Background
Current policy context
Year | Publication | Standard |
---|---|---|
2009 | KCND Maternity Care Pathways [8] | Multidisciplinary maternity risk assessment and care pathways Antenatal: Midwife first point of contact clinician who conducts initial risk assessment recommends clinically appropriate care pathway 9 antenatal visits in first and 7 antenatal visits in second and subsequent pregnancy up to 40 weeks. Labour: Continuous assessment, appropriate birth environment and reduction of inappropriate interventions. Postnatal: Continuity of carer and person centred care plans. |
2010 | NHS Scotland Healthcare Quality Strategy [11] | Healthcare Quality Ambitions. Safe: no avoidable injury or harm to people from the healthcare they receive. Effective: appropriate treatments; interventions; support and services will be provided at the right time to those who will benefit and harmful variation will be eradicated. |
2011 | Birthplace Study [44] | National evidence of 21.9% transfer rate in labour from freestanding CMU to Obstetric Unit. |
2011 | The Refreshed Framework for Maternity Care [12] | Ten Principles of Maternity Care, but no specific benchmarks offered. Key Quality Indicators: Assets based and outcomes focussed maternity services aiming to improve the equity and quality of maternity care |
2014 | Health Efficiency and Access Target [13] | Antenatal Access: “At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015.
|
2016 | NICE [3] | Antenatal guidance: Women are supported to access antenatal care, ideally by 10 weeks. Antenatal care should take place in a location that women can easily access. Intrapartum guidance: Women in established labour should have one-to - one care and support from an assigned midwife. |
2015 | Healthcare Improvement Scotland: Maternity and Children Quality Improvement Collaborative [15] | Reduce the incidence of avoidable harm in women and babies by 30% by 2015. |
2016 | Better Births [16] | Continuity of carer: “to ensure safe care based on a relationship of mutual trust and respect in line with the woman’s decisions. Every woman should have a midwife, who is part of a small team of 4 to 6 midwives, based in the community who knows the women and family, and can provide continuity throughout the pregnancy, birth and postnatally”. Safer Care: “professionals working together across boundaries to ensure rapid referral and access to the right care in the right place”. |
"Improve outcomes and reduce inequalities in outcomes by providing a safe, high quality care experience for all women, babies and families across maternity care settings in Scotland" [15].
Methods
Setting and selection of CMUs
Ethical considerations
Data collection
Selection of variables
Data storage
Data analysis
Results
CMU | Seaview | Cherrytrees | Total | |||
---|---|---|---|---|---|---|
Characteristic | Frequency | Percentage (%) | Frequency | Percentage (%) | Frequency | Percentage (%) |
Maternal age (years) | ||||||
15-20 | 41 | 10.8 | 29 | 9.6 | 70 | 10.2 |
21-25 | 111 | 29.0 | 79 | 26.2 | 190 | 27.8 |
26-30 | 124 | 32.5 | 97 | 32.1 | 221 | 32.3 |
31-35 | 71 | 18.6 | 77 | 25.5 | 148 | 21.6 |
36 and over | 34 | 9.1 | 20 | 6.6 | 54 | 8.0 |
Total | 381 | 100 | 302 | 100 | 683 | 100 |
Nationality | ||||||
White British | 337 | 88.5 | 274 | 90.7 | 611 | 89.5 |
East European | 37 | 9.7 | 10 | 3.3 | 47 | 6.9 |
Asian & African | 4 | 1.0 | 9 | 3.0 | 13 | 1.9 |
Other European | 3 | 0.8 | 9 | 3.0 | 12 | 1.7 |
Total | 381 | 100 | 302 | 100 | 683 | 100 |
Previous Births | ||||||
None | 177 | 46.4 | 145 | 48.0 | 322 | 47.2 |
One | 131 | 34.4 | 98 | 32.5 | 229 | 33.5 |
Two or more | 73 | 19.2 | 59 | 19.5 | 132 | 19.3 |
Total | 381 | 100 | 302 | 100 | 683 | 100 |
Scottish Index of Multiple Deprivation | ||||||
Quintile 1 | 34 | 8.9 | 16 | 5.3 | 50 | 7.3 |
Quintile 2 | 77 | 20.2 | 89 | 29.5 | 166 | 24.3 |
Quintile 3 | 111 | 29.2 | 82 | 27.3 | 193 | 28.2 |
Quintile 4 | 114 | 29.9 | 91 | 30.1 | 205 | 30.1 |
Quintile 5 | 45 | 11.8 | 24 | 7.8 | 69 | 10.1 |
Total | 381 | 100 | 302 | 100 | 681 | 100 |
Effectiveness
CMU | Seaview | Cherrytrees | Total | |||
---|---|---|---|---|---|---|
Characteristic | Frequency | Percentage (%) | Frequency | Percentage (%) | Frequency | Percentage (%) |
1st Point of Contact Clinician | ||||||
Midwife | 372 | 97.6 | 268 | 88.7 | 640 | 93.7 |
GP/Other | 9 | 2.4 | 34 | 11.3 | 43 | 6.3 |
Total | 381 | 100 | 302 | 100 | 683 | 100 |
Gestation | ||||||
Before 12 weeks | 363 | 95.3 | 291 | 96.4 | 654 | 95.7 |
After 12 weeks | 18 | 4.7 | 11 | 3.6 | 29 | 4.3 |
Total | 381 | 100 | 302 | 100 | 683 | 100 |
Care Pathway | ||||||
Midwife-led | 259 | 68.0 | 227 | 75.1 | 486 | 71.2 |
Obstetrician-led | 122 | 32.0 | 75 | 24.9 | 197 | 28.8 |
Total | 381 | 100 | 302 | 100 | 683 | 100 |
CMU | Seaview | Cherrytrees | Total | |||
---|---|---|---|---|---|---|
Intended Birthplace | Frequency | Percentage (%) | Frequency | Percentage (%) | Frequency | Percentage (%) |
At Booking | ||||||
CMU | 197 | 51.6 | 199 | 65.9 | 396 | 58.0 |
Obstetric Unit | 130 | 34.0 | 56 | 18.5 | 186 | 27.2 |
Undecided | 42 | 11.0 | 42 | 13.9 | 84 | 12.3 |
Other Midwife-led Unit | 9 | 2.5 | 2 | 0.7 | 11 | 1.6 |
Home | 3 | 0.9 | 3 | 1.0 | 6 | 0.9 |
Total | 381 | 100 | 302 | 100 | 683 | 100 |
At 36 weeks | ||||||
CMU | 221 | 58.0 | 225 | 74.5 | 446 | 65.3 |
Obstetric Unit | 127 | 33.3 | 66 | 21.9 | 193 | 28.3 |
Undecided | 8 | 2.1 | 1 | 0.3 | 9 | 1.3 |
Other Midwife-led Unit | 16 | 4.2 | 5 | 1.6 | 21 | 3.1 |
Home | 1 | 0.3 | 2 | 0.7 | 3 | 0.4 |
Given Birth | 8 | 2.1 | 3 | 1.0 | 11 | 1.6 |
Total | 381 | 100 | 302 | 100 | 683 | 100 |
At Onset of Labour | ||||||
CMU | 194 | 50.9 | 188 | 62.2 | 382 | 56.0 |
Obstetric Unit | 154 | 40.4 | 105 | 34.8 | 259 | 37.9 |
Other Midwife-led Unit | 26 | 6.8 | 2 | 0.7 | 28 | 4.1 |
Home | 0 | 0.0 | 4 | 1.3 | 4 | 0.6 |
Given Birth | 7 | 1.9 | 3 | 1.0 | 10 | 1.4 |
Total | 381 | 100 | 302 | 100 | 683 | 100 |
CMU | Seaview | Cherrytrees | Total | |||
---|---|---|---|---|---|---|
Resuscitation Performed | Frequency | Percentage (%) | Frequency | Percentage (%) | Frequency | Percentage (%) |
None | 149 | 90.8 | 156 | 96.9 | 305 | 93.9 |
Stimulation | 9 | 5.5 | 3 | 1.9 | 12 | 3.7 |
Bag and Mask ventilation | 6 | 3.7 | 2 | 1.2 | 8 | 2.4 |
Intubation | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 |
Total | 164 | 100 | 161 | 100 | 325 | 100 |
Safety
CMU | Seaview | Cherrytrees | Total | |||
---|---|---|---|---|---|---|
Degree of Perineal Trauma | Frequency | Percentage (%) | Frequency | Percentage (%) | Frequency | Percentage (%) |
None | 70 | 42.7 | 93 | 57.8 | 163 | 50.1 |
First Degree | 53 | 32.3 | 50 | 31.1 | 103 | 31.7 |
Second Degree | 37 | 22.6 | 18 | 11.1 | 55 | 16.9 |
Third Degree | 1 | 0.6 | 0 | 0.0 | 1 | 0.3 |
Episiotomy | 3 | 1.8 | 0 | 0.0 | 3 | 1.0 |
Total | 164 | 100 | 161 | 100 | 325 | 100 |