Delivering Better Births in Walsall - WhatDoTheyKnow

Walsall Healthcare NHS Trust ‘Towards physiology: optimizing normal birth’ 2016 v3 20.2.17 SB 1

Delivering Better Births in Walsall

1. Introduction Walsall Healthcare NHS Trust is is committed to optimising physiological, normal

childbirth.

We recognise that current rates of births intervention are higher than the national average. The service has embraced quality reviews which have highlighted areas for improvements within the maternity service, including the requirement to consider the reduction of operative birth, and induction of labour.

What is Normal Birth?

There are several definitions of normal birth, and ongoing discussion and debate as to the most appropriate terminology to describe it. Because of this, it is important to acknowledge that by ‘normal birth’ we mean a straightforward, physiological event.

A widely used definition1 suggests that normal childbirth:

is characterized by spontaneous onset and progression of labour

includes biological and psychological conditions that promote effective labour

results in the vaginal birth of the infant and placenta

results in physiological blood loss2

facilitates optimal newborn transition through skin-to-skin contact and keeping the mother and infant together during the postpartum period; and

supports early initiation of breastfeeding

2. Why is it important? Increasing normal, physiological childbirth rates by lowering the rate of birth by caesarean section (CS) has become high on the list of health priorities for

1 ACNM/MANA/NACPM (2013) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647729/ 2 Dixon L et al. (2011) Systematic review: the clinical effectiveness of physiological (expectant) management of the third stage of labor following a physiological labor and birth. Int J Childbirth 2011;1 (3):179–195

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647729/


professional and government bodies throughout the developed world (WHO 2015). In 2016 a Lancet report raised concerns about ‘trends towards excessive, unnecessary, or inappropriate use of obstetric interventions in health facilities…..examples include unnecessary ultrasound examinations, routine continuous cardiotocography, routine episiotomy, non-medically indicated caesarean sections, and high rates of labour induction and augmentation’ (Miller et al). In addition:

1. Most women, in every country across the world, would prefer to give birth as physiologically as possible (Downe 2015).

2. For most women and babies, this is also the safest way to give birth, and to be born, wherever the birth setting (Birthplace, NICE 2014).

3. Excessive costs related to unnecessary interventions (Conrad et al 2010) are unsustainable.

4. If routine interventions are eliminated for healthy women and babies, resources could be freed up for the extra staff, treatments and interventions that are needed when a laboring woman and her baby actually need help. This would ensure optimal outcomes for all women and babies, and sustainable maternity care provision overall.

5. External reviews of the Maternity service at Walsall Healthcare NHS Trust 3

have recommended that the maternity service to consider ways to support

and improve active birth, and to reduce the induction of labour and

caesarean section rates. These recommendations have been accepted by the

service and the Trust.

6. In 2015, the WHO published a statement on caesarean section based on

systematic reviews of ecological studies, noting that when population-based

caesarean section rates increase above 15%, neither maternal or neonatal

mortality rates improve. This, therefore, means that operative births carried

out above this number are potentially unnecessary, and there is emerging

evidence that they could be harmful in the long term (Dahlen et al 2013).

In England, CS rates have increased steadily over decades (see Diagram 1), and normal birth rates have declined. The stark variations in maternity care between Trusts4 in England have been highlighted, and RCOG President David Richmond stated that this ‘may suggest that not all women are getting the best possible care across the country or that NHS resources are not being used in the most efficient way’.

3 https://www.cqc.org.uk/sites/default/files/new_reports/AAAE1520.pdf

4 https://www.rcog.org.uk/en/news/rcog-press-release-report-highlights-variation-in-maternity-care-across-england/


Diagram 1 (Dodwell 2016)

Our current provision of maternity services is challenged with high number of births, increasing workforce and an environment that requires further modernisation. Alongside this the Trust serves a local population where the public health indicators are generally worse than the England average. Deprivation is higher than average and about 16,700 children live in poverty. Life expectancy for both men and women is lower than the England average. Levels of initiation and smoking in pregnancy are worse than the teenage pregnancy, GCSE attainment, breast feeding England average. Estimated levels of adult 'healthy eating', smoking, physical activity and obesity are worse than the England average. Rates of sexually transmitted infections, smoking related deaths and hospital stays for alcohol related harm are worse than the England average. Public Health Priorities in Walsall include infant mortality, male life expectancy, child and adult obesity (DOH2012). Furthermore Walsall continues to have rising numbers of births. Whilst the context is important we acknowledge that our rates of intervention which are on average above 30% remain consistently higher than our neighbours and also higher than the national average, with this in mind we recognise the need to develop a local strategy which undertakes to promote normal birth wherever possible for women in Walsall.


3. A strategy for change

This strategy has been developed using feedback from clinician’s priorities for service improvement and external reviews, current evidence and should be considered by the maternity team, i.e. midwives, obstetricians, neonatologists, and parent advocate/service user groups. It is important to note that a supportive, collaborative approach is crucial to achieving shifts in culture and practice, and the suggested strategy and activity is underpinned by the importance of humanised maternity care. This work should not be seen as a ‘tick box exercise’, but a focus on current evidence, with team learning and sharing. A core group, including interested and motivated members of the multidisciplinary team, will be charged with progressing this strategy. When considering the necessary changes to promote and support physiological childbirth the Lancet Quality Maternal and Newborn Framework (Renfrew et al 2014) should be considered (Diagram 2). Diagram 2 (Quality Maternal & Newborn Framework)

The above framework is intended to be relevant to any setting, and to all who need, or provide, maternal and newborn care and services. Interdisciplinary teamwork and collaboration are inherent in implementation of the framework. The considerations below are derived from the framework, and are interlinked.


4.1. Considerations:

a. A culture of normality and challenge to practice

b. Personalised care

c. Environment

d. Communication and engagement: staff and parent and public involvement

c. Staffing and model of care

d. Education and development

e. Leadership

f. Pathways

g. Data collection and audit

h. Choice in place of birth: development of the MLU (Birth Centre) service

a. A culture of normality and challenge to practice A shift in the culture of practice where normal birth is facilitated for all women is a key element to the reduction of intervention. This is supported with healthy constructive challenge between clinicians. Action:

Commencement of a normal birth strategy group to oversee the delivery of this strategy

A daily multidisciplinary review meeting will be introduced to review all births requiring intervention in the previous 24 hours

It is important to note that each consideration is an integral part of the strategy. Whilst independently written, they are frequently interdependent on each other – for example antenatal preparation and information to empower women to achieve a physiological birth will be ineffective if midwives, doctors and support workers do not have appropriate skills, or are not able to provide the encouragement and support needed.


b. Personalised care

According to The NHS Constitution 5, and national maternity strategy6, women and

families using maternity services should be treated with dignity and respect, receive

compassionate individualised care, and have their choices respected. During a

women’s maternity journey she should be offered appropriate, timely information to

help her make decisions about her care, based on the best available evidence, and

her personal preferences. In relation to the promotion and support of physiological

birth, information should be shared about choice of place of birth (NICE 2014). For

women not expecting complications (low-risk), and when available, all four places

[home, free standing midwifery led unit(FMU), alongside midwifery led unit(AMLU),

Obstetric unit (OU)] should offered. The benefits and risks of ALL options should be

discussed, using non-directive or coercive language, and using available decision aid

tools (Coxon 2014, Which? 2016, NICE 2014). This discussion must include the fact

that, for women without complications, the chance of having a straightforward,

normal birth is more likely to occur in an out of obstetric unit (labour ward) setting

(NICE 2014).

Action:

Review staffing and audit one-to-one care in labour, thus offering

appropriate support to laboring women

Consider NICE and best practice recommendations and ensure clinical

guidelines reflect up-to-date guidance

Develop and share information resources with women using the service,

utilising the identified tools

Any new resources used for information sharing should be implemented in

conjunction with education sessions for staff, on techniques for sharing

evidence, and consent (NICE 2012)

c. Environment There is ample research evidence to demonstrate that the birthing environment, including the journey the woman makes to reach the destination, can impact on her ability to labour and give birth more easily (Buckley 2015, Foureur et al 2010). The continual striving for sophistication in the design of the hospital birth environment has resulted in birth spaces that are characterised by high levels of surveillance of the birthing woman. Although continual surveillance may reassure care providers, from the woman's perspective such surveillance may actually undermine her ability to labour effectively and to give birth unaided (Stenglin & Foureur 2013). Also, the

5 https://www.england.nhs.uk/ourwork/patient-participation/patient-centred/planning/ 6 https://www.england.nhs.uk/2016/02/maternity-review-2/


birth environment may play a direct role in the provision of quality midwifery care (Hammond et al 2103).

We recognize that frequently:

Women give birth in lithotomy position

Women give birth in semi-recumbent positions

There is lack of equipment to aid active birthing which should be available

Actions:

Undertake a photographic journey of the path a laboring woman takes when coming in labour (fresh eyes) involving parent user groups (MSLC)

Review birth rooms with women who use the service, and consider changes needed to optimise physiology, i.e. use of bed, lighting

De-clutter birth-pool room, and in conjunction with education sessions, re-visit waterbirth guidance (including evacuation procedure) and actively promote use of water for labour and birth

Consider purchase of birth aids/equipment including wireless monitoring, to enable active birth

Review signage throughout

d. Communication and engagement: staff and parent and public involvement

Staff and service user involvement should be integral to all activity. We should

consider of ways of improving the sharing of information and improving engagement

with midwifery staff, so they are aware of, and involved in, future developments.

Actions:

Staff Day to day updates via ad hoc conversations

Consider regular newsletter to all maternity staff

Communication/engagement events with multidisciplinary team

Consider ‘Whose shoes?’ workshop7

Parent and public Regular liaison with MSLC leads

Pursue opportunity for support for wider consultation from CCG’s

Consider information sharing strategies around advantages of normal, physiological birth, via social media (i.e. Bath NHS Trust

7 https://whoseshoes.wordpress.com


https://www.facebook.com/bathmaternity/photos/a.769562386416374.1073741829.751872594852020/1253598421346099/?type=3 ) and use of film

Invite parent representatives to review birth rooms

Consider ‘Whose shoes?’ workshop

e. Staffing and models of care

External reports have identified regular shortfalls in midwifery staffing, where one-to-one care in labour was not achieved. Personalised one to one care in labour is a key element in maintaining normality. Actions:

Review staffing of overall maternity strategy

Consider integrated staff model to develop services in MLUs

Consider recommendations for specialist midwives

Review antenatal education, and active birth sessions for women

Explore continuity of care model for marginalized groups

Audit continuity across the service

f. Education and development

A detailed programme for engaging and educating the maternity multidisciplinary

team in the importance and effective support of optimising physiological childbirth

should be developed. This should include ideas and plans for maximising

opportunities during the antenatal, intrapartum and postnatal periods, regardless of

how or where birth takes place. For example, reduction of antenatal stress, use of

water immersion in labour, optimal cord clamping, skin-to-skin contact,

breastfeeding and no separation of mother and baby, with special consideration

given to mothers having operative and assisted births. Encouragement, support and

mentorship is as important as clinical knowledge, and should be built in to the

learning strategy. Learning opportunities should be preceded by SWOT analysis with

participants, to understand personal and organisational opportunities and threats

when aiming to influence/improve services.

Action: Pursue opportunities for:

Personalised care workshops (i.e. importance of human rights, choice, and consent)

Multi-professional events exploring physiology of childbirth continuum

Active birth workshops

https://www.facebook.com/bathmaternity/photos/a.769562386416374.1073741829.751872594852020/1253598421346099/?type=3

https://www.facebook.com/bathmaternity/photos/a.769562386416374.1073741829.751872594852020/1253598421346099/?type=3


Water birth workshops

Multi-professional active upright breech workshops

Wireless telemetry and CTG competency and escalation workshops

Implementing the UNICEF BFI8

A program of staff development will take place to encourage staff at each

level to speak out and even challenge senior staff if they need to.

Review education and competencies for maternity care support workers

Revise the competency for all midwives, focusing on normalising birth.

A band 5 midwives “club” that will provides junior midwives support with

promoting normality.

g. Leadership

Leadership is everyone’s potential and everyone’s responsibility. Positive leadership that is valued will drive change, and influence negative cultures. It will be important to identify and nurture leaders at all levels, from student midwives to senior teams, to champion the normality initiative. These individuals should receive coaching and learning opportunities.

Actions:

Utilise leadership resources such as the NHS Leadership Academy Healthcare Leadership Model9 and the RCM resources10

Consider appointment of consultant midwife or normality lead

Consider mentorship and coaching opportunities

h. Pathways To facilitate a shift in clinical practice towards reducing CS and promoting normal physiological birth, enhance safety, and support midwives to support women, the use of clinical care pathways should be considered. Clinical pathways aim to improve the quality of care by reducing undesirable variations in practice and standardising care delivery. 1. There is clear evidence (Birthplace 2011) that healthy pregnant women are three

times more likely to have a CS if they give birth in an obstetric unit. A pathway that provides accurate information on place of birth11, & supports women’s choice should be considered (also see Personalised Care)

2. The All Wales Care Pathway for Normal Labour12, and the recent Northern Ireland Normal Labour and Birth Pathway 13 are examples of pathways particularly developed to support normal labour and birth, and could be adapted for local use.

8 https://www.unicef.org.uk/babyfriendly/ 9 http://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/ 10 https://www.rcm.org.uk/leadership 11 https://pathways.nice.org.uk/pathways/antenatal-care-for-uncomplicated-pregnancies 12 http://www.wales.nhs.uk/sites3/page.cfm?orgid=327&pid=5786 13 https://www.rqia.org.uk/RQIA/files/0b/0b9d5aee-0f80-47e6-8967-0c34216200af.pdf


3. Following an audit of current practice and outcomes, an Induction of Labour pathway should be developed using NICE guidance14, and a Caesarean section (CS) pathway, which includes use of a debrief for women following CS to discuss suitable mode of birth in future pregnancies.

4. Women who have had a previous CS should be offered VBAC as routine, with relevant timely information and support as part of a pathway of care (RCOG 2015).

5. Collaborative models of care have demonstrated a reduction in the primary CS rate for breech birth (Larsen 2014), and therefore a clinical pathway for breech presentation, that offers ECV and option for vaginal breech birth, should be considered.

Actions: Consider pathways for

Choice in place of birth

Normal labour and birth

Pain relief options in labour

Induction of labour

VBAC

Breech presentation

Audit effectiveness of all pathways implemented

i. Data collection and audit The importance of collecting and comparing maternity outcome data was highlighted in the Better Births15 report, and this year the RCOG launched a new interactive website16 to make this possible. The Clinical Indicators Project17 aims to develop clinically relevant, methodologically robust performance indicators for maternity and gynaecological care using currently available data. This information will be used to inform quality improvement initiatives and enable comparative benchmarking of women’s health services across the UK. At the time of writing this strategy, Walsall Healthcare NHS Trust’s maternity data was not yet available on the site.

Actions:

14 https://pathways.nice.org.uk/pathways/induction-of-labour 15 https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf 16 https://indicators.rcog.org.uk 17 https://www.rcog.org.uk/en/guidelines-research-services/audit-quality-improvement/clinical-indicators-project/

https://indicators.rcog.org.uk/


Ensure systems in place to collect relevant data, and report to national programmes

Audit one to one care in labour

Consider regular audit of this strategy using the Lancet Framework above, measuring activity and outcomes against each criteria.

Develop audit calendar for any adopted pathways including VBAC and ECV success rates

j. Choice in place of birth: development of the MLU (Birth Centre) services NICE guidance for intrapartum care for healthy women and babies (2014) directs maternity care providers to advise low risk multiparous women that planning to give birth at home or in a midwifery led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit. Outcomes for primigravida are the same, except for a small risk to baby with home birth. There were 698,512 live births in England and Wales during 2013 (ONS, 2014), and estimates suggest 45% of women giving birth in NHS settings are at low risk of complications (Sandall et al, 2014). Based on other successful MLUs (East Lancashire and Birmingham), where 25-30% of women give birth outside an obstetric unit, is a realistic number to strive for. There are opportunities to develop MLU services at Walsall NHS Trust, to provide the full choice offer in line with national guidance (NICE 2014, NICE 2015, NHS 2016). NICE (2014) highlighted Freestanding Midwifery Unit (FMU) services as having the best outcomes for first time mothers, and best for multigravida women, after home birth. There is no difference in outcomes for babies. In addition, birth in FMU facilities is less expensive (NICE 2014). Actions:

Review MLU services for potential developments including the relocation to a alongside MLU

Develop marketing strategy and information sharing regarding choice offer

Develop information resources for parents

Education and development for staff regarding philosophy of care, and relevant skills

Review staffing models

References NHS England (2016) Better Births: improving outcomes of maternity services in England. Accessed at: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf


Birthplace study (2011) The Birthplace cohort study: key findings. Accessed at: https://www.npeu.ox.ac.uk/birthplace/results

Buckley S (2015) Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. Accessed at: http://transform.childbirthconnection.org/reports/physiology/ Conrad P et al (2010) Soc Sci Med 70(12) 1943-7 Coxon K (2014) Birthplace decisions: information for women on planning where to give birth. Accessed at: http://www.pdcap.cz/Texty/PDF/Birth_place_decision_support.pdf Dahlen H et al (2013) The EPIIC hypothesis: intrapartum effects on the neonatal epigenome and consequent health outcomes. Accessed at: http://linkis.com/www.ncbi.nlm.nih.gov/4M6iU Downe S (2016) Why normal births and normalisation of the process is so important Accessed at: https://www.rcm.org.uk/why-normal-births-and-normalisation-of-the-process-is-so-important Foureur M et al (2010) The relationship between birth unit design and safe, satisfying birth: developing a hypothetical model. Midwifery 26, 520–523. Hammond A, Foureur M, Homer C, Davis D (2013) Space, place and the midwife: Exploring the relationship between the birth environment, neurobiology and midwifery practice. Women and Birth 227-281 Larsen J (2014) Primary Cesarean Delivery Prevention: A Collaborative Model of Care. Obstetrics and Gynaecology Vol 123 Pp1S-198S Miller S, Abalos E et al (2016) Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Accessed at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31472-6/fulltext NICE (2012) Patient experience in adult NHS services: improving the experience of care for people using adult NHS services Accessed at: https://www.nice.org.uk/guidance/cg138 NICE (2014) Intrapartum care for healthy women and babies Accessed at: https://www.nice.org.uk/guidance/cg190

Renfrew et al (2014) Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care The Lancet Midwifery Series Accessed at: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)60789-3.pdf

https://www.npeu.ox.ac.uk/birthplace/results

http://transform.childbirthconnection.org/reports/physiology/

http://www.pdcap.cz/Texty/PDF/Birth_place_decision_support.pdf

http://linkis.com/www.ncbi.nlm.nih.gov/4M6iU

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31472-6/fulltext

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31472-6/fulltext

https://www.nice.org.uk/guidance/cg138

https://www.nice.org.uk/guidance/cg190


Richmond D (2016) Press release for Patterns of maternity care in English NHS trusts 2013/14. Accessed at: https://www.rcog.org.uk/en/news/rcog-press-release-report-highlights-variation-in-maternity-care-across-england/ RCOG (2015) Birth after Previous Caesarean Birth Green-top Guideline no 45. Accessed at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/ Sandall J, Murrells T, Dodwell M, Gibson R, Bewley S, Coxon K, Bick D, Cookson G, Warwick C, Hamilton-Fairley D. (2014) The efficient use of the maternity workforce and the implications for safety and quality in maternity care: a population- based, cross-sectional study Health Services and Delivery Research Vol: 2 Issue: 38 Stenglin M, Foureur M (2013) Designing out the Fear Cascade to increase the likelihood of normal birth Midwifery Volume 29, Issue 8, Pages 819–825

Which? Birth Choice (2016) Accessed at: http://www.which.co.uk/birth-choice/

WHO (2015) WHO Statement on Caesarean Section Rates. Geneva: World Health Organization Accessed at: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

Further reading/resources: The American College of Nurse Midwives Association Healthy Birth Initiative Accessed at: http://www.midwife.org/ACNM-Healthy-Birth-Initiative https://www.rcm.org.uk/clinical-practice-and-guidance/evidence-based-guidelines WHO Care in Normal Birth: a practical guide. Accessed at: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/MSM_96_24_/en/ https://www.rcm.org.uk/sites/default/files/Birth%20position%20Report%20FINAL%20Aug2011_0.pdf

https://www.rcog.org.uk/en/news/rcog-press-release-report-highlights-variation-in-maternity-care-across-england/

https://www.rcog.org.uk/en/news/rcog-press-release-report-highlights-variation-in-maternity-care-across-england/

http://www.which.co.uk/birth-choice/

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

http://www.midwife.org/ACNM-Healthy-Birth-Initiative

https://www.rcm.org.uk/clinical-practice-and-guidance/evidence-based-guidelines

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/MSM_96_24_/en/

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/MSM_96_24_/en/

https://www.rcm.org.uk/sites/default/files/Birth%20position%20Report%20FINAL%20Aug2011_0.pdf

https://www.rcm.org.uk/sites/default/files/Birth%20position%20Report%20FINAL%20Aug2011_0.pdf



Towards physiology: optimising normal birth

Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING A culture of normality and challenge to practice

A daily multidisciplinary review meeting will be introduced to review all births requiring intervention in the previous 24 hours. Commencement of a normal birth strategy group to oversee the


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING delivery of this strategy

Personalised care

Review staffing

and audit one-

to-one care in

labour

Consider NICE

and best

practice

recommendati

ons and ensure

clinical

guidelines

reflect up-to-

date guidance

Develop and

share

information

3 Months 2 months

1. Review ante-natal risk assessment criteria against peer organisations and NICE guidance

2. Review MLU & Home Birth guidelines

1. Choice in place of birth 2. Contraception leaflet (staff idea)


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING

resources with

women using

the service

Education

sessions for

staff, on

techniques for

sharing

evidence, and

consent.

Environment

Undertake a photographic journey

Review birth rooms De-clutter

1. Source images for walls 2. Purchase chairs for upright positions in

labour 3. Smaller trollies in birth rooms – review

packs used for delivery


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING birth-pool room Consider purchase of birth aids/equipment including wireless monitoring, to enable active birth Review signage throughout

Communication and engagement

STAFF

Day to day updates via ad hoc


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING conversations Consider regular newsletter to all maternity staff Communication/engagement events with multidisciplinary team Consider ‘Whose shoes?’ workshop PARENT & PUBLIC

Regular liaison with MSLC leads

‘


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING Parent involvement with all developments in service provision, including information resources Pursue opportunity for support for wider consultation from CCG’s Consider social media Parent participation in reviewing environment Consider


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING ‘Whose shoes?’ workshop Parent involvement in reviewing antenatal education

Staffing and models of care

Review staffing of overall maternity strategy Consider integrated staff model to develop

.

.


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING services in MLUs Consider recommendations for specialist midwives Review antenatal education, and active birth sessions for women Explore continuity of care model for marginalized groups Audit continuity across the service

Consider venues, and collaboration with other agencies Consider Positive Birth Movement sessions (parent-led, please refer to website)


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING

Education and development

Pursue opportunities for: Personalised care workshops (i.e. importance of human rights, choice, and consent) Multi-professional events exploring physiology of childbirth continuum

.


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING Active birth workshops Water birth workshops Wireless telemetry and CTG competency and escalation workshops Multi-professional active upright breech workshops Implementing the UNICEF BFI18

18 https://www.unicef.org.uk/babyfriendly/


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING

A program of

staff

development

will take place

to encourage

staff at each

level to speak

out and even

challenge

senior staff if

they need to.

Review

education and

competencies

for maternity

care support

workers

Revise the

competency


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING for all

midwives,

focusing on

normalising

birth.

A band 5

midwives

“club” that will

provides junior

midwives

support with

promoting

normality.

Leadership

Utilise leadership


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING resources such as the NHS Leadership Academy Healthcare Leadership Model19 and the RCM resources20 Consider appointment of consultant midwife Consider mentorship and coaching opportunities

19 http://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/ 20 https://www.rcm.org.uk/leadership


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING

Pathways

Consider pathways for Choice in place of birth

Normal labour and birth Pain relief options in labour Induction of labour

VBAC Breech presentation Audit


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING effectiveness of all pathways implimented

Data collection and audit

Ensure systems in place to collect relevant data, and report to national programmes Audit one to one care in labour Consider regular audit of this strategy using the Lancet Framework above, measuring activity and


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING outcomes against each criteria Develop audit calendar for any adopted pathways

Choice in place of birth

Review MLU services for potential developments (including FMU) Develop marketing strategy and information sharing regarding choice offer


Need

MONTH

TIMELINE

ACTION

OWNER

RISK

RATING Develop information resources for parents Education and development for staff regarding philosophy of care, and relevant skills Review staffing models

Documents

Delivering Better Births in Walsall - WhatDoTheyKnow