HSE HOME BIRTH SERVICE CLINICAL PROFESSIONAL SEMINAR WORKSHOP

HSE HOME BIRTH SERVICE CLINICAL PROFESSIONAL SEMINAR & WORKSHOP FOR HEALTHCARE PROFESSIONALS

National Strategy for Maternity Services. DOH Creating a Better Future. Together: 2016 – 2026 A Woman Centred Approach Sheila Sugrue (RM, RN RMT BNS, MSc Midwifery) National Lead Midwife ONMSD 2

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals 3

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Background • • 1951 Minister for Health Dr Noel Browne proposed Mother and Child Scheme • Universal health care for mothers and children for the first time • Resistance • From Church and Medical Profession(Kennedy and Einasto, 2010) • Proposal abandoned • Shaped maternity services for the next 50+ • Introduction of Maternity and Infant Care Scheme 4

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Mother and Infant Scheme 1954 • Assumption that Care is provided by the GP and the Obstetrician • led to under-development of midwifery provided/led services • A fee entitled women private care/choice/continuity of carer • Private Health Care 1956 • A few attempts to address it • • Kinder Report 2001 Blueprint for Women Centred care Introduction of Midwifery Led Units KPMG Report 2008 Reference: Kennedy P. (2012) Change in Maternity Provision in Ireland “Elephants on the move” 5

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Drivers • • Adverse Events Media Coverage International Maternity Policy Trends Need to Restore Public Confidence Willingness for Change Women Asserting their needs Unique opportunity to focus on health and wellbeing • Making every Contact count 6

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Current Irish Maternity Services • Consultant Led and Hospital based • 4 Stand alone Maternity Hospitals • 15 co-located hospitals • Competing for resources • Voice Diluted • 2 MLU • Number of Births expected to decrease until 2020 • Home Births – Planned HSE – Number have increased year on year with 180 births recorded in 2015 7

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Number of Births Hospitals Number of Maternity Hospitals/ Units <1500 3 Sligo General, South Tipperary General and Kerry General Hospitals 1500 - 2000 7 St Luke's Kilkenny, Wexford General, Midland Regional Portlaoise, Cavan General, Letterkenny General, Mayo General and Portiuncula Hospitals 2000 - 3000 3 Midland Regional Hospital Mullingar, University Hospital Waterford and University Hospital Galway 3000 - 4000 1 Our Lady of Lourdes Hospital Drogheda 4000 - 5000 1 University Maternity Hospital Limerick 5000 - 8000 0 8000 - 9000 3 Coombe Women & Infants, Rotunda and Cork University Maternity Hospitals >9000 1 National Maternity Hospital 8

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Expectant Women • • Average giving birth: 32. 3 yrs Nationalities: • • • Health and Wellbeing • • • 20% Smoke/Drink • 25% Obese Breastfeeding Rates: - 56% initiated in 2013 (Australia 96% and UK 81%) with 35% recorded at 3 months PHN visit Complex pregnancies: • • • 15. 5% EU outside Ireland 6. 6% Non EU Require increased support Low birth weight and pre-term births increased Perinatal Mental Health: • Prevalence reported 11. 4 -28. 6% 9

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Female Population Ages 15– 49 up to 25, 000 25, 001– 40, 000 40, 001– 60, 000 60, 001– 130, 000 over 130, 000 up to 2, 000 Births 2, 001 - 5, 000 Births above 8, 000 births 10

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Process • • • First Maternity Strategy Chair: Ms Sylda Langford 31 members – multidisciplinary Service Providers Consultation – Professional and Public • > 1, 300 submissions • May 2015 –January 2016 11

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals What did women and professionals want Public Consultation o Who: o What works well? : o Not Working Well o How can services be improved? o o o Partnerships Facilitate Choice Implement evidence based policies and practice Ensure continuity of care Standardise the System 12

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Consultation 13

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Not Working Well. How can services be improved? • • Poor quality, inconsistent antenatal and postnatal care Poor Communication Limited Mental Health Support Poor Breastfeeding support in hospital and community • • Standardise health promotion advice and information for pregnant women Make it available on-line Devise and roll out public health campaigns Provide better quality breastfeeding information and education Advice must be consistent, clear and impartial Implement evidence based policies Make every Contact Count 14

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals National Maternity Strategy PRINCIPLES • • Access to safe, high quality, nationally consistent womancentred maternity care Health and Wellbeing Approach is adopted Develop a culture of normality Integrated service available Maternity Services appropriately resourced Strong effective leadership, management and governance arrangements Delivered by a skilled and competent workforce 15

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals What Women Want • Choice • Express preferences • Linked to information sharing • Availability of options • Continuity of Care • Form relationships • Emotional and Physical connection • Journey • Control • Being listened to 16

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Health and Wellbeing Approach • • • Underpin Policy and Service delivery Healthy Ireland 2013 -2025 Breastfeeding Action Plan 2016 -2020 • Preconception • • • Antenatal Care • • • Empowerment of women Preconception GP Visit Holistic approach to women’s healthcare needs –responsive and timely and in appropriate environment Integrated and appropriately structured maternity care Specific groups may need focused attention Information – readily understandable – should be assessed Postnatal Care • • • Mother baby attachment facilitated and supported Continuity of care/carer Appropriate referrals 17

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Health and Wellbeing Approach 2 • Breastfeeding • • • Evidence of very low rates Provide better quality Information and education Importance of dedicated staff Postnatal support Develop KPIs/Metrics Bereavement • Improve and standardise bereavement care • HSE will implement Standards for Bereavement Care Following Pregnancy Loss and Perinatal Death 2016 • Establish trained bereavement teams in each maternity unit/hospital. 18

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Model of Care - Choice • Suite of maternity choices – preferred pathway of care • Involves – a clinical risk/need assessment • Individualised approach • Proposes 3 care pathways • Supported • Assisted • Specialised 19

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals 20

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Supported Care • • Homebirths Alongside birth centres Care provided by Community Midwifery team Integrated Service Part of the Maternity Network Agreed National Standards Clear pathways for any change in risk profile 21

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Implementation • National Women and Infants Health Programme • • Requires a detailed Plan and Timetable Finalised within 6 months • Care provided by Multidisciplinary teams • Each woman will have a named appropriate health care professional according to her needs • Maternity Network • • Defined patient safety and quality framework Leadership, governance, clinical commitment, clinical effectiveness approaches DOM in 19 Units Group DOM- 13 in post • HIQA - Standards for a better Maternity Service –Dec 21 st • Establish a new Community Midwifery Service 22

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals National Women and Infants Health Programme • • Dedicated Expertise Response to HIQA Report into Portlaoise Lead, Manage and Organise Maternity Services Provide oversight and support for service providers All services developed coherently Funding made available through the Programme Director member of HSE Leadership Team 23

HSE Home Birth Service Clinical Professional Seminar & Workshop for Healthcare Professionals Make Every Contact Count Thank You 24

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