A letter sent to Jacob Rees-Mogg by chair of Royal College of Midwives Bath and Trowbridge branch

Dear Mr Rees-Mogg,

I am writing in response to the recent proposals made by the ‘Local Maternity System’ regarding the future of local maternity services, which you will find attached to this letter.

The local branch of the Royal College of Midwives, as an organisation that advocates for childbearing women and the Midwives who provide their care, would like to highlight the following concerns to anyone planning to respond to the public consultation, which ends on the 24th of February.

You will observe that these proposals include the reconfiguration of birth services in our immediate area, which will result in the end of births being supported at Paulton and Trowbridge Birth Centres.

These proposals are being made at the same time that a number of similar birth centres are closing their doors across the country, most locally the outstanding facility at Cossham in Bristol, which flies in the face of recent NICE guidance recommending that women at low-risk of complication avoid hospital birth.

Further into the redesign plan there may be provision of a Midwifery-led unit similar to that currently provided in Paulton, located on the Royal United Hospital site alongside the main Obstetric-led unit.

However, this part of the plan is far from certain, dependant as it is upon permissions and funding. In the meantime, women from our local area will be restricted in their choices of birthplace.

It is unclear how long this situation will continue once intrapartum care ends at Paulton.

Once operational, the ‘alongside’ midwifery unit will offer women at low-risk of complication midwifery care in a setting distinct from hospital, but on the same site. It is clear that this will be of benefit to women in the Bath area, who have historically been unaware of the option of using the existing birth centres.

Such alongside units as the one proposed have been shown in research evidence to offer improved outcomes for women and babies at low risk of complication when compared to obstetric settings, but not when compared to freestanding units such as Paulton.

Indeed, women who are having their second or subsequent babies are at higher risk of intervention and complication when giving birth in alongside midwifery units than freestanding ones.

Unfortunately this information is not discussed in the public consultation document.

Other concerns regarding the provision of a new alongside unit raised by staff include the expectation that pressure on the main unit will inevitably result in movement of staff from the alongside unit, thus compromising care offered and potentially limiting women’s choices further.

Training to ensure competence and confidence in providing midwife-led care will also be a concern for staff who have so far only worked in the obstetric setting. Staff who are experienced in midwife-led care in the community units under threat are unhappy about the prospect of being expected to work in a number of different settings also.

Research evidence in this area shows that supporting specialism results in improved outcomes for families, as well as improved morale amongst staff. Important skills will be adversely affected by reducing the number of settings in which midwives can practice, and this could consequently increase risk for women and babies.

During the course of the public consultation, some concerns have been raised regarding the presentation of data, and the RCM would like to clarify some of the terms used.

Transfer during labour from Paulton was quoted as being as high as 50% for first-time mothers at a recent meeting. This figure comes from Paulton’s most recent data for the last quarter.

Such small data requires careful interpretation, due to the variance observed over time. National figures quote 1 in 4 women being transferred to hospital from such units during their first labour.

The predominant reason for these transfers was stated as being “fetal distress”. This term has not been used for some considerable time, being emotive and inaccurate. In fact, most problems identified in labour when a thorough risk-assessment has taken place are slow- growing problems, where preparations for transfer can be made calmly.

The majority of ladies transferred during labour from Paulton also go on to have vaginal births. The way this particular area of information has been imparted is of some concern, since perception of risk is a major aspect of decision-making for families planning birth, particularly for the first time.

Another aspect of the case for change within the document refers to the upkeep of inefficient buildings. The Paulton Hospital League of Friends has a substantial pot of funds donated for maternity, which would cover the cost of refurbishment in the event of the centre’s future being confirmed.

Centres such as Cossham are prime examples of how sensible investment into older buildings can and does result in effective services being provided. Some 350 babies were welcomed at Cossham in the year before it was forced to close its’ doors.

Whilst all would agree that the local birth centres are currently under-utilised, and the figures presented by the Transforming Maternity Services team are a compelling case for change, it must be acknowledged that one cannot measure the extent to which a local facility is valued within its’ community.

Generations have been born at Paulton, and there are many families who would dearly love to continue this part of their tradition. Staff at Paulton birth centre are dedicated individuals, who are invested in their community and passionate about providing continuity of care for local families

Being unable to offer birth with a familiar midwife is a big step in the wrong direction for the continuity agenda outlined by the Better Births strategy.

In an age where all interactions can be remote, having a baby should remain an intimate, special time where a family can be integrated into their community. Due to the distribution of population within the area of the consultation, it is feared that the many voices of families in Bath itself will drown out those of this locality, and result in the proposals being implemented unchallenged.

As Midwives, a fundamental aspect of our role is to make sure that any information or advice given is evidence- based, including information relating to using any health and care products or services.

I feel that the RCM and other local representatives, such as yourself, have a role to play in promoting informed engagement with this public consultation, to ensure that the views of people are represented and based upon sound information. I hope that we have your support.

Yours sincerely,

Melody Rich BSc (Hons) RM PG Dip

Chair, Royal College of Midwives Bath & Trowbridge branch