26 May 2017

You may have seen or heard about the recent temporary suspension of services at some of our Midwife-Led Units (MLUs) in Shropshire. Here Sarah Jamieson, Head of Midwifery, explains why these temporary closures are necessary to ensure the continued safety of all women using our Maternity Services

“We are fully supportive of birth choice and women whose birth is considered to be low risk

Sarah Jamieson

can choose to give birth at one of our MLUs (in Bridgnorth, Ludlow, Oswestry, Shrewsbury and Telford), at home or at our Consultant-Led Unit in Telford.

Birth rates at our Consultant-Led Unit continue to rise, whilst the number of women choosing to give birth in our MLUs continues to decline and this appears to be an on-going trend which has been developing over many years.  In 2008/2009 MLU births accounted for 26% of our activity (including home births).  In 2017 this is now 14% (including home births).

We manage the service as a whole and staff our units based on demand as it’s important to ensure we have enough staff to care for women at the locations where they have chosen to give birth, rather than focusing on staffing buildings which may have little or no birth activity for days or weeks. This is in line with national guidance and means our staff are where they are needed, rather than having a number of Midwives and care support workers in one MLU where there may be no women being cared for.

Demand has been high at our Consultant-Led Unit in recent weeks and months.  Unfortunately, on some occasions this demand has coincided with unexpected staff sickness within our service.

At these times we have had to make some tough decisions to ensure the service is safe and on some occasions this has meant we have had to temporarily suspend services at our MLUs.

This is not new and is something that has previously happened on occasions over recent years, but as part of our commitment to being open and transparent we have decided to now publicise the temporary suspension of our services on our website and inform the local media.  I believe this is the right thing to do and that women should be fully informed and aware of decisions which may impact on their care.  For this same reason, at the beginning of their pregnancy all women are informed via their Patient Information Booklet that in exceptional circumstances and times of very high activity we have to enact our escalation policy to ensure the safety of women and babies and that this means they will not be able to give birth in the unit of their choice, either because the unit is closed altogether or because some staff have to be re-deployed to cover other areas.  They are informed that if their birth is considered low risk they can still have the choice of low risk care in any of our other units, they are also informed that it is likely that they will be able to transfer back to their unit of choice for postnatal care once the period of high activity is over.

Publicising this information is important but this means you may be more aware that at times we must temporarily suspend our services. This usually just affects one MLU at a time with the suspension taking place either overnight from 8pm until 8am or at a weekend and in exceptional circumstances this can involve suspending our consultant led service, although this is very rare indeed and we do everything possible to protect the safety needs of the service as a whole.

The decisions are never taken lightly, and are made by senior midwives, senior clinicians and Executive Directors.

At times we have experienced unexpected levels of staff sickness within our Maternity Service, and this has coincided with high demand at our Consultant-Led Unit, including some women who needed a high level of care, whilst other MLUs were also busy.

Midwifery is a highly specialist field and we try to avoid the use of agency staff (temporary Midwives who aren’t employed by the Trust) to care for our women and rely instead on our own trained and experienced staff to work extra hours, wherever possible.

As a result, in line with our policies and procedures to ensure the continued safety of our service, we always try to suspend services at an MLU which at the time has no patients.

Expectant mothers who chose to give birth at the affected unit and may give birth imminently are informed and offered another place of birth, at one of our other MLUs or at our Consultant-Led Unit in Telford.

I must stress that we never take such decisions lightly and we review all risks to ensure the safety of all women using the service.

I hope this reassures you about why we have at times had to temporarily suspend services at our MLUs and that managing unexpected sickness and periods of high demand is simply part of our everyday business.

I would like to apologise for any inconvenience these closures may have caused and can assure you that the safety of all of our women is paramount.”