What happens at the moment in Nottinghamshire?
Find out more about what happens at the moment in Nottinghamshire and your feelings about the service in these four areas by using the quick links.
Pregnancy Care
Birth
After the baby is born
Specialist care for the smallest, critically ill babies
Women tend to access the service through their doctor who then refers them to a midwife, based in their GP surgery or a Children’s Centre, for most of their pregnancy care.
Women are currently classed as ‘high’ or ‘low’ risk early in pregnancy. This takes into account things like the woman’s age, the results of some initial tests and whether a woman has had a baby before.
Those defined as ‘high risk’ may then attend hospital for most of their pregnancy care. In some cases this care could safely be provided more conveniently, nearer to home.
Many women need a medical opinion at some stage during their pregnancy, but then have no further problems and are no longer ‘high risk.’
Women told us…
“The midwives were really caring they made you feel like an individual.”
“I felt particularly well supported by community midwives.”
“The baby defines what it is all about, while maternity focuses on the care that is needed to make sure the mother is healthy. You need to consider both.”
“I didn’t have the same midwife twice for antenatal care.”
“I had to explain the same thing over and over.”
“Not all health professionals, including GPs, and midwives, are reading from the same book. It’s just their own opinions; they often say don’t say I said this but…”
“Because I moved, my records were missed, so it was a good six weeks after the birth until I could see a GP, even though my daughter was early. What would happen if there had been complications? People are always too busy.”
Women tend to access the service through their doctor who then refers them to a midwife, based in their GP surgery or a Children’s Centre, for most of their pregnancy care.
Women are currently classed as ‘high’ or ‘low’ risk early in pregnancy. This takes into account things like the woman’s age, the results of some initial tests and whether a woman has had a baby before. Those defined as ‘high risk’ may then attend hospital for most of their pregnancy care. In some cases this care could safely be provided more conveniently, nearer to home.
Many women need a medical opinion at some stage during their pregnancy, but then have no further problems and are no longer ‘high risk.’ The vast majority of women have their babies in hospital, mainly on busy labour wards with a mixture of normal and complicated cases. Very few women meet their birth midwife during the pregnancy.
Home birth is available for a few women, depending on their medical history. The opportunity to choose home birth varies across Nottinghamshire, partly due to the way services are organised. Women may be encouraged not to choose a home birth on grounds that are not medical.
Where women do have their baby at home, two midwives come to care for the mother and baby, bringing their equipment with them. There are midwife-led home-fromhome rooms, in King’s Mill Hospital, and at both Nottingham University Hospital sites. These are in the same buildings as consultant-led maternity care.
They are suitable for women who have had a healthy pregnancy and want a natural birth in a homely and relaxed atmosphere. These facilities are being increased and women will be given clearer choices. There are no separate stand alone midwife-led units or centres in Nottingham City or Nottinghamshire County.
Midwife-led units or centres are those where birth is supported in a home from home environment by a midwife in a separate and distinct midwifery facility. These may be co-located with existing labour facilities but are not part of labour suite or may be units away from the main hospital facilities.
Consultant-led maternity facilities are based in King’s Mill Hospital, and at both Nottingham University Hospital sites. They are intended for women with medical, pregnancy or labour problems, and for those who want to have epidural pain relief during labour. However, anybody can choose to have their baby here if they wish.
What women told us…
“Staff were nice when you needed them.”
“I was told there was no bed space when my waters broke so was sent home.”
“I think the continuity of care during labour was brilliant.”
“Sometimes I don’t feel like their hearts are in it anymore…I didn’t even know her [the midwife] shifthad changed.”
“No need for doctors if things are going well – they have better things to do.”
“A lot of people are now having the baby at home. I had my baby that way, its much better. I got two midwives to myself.”
• There is not enough support for breast feeding.
• After discharge from hospital a community midwife visits the mother and baby at home.
Specialist care for the smallest, critical ill babies
Intensive care for newborn babies is required when babies are born very early, have problems that need surgery or develop serious illnesses after birth. This sort of care is required only by a small proportion of babies born each year but the availability of a highly technical and expert service can be life saving. This has also been associated with falling infant death rates and a reduction in disabilities found in survivors.
Neonatal care is organised in networks so that care for sick babies is provided in local hospitals where possible. The smallest and sickest babies who need the most care are transferred to those centres in each network with the expertise and staff to deal with them. When possible mothers are transferred before birth rather than the baby after birth. In Nottinghamshire the hospitals are part of the Trent Perinatal Network which includes Nottingham, and Kings Mill but also Derby, Lincoln and Boston.
The neonatal unit at Kings Mill offers care for 18 babies including three intensive care cots and four high dependency cots. The smallest and sickest babies (below 28 weeks of pregnancy) are currently transferred into the Nottingham Hospitals for ongoing care in a planned manner as part of the network.
In Nottingham, there are two intensive care units for babies. The neonatal intensive care unit at the City Hospital Campus has 24 cots and provides medical intensive care for babies born there of all gestational ages and transferred into Nottingham. The neonatal intensive care unit at the Queen’s Medical Centre (QMC) has 20 cots and provides neonatal intensive care of all levels as well as specialist care including surgery, neurosurgery, ophthalmology and Ear, Nose and Throat (ENT).
Women told us……
“The hospital was obviously shortstaffed. I had a younger daughter so I wanted to leave on Saturday but there was no paediatrician available to discharge me. I either had to wait until Monday when he was back in, or discharge myself and come back in on Monday!”
“Core stuff around post natal physical and mental health needs to be sorted. Mums can feel isolated in the process.”
“I was supported with breast feeding for four hours.”
“The patient hotel was very professional.”
“I felt abandoned after birth.”
“You get a bit bullied…particularly around breastfeeding. I felt very insecure.”
“The midwives were really kind to me. They really looked after me and my baby and didn’t look down their noses at me.”
