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

2. 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

3. 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

4. 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

5. 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

6. 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

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

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

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

10. 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

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

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

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

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

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

16. 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!

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

18. 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!

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

20. 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!

21. 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

22. A happy story!

23. QUESTIONS AND DISCUSSION

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