OVER VIEW OF COMMUNITY MIDWIFERY IN NHS HIGHLAND Sarah McLeod, Midwife

IN THIS SESSIONS I WILL.. Give a brief history on Midwifery Services in Scotland, regulation etc. Give a brief insight into current policy that drives maternity services in Scotland Give an overview of how Community Midwifery in Highland functions Take you through Claire & Peter’s journey from booking to birth and following Give you an opportunity to discuss and ask questions

HISTORY & REGULATION Midwives (Scotland) Act 1915 Regulations via Nursing & Midwifery Council (NMC) Midwifery Supervision – statutory requirement Midwives are autonomous practitioners of normal midwifery Making training, examination and regulation compulsory. Earlier in England & Wales 1902 There have been various other parliamentary reforms, amendments etc. over the years but won’t bore you with those! Supervision currently remains in place but is changing overarching aim to protect the public

POLICY DRIVERS IN SCOTLAND NHS Scotland Framework for Maternity Services (2001) refreshed in 2011 NHS Scotland Expert Group on Acute Maternity Services (2003) Scottish Government Early Years Framework (2008) Health Improvement Scotland Scottish Patient Safety Programme (2008) Scottish Government Getting it Right for Every Child (2008) Health Improvement Scotland Keeping Child Birth Natural & Dynamic (2009) NHS Highland Quality Approach Variety of big documents drive maternity services in Scotland they also act of measures around performance. Can be very challenging to implement recommendations as most are reflect care in urban areas Main focus of early years work is around giving children best start in life – Midwives have a huge part to play in this GIRFEC a vital component KCND – focuses on ensuring women are stream lined in appropriate pathways of care, cared for by the right person at the right time in the right place

OVERVIEW OF COMMUNITY MIDWIFERY IN NHS HIGHLAND Designed to provide care as close to home as possible Women book with a midwife around 10 weeks, named midwife assigned Booking process very detailed, risk assessment, appropriate pathway etc. booking bloods etc. U/S & screening Bulk of care carried out in community, hospital referral only if necessary National Pathway of care followed, care provided in a variety of settings, health centres, home or community hospitals All women and partners offered preparation for parent hood classes, hypnobirthing option etc. Women referred to other agencies if appropriate for further support – collaborative working vital Birth of baby can either be at home, Community Midwifery Unit or Obstetric Unit Post natal care for a minimum of 10 days but can be up to 28 days post birth Breast feeding actively encouraged and very well supported by midwives and support workers Officially care is passed over to Health Visitor colleagues on day 10 – they now become lead professional until school age 4/5yrs This is a very quick whiz through! Midwives working in the community tend to be experienced clinically particularly those working in the remoter midwifery units Women have 8-10 visits throughout pregnancy continual risk assessment. Particularly relevant for remote practice – need to think up stream Inductions at 42 weeks – change of pathway, intervention

A JOURNEY… Claire & Peter….. We will now use some more interesting pictures to tell the story of Claire & Peter – young parents to be Claire is 21 Peter 24 and this is their first baby…. They live on Skye etc. Not really trying for a baby

Claire has missed 2 periods….. It’s positive!

IT’S POSTIVE WHAT NOW….! Find the local midwife – phone the hospital etc.

Call The Midwife…..! Chummy! Well worth reading Jennifer Worth’s book post car London etc. Claire is around 10 weeks

Claire & Peter meet their midwife Lots of chat & questions galore! All booked in Claire has her hand held notes – ‘Green Pathway’ Very exciting apart from the blood bit! Baby can be born in local hospital all being well Claire & Peter meet their meets just before 11 weeks

Claire is a bit too familiar with…. Normal sickness!

What’s next the scan! Needed to go to Inverness for this bit.. Claire is now just over 12 weeks

All well bump growing only one in there phew! Claire will see her midwife regularly following national pathway

Time for classes – exciting! Claire & Peter meet lots of lovely people – quite a big class for Skye! Now 32 weeks

Claire & Peter inspired by parenting sessions thinking of using hypnobirthing Well worth a try and quite a few of the midwives use this technique

Time marching on all well, birth planning now! Claire & Peter thinking about water birth… New birthing unit they now have a birthing pool 38 weeks now!

Claire is 5 days over her due date, so fed up something must happen soon!

D DAY! 0300 7 days over Claire thinks she is labour. Peter in a panic! Claire calms him down Call the midwife Off to Birthing Unit Yes definitely in labour! These contractions are definitely coming regularly!

Amy makes an appearance a little ‘water baby’ A very calm birth

Amy weighs 7lbs 2ozs Her birth was entirely natural Claire used hypnobirthing techniques Peter was brilliant so supportive Midwives in attendance had a wonderful birthing experience A very happy occasion!

NEXT 28 DAYS… Claire, Peter & Amy were visited regularly by their midwife Claire breast fed Amy – a few tricky & painful moments to start with Health Visitor took over care on day 10 Midwives continued to visit until day 28 Claire also had support from local breast Feeding Support Worker

A happy story!

QUESTIONS AND DISCUSSION

Email: sarah.mcleod2@nhs.net twitter: sarah jane mcleod@Mcleod2Sarah