1. Midwifery is a vital solution to the challenges of providing high-quality maternal and newborn care for all women and newborn infants, in all countries” Lancet Series 2014

2. Low risk 2014 – 24,394 births NI Currently less than 15% NI 40% of mothers fit the strict criteria 40% = 10,000

3. History of MLUs in SET Alongside MLU Home from Home 2007 Freestanding MLU Downpatrick 2010 Freestanding MLU Lagan Valley 2011 Currently 30% SET births within MLUs

5. Dashboard Trends Apr 2014- Feb 2015 365 births within SET per month 20 births per month in the MLU’s 79 births per month in HFH 266 birth per month in labour ward 61% of these births were normal birth 14.9% were instrumental deliveries 24.8% were caesarean section deliveries

6. Promoting normality in antenatal care Increasing community bookings for low risk women Midwife first point of contact. Self-referral form – piloted for 1yr in Hillsborough. Utilised in LVH MLU. Upskilling of community midwives in early pregnancy scanning –practical and theory Normalising AN Care working group – meetings 3 monthly

7. Normal Labour Care Pathway Structured evidence based framework for normal labour Not prescriptive - used as a guide Encourages clinical judgement To be used and documented Regularly updated with changes in practice Regional consistency - Included in regional notes Documentation is VITAL Document the decisions you make Variants from the norm should be noted and explained

9. Promotion of Normal Childbirth in the Intranatal Setting Focus has been on promotion of the stand alone midwifery unit and Home from Home. Need to shift the focus towards promoting normal labour and birth in a high risk labour ward with the aim of improving the birthing experience for mothers.

10. Birth Options Clinic Weekly evening clinic Multidisciplinary Team Individualised Care Review – 16 weeks, – 36 weeks (optional) – T+

11. VBAC STATISTICS

12. C/Section rate

13. Normality in High risk labour ward Environment: Funding available from MOM Conference” Striving for Normality” Telemetry CTG monitoring Use of longer entonox tubing Birthing aids available in all the rooms; ball, mats and birthing stool Aim to mimic the environment in HFH in one designated labour ward with a birthing pool RCM Campaign for Normal birth posters in prominent places

14. People: Normality Workshop with PD midwives and Labour Ward Band 7 midwives From this Normality Bundle developed Rotation of midwifery staff between the MLU’s, HFH and labour ward Introduction of “Normal Labour Integrated Care Pathway” into Labour / Regionally through GAIN Induction of Bay midwives encouraged to challenge the indications for induction Top Tips towards Normal birth leaflet which invited feedback from mothers Linking with the MLU, HFH and Antenatal Normality Group

15. SET Normalising Bundle

16. Why it matters the way a woman gives birth can affect the whole of the rest of her life - how can that not matter - unless the woman herself doesn’t matter… Beeches and Phipps 2004