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Written Statement - Maternity Services in Wales

Mark Drakeford, Minister for Health and Social Services

Following the Business Statement on May 13, where questions were asked about recently published draft guidelines on the care of healthy women and their babies during childbirth, a commitment was given to provide a written statement on maternity services in Wales.

Firstly, let me make it clear the provision of high-quality, safe maternity services in Wales is a priority for the Welsh Government.

The strategic vision for Maternity Services in Wales, published in September 2011, states that the foundations for health and well being start in pregnancy. From heart disease to obesity, educational achievement and economic status, the months before and the years immediately after birth are crucial to the life chances of the mother, her child and her family.  

We know the health and happiness of future generations can be enhanced through the provision of high-quality maternity services and that pregnancy is a powerful motivator for change. This is particularly important, not just in the context of the pregnancy, but also because we know that when women make changes to their own health, they significantly influence the lifestyle choices of their children and family.  

Pregnancy is therefore  an  opportunity to impact on the health and wellbeing of individuals, families and communities and it is vitally important that efforts to ensure mother and child are safe and healthy well before birth.  The strategic vision sets out the results we want for women and their babies during pregnancy and childbirth, as well as our expectations of NHS Wales in delivering maternity services that make a real difference to families in Wales. 

The Welsh Government’s vision for maternity services in Wales is one which promotes pregnancy and childbirth as an event of social and emotional significance where women and their families are treated with dignity and respect. For every mother, wherever they live and whatever their circumstances, pregnancy and childbirth will be a safe and positive experience so that she, her partner and family can begin parenting feeling confident, capable and well supported in giving their child a secure start in life.

Continuous improvements are being made to maternity services and, the Chief Nursing Officer holds bi-annual maternity performance board meetings to support health boards and measure progress against the outcomes and performance measures set following the publication of the strategic vision.

The health of pregnant women in Wales is a concern and, with high rates of smoking in pregnancy, health boards have been working with Public Health Wales to pilot new ways of offering support to women and their partners who want to quit. With very successful results from the pilots, Public Health Wales is now working to roll these services out across Wales.
A safe high-quality maternity service is predicated on having the right number of well-trained staff. The Welsh Government requires all health boards to comply with the midwifery workforce  standards set by ‘Birth Rate Plus’ and this is monitored bi-annually. I am proud to say all health boards are compliant.

In relation to obstetric staffing Wales, like the rest of the UK,  has expericed some recruitment challenges,  but health boards have not reported any specific issues.             

On 12 May, the National Institute for Health and Care Excellence (NICE) published its draft guidelines on the care of healthy women and their babies during childbirth.  It recommend that women with straight forward (low risk) pregnancies should be encouraged to give birth in a midwife-led unit rather than a traditional labour ward.

The guidelines are based on a Cochrane systematic review, carried out in in 2010, which summarised the outcomes for women planning birth in a midwife-led unit. The review reported that midwife-led birth settings were associated with an increase in normal birth and maternal satisfaction as well as less intervention.

The policy in Wales, since 2002, has been to support women to make the choices most appropriate for them. In discussion with their midwife, all healthy women with straightforward pregnancies are offered the opportunity to give birth at home, or in a consultant-led unit and, where the facilities exist, at a midwife-led unit.  In Wales there are 15 midwife-led birth centres, which offer women a safe alternative to a consultant-led birth.

We know it is safe for low risk women to give birth in a midwife-led unit or at home but, some women, regardless of risk, will choose consultant-led care and this option will remain available to all women who feel this is the best place for them to give birth.

In relation to women’s involvement in their care, co-production has long been a theme in running and developing services. Since the mid-1980s maternity services in Wales have set up maternity service liaison committees, where service users and health professionals meet to discuss and plan improvements in local services. All health boards have these in place, chaired by a service user who is also invited to attend  maternity performance board meetings at Welsh Government.

Satisfaction survey results are reported to the performance boards and I am pleased to note that women report very high levels of satisfaction with more than 85% of respondents saying they are pleased with their care.

The 1000 Lives Maternity Collaborative aims to improve the experience and outcomes for women, babies and their families  and following consultation with key stakeholders, a series of interventions have been developed and introduced.

The two areas of focus have been the recognition and response to the acutely deteriorating woman and the prevention, recognition and management of thromboembolism. Work is also continuing to develop and implement strategies aimed at reducing levels of stillbirth.

In order to maintain this momentum the 1000 Lives Community of Practice Maternity Network is in the process of being set up. The network will be made up of stakeholders from health boards, Royal Colleges and the Welsh Government with the aim continuing to drive the standardisation of maternity care across Wales.

Finally, the reconfiguration of maternity services in Wales will seek to maintain both safety and quality care and ensure our vision for maternity services is maintained.  We know that investing efforts to improve maternity services now and in the future is imperative if Wales is to build healthy and happy families and communities.