From: Louise Silverton <[log in to unmask]>
Date: 1 December 2014 09:22:18 GMT
To: "'[log in to unmask]'" <[log in to unmask]>
Cc: "Billie Hunter ([log in to unmask])" <[log in to unmask]>, "Colin Beesley" <[log in to unmask]>, Manuela Helena Da Costa-Fernandes <[log in to unmask]>, 'Soo Downe' <[log in to unmask]>, "J Sandall" <[log in to unmask]>
Subject: Sunday Times article

Dear All,

 

Excuse me for gate crashing your group but Billie sent me your messages. What we have here is an example of the RCOG getting its attack in first. As a stakeholder in the guidelines (as is the RCM), they were sent an embargoed copy of the guideline being launched on Wednesday. The press conference for this takes place at 10 today. Cathy Warwick will be there to speak to any journalists. This is evidence of how seriously the RCM takes these guidelines.

 

I was contacted by the author, Sarah Kate Templeton on Friday and referred her to the original report. I disagreed with her figures regarding the doubling of the risk and referred her to the correct tables in the cohort study report. I even emailed this to her. Despite this she has continued to misquote the report. I do think though that the small quote from the long conversation I had with her is correct.

 

One other point worth making is that the only person the Sunday Times could find to argue against this recommendation is a retired surgeon and not even an obstetrician. The only case mentioned dates back to 2009 since which there has been a rise in midwife led births. It would be interesting to see the equivalent figures for hospital births over this period! What we need to do is to debunk the default position that hospital birth is both safe and optimum. We have evidence that this is not the case.

 

We have refuted the contents of the 2011 BMJ letter but there is still a number of our obstetric colleagues who are implacably opposed to out of hospital birth.

 

As the RCM lead on research, is it possible for me to be a member of your email group? It would assist me in communicating with your members.

 

In case people haven’t seen it, I have copied the article below

 

With all best wishes

 

Louise

 

 

 

IT IS safe for women to give birth in midwifery units miles from the nearest hospital, controversial new guidelines will say this week.

The National Institute for Health and Care Excellence (Nice) is expected to recommend that even first-time mothers can safely use the centres, which are staffed only by midwives.

The guidelines are supported by the Royal College of Midwives (RCM), which says they will encourage women to give birth without medical intervention such as an epidural or forceps delivery.

But some doctors fear babies will die when mothers get into difficulty during labour and have to be transferred sometimes long distances to hospital by ambulance.

Dr Peter Milewski, a retired surgeon who has campaigned against the closure of maternity hospitals, said: “I would disagree with any advice to first-time mothers that it is safe to deliver in freestanding midwifery units. In my opinion, that is not safe.

“There is good evidence that higher transfer distances increase perinatal mortality. That is why I shall not be willing for my daughter, who is due her first baby shortly, to be persuaded to use a freestanding midwifery unit.”

Milewski said that in Pembrokeshire, west Wales, where he lives, transferring a mother from a midwifery unit to a hospital could take up to an hour.

Nice will make the recommendation despite objections from the Royal College of Obstetricians and Gynaecologists (RCOG). The professional body says first-time mothers, who are at higher risk of suffering problems, should give birth either in hospitals where they can be treated by consultants if they require medical help or at midwifery units alongside hospitals.

In a letter to the British Medical Journal (BMJ) in 2011, the RCOG wrote: “Transfer for [first-time mothers] was up to 45% for mothers delivering at home or in midwifery units into obstetric units. Based on these findings, the RCOG advocates that first-time mothers should be advised of the benefits of delivering in obstetric units or alongside midwifery units.”

Nice will base its recommendations on the Birthplace study, which analysed data from all freestanding midwifery units. It was published in the BMJ in 2011 and concluded there was no significant increased risk when a baby was delivered in a midwifery unit.

However, an analysis of only those units that had submitted at least 85% of the required data — about three quarters of the total — found a baby had more than double the risk of suffering serious harm or death if born in a freestanding midwifery unit rather than a hospital staffed by obstetricians.

Maureen Treadwell, cofounder of the Birth Trauma Association, which campaigns for women to be given the choice of a hospital birth, said: “There is no robust evidence for this [recommendation] whatsoever. If it is deemed to be both ‘safer’ and ‘cheaper’, health commissioners will only commission places [in hospitals] for high-risk women.”

Many maternity hospitals that were previously staffed by consultant obstetricians have been closed or downgraded to freestanding midwifery units. Many of the consultants have been moved to larger specialised maternity hospitals.

Louise Silverton, director for midwifery for the RCM, defended the validity of the research. “For many women, what had been their local obstetric unit has now become midwife-led but they want to have their baby in their own town,” she said.

“I do not see any reason why, if they have no complications, they should not have their baby at that same unit but under midwife care. If things don’t work out, she transfers.”

Kate Stanton-Davies died six hours after she was born at a freestanding midwifery unit in Shropshire in March 2009. An inquest ruled she could have survived had she been born at a hospital and that being born at the midwife-led unit had contributed to her death.

Her mother, Rhiannon Davies, had suffered complications and her daughter fell ill soon after birth. By the time she was transferred the 40 miles by air ambulance from the midwife-led unit at Ludlow Community Hospital in Shropshire to Birmingham Heartlands Hospital, it was too late.

Davies said: “Absolutely, categorically, no first-time mother should go anywhere near a stand-alone unit. If they want low intervention they should be in an adjacent midwifery-led unit. If anything goes wrong you have then got an operating theatre, obstetricians and your life and your baby’s life can be saved.”

Meg Pickard, 40, a digital consultant from south London, gave birth to her daughter, Erin, two, at home and believes that it was far less stressful than going into hospital.

“There was something about being in a foreign environment with strip lighting and a hospital bed that got me a bit stressed [so] . . . I changed to a home birth. The home birth team couldn’t have been more supportive.”

 

 

Louise Silverton

Director for Midwifery

The Royal College of Midwives

15 Mansfield Street

London W1G 9NH

 

Tele:  0300 303 0444

Fax:   020 7312 3536

Web:  www.rcm.org.uk

 

 

Supporting seasonal flu vaccine for  midwives and pregnant women

 

 

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