"Never believe that a few caring people can't change the world. For,
indeed, they are the only ones who ever have."
Margaret Mead
----- Original Message -----
Sent: Tuesday, August 03, 2004 11:01
PM
Subject: Re: [ozmidwifery] the UK unit
that owered it's cs rate
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 -----
Sent: Tuesday, August 03, 2004 7:15
PM
Subject: [ozmidwifery] the UK unit that
owered it's cs rate
Can anyone remember the details of the UK unit
that lowered their cs rate dramatically by putting in place a heap of fairly
basic yet effective measures...things like upskilling care providers on
monitor interpretation and so forth.....
It was posted on the list a few years back and
although I have looked on the archives and searched my computer I simply
cant find it!
If anyone can help it would be
great!
cheers
Jo
