Redesigning Maternity Services Together
Informal Engagement
Informal Engagement
Did you know we deliver over 4,800 babies a year across our freestanding Birthing Centres in Paulton, Chippenham, Frome and Trowbridge, the Bath Birthing Centre at the RUH or in homes across the area?
We know that choosing where to have your baby is a big decision, that's why we're currently looking at what we provide across our region to make sure we are getting it right for women, both now and in the future.
Why are we looking to redesign our Maternity Service now?
Changes to the way maternity services are commissioned in this area (planned, agreed and monitored), so that services are contracted for more than a three-year period, means we now have a great opportunity to plan for the longer term. There have also been a number of national reports published recently which outline new recommendations for best practice maternity care across the NHS. It's a perfect time to take a fresh look at what we are providing.
We want to continue to support home births and provide midwife and consultant-led centres and we need your help to understand what the best mix could look like for the mothers and families we support, taking into account the staff and resources we have available to us.
We want to work with you to create a sustainable service for the future and over the next few months we'll be talking with mums, families, staff, patients and anyone with an interest in these services to help us answer some key questions.
We want to understand what matters most to those who use or work in our maternity services.
- What lies behind the decision on where to give birth?
- What do we do well and what could we improve or introduce?
- Do we offer the right mix of choices in the right locations?
We'd like to hear from those who use our services and your feedback will inform our planning to ensure that we can continue to provide high quality care in the best environment for each woman, taking into account her personal circumstances and preferences.
What we currently provide
Across our region the RUH provides what are known as freestanding Birth Centres which are midwife-led, a consultant-led centre, the Bath Birthing Centre, and support for home births. We also provide antenatal and post-natal care as well as screening services and specialists support such as tongue tie services, breast feeding support and birth reflections.
Freestanding Birth Centres are located in Chippenham, Frome, Paulton and Trowbridge. These offer midwife-led care for those who are considered to have a low risk of complications during labour and are otherwise fit and healthy.
Our consultant-led centre, the Bath Birthing Centre is based at the Princess Anne Wing of the RUH and provides consultant-led care to women with complex needs as well as those with uncomplicated pregnancies. The Bath Birthing Centre offers direct access to obstetricians, anaesthetists (who give epidurals and general anaesthetics) and neonatologists (specialists in newborn care) and the Dyson Centre for Neonatal Care (NICU).
You can also choose to have your baby at home, supported by our Community Midwives, if you have an uncomplicated pregnancy.
Our commitment
We are committed to providing high quality services, delivered by the right mix of staff in an appropriate environment. We will continue to offer women a choice of giving birth in a midwife-led Birth Centre, a consultant-led Centre or giving birth at home and we need your help to make sure we get the balance right.
Listening to our staff
Since taking on responsibility for providing maternity services, we've spent time talking with and listening to those who deliver these services, and gathering their views on what works well, what could be improved, and what could be introduced. We'll continue to work closely with maternity staff and we are looking forward to sharing your thoughts with them as we look to plan for the future together.
Things we need to consider
Number of births at each centre
On average, the RUH's maternity service supports the birth of around 400 babies a month. The majority of these, around 80%, are born at the Bath Birthing Centre, at the RUH's Combe Park site, as described in the table below:
| 2015/16 | % | Monthly average | |
| Bath Birthing Centre | 3,827 | 79 | 319 |
| Home births | 133 | 2.7 | 11 |
| Chippenham | 196 | 4.0 | 16 |
| Trowbridge | 291 | 6.0 | 24 |
| Paulton * | 154 | 3.2 | 13 |
| Frome | 244 | 5.0 | 20 |
| Shepton Mallet ** | 0 | 0 | 0 |
| Total | 4,845 | 100 | 404 |
* temporarily closed for a short period in 2016 for NHS Property estates work
**only provides ante-natal and post-natal care
Despite best efforts to promote and support our midwife-led Birth Centres, we are not seeing a sustained increase in the number of mothers choosing to give birth in these Centres and we want to understand more about what lies behind the choices women make.
Alongside Birth Centre
Our region is unusual in not providing a midwife-led Centre alongside a consultant-led service, and NICE guidance suggests that this should be a choice we provide. At the moment, it means women in our region who wish to give birth in a midwife-led Birth Centre need to transfer from Frome, Paulton, Trowbridge or Chippenham to the Bath Birthing Centre at the RUH if there are complications during or after labour or to access pain relief such as epidurals. Around 23% of women make this transfer, a journey of between 11 and 15 miles.
We want to understand how mums to be in our area feel about this, would an alongside Birth Centre be something we should consider?
Making the most of what we have available
Our community Birth Centres are very busy during the day offering ante and post-natal appointments, workshops, tongue-tie clinics and glucose testing, as well as supporting women who are giving birth. However, there are frequently days or nights when no babies are born at a community Birth Centre. Nevertheless, we need to have staff and resources in place to support birth 24 hours a day, 7 days a week at each Centre.
Is this the best way to use the staff and resources we have available?
Buildings and environments
Since taking over maternity services in 2014, we have made a number of improvements to the environments, but we know some of our Birth Centres could require significant investment in the future to provide the kind of facilities we would like to offer to all women.
We need to understand what women want and where is it best to invest our limited resources?
Day Assessment Unit Capacity
Located at the RUH, the Unit provides close monitoring throughout pregnancy for mothers and their unborn baby where complications have developed during pregnancy. The unit has seen an increase in demand, due to a number of factors including new clinical guidance and an increase in the number of women with complex needs or pre-existing conditions such as diabetes. The service needs to expand to meet the needs of our community, this could mean longer opening times and more beds available but it would also mean we'd need more staff working at the unit - what is the most effective way of using our existing workforce?
Share your views and help us in our planning
It is not sustainable to continue to provide our maternity services in the way we currently do and something needs to change. We want to work with you to understand where best to use our resources and enhance services to meet the needs of women and families. We want to understand what matters most to those who use or will use these services - what's good about the options we offer, what could be improved or introduced and what the best mix of choices could look like. This will help us in our planning to ensure that we can provide high quality care in the best environment for each woman.Obviously, each woman's preferences and requirements are different; there is no 'one-size-fits-all' solution, so we want to hear from as many women and people with an interest in this service as possible.
We have already held some informal discussion groups :
- Tuesday 14th February 2017, 2-4.30pm
Oasis Boardroom, RUH Bath, Combe Park BA1 3NG - Monday 27th February 2017, 1-3.30pm
Victoria Hall, Church Street, Radstock BA3 3QG - Tuesday 7th March 2017, 1-3.30pm
Assembly Hall, Market Place, Melksham SN12 6ES - Tuesday 14th March,6.30pm
Wiltshire Council, The Atrium, County Hall, Bythesea Road,Trowbridge BA1 8JN
We also held an informal discussion for women and families who have used the RUH's Maternity Service, as well as individuals or groups who have a special interest in pregnancy, birth and postnatal care on Wednesday 6th September at the Oasis Conference Centre, RUH, Combe Park.
We received a huge amount of feedback, from our discussion groups and via email and our questionnaire, thank you to all those who participated. We're now using that feedback to think about the ways our Maternity Service could change.
Please email us to share your thoughts at ruh-tr.maternityredesign@nhs.net. We'll use this feedback to help us in planning for the future of your maternity services.
What might change in the future?
We don't know yet, we are at the early stages of reviewing what we provide and that is why we are asking for people's views. We will share any plans as a result of this review. If feedback suggests we need to make significant changes to your maternity services, there will be a formal process of engagement or consultation and you will again have the opportunity to tell us what you think.
Your feedback will help us shape the future together. We will use this along with feedback we routinely collect from a range of sources to help us make improvements to our service, including conversations with women and families, our 'In Your Shoes' listening events from 2016, our monthly Positive Birth Forum, our Twitter and Facebook pages,our Patient and Advice Liaison service, the NHS website and formal surveys such as the Care Quality Commission's Maternity Services survey.