Keeping Childbirth Natural and Dynamic (KCND)

Scottish Government Health Directorates

Scottish Government policy context

Framework for maternity services / EGAMS Reports – Endorse pregnancy & childbirth as normal life events– Recommend care packages based on need

Community based, midwife led care for healthy women Obstetric led, maternity team care for complex cases Ongoing medical care by GP

– Significant progress made in implementing Variance across NHS Scotland

– Key aspects still to be achieved in some areas

KCND

Purpose– Support implementation of policy at Board level– Promote multidisciplinary working & care tailored to need

Multiprofessional programme of work

Aims – Maximise opportunities for women to have as natural birth

experience as possible through Evidence based care, reducing unnecessary intervention,

ensuring informed choice Introducing multiprofessional antenatal, intrapartum and

postnatal care pathways

Objectives

Implement national referral criteria and care pathways

– Green Midwife lead professional

– Amber Further assessment

required

– Red Obstetric team care

recommended

– Flow between care streams as risk alters

Objectives

Implement lead professional by risk

– Maternity team roles Midwifery lead, healthy women Obstetric lead, complex cases Neonatology lead, sick baby Named on SWHMR, ISD

– Primary care team roles GP ongoing responsibility for

medical care of mother & baby Health visitor ongoing care of

well mother & baby– Women’s choice

Objectives

Implement normal birth pathways

– For healthy women– Regardless of setting– 1st, 2nd 3rd stage labour

Evidence based– No admission CTG– Guidance for

monitoring and care

– Flow between midwifery and obstetric team care as risk alters

Objectives

Implement midwife 1st point professional contact

– Initial risk assessment Against national criteria Social circumstances Health promotion

– Stream woman to midwifery or obstetric team care to book

Prior to 12 weeks GP opinion on stream

– Additional relevant history?

Workstreams

Led by Scottish Government Health Directorates– National steering group, stakeholders engaged

Reports to MSAG

NHS Boards– Funding allocations

Consultant Midwives to support local implementation

Chief Scientist NMAHP Research Unit– Literature review to support programme– Evaluation lead – partnership working

Multi-strand approach – quantitative and qualitative

Workstreams

NHS Education Scotland– Leadership and change management support

Leadership programme for new Consultant Midwives Multiprofessional work 2008

– Challenges for implementation, strategies for change

NHS Health Scotland– Support change management

Literature for women, publications

NHS Quality Improvement Scotland– Antenatal, intrapartum, postnatal criteria and pathways

1st drafts for consultation May, launch Dec 08

Wider context

Rising birthrate trend– Economic and social migration

Increased case complexity – Rising maternal age, improvements in the management of

longterm medical conditions Career framework changes - MMC, GMS, EWTD

– Pregnancy & childbirth normal for many but– Need to ensure specialist services readily available as

required Need to direct resources appropriately

– Right professional, right women, right place, right time

Summary

Focus on implementing current policy – Nothing new

Robust foundations– Wider maternity team works

GP well established role for ongoing medical care Evidence on efficacy of midwifery led care Enough work to go round

Stakeholder engagement– All Royal Colleges, users

Outcome efficient and effective services– Appropriate care packages for women based on need