Maternity Workstreams Sub-group Workshops: Transforming postnatal care and early neonatal experience and outcomes Supporting Normality in Birth and Improving Birth Outcomes and Experience

th 16 May 2017 – Taunton Rugby and Football Club

Present:

Name Surname Role Organisation Tracey Kay Consultant Obstetrician and Gynaecologist Royal Devon and Exeter NHS Foundation Trust Zita Martinez Head of Midwifery Royal Devon and Exeter NHS Foundation Trust Kathryn Owen Deputy to Clinical Midwifery Manager Great Western Hospitals NHS Foundation Trust Charlotte Sullivan Obstetrician Consultant Great Western Hospitals NHS Foundation Trust Linda Hicken Community Midwifery & Birth Centre North Bristol NHS Trust Matron Rebecca Mann Consultant Paediatrician South West Neonatal Operational Delivery Network Ann Remmers Clinical Director, SW Maternity and South West Maternity and Children's Children's SCN Clinical Network Richard Harris Manager, SW Maternity and Children's South West Maternity and Children's SCN Clinical Network Dawn Morrall Assistant Director of Maternity & Fertility Gloucestershire Hospitals NHS Foundation Services/Clinical Improvement Lead Trust/South West Maternity Clinical Network Asha Dhany Practice Development Midwife Gloucestershire Hospitals NHS Foundation Trust Alison West Quality and Safety Manager NHS England South - South Central Sarah- Pedler Practice Development Midwife Royal Cornwall Hospitals NHS Trust Jayne Jan Blews Service Improvement Manager North Somerset CCG Rebecca Evans- Consultant O&G Lead for Clinical Gloucestershire Hospitals NHS Foundation Jones Governance Trust Lydia Woodward Service Development and Clinical Somerset CCG Engagement Manager Amanda Gell Midwifery Matron and Supervisor of Royal United Hospitals Bath NHS Midwives Foundation Trust Sally Freeland Regional Officer The Royal College of Midwives Sarah Merritt Head of Nursing and Midwifery Royal United Hospitals Bath NHS Foundation Trust Helen Saad Matron Torbay and South Devon NHS Foundation

High quality care for all, now and for future generations

Notes Page 1 of 5

Notes of Meeting – 10/05/2016 Trust Sallyann King Better Births Early Adopter Project Taunton & Somerset NHS Foundation Trust Manager, Somerset Katy Evans Matron for Antenatal Services, Birth Taunton & Somerset NHS Foundation Trust Centres & Community Midwifery Johanna Taswell Associate Directorate Manager Taunton & Somerset NHS Foundation Trust Sara Wright Lead Midwife for Normal Birth and In- Northern Devon Healthcare NHS Trust patients Viv Duncan Ward Sister Taunton & Somerset NHS Foundation Trust Charlotte Ashman- Senior Midwife Salisbury NHS Foundation Trust Scott Claire Storey Maternity Project Manager Bristol CCG Sarah Collett Commissioning Support Manager South Gloucestershire CCG Emma Treloar Consultant Obstetrician University Hospitals Bristol NHS Foundation Trust Amy Warren Quality Improvement Lead South West Maternity and Children's Clinical Network Carolyn Bell Quality Lead Swindon Clinical Commissioning Group Debbie Beilby Neonatal Practice Development Sister/Unit Taunton & Somerset NHS Foundation Trust Manager Chris Knight Consultant Paediatrician Taunton & Somerset NHS Foundation Trust

Sue Fulker Neonatal Unit Manager Taunton & Somerset NHS Foundation Trust

Apologies Julia Chandler RCM Regional Officer South West Royal College of Midwives

Shona Charlton Senior Commissioning Manager South Devon & Torbay CCG Ailish Edwards Midwifery Matron and Supervisor of Weston Area Health NHS Trust Midwives Margaret Fairbairn Project Manager Bath and North East Somerset CCG Helen Ford Senior Commissioning Manager Gloucestershire CCG Deborah Forward Maternity Commissioner Bath and North East Somerset CCG Rachel Glasson Head of Midwifery Torbay and South Devon NHS Foundation Trust Ruth Wellings Mental Health and Learning Disability Kernow CCG Commissioning Lead Helen Williams Associate Director of Nursing and Head of Yeovil District Hospital NHS Foundation Midwifery Trust Debra Young Head of Midwifery & Children’s Services Taunton & Somerset NHS Foundation Trust Cathy Molloy Clinical Matron for Delivery Suite, DAU and North Bristol NHS Trust ANC Lisa Marshall Director of Midwifery North Bristol NHS Trust Inge Shepherd Programme Manager Children and Bristol Clinical Commissioning Group Maternity Commissioning Angela Whittaker Inpatient matron Royal Cornwall Hospitals NHS Trust Balpreet Attilia Consultant Obstetrician & Gynaecologist Taunton & Somerset NHS Foundation Trust

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Notes of Meeting – 10/05/2016

Improving postnatal care and early neonatal experience and outcomes workstream

Welcome and Introductions Action Ann Remmers welcomed those present and introductions were made.

Notes and actions from 31 January meeting The notes of the last meeting were accepted as an accurate record.

Update from SW Neonatal Network Rebecca Mann gave an update from the South West Neonatal Network. It was noted that all units had received unit specific reports comparing them to others within the region. 60% of all admissions to a neonatal unit are at term. Rebecca Mann_Term Admissions summary SW ODB 16052017-5.pdf

Local updates GWH Charlotte Sullivan informed the group that they have appointed a breastfeeding specialist midwife and that all staff are Baby Friendly Initiative trained. All babies have two breastfeeding assessments within the first week and community midwives have a clear feeding plan. Women can borrow breast pumps from the trust and there is a community and hospital based clinic which takes place each week. There has been a significant reduction in the number of babies being readmitted due to weight loss. South Devon and Torbay A drop in readmission due to weight loss has also been noted. Babies are not weighed beyond day three. Anxiety around weighing can contribute to reduced lactation. Breast feeding initiation rates have remained the same. Taunton Small babies are weighed on day three, with more intensive support made available on days one and two. More rooms have been made available to women who have babies on NICU. Cornwall Partners are now allowed to stay on the postnatal ward. Feedback so far has been positive. Partners are able to help out with some things, e.g. passing babies to women who’ve had a Caesarean section. RUH Staff are using Baby Vision to allow mothers to face time their babies. This is especially useful for women who are in the High Dependency Unit. It was noted that this would be valuable for women who are on different sites to their babies also. RD&E RD&E noted that they are about to start using Baby Vision too. Tracey Kay talked of enhanced recovery for women who have had a Caesarean section, who usually go home the next day. They are advised to buy pain relief before they come in and are provided of a clear idea of the progress they would be expected to be making each day. Claire Storey noted that many within the Bristol Maternity Voices group felt that they had done too much too soon after a CS, adding that perhaps the expectation of the progress they would be making wasn’t made clear beforehand. Tracey Kay to send guidelines to network support team so that they can be shared with the Tracey Kay group.

8th June workshop – discussion The group ran through the agenda for 8th June event and members were encouraged to spread the word amongst colleagues for signup.

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Notes of Meeting – 10/05/2016 Community offer for postnatal care Dawn Morrall informed the group that all trusts had responded to the PN care survey that had been distributed. A big variation in the core offer being provided was noted, including the number and type of contacts, as well as the percentage of care being provided by midwives. Postnatal survey_DM.xlsx

Any other business The link between postnatal care and social care for children was discussed, along with the need to have LA representation in the Local Maternity Systems. It was noted that some babies are admitted to NICU for social care reasons and that at times there are delays in plans being put in place.

Dates of events and future meetings 8th June – Sandy Park, Exeter - Transforming Postnatal and Early Neonatal Care Workshop 6th July – Taunton Racecourse – Supporting Normality in Birth Workshop

Dates of future meetings – 11th July, 19th September and 21st November 2017 (Taunton RFC)

Supporting Normality in Birth and Improving Birth Outcomes and Experience Workstream Welcome and Introductions Action ARemmers welcomed the group and introductions were made.

Notes of the last meeting The notes of the last meeting were agreed as an accurate record.

Local updates Impact of STAN Sarah-Jayne Pedler presented the use of STAN at RCHT to the group. No one else present at the meeting was currently using STAN. At RCHT all staff, including community midwives, undertake STAN training. RCHT have found that their low risk care has improved also, with longer periods of PRESENTATION_Sarah-Jane Pedler.pdf listening in, not just after each contraction. It was noted that a lot of consultant input was required in order to get started in the use of STAN. The group discussed how trusts who have a greater reliance on agency staff have had to stop using STAN due to a lack of confidence and skill in using. Whilst too early to establish whether this will lead to an increase in normal birth, it appears that staff are feeling empowered by it, tending to watch the CTG rather than going straight to CS or instrumental delivery. STAN is only used on women with a known risk factor.

Annual competency assessment is mandatory.

Impact of Mums Up and Mobile (MUM) project

Dawn Morrall spoke of the Gloucestershire MUM project, with all monitoring being wireless on the delivery suite. This has hugely increased the satisfaction of service users. For those who had access to wireless monitoring but whose staff were not using them, getting staff on board to DM_MUM - champion wireless monitoring was suggested. SWCN.pdf

RUH noted that they had renamed their delivery suite to Bath Birthing Centre and they are considering developing an alongside unit. A drop in use of their stand-alone units has been noted.

6th July workshop To date, the following speakers had been confirmed: Tony Kelly - National Maternal and Neonatal Health Safety Collaborative Florence Wilcock – Obstetrician from Kingston supporting normality in birth Claire Matthews – Continuity of Carer, Cheshire and Merseyside Early Adopter

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Notes of Meeting – 10/05/2016 Marie Washbrook - BirthRate+ acuity tool Denis Walsh – Birth Place Study follow-on research (TBC) The group felt that it would be good to have a hands-on midwife as a keynote speaker. The group discussed the need to manage expectations antenatally and that it wasn’t for clinicians to decide what normal or traumatic was. Birth Afterthoughts services were discussed and the importance of being able to go through with women their birth experience. GWH are planning to text women who had had a CS six months postnatally to invite them to discuss their birth, as it is felt that by the time a woman becomes pregnant again she is less open to considering the option of trying for a VBAC.

Dates of events and future meetings 8th June – Sandy Park, Exeter - Transforming Postnatal and Early Neonatal Care Workshop 6th July – Taunton Racecourse – Supporting Normality in Birth Workshop

Dates of future meetings – 11th July, 19th September and 21st November 2017 (Taunton RFC)

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