RCM media statement on Dr. Gray’s Hospital Maternity Services in Elgin Scotland
The Royal College of Midwives (RCM) is aware that there is significant concern being expressed by members of the Elgin and Moray community about the proposed changes to maternity services at the Dr Gray’s hospital and we understand those concerns. The maternity services in Elgin are a much loved, valued, highly respected and vital part of the community.
The RCM believes that women and their families should be able to access high quality safe maternity care as close to their home as possible.
The RCM’s understanding of the situation is that the maternity unit will temporarily become a midwife led unit, changing from its current status as a consultant led unit. The midwife led unit will be able to provide labour, birth and early postnatal care to healthy women who do not have complications in their pregnancy and do not have risk factors that mean they would be advised to give birth in a consultant led setting. Where it is known before labour starts that a woman will need obstetric led care, women will be advised that they will generally be cared for at Aberdeen maternity hospital. Where a woman starts her labour at the midwife led unit at Dr Gray’s, but then requires transfer to consultant led care, the Scottish ambulance service will follow established transfer arrangements and generally take the woman to Raigmore hospital as it is the nearest obstetric unit for most women living in Moray. Women, whatever their health status, will be able to continue to receive their routine antenatal and postnatal care as they always have in Elgin and Moray.
The RCM would like to reassure women and their families in the Elgin area that there is strong research evidence for the safety of freestanding midwife led units. The ‘Birthplace’ study undertaken by the National Perinatal Epidemiology unit and published from 2011 to 2017 looked at the outcomes of around 65,000 births and found that for healthy women with a low risk of complications, a midwife led unit offers a safe place to give birth. In fact, women who give birth in a midwife led setting are less likely to experience interventions, while having as good outcomes for themselves and their babies, as women who give birth in an obstetric led setting. Women who have given birth before have a low chance of being transferred because of complications arising during labour or birth (about one in ten chance). Midwife led units are a well established model of care in many parts of the UK, including other rural areas in Scotland and Wales, with similar travel times to the obstetric unit as in Elgin. Dr Gray’s hospital has a great team of very experienced, committed and highly skilled midwives who are educated to a high level to provide safe and high quality care to women throughout the childbirth journey. They have up to date training on all aspects of care including identifying the need to transfer in a timely way, recognising complications early and responding effectively to any emergency situation. Childbirth for most women is a normal physiological process that does not require medical intervention. Midwives are the experts in facilitating this physiological process, with the skills to intervene if needed.
The RCM’s understanding of the reason for the change in status of the maternity unit in Elgin is due to long standing and recurring problems with recruitment of doctors to work at Dr Gray’s, particularly in the paediatric team. The RCM agrees that if safe levels of medical cover are not possible, then it is not safe to continue to offer a service for high risk women and babies that are likely to require medical intervention.
Since the problems with medical staffing at Dr Gray’s became very apparent in Spring 2017, the RCM’s Director for Scotland and the team in Scotland have been in regular contact with the managers of the Grampian wide maternity services and have met with our midwife members at Dr Gray’s and supported members at a number of meetings with managers when discussing the changes. From these ongoing discussions we know that the decision to move to a midwife led unit model has not been taken lightly and that very significant and ongoing work has been undertaken to seek to address the gaps in medical staffing at the hospital. We have also been reassured that time has been taken to ensure that the midwives and other staff in the maternity unit at Dr Gray’s have had the preparation, guidance, support and systems in place to ensure that they will be ready to provide this midwife led service successfully and safely.
We have been in communication with the Heads of Midwifery in both Raigmore and Aberdeen maternity hospitals about their capacity to receive additional admissions to their labour wards as a result of the change. The RCM will continue to monitor this situation closely and are encouraging our RCM midwife and maternity support worker members in those areas to contact the RCM team if they have any concerns.
The RCM are very aware and concerned about the ongoing pressures and difficulties in recruiting and retaining a range of health professionals in a number of areas in the North of Scotland. We have been lobbying to address these pressures in relation to midwife numbers through the increase in student midwife places, the development of a new shortened midwifery training programme in Inverness, the retention of the bursary for student midwives and by marketing vacancies widely across the UK. We are hopeful that the improved pay deal we have negotiated for health professionals in Scotland may help the service attract and keep midwives in our service. There is clearly still significant work to be done to address the workforce shortages in the North of Scotland and we will continue to lobby the Scottish Government to take bold and timely action to address them.
Further information about the Birthplace study can be found here: https://www.npeu.ox.ac.uk/birthplace
For more information about midwifery units, see the Midwifery unit network: http://www.midwiferyunitnetwork.com/
Information for women and families about having a baby in a midwifery unit can be found here: https://www.nct.org.uk/birth/giving-birth-midwife-led-unit-or-birth-centre
To contact the Media Relations team call 020 7312 3456, or email firstname.lastname@example.org.
The RCM is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance and information, and learning opportunities with our broad range of events, conferences and online resources. For more information visit the RCM website at https://www.rcm.org.uk/.