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