How maternity services are developing in NI July 2023

AIMS Journal, 2023, Vol 35, No 3

By Anne Glover

Here is a review on the developments in Northern Ireland. AIMS would be interested to have similar information on what is happening in the rest of the UK. Please get in touch if you are able to help with this.

There are two main types of maternity care for women in Northern Ireland

1. a) Midwife-led care with the woman birthing at home or in a midwife-led unit.

2. b) Consultant-led care with the woman birthing in an obstetric unit (hospital).

In December 2022 the Department of Health made the decision under coroner's recommendation to withdraw 2 regional guidelines¹ on admission to Midwife-led units (MLUs) and support for home births, stating a number of clinically significant omissions and discrepancies when compared to the National Institute for Health and Care Excellence (NICE) Intrapartum care guidelines² for healthy women and babies CG190. Stricter guidelines have led to more antenatal consultations for individualised care plans if women choose to give birth under midwife-led care in NI - whether this is in hospital alongside MLU, or at home. As a result of the Covid pandemic and this more recent decision, all freestanding MLUs are now closed down in NI. There are currently 6 alongside MLUs. These are shown below under the heading, ‘The 6 Health and Social Care Trusts in NI’.

Strategic direction for maternity care in NI

The Department of Health determines the maternity model of care in Northern Ireland, and in July 2012 it launched A Strategy for Maternity Care in Northern Ireland 2012-2018³, adopting a health improvement approach:

• give every baby and family the best start in life

• effective communication and high-quality maternity care

• healthier women at the start of pregnancy (preconception care)

• effective, locally accessible, antenatal care and a positive experience for prospective parents

• safe labour and birth (intrapartum) care with improved experiences for mothers and babies

• appropriate advice, and support for parents and baby after birth.

The strategy places a strong emphasis on the normalisation of pregnancy and birth as a means of improving outcomes and experiences for mothers and babies. It is overdue for renewal and there has been a call for this by the director of the Royal College of Midwives Northern Ireland in the recently published report, ‘The case for a new maternity strategy for Northern Ireland’.⁴

Maternity services in the UK have slowly been moving towards a more consistent model of care since the publication of Better Births⁵ in 2016. Research has shown that women have better outcomes if they have maternity care from the same midwife throughout their pregnancy, birth and postnatally.⁶ Up until recently, most women usually see numerous midwives, doctors, obstetricians at their appointments, during labour and birth, and in the postnatal period.

Recent Developments

2021: Regional group set up to begin a move towards transforming maternity care in NI

March 2022: RCM Blueprint for better maternity care in Northern Ireland⁷

November 2022: RCM call for urgent start on review of maternity services in NI⁸

November 2022: Department of Health withdrew the Regional Quality Improvement Authority (RQIA) Guideline for Planning to Birth at Home (2019) and the Guidelines and Audit Network (GAIN) Guidelines for Admission to Midwife-led Units (MLUs) in NI (2016, updated 2018), on coroner's recommendation.

May 2023: RQIA issues Maternity Review Report⁹ - Review of governance arrangements in place to support safety within maternity services in Northern Ireland.

1st May 2023: The Department of Health commissions a new report into midwifery services in Northern Ireland¹⁰ ‘Enabling Safe, Quality Midwifery Services, and Care in Northern Ireland’. Prof Renfrew to develop recommendations for policy, practice, education and research in Northern Ireland. This is due to be completed in October 2023.

30th May 2023: ‘The state of maternity services in Northern Ireland’ was launched by the RCM at Stormont, with AIMS in attendance.¹¹

17th July 2023: Closure of Causeway Maternity Hospital, Coleraine.¹²

The Continuity of Midwifery Carer Model

A pilot scheme commenced in August 2020 to introduce Continuity of Carer¹³ at the Causeway Hospital, Coleraine (Northern Trust).

Earlier this year (2023) saw the gradual introduction of the Continuity of Midwifery Carer (CoMC) model¹⁴ in all Trusts, with women being assigned a named midwife at their booking appointment to be with them continually throughout their pregnancy journey, and on into the postnatal period. Small teams in each Trust provide consistent care to those at higher risk of having poorer outcomes, for example, living in under-privileged areas, smokers, under 20s, Black, Asian and mixed-ethnicity. As the roll-out continues, it should become available to more pregnant women in Northern Ireland.

The 6 Health and Social Care Trusts in NI

Belfast www.belfasttrust.hscni.net – Royal Jubilee Maternity Hospital has 13 rooms in the delivery suite and 4 midwifery-led rooms known as the Active Birth Centre (ABC). There are two rooms with pools, one in the delivery suite and one in the ABC unit. A new maternity hospital is due to be opened on site later in 2023. There are approximately 5000 babies born in the Royal per year. The freestanding Midwifery Led Unit in the Mater Hospital has been closed to births since the beginning of the COVID-19 pandemic.

Southern www.southerntrust.hscni.net– Craigavon Hospital has 8 birthing rooms in the delivery suite with one pool, and 8 rooms in the alongside midwifery-led unit with baths available for water births. Daisy Hill Hospital in Newry has 4 rooms in the delivery suite, and 2 midwifery-led rooms with pools.

A dedicated homebirth team was established in 2022. There are approximately 5,300 babies born each year.

South Eastern www.setrust.hscni.net– Ulster Hospital has 7 rooms with one pool in the delivery suite and an alongside midwifery-led unit known as Home from Home, with 7 rooms and a pool in each room. 4500 babies are born on average each year. The freestanding MLUs at both the Lagan Valley Hospital and the Downe Hospital have been closed since 2022.

Northern www.northerntrust.hscni.net – Antrim Area Hospital has 6 rooms in the delivery suite with one pool. Coleraine Hospital closed 17th July 2023. 3700 babies are born each year.

Western www.westerntrust.hscni.net – South West Acute Hospital in Enniskillen has 5 rooms in the delivery suite, plus an alongside midwifery-led unit with 6 rooms, and 2 pools. Altnagelvin Hospital in Londonderry has 5 rooms in the delivery suite, plus an alongside midwifery-led unit with 7 rooms and 2 pools. Approximately 3700 babies are born each year.

Each of these Trusts has an allocated Consultant Midwife, Perinatal Mental Health Midwife and Continuity of Midwifery Carer Lead Midwife.

There is a Maternity Services Liaison Committee for each Trust. The forums are made up of local maternity service users and representatives of organisations who work with the maternity services. The aim is to work together and improve services in response to the needs of women.

Northern Ireland Ambulance Service www.niamb.co.uk is one of the Health & Social Care Trusts.

In situations where a mother has mental health issues, NI is the only country in the UK not to have a Mother-Baby unit, although there are ongoing discussions and campaigns to establish one.^{15 16}

The mother’s ‘green notes’ (her maternity file), allows her to easily transfer and choose to have her care in any Trust.

There are no independent midwives in NI.

Women can pay to have private antenatal obstetric care.

Who's who?

The NI Assembly: Is the devolved legislature for NI, responsible for making laws on transferred matters, [eg health,] and for scrutinising the work of ministers and NI government departments www.niassembly.gov.uk

NI Executive: Comprises First Minister, deputy First Minister and 8 departmental Ministers, one of which is the Health Minister. www.northernireland.gov.uk

NHS in NI: In NI, the NHS is referred to as HSC – Health & Social Care. www.health-ni.gov.uk

It is the publicly funded healthcare system in NI, and one of the four systems which make up the National Health Service in the UK. (NHS England, NHS Scotland & NHS Wales)

Key

HSCB: Health & Social Care Board – commissions services, manages resources & performance improvement

LCGs: Local Commissioning Groups, one for each trust, responsible for the commissioning of health and social care by addressing the needs of their local population. www.hscboard.hscni.net

HSC Trusts: Provide health and social services across NI www.online.hscni.net

PHA: Public Health Agency, major organisation in NI for health improvement and health protection www.publichealth-hscni.net

RQIA: Regulation and Quality Improvement Authority is the independent health and social care regulatory body for NI. www.rqia.org.uk

Resources

Strategy for maternity care in NI 2012-2018 can be found at: https://www.health-ni.gov.uk/publications/strategy-maternity-care-northern-ireland-2012-2018

Information and services on any government department and services can be found at: www.nidirect.gov.uk

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Author bio: Anne is a volunteer on the AIMS Campaigns Team. She is a well known doula in Northern Ireland with over 8 years experience, and is the Doula UK Area Representative for NI.

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