The Trust that I work in has recently been subject to a review of maternity services - basically the trust covers a wide geographical area, and consist of two consultant led units of 1600-1700ish births per year each, plus a standalone midwife led unit with 300-350 births per year. The decision has been to retain the MLU 'as is' (due to a very strong local supporting committee the future of this unit was never brought into question), to retain one of the two units as a consultant led unit, and to 'downgrade' the other unit to become a MLU - although it will still be situated within the general hospital. There is much local unrest, and much local publicity and consternation about the 'downgrading'

I don't feel that the correct decision has been made - I feel that people will die. This is not because I feel that midwife led care is in any way dangerous, but because the geographical area served is wide, and there are many complex needs among the local population. Many women who have clinical need for consultant led care will have difficulty accessing this for social and financial reasons if they live at the 'wrong end' of the area.

But what is really riling me at the moment is the widespread use of the word 'downgrade'. Surely for low risk women, increasing the access to midwife led care can only be a positive thing? Is the definition of the role of a midwife not to be the expert in normal pregnancy, birth, and postnatal care? Surely the ethos of this soon to be midwife led unit should be one of positiveness, of opportunity to provide something really special and to make birth normal for those women who fall within its remit - rather than the doom and gloom forecast from both the staff and the local media who are giving local women the impression that they are to be given something lesser and dangerous.

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Love Dory xxx
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Dory, I agree wholeheartidly. The media has got caught up with the 'women will die' thing and quite right too. Having an obstetric led unit far away will increase risk to life and reduce homebirths as the mental reassurance of a hopistal 10 mins away will put women off.

Also agree re 'down grading' its great we can offer ML units and this is very positive for local women and local midwives alike. It really annoys me when we are 'just' midwives - we save lives too!

Whats the answer to the unit changes? If its aint broke etc? or is it broke?

Keeps me awake at night I know that much...

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J
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