H.O.M.A.G

Heads of Midwifery

Advisory Group

WALES

Strategic Vision for Maternity Services

in Wales(2011)

Birthplace Study (2011)

Prudent Healthcare

Wales (2016)

Your Birth, We Care

(2017)

Midwives Voices Wales

New Vision for Maternity Services in Wales

4583 responses: 3968 were eligible.

Over 70% responded in the first 72 hours.

Models of care Antenatal information giving

Continuity of carer Enabling choice

Antenatal classes helped me to have a normal

birth with relaxation techniques and information

about the process’……the classes reassured

my partner that I didn’t need to be in a medical

setting to have a safe labour’. ‘‘I was sent on

hypnobirthing classes to help with anxiety. The

woman who ran the class opened my eyes to a

natural birth and I cannot thank her enough for

that..

Continuity of care from my named midwife who was very pro-choice and supportive of my decisions, gave me thorough information to help base my decisions upon

More individualized care planning for people with complicated pregnancies that would allow them more choice over place of birth and less ‘blanket’ decision making’

‘I was told every time how high risk I was making me more anxious as they only focussed how dangerous the pregnancy was’.

‘I wasn’t able to make a choice. I was told I

was giving birth on an obstetric unit’

Supporting Women’s Choice

Staffing & Acuity

Continuity of Carer

We need to actively listen to women’s opinions and experiences on the topic before we just go in with our recommendations. Ensuring we provide truly personalised care and support.

We should do everything in our power to provide the service our clients have not only been promised but often been encouraged to use. To expect a home birth and then be told sorry we're so busy you'll have to come to hospital is totally unacceptable!

Midwives need to be confident and competent in discussing home birth and MLU options…. also feel confident themselves to work in those areas, as this can impact upon how home birth for example… is sold to a woman.

It is sad to see that women are still being advised to deliver in hospital ‘just in case.’

Consultants need to refer women back to MLC when appropriate.

Staff the women and not the clinical areas! Midwives follow the women where they choose to birth and are booked. Stop staffing areas, of course being mindful of the need for core who have expertise. But value all midwives’ skills to support women wherever they choose to birth.

The acute services should provide their own ‘on-call’ staff to help the acute area when there is increased activity. They should not depend on the community midwives as these are being used and abused!

Unfortunately, I cannot see that in periods of extraordinary activity or unforeseen circumstances that there is any alternative other than to centralise services and redeploy staff to ensure safety of all women. Focus on getting women to commence their

labours outside of obstetric units, therefore decreasing the likeliness of community midwives being required in obstetric units due to high acuity. on-call provision being provided by more than just community midwives, all midwives being required to undertake on-call for their place of work.

7 Continuity of carer model options

Is Continuity of Carer something you would like to see during

the intrapartum period?

I am a strong believer in CoC & something that I strive to achieve within my current caseload. Furthermore, it is fundamental that women with complex needs receive CoC as evidence shows. Intrapartum CoC could be considered once AN and PN CoC is truly achieved.

Midwives are reluctant because they have experienced burnout before.

Small teams and self-organised…. I’ve done it and it works well.

Engagement of all staff including obstetric colleagues.

Not all midwives see continuity as important and are happy to pass women from pillar to post. Personally, my caseload is of a size that I struggle to take on extra women, I do so, but this often results me working over my hours. I then get scolded by my manager for not managing my time well enough.

I think it’s really important to do our best to implement this and I don’t think it’s totally unachievable, but I think if we aim for this type of model then recognition regarding sickness/annual leave will inevitably have some impact.

Teams of four midwives, two sets of ‘buddies’. The woman gets to know their named midwife and the buddy. They meet the other two at antenatal classes or coffee mornings. Then in labour they have a good chance of having a known midwife.