Why births were halted at maternity unit: your questions answered

Northumbria Healthcare NHS Trust medical director David Evans explains the decision and answers your questions

Why was the decision made so quickly and without notice?

The extremely small numbers of births at Berwick has given us cause for concern for some time, but the recent further drastic decline has made the situation critical which is why we took the decisive action last week to protect both our midwives and the mothers and babies in our care. Following discussion with our commissioners and given the low numbers of women booked in for delivery, we could not let the situation continue without review.

What are the safety issues?

Our concerns over safety relate directly to the low number of births. All midwives must be able to regularly practise everything from antenatal care through to postnatal care, but most importantly, the actual delivery of babies, in order to maintain their skills. This is simply not happening in Berwick and our prime concern has got to be the safety of the women and babies in our care.

Have mothers and babies been put at risk already?

There have been two recent serious incidents which have brought the issue of low birth numbers to our immediate attention which is why we took the decisive action last week. We cannot comment further on these incidents due to patient confidentiality but they caused us enough concern to temporarily close the unit to births with immediate affect.

What will the internal review look at?

Working with the Local Supervising Authority of Midwives (the independent body which oversees all midwifery practice in the North East) and our commissioners NHS North of Tyne, we intend to thoroughly review, in line with national best practice, both the volumes of births required and levels of regular birthing practice required, in order to provide a safe and sustainable midwifery service.

Will the strength of public feeling in opposition to the closure be taken into account when deciding what service provision there will be in the future?

Absolutely, any long term future changes would of course require full public consultation. We are also in discussion with our commissioners to plan some engagement activity with local women and their families during the temporary closure, to help us better understand about the maternity service they will be looking for in the future.

How many babies would need to be born in Berwick each year in order to justify keeping the unit open to births?

This is what we are hoping to determine from the internal review. Our absolute priority must always be the safety of mothers and babies in our care and we need to thoroughly examine, looking at all possible evidence, what a safe and sustainable service may look like in the future.

Critics say the falling birth rate is not because women are choosing to have babies elsewhere but because a lack of resources in Berwick mean most have no choice but to go elsewhere. Why has the maternity unit been under resourced?

The midwifery-led unit at Berwick has not been under resourced. In fact, we have continued to invest in the unit to make sure women have access to the best possible maternity care – equal, if not better, than that of any other midwifery-led unit across the country. For a lot of women however, even when they are considered low risk, they simply feel more secure giving birth in a larger, consultant-led unit where they are surrounded by emergency medical teams should any problems arise.

Why not invest money in Berwick Maternity Unit to ensure it is equipped to deal with all births rather than risk sending women 50 miles away?

It is simply not possible for the NHS to deliver a full consultant-led midwifery service in every single hospital in every single town and city across the country – to do this also requires intensive care facilities, theatres, not to mention extensive staffing which would be impossible for the NHS to sustain, especially in areas with relatively small populations and low volumes of birth. That is why in many areas, like Berwick, we can offer a midwifery-led service as a safe alternative for those women who are considered low risk. For women in Berwick who are high risk or who simply want the comfort of a larger consultant-led facility, they can already choose to deliver at Wansbeck General Hospital, which over 2300 women did last year.

Do you think a 100-mile round trip from Berwick to Wansbeck is an acceptable level of service?

Hundreds of women from Berwick already choose to deliver their babies in Wansbeck and that is because, after discussion with their midwives, they have decided that they want the extra peace of mind and security of delivering their baby in a consultant-led facility. During the temporary closure to births at Berwick, women also have the choice of accessing our midwifery-led unit in Alnwick, provided they are low risk.

Why have so many local mothers been advised to have their babies at Wansbeck Hospital, leading to a small number of births at Berwick?

Every woman is always offered a choice when arranging their birthing plan. All of our midwives follow national best practice guidelines on antenatal care and will discuss all of the options available. For many pregnant women in Berwick, after discussion with their midwives, they have decided that they want the extra peace of mind of delivering their baby in our consultant-led facility in Wansbeck, where they know specialist teams are on hand if there are complications.

Can women still choose to have a home birth in Berwick during the temporary closure?

No, during the closure babies will not be delivered in the hospital or the community area covered by the midwives working out of Berwick Maternity Unit. This is because we want to make sure our midwives get the chance to practise in a busier birthing unit so that they can bring their birthing skills and experience up to date. There were no home births during the past year and we do not expect this to affect any women.

Can you guarantee that antenatal and postnatal care will be retained?

Yes. The unit remains open seven days a week for antenatal clinics, consultant-led clinics, postnatal drop-in clinics and community midwifery services, including rural clinics. The temporary closure at Berwick Maternity Unit affects the actual delivery of babies only.

Why have more mothers not been offered aftercare at Berwick?

All women deemed medically appropriate will of course have been offered any necessary postnatal aftercare as an inpatient at Berwick Maternity Unit. However, like thousands of others across the north east, women are often back in the comfort of their own homes soon after giving birth, unless there is a medical reason why they need to remain in an acute hospital setting. During the temporary closure to births at Berwick Maternity Unit, no women will be admitted for postnatal care. All postnatal drop-in clinics will continue.

How can staff at Berwick be given more opportunity to keep up their skills and experience?

We greatly value the knowledge and skills of all our midwives which is why we are now taking all necessary steps to make sure our team in Berwick get the opportunity to bring their training and midwifery skills up to date by practising in a busier unit at Wansbeck General Hospital. During this time, our Berwick midwives will continue to provide all antenatal clinics, postnatal drop-in clinics and community midwifery services, including rural clinics from Berwick Maternity Unit which remains open 7 days a week such services.

How could more consultant and emergency support be provided for pregnant women in Berwick?

As with all midwifery-led units across the country, a consultant-led clinic for women experiencing high risk pregnancies is already held every week at Berwick Maternity Unit and this will continue during the temporary closure to births. Our advice, as always, for anyone faced with a medical emergency or life threatening situation would be to call 999 for an emergency ambulance.

When will the unit reopen?

It is not possible for us to put a timescale on this until we have completed the internal review which we expect to take around three months.

Will there be a maternity unit at Berwick’s new hospital? If so, what services will it provide?

We have previously said publicly that the model of care we are currently working on for the new hospital in Berwick would involve the relocation of the maternity unit. Discussions are ongoing regarding this and any decisions would need to ensure the highest possible medical standards and will of course need to be made in full consultation with the public.

David Evans is medical director at Northumbria Healthcare NHS Foundation Trust and has practised as a consultant obstetrician for the past 30 years working with hundreds of pregnant women.