Having a baby at North Bristol NHS Trust

Having a baby at North Bristol NHS Trust Exceptional healthcare, personally delivered

Congratulations on your pregnancy! We hope that you will find this booklet helpful in providing you with useful information to help you make choices for your pregnancy, birth and following the birth of your baby. North Bristol NHS Trust is proud to be able to provide a variety of birth environments. n For healthy women with uncomplicated pregnancies we can support you to give birth at home, Cossham (a standalone birth centre) or co located Southmead Birth Centre at Southmead Maternity unit. n For women with underlying medical conditions or pregnancy complications we can support you to give birth at Central Delivery Suite in Southmead Hospital. A recent study (Birthplace in England 2011) states: There is a substantially lower incidence of major intervention, including intrapartum caesarian section, for women who birth at home, standalone birth Centre (Cossham) or co-located birth Centre (Birth Suite Southmead). This also has potential future benefits to both the woman (increased satisfaction) and the NHS in terms of avoiding surgical complications and reducing the need for repeat caesarean births in future births The Birthplace cohort study: key findings The Birthplace cohort study compared the safety of births planned in four settings: home, freestanding midwifery units (FMUs), alongside midwifery units (AMUs) and obstetric units (OUs). The main findings relate to healthy women with straightforward pregnancies who meet the NICE intrapartum care guideline criteria for a low risk birth. 2

Key findings: Giving birth is generally very safe Midwifery units appear to be safe for the baby and offer benefits for the mother. For planned births in freestanding midwifery units and alongside midwifery there were no significant differences in adverse outcomes compared with planned birth in an obstetric unit. Women who planned birth in a midwifery unit (AMU or FMU) had significantly fewer interventions, including fewer caesarean sections, and more normal births than women who planned birth in an obstetric unit. For women having a second or subsequent baby: n Home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother n There were no significant differences in adverse outcomes between planned home births or midwifery unit births and planned births in obstetric units. n Birth in a non-obstetric unit setting significantly and substantially reduced the odds of having a caesarean section, instrumental delivery or episiotomy. n The proportion of women transferred to an obstetric unit during labour or after the birth was 12% for planned home births, 9% for planned FMU births and 13% for planned AMU births. For women having their first baby: n A planned home birth increases the risk for the baby n There is a chance of transferring to an obstetric unit during labour or after birth of 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births (Birthplace in England 2011) Please see the following pages to help you make your choice. Your community midwife will be able to assist you with your choice depending on your personal circumstances. 3

For healthy women with a straightforward pregnancy there are several choices for where to give birth. Home Birth If you decide to give birth in your own home our community midwives will attend the birth. At home you are more likely to feel relaxed, have greater privacy and feel free to move around. Giving birth in our own home was a magical experience- I felt calm and relaxed. My husband had organised dim lighting and calm background music for our second daughter s birth. Being able to spend time afterwards as a family was wonderful. The community midwives were caring and supportive (March 2013) 4

Birth at home is recommended when women have no medical conditions or pregnancy complications. This means that there is no access to acute medical interventions apart from initial emergency provision provided by midwives. The midwife will be continually assessing you and your baby throughout pregnancy, labour and birth and if this is not completely straightforward, it will be recommended that you transfer to Southmead Hospital delivery suite. Some emergency situations in mothers or babies may occur that cannot be predicted. Should this happen, midwives will ensure that transfer to Southmead Hospital is arranged quickly and do all they can to deal with the situation. Community midwives are trained in initial emergency care and resuscitation of mothers and babies. It should be noted that the average transfer time to hospital from home is 40 minutes and in some urgent situations this delay could lead to complications in either you or your baby. 5

Cossham Birth Centre Located in Kingswood, this recently opened unit (2013) has four birth rooms which all have pools for labour and birth and ensuite facilities. The midwives can support you to have a positive birth experience in a home from home environment. Partners are able to stay following birth. your knowledge and ability to make the environment as comfortable as possible during the birth (and after) for which we, despite all the book reading, could never have been fully prepared for. The way in which everyone we had contact with while we were in your care is something you do not experience on a daily basis and we would both like to thank you all for accepting our birthing methods as much as possible, for all your carefully led attention, care and successful birth of our little girl. You are all aces in our book (May 2013) 6

Midwife led birth units have been assessed as a safe option for low risk women in a large research study (Birth place study 2011) with no difference in outcomes for mothers or babies than if the women gave birth in a hospital maternity unit. Birth at Cossham Birth Centre is recommended for women who have no medical conditions or pregnancy complications as there are no doctors at the Centre. This means that there is no access to acute medical interventions apart from initial emergency provision provided by midwives. The midwife will be continually assessing you and your baby throughout pregnancy, labour and birth and if this is not completely straightforward, it will be recommended that you transfer to Southmead Hospital delivery suite. Some emergency situations in mothers or babies may occur that cannot be predicted. Should this happen, midwives will ensure that transfer to Southmead Hospital is arranged quickly and do all they can to deal with the situation. Cossham midwives are trained in initial emergency care and resuscitation of mothers and babies. It should be noted that the average transfer time to hospital from Cossham Birth Centre is 40 minutes and in some urgent situations this delay could lead to complications in either you or your baby. 7

Southmead Birth Centre, Southmead Maternity Unit, Southmead Hospital Located at Southmead maternity unit our Birth centre has 3 rooms, 2 of which have birth pools for labour and birth and en-suite facilities. The midwives can support you to have a positive birth experience in a home from home environment. If complications arise during labour or following birth transfer to the Central Delivery Suite, Southmead will be organised and discussed with you. In such cases transfer takes just a few minutes. at all time s staff were professional, efficient and compassionate. Throughout our stay in the Birth Suite staff respected our privacy and dignity and allowed us ample time together as a family. (January 2013) 8

Central Delivery Suite, Southmead Maternity Unit, Southmead Hospital We are able to provide: n 24 hour obstetric service Our Obstetrician-led unit is based in the maternity unit at Southmead Hospital. For women with an underlying medical condition or pregnancy complications giving birth at a Consultant unit is advised. The midwives will support you to have a positive birth experience. n 24hr obstetric anesthetic services (epidural service) n 24 hour neonatal service n Access to other specialists within the hospital if indicated n Neonatal Intensive Care Unit (NICU) n 10 Birth Rooms - 2 with pools n 2 obstetric theatres n 3-bedded recovery bay for women who have has a caesarean section or other operative procedures related to pregnancy or labour. Unfortunately the birth was not straightforward and I needed a caesarean section. Throughout the whole experience, the staff were professional and kind. We were kept informed throughout and staff showed empathy and understanding to our situation. The calmness displayed by your staff was reassuring to both my husband and myself The following day the medical staff came and checked that I understood why the birth had proceeded as It had and I was encouraged to ask questions. (January 2013) 9

For a majority of women, pregnancy and child birth are normal life events. Planning Birth Car parking Able to visit prior to birth Home environment Midwife led care in labour Home Cossham Birth Centre Southmead Birth Centre Depends p p p on home N/A p p p p p p p p p p p Mobility in labour p p p p Central Delivery Suite Southmead En-suite birth rooms Less likely to have intervention Coping in Labour Active birth equipment Music player Depends p p p on home p p p p Provide own Provide own p p p p p p Birth Pool Hire own p x4 p x2 p x1 Bed in room N/A p p p Aromatherapy p p p p TENS p p p p Entonox p p p p Pethidine Not p p p routinely Epidurals x x x p Maternity Drs on site x x p p Baby Drs on site x x p p 10

Emergency situations Transfer time from decision to arrival at Southmead Maternity Unit Home Cossham Birth Centre Varies Average 40 minutes Southmead Birth Centre Average 5 Minutes or less Central Delivery Suite Southmead N/A Transfer rate for first time mums (aprox). Transfer rate for subsequent birth Operating Theatres on site 45% 39% 40% 0% 20% 6% 20% 0% x x p p Postnatal care Dads able to stay overnight Breast feeding support N/A p p x p p p p Shop N/A p p p Single rooms available for hire after birth N/A x All single rooms x All single rooms x Limited numbers 11

Maternity Services at North Bristol NHS Trust At North Bristol NHS Trust our maternity team aims to provide a high quality standard of care and have achieved the highest standard for safety as determined by national standards regardless of place of birth. North Bristol NHS Trust Maternity unit works closely with local universities and participates in innovations of practice and research. Indeed multi professional training PROMPT (PRactical Obstetric MultiProfessional Training) was developed at North Bristol and has now been adopted by over 75% of UK Trusts and worldwide. We also participate in teaching students, and train individuals from a variety of backgrounds including student midwives, student doctors, student nurses and paramedics. The students will be working under the close supervision of the team looking after you. It is likely that there may be a student present during your consultation or examination. If you prefer not to have a student present, please let your midwife or doctor know and your wishes will be respected. It will not prejudice any aspect of your care. Since 2000 North Bristol NHS Trust has been accredited with UNICEF Baby Friendly Status (BFI). Our trained staff promote and support woman breast feeding. In 2012 we opened the South West s first milk bank. 12

Midwifery supervision Supervisors of Midwives are experienced midwives who have undertaken additional education and training for this role. They are appointed and supported by the Local Supervising Authority and are not managed by the Trust. How can Supervisors of Midwives help you? n We offer support and guidance to women using our services n We encourage the involvement of women and their families in the planning of maternity services n We work in partnership with midwives and women to explore options in maternity care n We will listen to concerns and offer an unbiased and impartial view to enable you to make decisions Our Supervisor of Midwives can be contacted via the details on the Team Page on the Trust Internet site. We aim to respond as quickly as possible but the majority of us are clinical midwives and therefore do not have access to our emails on a daily basis. Should you have an urgent issue, a Supervisor of Midwives can be contacted via Central Delivery Suite on 0117 414 6916 or 0117 414 6917 and we would aim to get back to you as soon as possible. Security Security at North Bristol NHS Trust has a very high priority. All staff will be wearing a photo ID badge. These should be clearly displayed. However, if not visible, you should request to see it. 13

References Birthplace in England Collaborative Group (2011) Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. NPEU Oxford. https://www.npeu.ox.ac. uk/birthplace Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011; 343:d7400 www.bmj.com/contents/343/bmj.d7400 MIDIRS: Where will you have your baby? Available at http://www. infochoice.org National Institute of Clinical Excellence (2007): Intrapartum care: care of healthy women and their babies during childbirth. NICE Clinical Guideline 55. London: National Institute for Health and Clinical Excellence; 2007. Available from: www.nice.org.uk National Childbirth Trust- www.nct.org Ackowledgement The Birthplace in England Research Programme combines the Evaluation of Maternity Units in England study funded in 2006 by the National Institute for Health Research Service Delivery and Organisation (NIHR SDO) programme, and the Birth at Home in England study funded in 2007 by the Department of Health Policy Research Programme (DH PRP). The views and opinions expressed by the Birthplace authors do not necessarily reflect those of the NHS, NIHR, NIHR SDO, DH PRP or the Department of Health. NHS Constitution. Information on your rights and responsibilities. Available at www.nhs.uk/aboutnhs/constitution 14

How to contact us: Southmead maternity unit Southmead Hospital Bristol BS10 5NB Southmead Hospital Switch Board 0117 950 5050 Antenatal Clinic 0117 414 6924 or 0117 414 6925 Cossham Birth Centre Lodge Road Kingswood Bristol BS15 1LF 0117 340 8460 Assessment Unit 0117 414 6906 Quantock Antenatal Ward 0117 414 6904 / 0117 414 6905 Southmead Birth Centre 0117 414 6900 / 0117 414 6901 Central Delivery Suite (if in labour) 0117 414 6916 / 0117 414 6917 Percy Phillips Ward 0117 414 6821 / 0117 414 6822 www.nbt.nhs.uk/maternity If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. This edition published January 2015. Review due January 2017. NBT002813