Archive for March 20th, 2008

“Unscheduled closures should only occur in very exceptional circumstances when to keep a unit open would be unsafe.” so said the NCT. What caused this statement? The news today that 50% of maternity units had to turn away women because they were full and 10% also had to close because of shortage of staff or facilities.  Thanks to the Conservative party this is now public knowledge and they are using the figures to show that  smaller maternity units shouldn’t close as they have fewer closures. I applaud their effort but do worry about their rationale for the link. Larger units, on the whole, provide care to ‘higher’ risk women as they have more specialist obstetric services, facilities and a higher level of special care units for premature or poorly babies. On this basis they are in higher demand and so more likely to experience having to turn women away if the woman, or baby is need of specialist services. I do agree though that the current policy of closing smaller units is unfortunate. They are there to serve a local community, whereas the ‘new’ larger units require women to travel 15 plus miles which has two effects. The first is that some women will go to the hospital earlier than they need to as they are aware they have some distance to go, frequently involving problems with traffic congestion, and once there are reluctant to return home until labour is established, and who can blame them? However, this has the effect of the unit becoming ‘clogged up’ with women who really do not need to be there. The other problem this can cause is that the labour is more likely to be subject to intervention, either early use of epidural or augmentation in an effort to speed up transit through the labour ward and so requiring increased vigilance as this is no longer ‘normal’ labour. As a result the staff are more pressurised, safety on the unit, due to staffing levels, becomes a concern and so the unit temporarily closes it’s doors. One of the reasons that smaller units are closing, and I’m not talking about ‘stand alone’ birth units here, is that because of the reduced hours of junior doctors smaller units are not able to sustain adequate medical cover, particularly paediatric, the solution is to consolidate services in one location. I’ve mentioned the stand alone birthing centres, these are midwife-led and have no medical cover so the shortage of medics cannot be used as the excuse as to why these are opening to great fanfare and then, all too often, closing after a couple of years. No, these close due to midwife staffing problems at the obstetric unit they are linked to. In the end, as usual, it’s all down to the finances as, if staffing levels, doctors and midwives, were not kept at minimal possible numbers, frequently below those recommended by Birthrate Plus, the units would not find themselves having to turn women away.

“It is difficult to precisely predict when a mother will go into labour and sometimes, at times of peak demand, maternity units do temporarily divert women to nearby facilities,” said a spokesperson for the DOH.

“True, this is something that will happen occasionally, but improving the numbers of Doctors and Midwives and keeping smaller units and birth centres open should make it less likely that this or this tragedywill be repeated.” said Midwifemuse.

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