Belfast Telegraph

Time to deliver a strategy that focuses on midwives

Every woman deserves to have maternity care tailored to her specific needs, says Edwin Poots

Earlier this week, I launched a maternity strategy for public consultation. It outlines a number of recommendations which, if implemented, will significantly change the way services are delivered.

The strategy has been developed by experts and it is based on the best available evidence. It is important that you have your say and I urge you to respond to the consultation before it closes on December 23.

I am totally committed to the provision of safe, sustainable, high-quality maternity services. I also recognise that we cannot approach maternity care with a one-size-fits-all attitude and that services must be tailored to meet the needs of the individual woman.

Good care starts at the pre-conception stage and the strategy stresses the need for women to be as healthy as possible before becoming pregnant and the need to make positive lifestyle choices throughout their pregnancy.

For the majority of women, giving birth is a completely normal experience and this strategy promotes normality during pregnancy and puts midwives back at the heart of maternity services.

However, it also recognises that those women, or babies, with extra needs will require the additional care of obstetricians, or other specialists.

I want to support women to have a positive and normal birth experience that will have the best outcome for both mum and baby.

So, in the future, women who are likely to have straightforward births will be encouraged to consider having their baby in a midwife-led unit, or to have a home birth, if appropriate.

To help them make this choice, it is proposed that each trust will be expected to provide at least one consultant-led unit with a midwife-led unit on the same site.

The strategy places emphasis on early direct contact with a midwife, which will provide women with the opportunity to discuss their options for care.

It also sets out clear recommendations for providing more choice, providing care closer to home and tackling public health issues, such as obesity, smoking and alcohol abuse in pregnancy.

It emphasises the importance of team-working, in which the woman is the centre of that team and supported by a range of professionals throughout the antenatal, labour and postnatal period.

There has been much discussion around the issue of caesarean sections. Let me be clear - caesarean sections can and do save lives.

However, in Northern Ireland we have a higher unexplained rate of caesarean births compared to other parts of the UK. The strategy aims to reduce this discrepancy by ensuring that those who need a caesarean section on clinical grounds get it and those who do not need it are supported by the midwife and through good clinical leadership throughout labour.

Caesarean section is major surgery and carries risk for both mother and baby; they should never be carried out for the convenience of the woman, or the hospital.

Paying for caesarean sections is not a recommendation of the draft maternity strategy, but it is essential that we get to the bottom of why Northern Ireland has such a high caesarean section rate and whether or not private maternity care contributes to this high rate.

We need to ensure that care - whether public or private - conforms to high standards and that we use our limited resources wisely.

I will expect each trust's chief executive to look at the rate of caesarean section and other interventions within maternity units and audit and benchmark their intervention rates against comparable units across Northern Ireland and the UK.

Improving our data-quality and ensuring a co-ordinated approach to the collection of regional data is important to enable us to identify regional outcomes and support continuous improvement in the service.

The case for change is compelling and is underpinned by sound clinical evidence. Women and their babies deserve to receive the right care, both physically and emotionally, and that is what this strategy is about.


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