By Diane Guiver
ST MARY'S Maternity Unit, in Melton Mowbray, Leicestershire provides midwife-led antenatal, intrapartum and postnatal care to approximately 350 women per year. The midwives also provide care and support to women who deliver in consultant units.
Until 1994, all previous audits had been undertaken by one of the local GPs. While this provided basic ‘number crunching´, it did not provide any reflection on the midwives´ practice. The audit of midwifery practice was facilitated by the Leicester General NHS Trust´s strategy of working towards women-centred service, by implementing the recommendations of Changing Childbirth (1993).
In 1994, to facilitate the evolvement of a woman-centred service, it was necessary to audit practice at that time, first, to assess current practice and second, to establish a measurable comparison to any changes made. The service was measured against the 10 indicators of success suggested by Changing Childbirth. The results of the initial and all subsequent audits, which are still ongoing, are presented to the midwives to facilitate active discussion on both positive and negative aspects of care highlighted. The midwives then decide as a group any action plan. This has been an essential prerequisite to achieving improvement in care, as the midwives encompassed the objectives set by this report and continually strive to improve the care they provide to women and their families.
For the woman, it has meant that we are able to offer a clear picture of the care we provide and as a result more than 83% of women now opt for midwife only care within the antenatal period. The remaining 17% are accounted for by one GP who likes to provide shared care and those women who need to see the consultant obstetrician for obstetric or medical reasons.
For the midwives, it has created a greater level of autonomy in our practice and empowered both midwives and mothers. For the managers, the improvements in care have been made within existing resources, which is an important issue, given the ever increasing financial restraints on the NHS as a whole and the cost argument so often used to close such units.
There is no doubt that the commitment of midwives has made the changes possible, through their willingness to work with the women of Melton Mowbray to improve the care they provide. The midwives provide the care women want, not the care the midwives think they need and this has made all the difference.
1. All women should be entitled to carry their own notes.
June 1995 Hand held notes were introduced for all women.
May 1998 National hand held notes replaced existing documentation
2. Every woman should know one midwife, who ensures continuity of her midwifery care, `the Named Midwife'.
February 1995: Named midwife standard introduced.
March 1998: Women saw their Named Midwife on an average of 3 occasions and
20% were delivered by their Named Midwife
3. At least 30% of women should have the midwife as the lead professional.
October 1995: 60% of women have midwife-led care
March 1998: 83% of women have midwife-led care
4. Every woman should know the lead professional who plans their care.
All women are aware of the lead professional who plans their care
5. At least 75% of women should know the person who cares for them during their delivery.
January 1996: 49% of women were delivered by a
midwife known to them
March 1998: 56% of women were delivered by a
midwife known to them
6. Midwives should have direct access to some beds in all maternity units.
Access is available to all beds in St Mary's and direct referral is available to Leicester General Hospital NHS Trust
7. At least 30% of women delivered in a maternity unit should be admitted under the management of a midwife.
All women admitted to St Mary's are under the management of a midwife
8. The total number of antenatal visits for women with uncomplicated pregnancies should be reviewed in light of the available evidence and RCOG guidelines.
A new schedule of antenatal care for women with uncomplicated pregnancies was introduced in 1997
9. All front line ambulances should have paramedic service, to support the midwife who needs to transfer a women to hospital in an emergency.
Currently under review by the Maternity Services Liaison Committee and the ambulance service
10. All women should have access to information about the services available in their locality.
All women are informed of the maternity services available by an information leaflet given to all women prior to booking and again on their first appointment with the midwife
AH updated 27 September 1999