Expecting a Perfect Start ....

Had a quiet afternoon reading the recently published report on our local maternity services.  We have in the London Borough of Hillingdon had an extra challenge to face with the closure of the neighbouring borough maternity unit at Ealing hospital.  This is part of the "Shaping a Healthier Future" for the North West of London.   The mothers now have to come to Hillingdon Hospital from the catchment area of Southall and Ealing.  I personally cannot see the logic in a growing population and a denser population in a small geographical area of closing units and putting pressure on another.  In the catchment area for Hillingdon area we have seen much needed apartment buildings in Hayes, West Drayton and Yiewsley .... they are popular executive look buildings with easy access to the city of London on the rail network to Paddington..... So this is attracting young couples and the inevitable happens babies come along.... !!

In Southall and the surrounding area of Ealing there are new builds and multiple rents for families, overcrowded houses turned into a maximum rent gain by landlords squashing in families - even to converting sheds into studio apartments.  This means intensification of the density of population and the result is babies come..!! 

So it soon becomes apparent that you need more maternity services not a reduced or uni-focal one.  Because of density of population roads become congested and it becomes difficult to get to that uni-focal maternity unit in a time of need or even to routine appointments.  

This does come out in the report too of the mothers fear of getting to Hillingdon in time from Ealing.  Also there is a cost burden to the need to travel.  This actually is not only a personal cost to travel, but I am thinking it is likely many will call for an ambulance in labour to ensure quick arrival at the maternity unit. So there is a spin off cost to the support services with this point alone. 
One thing that is not addressed in the report is the spatial arrangement of Hillingdon hospital.  We have for many years been asking for a complete rebuild of a new hospital but this has been promised and promised but not happened as yet.  The maternity unit is a small area given the need now to accommodate extra clients.   Now this does come out in the report in the fact that Antenatal facilities feel over crowded.  There is an innovative request for a text message to let women know when they are to be seen... so that they can go out in the grounds or away from the clinic to reduce the congestion.    But compared to other units I have practiced in as a midwife the unit is small. Leeds maternity unit in the Clarendon Wing is spacious and our Birth Unit at St Tommys is spacious... mind you Tommys does have an edge on the fact it is the best place in the city to hang out with all the Tourist views on the doorstep! 
But if you are to merge units with workload doubling then there needs to be a building respect for this and space allocation. This is out of creating a good ambiance for clients and staff to be in but also out of safety as there will be a proportional increase in potential emergencies.   
There is in the report no indication of midwifery led units being built to ease the situation in key points in the catchment areas.... I am thinking back to the what was called the GP unit..... we had such in Otley General when I was having my girls.... this was really a midwifery led unit with call of GP for some obstetric need... but emergencies were blue light transfered to Leeds and then we had alternate days take between St James's University Hospital obstetric unit and Leeds Maternity unit - now the Clarendon Wing in LGI...... But many a good SVD was achieved in this midwifery led unit without a need to call the doctor... as indeed in many midwifery led units nationwide. 

In the report the women had highlighted conflicting advice on breastfeeding.  The hospital has bedside TV channels and it worked well in St Thomas's for there to be a TV hospital produced channel for breastfeeding advice and demos to ensure all singing from the same hymn sheet of advice. It was something that women could watch at anytime as was on a rolling replay.  There was also a large sitting room where midwives could gather mothers for a group help session on breastfeeding problems and how to problem solve.  This was supporting on many issues to share and help realise common concerns are not a failing of any one mother to be a mother.  The common guilt trip that can mentally torment a woman if she perceives she is failing at breast feeding when in fact it can be a problem many have and can be solved.  Of course there needs to be a calm mind to help with breast milk let down.  One mother comes to my mind how we relieved her engorgement and her sudden pride as she saw lots of her breast milk ejaculating out of her breasts....Bless her and her baby was guzzling well satisfied with the new supply. 

I am so glad I followed an internal impression to call in the Healthwatch Hillingdon centre in the Pavillons in Wednesday and found copies of this report. Found it a stimulating read as a retired midwife and there is a lot more to look at too.. 

Here is the link to find out more about the Expecting a Perfect Start Report plus more of the work that Healthwatch does.... 
http://healthwatchhillingdon.org.uk/index.php/2017/03/12903/