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
Table 20 Levels of care by location, childbirth
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
- 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:
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