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Maternity Services in Scotland - Overview
This page will provide an introduction to Maternity Services in Scotland and supply resources and information hosted in this section.
In February 2001 A Framework for Maternity Services in Scotland was published by NHS Scotland and the Scottish Executive. The Framework was the product of a wide consultation with women and professionals. The following excerpt from the Framework outlines the care requirements and service planning needed to ensure that women's expectations of a positive birth experience are met. (Reproduced with kind permission of the Crown Copyright 2001.) Maternity services, including obstetric and neonatal services, should provide a fully integrated childbirth service responsive to the needs of mothers and their new-born babies. Local Action
- Women must be given information in a suitable format to allow them to understand that equal access to services cannot always be guaranteed because geographical factors can impact on the services available in their locality. Women must have information to allow them to make informed decisions by balancing risks;
- When planning the location for childbirth the following levels of care model should be considered in the local context: These are developed further in Table 20.
Level I
Primary Location
Ia
Home Birth
Ib
Stand-alone community maternity unit
Ic
Community maternity unit adjacent to a non-obstetric hospital
Id
Community maternity unit adjacent to a maternity unit
Level II
Secondary Location
IIa
Consultant-led maternity unit with no neonatal facility (<1,000 births)
IIb
Consultant-led maternity unit with on site neonatal facility (<1,000 births)
IIc
Consultant-led maternity unit with full range of services (1,000-3,000 births)
Level III
Tertiary Location Consultant-led Specialist Maternity Unit
Table 20 Levels of care by location, childbirth
Level of care
Location of delivery
Lead carer
Clinical situation
Care need and delivery
Suggested No. of deliveries per year
Ia
Home (planned)
Midwife (GP)
Normal pregnancy andlabour
Suitable home facility with back-up from the Scottish Ambulance Service (paramedics) and supporting advice from a linked maternity unit
Ib
Stand-alone community maternity unit
Midwife (GP)
Normal pregnancy and labour
Appropriately equipped midwifery unit for normal care and agreed transfer guidelines to a linked maternity unit
Ic
Community maternity unit adjacent to non-obstetric hospital
Midwife (GP)
Normal pregnancy and labour
As Ib above.Medical staff (surgeon/GP) appropriately trained to perform emergency caesarean section
Id
Community maternity unit adjacent to maternity unit
Midwife (GP)
Normal pregnancy and labour
As Ib above
IIa
Consultant-led maternity unit with no neonatal facility
Consultant Obstetrician (plus midwife)
Low risk pregnancy and labour
Maternity unit care with monitoring facilities and anaesthetic cover with no access to paediatric facilites on site
<1,000
IIb
Consultant-led maternity unit with on-site neonatal facility
Consultant Obstetrician (plus Midwife)
Low to medium risk pregnancy and labour
Maternity unit care with monitoring facilities, access to anaesthetic and paediatric cover, but transferring out as required to special care baby unit or neonatal intensive care in a larger maternity unit
<1,000
IIc
Consultant-led maternity unit
Consultant Obstetrician (plus Midwife)
Low and most high risk pregnancies and labour
Full maternity unit and support services with easy access to special care baby unit/neonatal intensive care and access to adult high dependency care and adult intensive care
1,000-3,000 approx
III
Consultant-led specialist maternity unit
Consultant Specialist in Maternal Fetal Medicine(Midwives plus other consultant specialists)
Complex and high risk pregnancies and labour
As for level IIc, but with on-site neonatal intensive care and access to neonatal surgeryand adult intensive care
>3,000
Acute and Primary Care NHS boards should jointly plan and provide a fully integrated neonatal service responsive to the needs of new-born babies and their parents. Local Action
- NHS boards should adopt the Neonatal Levels of Care model set out in Table 21 when considering the provision of immediate and early neonatal care. It is based on the British Association of Perinatal Medicine Guidelines adapted for this Framework, giving due consideration to local demography and clinical provision:
Table 21 Neonatal levels of care model
Level of care
BAPM category
Location
Lead carer
Support carer
Care
I
Normal Care
Home, GP/Midwife Unit, Maternity Unit I-III
Mother + wider family
Midwife, Neonatal Nurse, Paediatrician
Advice and supervision, birth examination, vitamin K administration, discharge examination, screening programme, parental support and education
II
Special Care
Maternity Unit I-III, Postnatal Ward, transitional Ward, Special Care Baby Unit
Midwife, Specialist neonatal nurse, Mother
Paediatrician, Midwife, Specialist Neonatal Nurse
Care and treatment exceeding normal care includes Level I care
III
Level 2 High Dependency Intensive Care
Maternity Unit II-III, Special Care Baby Unit, Neonatal Intensive Care
Paediatrician/ Neonatalogist
Specialist Neonatal Nurse
Continuous skilled supervision but not as intensive as Level IV, parenteral nutrition, respiratory support, intra arterial monitoring, includes Level I care
IV
Level 1 Maximal Intensive Care
Maternity Unit II-III, Neonatal Intensive Care
Neonatologist
Specialist Neonatal Nurse, Other consultant specialities
Continuous highly skilled supervision, assisted ventilation, circulatory support, peritoneal dialysis, post-op care, intensive parental support, Includes Level 1 Care
Full text of A Framework for Maternity Services in Scotland is available on the Scottish Government websites www.scotland.gov.uk and www.show.scot.nhs.uk
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Scottish Multiprofessional Maternity Development Programme - NHS Education for Scotland - 66 Rose Street - Edinburgh
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