1. Critical Co-dependencies Maternity Services Stephanie Mansell SCN Clinical Lead – Maternity

2. Overview of Maternity Services Maternity Services are used by over 700,000 women a year and the birth rate continues to rise at around 2% per year Effective maternity services are interdependent on primary care, specialist services and the range of early years services provided in community settings Increasing case complexity resulting from changing demographic factors such as increasing average age of first time mothers, increased rates of obesity, multiple pregnancy and the numbers of women with existing co morbidities Just over half of all women having a baby will be low risk at the beginning of pregnancy and have a low risk birth and postnatal period. Some women may require seamless escalation of care.

3. What approach did we take? Patient safety Access Sustainability Economic efficiencies of scale Needs of the population Identification of key evidence and guidance including feedback from clinical experts

4. Good available evidence for maternity services Royal College Of Obstetricians and Gynaecologists (2013) Reconfiguration of women's services in the UK (Good Practice No.15) Royal College of Anaesthetists (2013) Providing Equity of Critical and Maternity Care for the Critically Ill Pregnant Royal College of Anaesthetists (2011) Recently Pregnant Woman British Association of Perinatal Medicine (2010) Service Standards for Hospitals Providing Neonatal Care British Association of Perinatal Medicine (2008) The Management of Babies Born Extremely Preterm at Less than 26 Weeks of Gestation: a Framework for Clinical Practice at the Time of Birth Neonatal Expert Advisory Group (2013) Neonatal Care in Scotland: a Quality Framework. Sussex Maternity and New-born Clinical Reference Group Clinical and Service Users’ consensus of the intrapartum care evidence base Royal College of Obstetricians and Gynaecologists, Royal College of Radiologists and British Society of Interventional Radiology (2007) The Role of Emergency and Elective Interventional Radiology in Postpartum Haemorrhage. Good Practice No. 6. What evidence did we use?

5. Co-located - Co-location on same site essential Critical care (adult): ITU/HDU, General Anaesthetics*, Neonatology, Urgent diagnostic Haematology and Biochemistry, Transfusion and Blood Bank Networked - Ideally on same site but could alternatively be networked via robust emergency and elective referral transfer protocols Acute General Medicine, Respiratory Medicine, Gastroenterology (and urgent endoscopy), Diabetes and endocrinology, Rheumatology, Dermatology, Gynaecology, General Surgery (upper GI and lower GI), Trauma, Urology, Spoke vascular surgery, Plastic surgery, Acute Cardiology, Acute stroke service, Inpatient nephrology, Neurology, Diagnostic radiology, CT scan, MRI scan, Interventional radiology (including neuro- IR), Microbiology, Rehabilitation, Occupational Therapy, Physiotherapy, Dietetics, Acute mental health services No co-dependency - Does not need to be on same site or networked. Appropriate arrangements are in place to obtain specialist opinion or care A&E /Emergency Medicine, Elderly Medicine, ENT, Maxillo-facial surgery, Hub vascular surgery, Neurosurgery, Burns, Critical care (paediatric), Thoracic surgery, cardiac surgery, Hyper acute stroke, Inpatient dialysis, Acute oncology, Palliative care, Paediatrics, Paediatric surgery, Cardiac MRI, Nuclear Medicine, Speech and language Summary of ratings

6. Diagnostic services: Diagnostic Radiology, infrequently required but obstetric ultrasound co-location essential, MRI Scan, Microbiology Surgical backup needed for infrequent complications occurring during childbirth 24/7: Gynaecology, General surgery (upper GI and lower GI), Urology, Interventional radiology Increased numbers of women with existing co-morbidities: Acute General Medicine, Respiratory Medicine, Diabetes and Endocrinology, Acute Cardiology, Key areas for discussion