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Jo
It was the North Hants Hospital in
Basingstoke. Below is the message that was sent to the NCT list that I
am on which. The person who told us about it is a member of the
Maternity services comittee there.
St George's in Tooting, London have also reduced
their rate from 24 to 18 percent.
Debbie
The North Hampshire Hospital, Basingstoke,
has halved its caesarean section
rate! > The Head of the Labour Ward (Carol) is behind it, supported by the Lead Obstetrician (Claire). Carol was at the last Rising Caesarean Rate Conference in January and expressed her frustration that it was all very well but what *exactly* had to happen to get the rate down. > > The Maternity Forum met last week, and since we have just lost our administrative support goodness knows when we'll get any minutes so what follows is from my memory: > > The graph showed that the csr peaked in Dec/Jan at around 28-30%. There was lots of talk about how they could get the rate down. From May there has been a steady decline in the rate reaching 15% in October, and 13% over the first couple of weeks in November. They are hoping to be able to maintain this. They are really excited by their success, but it was clear they wanted to maintain it for a few more months before they feel confident to start shouting about it. The year end csr won't show the dramatic improvement although they are expecting it to end up at around 20% overall as opposed to 25% last year. > > So, how have they done it. Well it is multifactorial. > > 1. Feb/March saw the annual change of registrars. Two female registrars joined who are very pro vaginal birth. > 2. VBAC - women with a history of caesarean section are encouraged to labour. > 3. Breech - Despite results of the Term Breech Trial, they are still supporting those women who wish to give birth vaginally to breech presenting babies to do so. In 1991 3% of breech babies were born vaginally, currently 15% of breech babies are born vaginally. > 4. CTG training package - Last year they had a doctor who was very interested in this and who put together a very good training package for the midwives resulting in better interpretation of EFM traces. > 5. Carol was given a small amount of money to spend on improving things for women. She decided the beds in the labour rooms looked very clinical and spent the money on nice duvet covers and pillow cases (no, wait, keep reading). She then moved the beds so they are along the wall, with a chair in front of bed. Male partners are encouraged to sit on bed with the labouring woman using the chair. Women then generally stand up and move for contractions, the more upright position being better for labour. She has had to fight to keep those beds along the walls. Auxillary staff keep moving them back to the middle and it sounded like she has had a bit of a set to with them. Her and Claire have had to be very persistent in moving the beds back! But she has won. > 6. Induction - There has been a change of induction procedure. Epidurals are no longer fitted before induction but are available afterwards if and when needed. Women are finding that they can cope with induced labour and midwives are gaining confidence that women can cope. More inductions are being carried out since it is now policy to induce at 10 days (due to NICE guidelines) rather than 12 days as previously, but more are resulting in spontaneous vaginal deliveries. > 7. Midwife ventouse practitioners - Basingstoke now have four midwives trained to do ventouse deliveries. In 55% of cases where a midwife is called to carry out a ventouse delivery, a spontaneous vaginal birth is achieved. But more important are the opportunities this gives for experienced midwives to pass on their skills to less experienced midwives. > > What these measures have succeeded in doing is changing the attitude of the unit as a whole. It is early days yet, but they have high hopes of being able to sustain the change. They have recently taken on a new obs and Carol says she made it very clear to him at their first meeting that this is how things are going to be run and that he will have to fit in. > > There was another graph too. Just in case anyone thinks they are doing less cs and more forceps/ventouse that is not the case. The forceps/ventouse deliveries have remained unchanged. The number of caesareans has gone down and the number of svd's has gone up. > > I am so please this has happened anywhere, but for it to happen on my patch > is great - although I can claim absolutely no credit whatsoever! ----- Original Message -----
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