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A Framework for maternity services in Scotland
 A
modern 21st century maternity service
Setting the context
This Framework sets out a philosophy for care and the roles of the key professionals
providing care.
Philosophy of care
Childbirth and early infancy have an unparalleled impact on the lives of parents.
The arrival of a baby is a significant event which impacts on the physical and
psychological health of the mother, the emotional adjustment of the parents
and the social relationship within the family unit. Pregnancy and birth are
periods of transition for parents, especially with a first baby, that requires
them to adapt to new roles and responsibilities.
A modern maternity service should aim to provide care and services to:
- help achieve the best possible start to family life; mothers who are healthy
and confident, and babies who are healthy and well cared for;
- make sure that quality services are woman and family-centred, essentially
community based and midwife managed while demonstrating a shared philosophy
of care irrespective of risk;
- provide a holistic package of care and consistent information throughout
the year of pregnancy, from pre-conception to parenthood, to allow women,
their partners and their families to maintain healthy lifestyles and make
fully informed choices about the circumstances in which the birth takes place;
- consult locally, and involve women and their partners, to make sure that
services match as closely as possible the needs of individual women. Services
should take into account women's right to privacy and dignity throughout their
contact with maternity services, as well as the clinical safety of the woman
and her baby;
- provide care for women and their families acknowledging their cultural values,
beliefs, attitudes, ethnic background and lifestyle;
- make sure that the professionals delivering the care have current knowledge
and skills according to the level of service they provide. At all times, care
should be delivered by the most appropriate trained professional according
to the level of need of the woman and her baby;
- provide continuity of care throughout, recognising the roles of all professionals.
Care during pregnancy and childbirth should be provided as close to a woman's
home as possible taking account of geography and demography, with agreed referral
pathways to other services and agencies in a network of maternity care;
- make sure that consideration is given to the nature of the physical surroundings
in which women are receiving care throughout pregnancy and childbirth, making
sure that a homely environment and efficient and effective hotel services,
such as catering and domestic services, are provided.
A number of key care providers have important roles in delivering this service
philosophy.
Care providers
A number of key care providers are involved in the delivery of maternity care.
Midwives are the main providers of care to pregnant women throughout
pregnancy, childbirth and the postnatal period.
Midwives provide clinical care and emotional support in both community and
acute care settings, and are usually the lead professional throughout pregnancy
and childbirth for women with low risk pregnancies.
Their expertise is in normal pregnancy, childbirth and postnatal care, and
in making referrals to appropriate medical professionals and others if they
detect deviations from the normal. They also have a significant role in health
education and in supporting the mother and family in the transition to parenthood.
But rostered work patterns impact on service provision and continuity of carer.
Around 50% of midwives in Scotland are employed on part-time contracts and in
some areas, such as Fife and Lanarkshire, over 70% of midwives are working part-time.
In some of the more remote and rural areas, midwifery services are provided
by staff who carry out either community nursing, or community nursing and health
visiting alongside their midwifery role.
The new role of Consultant Midwife combines research, education and
leadership functions with a 50% clinical input.
General Practitioners have a responsibility for providing holistic care
to the whole family. They also have a continuing role in promoting health and
treating illness in pregnancy.
In most circumstances, they are the professional who confirms pregnancy and
many are still involved, to varying degrees, in providing "shared care" during
pregnancy and the postnatal period, especially for women with higher risk pregnancies.
They are occasionally chosen by women as the lead professional, but most GPs
have withdrawn from active participation during childbirth.
Obstetricians/Gynaecologists are expert in all aspects of pregnancy
and childbirth. They may be generalists or sub-specialists in maternal fetal
medicine, infertility, gynaecological oncology, gynaecological urology or community
gynaecology.
Obstetricians have a specific expertise in treating complications of pregnancy
and childbirth, and providing specialist screening and treatment. Women may
occasionally choose the obstetrician as the lead carer.
Women with a high risk pregnancy will have their care managed by an obstetrician,
with midwifery and GP support. Other women may see obstetricians to receive
specialist advice, have access to specialist screening, or to meet the consultant
who will be responsible for providing care if their pregnancy becomes high risk,
or if emergency support is required.
Paediatricians and Neonatologists have a responsibility for looking
after the medical needs of all babies, including premature infants, babies who
are ill, and babies with congenital abnormalities. Consultant paediatricians
provide hospital services for all children. Neonatologists are paediatricians
who specialise only in the care of the newborn baby, and they develop and supervise
intensive care, high dependency and special care services. All paediatricians
are fully trained in resuscitation and stabilisation of sick newborn babies.
They supervise clinical examination of the baby, and must be skilled in communication
with parents, especially in discussing anxieties about their baby.
Neonatologists work closely with obstetricians and midwives to plan care of
newborn babies when abnormalities have been identified prior to birth. Planning
with the parents may include choosing the optimal time of birth, maturing the
baby prior to delivery, and organising the appropriate intensive care facilities
for the sick newborn baby.
Neonatologists also have a responsibility for working closely with neonatal
nurses and midwives to make sure that a newborn baby is looked after with compassion
and respect, and that the parents are supported throughout the stressful time
while their infant is in a Neonatal Unit.
Obstetric Anaesthetists play an integral part in the team caring for
women during pregnancy and childbirth. They currently provide care for approximately
35% of women in labour.
Anaesthetists usually see women for counselling and advice at the request of
an obstetrician, GP or midwife. They provide routine epidural services for women
during childbirth and they are skilled in administering epidural, spinal and
general anaesthesia to pregnant women, and caring for them in emergency situations
including high dependency and intensive care.
Health Visitors are nurses who have specialised in family and public
health. They can work with midwives to provide parenting education and support
during pregnancy. At the point when midwifery care ends, health visitors take
on responsibility for the mother, baby and family, and will often have had contact
during the immediate postnatal period.
They play a key role in supporting families with child development, parenting,
social and emotional issues. They have a holistic role in healthcare and health
promotion, working with other agencies for all families, but particularly in
supporting the most vulnerable members of the community.
A number of non-NHS/Voluntary Organisations provide a valuable service
to women including parent education sessions, breastfeeding support and counselling
and support following bereavement, for example, the National Childbirth Trust
and the Stillbirth and Neonatal Death Society.
This Framework provides women with an opportunity to exercise choice in identifying
a lead professional for their care. Every woman should have a care co-ordinator
who would normally be a midwife. But, whoever they choose, they will continue
to receive midwifery care.
Women will have access to specialist ultrasonography services, and if
these are not available locally they will be referred to the closest linked
unit. Women should also have access to physiotherapy and dietetic services
during pregnancy and in the postnatal period.
The Scottish Ambulance Service (air and road) has an important role
in the urgent and routine transfer of women and babies to maternity units by
paramedics and ambulance crews trained to provide care for pregnant women and
newborn babies.
Women may also require input from other services including mental health,
community pharmacists, substance misuse workers, social workers and others.
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