UK 'has too many hospital births'

Source: BBC

Maternity services across the UK need a radical rethink, the Royal College of Obstetricians and Gynaecologists says.

Dr Anthony Falconer: 'We all have a moral responsibility to create the best services we can'

It wants the number of hospital units cut to ensure 24-hour access to care from senior doctors and says more midwife-led units are needed for women with low-risk pregnancies.

The National Childbirth Trust welcomed the report but says the proposals do not go far enough.
NHS managers said maternity care desperately needed to be reorganised.

Trolley saves lives of newborn

The Advertiser informs us about new life-saving equipment: bedside trolley for newborns. It can be used for resuscitation of newborns who need life-saving procedures while connected to the mother via umbilical cord as per WHO recomendations about cord clamping.

"Changing the timing of cord clamping and cutting from immediately after delivery of the baby to 1–3 minutes after delivery of the baby improves the iron status of the infant. Potential adverse effects on the infant of delayed cord clamping and cutting, such as jaundice requiring phototherapy, should be considered, especially in under-resourced settings."

A RETIRED North-East hospital consultant has helped to design an award-winning resuscitation trolley for newborn babies.

Former Darlington Memorial Hospital consultant obstetrician David Hutchon believes the bedside trolley could save babies’ lives if it becomes a standard piece of equipment in the NHS.

It is already in use at Darlington Memorial Hospital and two other hospitals in the UK.

The Basics (Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support) Trolley won a Medical Futures Innovation Award in London last night.

The bedside trolley has a built-in resuscitator, water supply and heater.

It allows doctors and nurses to check for vital life-signs while the baby is safely connected to its mother via the umbilical cord.

Midwives challenge Cameron's vision of NHS Modernisation & Broken Pledges for Maternity Care

RCM The Royal College of Midwives released their statement on proposed vision of the Maternity Care in UK.

For embargoed release, 1:45 p.m. Tuesday, 7th June 2011

RCM General Secretary Cathy Warwick, who attended David Cameron’s speech on the modernisation of the NHS and an update on the progress of the ‘Listening Exercise’ today at 1:45 p.m. at the National Hospital for Neurology and Neurosurgery, UCLH;, said: “We are concerned that you can’t  change a massive organisation like the NHS without listening to the staff and the public. David Cameron has not honoured his pre-election pledge to recruit 3,000 more midwives, so how can we trust him not to break his promise on these pledges?”

Hospital restricts free formula baby milk for newborns to encourage mothers to breastfeed

By DAILY MAIL REPORTER

Last updated at 3:29 AM on 2nd June 2011

Breast is best: Mothers in Hull and East Yorkshire who insist on using formula milk will be provided with just one bottle after giving birth

An NHS trust has stopped providing free formula milk for new babies in an attempt to encourage more mothers to breastfeed.

Those who do not will be expected to take their own formula milk to hospital or send out a relative to buy some. Maternity staff will only have access to a ‘small emergency stock’.

Mothers who insist on using formula milk will be provided with just one bottle after giving birth.

The decision by Hull and East Yorkshire Hospitals NHS Trust backs up the Government’s ‘breast is best’ campaign which recommends that babies have breast milk for at least six months.

Eight in ten women in England start the natural way, but by six weeks fewer than half are still breastfeeding.

Liz Mason, the Hull Trust’s infant feeding co-ordinator, said babies who are bottle-fed formula milk are at a higher risk of obesity and childhood diabetes.

Despite sustained publicity about the health benefits, the UK has one of the lowest breastfeeding rates in Europe, with around 20 per cent of new mothers never making any attempt.

Read more: http://www.dailymail.co.uk/news/article-1393353/Hospital-restricts-free-formula-baby-milk-newborns-encourage-mothers-breastfeed.html#ixzz1OW5XJIkz

Lawyer died after doctors gave 16 times correct dose of labour drug

RIP Suzanne Ballantyne, who died last year from drug overdose during labor in UK as reported by London Evening Standard .

NOTE: Drug Misoprostol is one of the drugs which are used for induction of labor(forcing labor to start) which was in this situation medically indicated, because of intrauterine death of the baby ( baby died in womb). Misoprostol use has certain risks, like overstimulation of uterus ( womb will contract very strongly which can cause rupture). Kindly scroll to the bottom of this article, where you will find adviced management. 

The family of a lawyer who died after being given 16 times the recommended dose of a labour-inducing drug could sue after a coroner voiced "grave concerns".

Suzanne Ballantyne, 47, was given 800 micrograms of misoprostol at St George's Hospital in Tooting to bring on delivery after her baby, a girl, died in the womb.

Mrs Ballantyne suffered multiple ruptures to her womb, causing vital organs to fail.
Four days previously, the Royal College of Obstetricians and Gynaecologists had recommend doses no higher than 50 micrograms - though at the time of Mrs Ballantyne's death there were no official guidelines from the Government's drug rationing watchdog, the National Institute for Clinical Excellence.

Weight management in pregnancy

Obesity in pregnancy is one of factors contributing to poorer pregnancy and delivery results. Therefore it is adviced to adjust maternal weight before pregnancy and maintaining optimal weight while pregnant.
Weight is evaluated by BMI Body Mass Index, you can calculate yours on  BMI Calculator.

Many hospitals provide specialised clinics like Cedar Clinic of Epsom and St Helier University Hospital, part of NHS  in UK for mothers with MBI more than 35.

"The aim of this pioneering clinic is to provide support, advice and individualised care, with dignity and respect for your wishes, and to achieve a good outcome for you and your baby.At your first appointment with the Cedar team, a detailed history of your medical and personal history will be taken and we will give advice in regards to your nutrition and physical activities.

Socioeconomic Value of the Midwife

RCM The Royal College of Midwives UK published paper on Socioeconomic value of Midwife. Results showed that Midwifey-led care has lower rates of interventions and also lower rates of cesarian sections, thus could be less costly. However more studies and up-to date economic evaluations are needed.

Preventing type 2 Diabetes ( PH 35 NICE)

NICE National Institute for for Health and Clinical Excellence in UK which makes recommendations to NHS ( National Health System) in UK published new guidelines of Preventing Diabetes Type 2 ( this type of diabetes is influenced by lifestyle )

State of Kuwait is one of the leading countries with high incidence of Diabetes Type 2 due to high rates of obesity, high energy foods- especially fat-saturated ( fast food), lack of regular activity and exercise.

NHS defines diabetes as follows:

Type 2 diabetes

Diabetes is a group of disorders with a number of common features characterised by raised blood glucose. In England the four commonest types of diabetes are:

Breastfed babies develop fewer behaviour problems (BMJ)

BBC Health News reported May 11, 2011 that breastfed babies have fewer behavioral problems with comparison to formula fed babies based on results of Millenium Cohort Study.

"10 037 mother–child pairs from white ethnic background (9525 term and 512 preterm children) were included in the analyses. Duration of breast feeding (at all or exclusively) was ascertained from parental interview at study baseline, when the children were aged 9 months. Child behaviour was assessed using a parent-completed questionnaire, the Strengths and Difficulties Questionnaire (SDQ). The authors used logistic regression to investigate the associations of breastfeeding duration with abnormal parent-rated SDQ total and subscores at age 5 in term and preterm children separately."

Quality evaluation of maternity services in UK

In my previous post I was describing system of maternity services in UK provided by NHS (National Health Services). Services are provided in hospitals and community centers (which include also midwifery-led birth centers) . Deliveries being assisted by Obstetritian ( specialists for complicated labour) and / or Midwives (Specialists for normal labour).
NHS encouradges low-risk pregnant women to deliver in birth centers citing study which confirmed low rate of interventions:

"A recent report on an NHS-run Birth Centre shows that women booked with the unit have fewer interventions in labour (even if they are transferred to hospital in labour) than low-risk women booked for hospital birth.^"  Saunders, D., Boulton, M., Chapple, J., Ratcliffe, J. and Levita, J. (2000) Evaluation of the Edgware Birth Centre North Thames Perinatal Public Health

This post will be try to explain quality evaluation of maternity health care provided within this system.
NHS supports full transparency  by publishing  data and making them available for mothers to be able to choose health care provider according their needs and wishes.
(Kindly open the links to see the statistics)

1. How to find nearest maternity unit
    a. By region
    b.By hospital

2.Basic maternity statistics for the region
     - with description of available care: Obstetritians, Midwives, GP
     - evaluated as:  national average, better or worse than average ( by colours)
     - UNICEF Baby Friendly Awards for breastfeeding ( level of accreditation)   

Birth choices in UK

Maternity services in UK are mainly provided by NHS- National Health Services in hospitals and community units, depending on woman` s choices or presence of pregnancy complications.

1. Consultant units (available only in hospitals)
These units are mostly choosen by women who prefere "hi-tech" birth enviroment or women who have pregnancy complications and need active management of labour and interventions.

"A woman is usually booked under the care of a particular consultant, but may only see them rarely throughout her pregnancy. Most of her care will be given by midwives. If complications arise during pregnancy or labour, the doctors will become more involved. Interventions such as epidurals and Caesarean operations are usually available in the unit. "

         a.  Obstetrics consultants: specialists in birth where there are complications, like cesarian section
                       
         b.  Midwifery consultants: specialists in normal births

"Hospital midwives work within a hospital. They run antenatal clinics, help women giving birth in the hospital, and look after women staying in the antenatal and postnatal wards of the hospital. Their work usually gives them experience of interventions such as induction, continuous monitoring and use of epidurals for pain relief. They often work closely with doctors.

2. Other Maternity Units ( available in hospitals and community centers )

"These types of maternity units provide maternity care for women who have chosen a "low-tech" birth environment. They include midwifery-led units, GP units and birth centres. They provide friendly, personal care from midwives. They can be grouped according to whether they are at a hospital which also has a consultant unit, or if they are situated away from a main obstetric hospital (community units)."