Development of Women Led Maternity Services Helen Wallace Midwifery Ward Manager Home from Home, Ulster Hospital And Downpatrick MLU Coordinator

Development of Women Led Maternity Services

Helen WallaceMidwifery Ward Manager

Home from Home, Ulster HospitalAnd Downpatrick MLU Coordinator

Leading Care: Supporting and Strengthening the Role of the Ward Sister/Charge Nurse - 6 th October 2010

My Role as Ward Manager in the Development of a Midwifery Led Unit within Existing Maternity Services at

the Ulster Hospital.


Background ReportsChanging Childbirth (1993)Promoted Choice Continuity of care and care giver Controlfor all women.These ideals were echoed in all subsequent reports


Reports (cont)• NSF Children, Young People and Maternity Services

Standard 11 (2004)• Maternity Matters (2007)• NICE guidelines (2007) Intrapartum Care• Safer Childbirth (2007)• Making Normal Birth a Reality (2007)• Towards Better Births (2008)


‘A less clinical, non threatening and more home like environment is less stressful for most women and this helps to create an atmosphere more conducive to the progress of the normal physiological birth process’

Safer Childbirth (2007)


Information……suggests that among women who plan to give at home or in a midwife-led unit there is a higher likelihood of a normal birth, with less intervention’

‘Women should be offered the choice of planning birth at home, in a midwife-led unit or in an obstetric unit

NICE Intrapartum care guidelines (2007)



Getting StartedThe catalystAn inspirational study day on water birth with Dr Elizabeth Cluett

Education for midwivesI negotiated study leave for midwives with water birth expert Dianne Garland Which led to:A placement for myself and a colleague to up skill in water birth and cascade that

training to other midwivesHosting study days/conferences at the Ulster Hospital with prestigious authors

researchers in Normality and Active Birth


Developing PracticeStarted in the old labour ward • I developed guidelines on using water for labour and birth• I met with women and gave them information on water

birth• I commenced a limited water birth serviceIn preparation for moving to the new unit• I led the development of guidelines and protocols• I completed a new Normal Birth Pathway


Developing Home from Home• Good communication with Architects Builders Capital team• Good relationships with our maternity services Liason

group ‘One Voice’• Good Community links: Community midwives Health centres and GP surgeries• Good Media Links





Active Birth Workshop• All women are invited• Women only• Exclusion criteria explained• Normality and Water birth is discussed• Practise exercises to help cope with labour and birth• Try out the equipment• DVD,leaflets and written information is given to back up

the class




OutcomesHome from Home surpassed the initial target of 300 births in the first year achieving 580700 births achieved in the 2nd yearHome from Home is on target for 1000 births in the 3rd financial year which will account for almost 1/3 of births at the Ulster HospitalWater birth rate is maintained at 40%Transfer rate is approx 35 % However further breakdown shows•18% request further pain relief – choice•17% medical reasons


Outcomes (cont)Of our transfers out in labour approx 8% have required a caesarean section

1.8% are postnatal transfers with:•0.8%postpartum haemorrhage•0.8% suturing•0.2 % retained placenta

Home from Home statistics are audited regularly and presented twice yearly at directorate meetings


Achievements• The first purpose built midwifery led unit in NI• True choice for women within South Eastern Trust• Water birth accessible to all low risk women• Impact on caesarean section rate within the Trust• The success of the Home from Home supported the

opening of a stand alone midwifery led unit in Downpatrick whose midwifery staff trained in water birth at Home from Home

• We are seen as a centre of excellence


Further DevelopmentGlobal Links• England Scotland Wales• Southern Ireland• Denmark (University of Copenhagen)• Russia• Malawi

Extension of inclusion criteria• Induction of labour for post maturity with prostaglandin pesaries• Women with history of group B Streptococcus• 2 successful vaginal births following previous caesarean section

ResearchI am in the process of completing a service evaluation on water birth with the practice

development midwife which is the first step in a research project with University of Ulster


The Secret of Success• The ability to motivate others to share my vision of both

promoting normality and providing choice for women• Building a team of midwives who supported me in the

development of guidelines and the pathway before the move to our new premises

• Support from the Head of Midwifery and Assistant Director WACH• The ability to collaborate with a very vocal Maternity Services

Liaison group and utilise their support• A growing band of women who have achieved the birth they

wanted in a safe and happy environment and are keen to tell others that they can do it too


Some comments from the last consumer satisfaction survey :

Accessibility:‘Home from Home

was fantastic. I would never have dreamt of a water birth only it was in my room’

Improved Care:‘The treatment and care were very positive - Home from Home made the experience relaxed and the midwives were supportive and informative. The water birth was very good and I really found this experience much better than the first birth here’



Thank you for Listening.

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Development of Women Led Maternity Services Helen Wallace Midwifery Ward Manager Home from Home, Ulster Hospital And Downpatrick MLU Coordinator