Airedale NHS Trust – Leading the Way!

On almost the same day that Airedale NHS Trust, Yorkshire, announced that it is welcoming independent midwives onto their midwifery bank, a study into The Albany, one of the finest examples of midwifery caseloading in the UK, has yet again shown how the outcomes of caseloading and continuity are outstanding, for women, families, midwives and indeed the NHS. (Click for full Albany document)
Airedale NHS has joined a number of NHS Trusts who have recognised that independent midwives and NHS health professionals are a team who can work together to improve care for women, and to improve NHS services. They have welcomed independent midwives onto their bank contract system, ensuring that women who were left without their known and trusted midwife following the NMC’s decision can now obtain antenatal, labour and postnatal care from the midwife that they have chosen. This applies to existing and to new clients, and is not limited to the Airedale geographical area.
A Yorkshire independent midwife who is part of the new arrangement explained the workings of the IM’s holding bank contracts & what that means for them & the women.

‘Under these new arrangements we will use a bank contract from AGH [Airedale] when attending our clients in labour to ensure that we have indemnity insurance in place as required by the NMC for registration. This situation is fully discussed with our clients during the antenatal period. We use NICE as a starting point for our care discussion already and most guidance from AGH is the same. If there are any differences between NICE and AGH’s guidelines, we will discuss them. AGH understand that many women opting for IM care do so because they want care which is different to hospital/NICE guidelines, and they respect that. If women choose to have us care for them under AGH bank contract for birth (some may choose alternatives) we have to acknowledge their guidance, discuss this with the woman and document the choices then made. We will be being supported in this by Sarah at AGH who will complete the hospital ‘risk assessment’ process for us by offering women a phone or meeting consultation where their choices can be documented so correct procedures are being followed internally. Women remain completely able to make the choices they wish and we will support them fully in their decisions’.

In return, the local IMs will work with Airedale Trust on joint training projects, sharing knowledge and experience and improving the maternity care offered by all. The IMs will also act as back up to the Trust’s homebirth service, especially to support women with more complex needs for which specific IMs have extensive experience in the context of home birth.

NOT a solution to the IMUK/NMC Crisis
It is essential to understand that this does not resolve the fact that the NMC have refused to allow midwives using the IMUK’s indemnity solution, despite the NMC’s statement to IMUK that, “We (the NMC) are unable to advise you about the level of cover that you need. We consider that you are in the best position to determine, with your indemnity provider, what level of cover is appropriate for your practice”
While this offers independent midwives the ability to be able to work and support women and families, and while we are hugely grateful for the support and understanding of Airedale Trust, this is still not midwives being truly independent. The fight continues!
Petition link

Save the NHS – Waterbirth!

“A woman in birth is at once her most powerful, and her most vulnerable.” Marcie Macari

There are some areas of maternity care which are so valuable, so game changing, that it is remarkable that they are not the default offering for women in labour.  At our most vulnerable time we can be supported to be our most powerful.  Labour and birth in water can transform childbirth, and at the same time it fulfils a vital requirement of our health service: to save money.

Jeremy Hunt continues to force the NHS to make “efficiency” savings, and the NHS has an obligation to provide the best care that it can. Given that waterbirth firmly ticks both of these boxes, it is essential that all trusts ensure that they are providing a sufficient number of birthing pools to be able to offer them to all women who wish to use water.

Tell me more about these cost savings

In summary, water labour and birth compared to land labour and birth reduces the number of interventions or complications that women experience. Some interventions and complications cost the NHS money immediately (such as caesareans, forceps, transfer to the hospital from an out of hospital birth, chemical pain relief) and some also create costs on an ongoing basis due to follow up care (eg caesareans, perineal damage, birth trauma).

Let’s back that up with some research.  Looking at caesarean sections, an Italian study in 2014 found that the women in their study who birthed in water had a 94-99% spontaneous vaginal birth rate, in a country where the caesarean birth rate is 38%! A follow on evaluation of Birthplace 2011 showed a reduction in risk of caesarean birth by 20% for first time mothers. The same review also showed that the number of women who were transferred to hospital having planned an out of hospital birth was also significantly reduced for women who laboured in water.

A 2004 observational study over a 9 year period found that waterbirths reduced the risks of perineal tearing, episiotomies and reduces the mother’s blood loss. This leads to NHS cost reductions in follow up care for tears or cuts, and for treatment for anaemia – and leads to a reduction in women coping with new parenthood without being able to sit comfortably (something that we all need to do a lot of as we feed our newborns), and reduces the number of women coping with pathological exhaustion on top of normal postnatal tiredness.

This is just a very small summary of the evidence that is available, because there are hundreds of studies which show the benefits of waterbirth to women, and to the NHS, which we will continue to blog about over the coming months.

Let’s put this into practice!

Aquabirths came about because of my passion for supporting women in birth, and because to be able to ensure that women have access to a pool if she chooses to birth in a hospital or midwife led unit, trusts need to be able to afford the capital cost of installing them. The original investment will be repaid by saving just a couple of women from an unwanted caesarean, and the human cost of an unwanted caesarean is priceless. Aquabirths fitted pools are available from £2900 including plumbing components, and are discounted even further when 2 or more are ordered. They’re manufactured in one piece to make fitting as easy as possible, and Aquabirths will do the installation if required.  The pools are easy to repair in the very unlikely situation that they’re damaged, due to their fibreglass construction rather than plastic, and they also come with an industry-best 10 year warranty.

Ongoing care is made easy and cheap by the fact that the baths are manufactured in one piece, making cleaning and hygiene control quick and effective. All plumbing components are standard parts, so they’re easy to replace if required, although this is very rarely needed, just like it’s almost never the case that you need to replace plumbing in your own home.

In a follow up post I’m going to talk some more about access to birth pools. At the moment, many trusts have a policy which means that many women are not eligible to use them unless they’re classed as “low risk” (a term which I should also cover at some point!). I’ll just leave this post with one final thought. “High risk” women are often denied access to a pool, but told to take a bath, and the same women are denied access to a pool, but instead offered heroin (diamorphine) in labour without being told what they’re being given. It’s time to take another look at labour and birth in water and the benefits of it to women, babies,

…and trust finances.

Aquabirths are running a special offer of a free birth couch (currently £795, normal price £950) with every Canberra, Venus or Heart-shaped Birthing Pool. Use code SB161102  when ordering the Pool.