Community maternity unit sets the standard

By Avril Nicoll

AIMS Journal 2003, Vol 15, No 4

Avril Nicoll discusses the Scottish Executive's controversial strategy to increase the number of community maternity units, which has received a boost with news of a remarkable turnaround at an existing unit

The midwife-led North Angus Community Maternity Unit in Montrose is celebrating the arrival of its 100th baby this year, a complete reversal of a downward trend experienced over many years. All local women receive their antenatal and postnatal care from the unit midwives, but a growing majority of women had been choosing a consultant unit for the birth of their baby. In 2002, only 47 women used Montrose.

Kirstin Hoggins, lay chair of the Angus Maternity Services Liaison Committee, comments, "When the unit was earmarked for closure during the Tayside Acute Services review, the Keep MUM (Maternity Unit in Montrose) campaign successfully argued that it should be reprieved, and that we should all work together to increase the number of births to 50 per cent of the local birthing population.

It is a credit to the commitment, skill and determination of the midwives that, although the total number of women in the area who are having children has stayed about the same, many more of them-in fact, 48 per cent so far this year-are now experiencing the quality of care available at Montrose."

Team leader and Supervisor of Midwives Bertha Leatherbarrow says, "For women who are at low risk of complications, research backs up our experience that there are many advantages to giving birth in a community maternity unit. Our midwives are taking every opportunity to let women and their families know about this, and the numbers speak for themselves." She adds, "The way our birthing room is set up, and our focus on encouraging women to follow their instincts during labour, positively encourages a straightforward, active birth to give mums and babies the best possible start together."

Community maternity units such as Montrose are suitable for women who are expected to have an uncomplicated birth. Research has shown that, for these women, planning to give birth in this type of facility reduces the likelihood that they will need medical interventions such as induction of labour, epidural anaesthesia, forceps and caesarean sections. In recent years, there has been increasing medicalisation of childbirth and centralisation in large consultant units, but community maternity units are part of the Scottish Executive's strategy[1] to reverse the trend and meet its commitment to local provision of services wherever possible.

Midwives and managers from other NHS boards have been visiting Montrose to find out the reasons for its success. Consultation is underway in Argyll and Clyde for a network of Community Maternity Units with one consultant unit, the preferred option of the NHS board.

Meanwhile, in NHS Tayside, which includes the Montrose unit and the South Angus Community Maternity Unit in Arbroath, Perth and Kinross public and midwives are considering whether to develop a midwife-led unit in Perth, or to put all local births to Dundee.

The North Angus Community Maternity Unit is 30 miles, or one hour, from the nearest consultant unit at Ninewells Hospital in Dundee. The team of 9.8 whole- time equivalent midwives are hospital- based, but are also responsible for community duties. They cover a rural area of approximately 317 square-miles with a population of nearly 26,000. This includes three main centres -Montrose, Brechin and Edzell-and they also see a number of women from the South Mearns area of Grampian.

The intrapartum transfer rate from Montrose (the percentage of women transferred to a consultant unit during labour because of complications) is under 11 per cent. The unit welcomes first-time mothers.

The North Angus Community Maternity Unit is currently situated in Montrose Royal Infirmary. A new purpose-built unit is planned for the end of 2004.

Births at the unit by year

Note: Avril Nicoll is a user representative on the Angus Maternity Services Liaison Committee.

Reference

1. Expert Group on Acute Maternity Services (EGAMS), 2002