. If they want low intervention they should be in an adjacent midwifery-led unit. If anything goes wrong you have then got an operating theatre, obstetricians and your life and your baby’s life can be saved.”…..

Additional reporting: Sanya Burgess

Why not use helicopters whilst the road is built? Expense..

emergency room cartoon humor: 'Maintenance to the O.R....Maintenance to the O.R....'

This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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