Home birth service and high risk women requesting midwife-led births: a letter from the CEO of Cambridge University Hospitals NHS Foundation Trust

The Rosie Hospital signpostThis letter from the CEO of Cambridge University Hospitals NHS Foundation Trust was sent to the MP for South Cambridgeshire. It responds to concerns raised, on behalf of a constituent, about the home birth service at the Rosie Maternity Hospital and how this may affect high risk women (e.g. those planning a VBAC birth at home) for whom choice is already limited.

It is reproduced here with permission, names removed.

Dear MP for South Cambridgeshire,

Thank you for your e mail and for raising the important issues you have covered.

Please be assured that our home birth service continues. During the day the home birth service is provided by the community midwives who work from 8:00am to 5:00pm. At night, the Trust is presently piloting a new way of working, whereby a community midwife who has not undertaken a day shift is now resident in the Birth centre rather than undertaking her on-call shift from home, and goes out to any mother going into labour who is booked for a home birth. This pilot is now in its seventh week, and an audit will be undertaken by the twelfth week in mid-January 2016. Prior to this pilot, the midwife on-call overnight had worked from 8:00am to 5:00pm and was then required to be on-call until 8:00am the following morning. There had been a potential that the midwife would be called out when tired having already worked a full day, and this pilot eliminates that risk as the midwife undertaking the night shift has not been required to work during the day.

As part of the Trust’s escalation policy to ensure safe care for all women in labour, the community midwives on-call were always available to be called into the unit should demand exceed capacity. Similarly our home birth guideline has always required that should there be no midwife available to send to a home birth because all available midwives are attending women in labour either at home or in the unit, then the woman would be asked to come into the unit to birth, or in exceptional circumstances when the Trust is already on divert, to one of our sister units. The Trust is very open regarding this escalation policy.

In relation to high risk women such as those having had a previous Caesarean section, it is recommended that the birth occurs on the delivery unit, as there may be a requirement for obstetric care. For those who decline this option, they are offered an appointment with the Consultant midwife where together, they are able to discuss fully the risks associated with delivering outside the delivery unit environment. Should a woman choose a home birth or birth centre birth following this discussion, the Trust is able to facilitate either of these choices.

I am delighted to acknowledge your comment on the addition of nine midwives and six maternity support workers, and the unit is currently recruiting into these posts. This will provide the Trust a 1:30 Midwife to mother ratio, which is in line with many of our neighbouring maternity units. We acknowledge that national recommendations are 1:28 and in light of this will be reviewing our establishments and skill mix on a regular basis.

I would be delighted to provide any additional information you require.

Yours sincerely

Chief Executive
Cambridge University Hospitals NHS Foundation Trust

The Chief Executive of Cambridge University Hospitals NHS Foundation Trust confirms if you request a home birth (HBAC) or VBAC at the Rosie Birth Centre, your midwife will offer you an appointment with the Consultant Midwife to discuss your individual needs.

Midwife-led VBAC and place of birth are topics which come up regularly in our online support group, we wrote a blog recently about how to arrange a midwife-led birth at a midwife-led unit (MLU) or birth centre.

We’ve put together lots of resources and VBAC, HBAC and CBAC birth stories.

For anyone planning birth after caesarean in Cambridge UK and the surrounding area, find support by connecting with other local women in our online support group or find out more about what we do.

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