Transcript Slide 1

Home Birth Conference
15/11/13
The challenges that Home Birth
can present
Martina Doolan CMTL
Jacqueline Robinson CMTL
Why not Home Birth?
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A Maternity Strategy for Northern Ireland (DHSSPS 2012)
Changing Childbirth 1993
Delivering Choice 1994
The Code NMC 2008
Midwives Rules and Standards 2012
NMC Circular Homebirth 03/2006
Ante natal care: Routine care of the healthy pregnant woman ( NICE
2010)
Intrapartum care NICE Clinical Guideline 55 (NICE 2007)
Birth Place Study (NPEU 2011)
Promoting Normal Birth Campaign
Why not Homebirth?
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A Maternity Strategy for Northern Ireland
(DHSSPS 2012)
NHSCT Strategy for Maternity Services 20092014
“To provide for all, equality of a service we
expect for our families and ourselves”
NHSCT homebirths since 2009
Less than 1% of births
Year
Requests
Actual Homebirths
DOMINOs
Antenatal transfers
Labour transfers
2009
22
9
3
9 (5x IOL)
1
2010
21
10
1
8
2
2011
17
8
0
3
6
2012
11
4
1
3
3
2013
16
11+3 on call
1
0
1
2014
3
Challenges facing Team leaders in
NHSCT
Workforce
 Policy and Guidance
 Resources
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Workforce
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Providing an “on-call” service while maintaining
normal community services
On-call provided by community staff
Training, maintaining skills and regular updating
Work/life balance
Working time directives
Maintaining Staff morale
Change in GP contract
NHSCT Policy and Guidance
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Homebirth guidance (currently in draft form)
Water for labour and Birth NHSCT /11/378
Care of Women in Labour NHSCT/13/667
Resources
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Budgets not set up to include the additional costs for
homebirth
On call costs and call out costs
Increase in the “on -call period” payments 2011
Equipment costs including provision of equipment,
drugs, medical gases and their transportation and
the necessary equipment servicing payments
Aging equipment
Challenges faced as a Team Leader
This means that the home birth service is
provided as a reactive service and not a
proactive service.
How we have met the challenges
Workforce
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Revision of on call rotas
Yearly update in maternity unit
Yearly attendance at PROMPT training with specific
Community scenarios
Targeted skills and drills for challenging cases
Regular team meeting and debrief following homebirth
Each midwife contacts their respective SoM for advice and
support while on call for Homebirth
Working together with hospital staff to accommodate
Examination of the Newborn
Meeting the challenges
Policies and Guidelines
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Home birth guidelines (updating 2013)
Water for labour and birth NHSCT 11/378
Care of Women in Labour NHSCT/13/667
Robust Risk assessment tool
Home visit to clients sitting outside of guidance “wearing 2
hats” (SoM and Team leader)
Management plans for those who sit outside guidelines who
continue to wish to homebirth
On-call rota to all SoMs and maternity units
Meeting the challenges
Resources
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Homebirth Drug Boxes
Business case for the updating of essential homebirth
equipment e.g. Entonox heads etc.
Business plan to provide a dedicated medical gas supply
available at all times for homebirth only
Revision of on call rotas to reduce the payment of oncall
periods
Accessing services of Consultant Midwife to provide Skills
and Drills
Maintaining good working relationships with the hospital
staff and SoMs
Homebirth Drug Boxes
Homebirth drug boxes
Case Scenarios
The way forward?
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A dedicated homebirth team
Offer a safe alternative to hospital birth fully
resourced and funded
Example of Northampton model
Increase our current homebirth rate
Truly providing choice
Fully Integrated with “Acute services”
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THANK YOU!
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ANY QUESTIONS???