Worcestershire Acute Hospitals NHS Trust provides maternity care for around 6,000 women and their families across the largely rural areas in and around Worcestershire. Antenatal care is provided on three main sites, with satellite clinics also running on a further two. Maternity inpatient care is currently provided on one site, at Worcestershire Royal Hospital. I joined the Trust in 2009 when the unit was on the brink of building a new alongside midwifery led unit. Unfortunately, it was not meant to be and plans were put on hold. A subsequent declined bid for Department of Health monies led to further frustration but also revealed the collective hunger of the midwifery team, the women and the Trust as a whole for a midwife led unit to be developed. Third time lucky – funding was secured from the Department of Health which led to an exciting 8 months as plans were activated and the midwifery led unit, named by a new mum as the “Meadow Birth Centre” (in keeping with the nature of the rural location), started to become a reality.
Setting up work streams
Challenges were many however, under the guidance of the Head of Midwifery, work streams were developed to focus on five main areas, distributing the essential work between the senior midwifery team: enabling works; environment; staffing models and preparation and guidelines.
Involving all stakeholders
Service users (past and present), doulas / birth attendants, maternity and obstetric staff, students, university lecturers, infection control, moving and handling team, pharmacy and the estates team engaged with the different work streams making valuable contributions to ensure all views and ideas were incorporated. Inclusion of the many key individuals was later reflected on as having been instrumental to ensure all ideas were achievable within the timeframes, avoiding unnecessary delays which would have been inevitable if different departments had to be contacted for review and approval.
Whilst the building work was, to some extent, limited by the available budget, this did not impact on the end product with large birth pools being the focal point in 4 of the 5 rooms and air flow being individually controlled in each room. Innovation and inspiration came into play as the collective team worked together to raise additional funds and find alternative ways of achieving the desired outcome. Networking with the University of Worcester led to a connection with the tutor from the graphic design department (who had previously experienced maternity care at the Trust herself). She quickly came on board and ‘got’ the vision and resulting theme for the unit, involving her students to participate as part of their project work and ensuring the women, families and team who would be receiving and providing care in the Meadow were involved every step of the way. The proposed colour schemes were somewhat bolder than we had initially envisaged but striking, homely and calming as a result with suitable names also chosen by the families. The focal quotes on the walls and the designs on the windows and the walls were chosen by the families and staff involved with the project. The Meadow team then chose the furnishings, making sure their practical designs remained comfortable and in keeping with the environment whilst providing opportunity for them to ‘make it their own’.
Focus on calmness and achieving the WOW factor
Lighting was key for all involved and the stubbornness about this was justified when the ‘wow’ factor was achieved (from a member of the estates team) as the longed for ‘twinkly lights’ were turned on and complimented the colour changing pool lights and free standing ‘mood tubes’. We quickly learnt that, having key members of the building team who were new or soon to be fathers certainly helped the desired outcomes to be achieved! The ambiance was further enhanced by the addition of music and aromatherapy diffusers maintaining calmness for the families and staff alike.
Selecting and preparing staff
As the journey progressed, focus turned to the staff selection. Again, the process involved our service users who engaged fully with this and reflected on the evident passion of the resulting team who are a credit to the unit. The importance of investing to prepare the team to care for women in the Meadow was never underestimated – to this point, they had provided care in the hospital’s obstetric units with very limited exposure to intrapartum care in a low risk setting.
This was highlighted when an incidental concern of some members of the team was raised regarding the toilet facilities. The Meadow is fortunate to have a large family room with sofas, dining facilities, kitchenette and bathroom. This is shared between families and staff (as at a homebirth). Whilst the team leader and I had backgrounds as community midwives, where using the family toilet and facilities is the norm, the majority of the team had not experienced this and the thought of sharing their toilet with ‘a man’ was initially a great worry!
Researching what midwives and maternity support workers needed in terms of preparation revealed a huge gap in evidence to draw upon so we set about discovering their needs, through enquiries and narratives from the team themselves and those who had been through a similar transition at neighbouring Trusts. This led to a bespoke maternity team preparation programme which covered all elements identified by the midwives and maternity support workers to be a potential cause of anxiety or a need, together with the elements of practice and care that MLU teams from neighbouring units reflected would have benefitted them (i.e. physiology refresher for all stages of labour; aromatherapy training; team building activities; conflict resolution; emergency skills drills in the new environment; re-focussing care – programme can be shared if desired). The programme started with a unique opportunity for the midwives to visit one of three neighbouring MLU’s on ‘observational placements’. This experience proved invaluable, affording them the opportunity to observe midwives, maternity support workers caring for labouring women and their families in established birth centres. They then each shared their reflections with the rest of the team in a facilitated session as part of the programme, providing insight into the importance of communication together with effective, attentive, supportive care.
Having previously valued the work of Mary Ross-Davie through academic study, I invited her to support our preparation programme and was delighted that she kindly accepted. The essence and lasting message of her inspirational sessions has greatly influenced the success of the meadow birth centre as is evident through the comments in the visitor’s book. Whilst the families are overwhelmed by the environment, they all comment on the amazing care received from the midwives and maternity support workers – Mary impressed upon them that they are the greatest intervention of all. The environment helps set the scene however how it is the way in which the care is provided that has the greatest impact.
One year on
A year since opening, the number of births has far exceeded the first year’s anticipated target with 650 babies having been born in the Meadow Birth Centre and more student midwives than initially planned having had opportunity to provide the essence of midwifery care in a low risk setting. The tree at the far end of the Meadow Birth Centre marks the births with new parents placing a leaf on the branches with their new baby’s name and date of birth – we have seen it grow and bloom with pride (albeit are now considering the need for an Autumn as the branches are very full!).
We have transitioned from a new birth centre to an established birth centre with ambitions to extend the cautious inclusion criteria to more individualised care planning. The future has to involve sharing the philosophy and re-focussing on the care provided to women in the delivery suite. Already, plans are afoot to improve the birth environment on the delivery suite with funds having been raised and the involvement of the same graphic design department - the aim is for a synergy between the birthing areas so all women experience the same standard of birth environment, whilst being appropriate to their needs.
It is exciting to see all that has been achieved already through the determination of the Meadow Birth Centre team with the support of the wider maternity and obstetric team; reiterated by the comments left from the families who received care, and the students who have worked alongside the team.
Rachel Carter has been a practising midwife for 21 years, providing all aspects of midwifery care, working in Birmingham and Worcestershire. During her career she has been supported to gain a variety of qualifications, including management, safeguarding, being appointed as a Supervisor of Midwives and achieving a Masters degree. Having been privileged to care for women in the community and maternity inpatients as a team midwife, team leader and matron, her passion is to ensure all women and families receive the highest possible quality of safe and individualised care to enable them to have the optimal pregnancy, birth and postnatal experience and outcome.
Meadow Birth Centre: A Grandad's View!
There are some questions that the Dad of a teenage daughter shouldn’t be expected to answer! Suzy’s water had broken early in the morning, but because of the speed of contractions (and her fear of hospitals) I was now speaking to Ambulance Control. “Is the head of the baby showing?” the person on the other end asked me. “I’m not sure I can answer that!” I said. Undeterred they asked: “Is there any brown liquid?” “Errr…”. By that stage the ambulance crew had arrived, had given Gas & Air, got Suzy into the van and, following on behind, we got to the Meadow Birth Centre.
I had known of the Meadow when it was just an idea. I had heard the vision and excitement of my friend and Midwifery Matron, Rachel Carter, as she talked about it. I had seen it in various incarnations through the building stage to its completion. I had been delighted that my friend Louise Turbutt was going to lead the team there. I had been impressed with the ethos of the staff team and the careful way in which they were recruited because of their values and temperament. I had been there at its opening and “WOWed” along with everyone else at the facilities, and the birthing pools, and the twinkling lights and the ambience. I had stood by the Tree of Life which, I knew, would soon be full of leaves with the names of babies ‘birthed’ there. I had got to know the team as friends and respected the way they had kept the ethos of tranquillity and choice. And a year on, I attended their 1st Birthday Party after helping more than 650 new lives come into the world.
BUT NOW…IT WAS MY DAUGHTER…arghhh. As soon as we go to the centre all my anxieties were eased. She was welcomed with kind and calm professionalism. Although I joke that I am an “honorary midwife” I left Suzy in the company of my wife Ali and the baby’s dad. I don’t know what went on behind those doors….so my daughter Suzy takes over the story.
“On the third of January 2016, I gave birth at the Meadow Birth Centre and I couldn't have asked for a better environment to be welcomed in to. The staff were all absolutely lovely and understanding of my needle and medical phobia. All of the medical equipment was tucked away in to cupboards, away from the viewing of the patients which I completely adored. My labour was assisted by Lucy Laird, who was very polite and friendly. I was later discharged by Allison Collins-Cunneen, who again, was lovely. All of the staff were so warm and loyal to their patients which really made my visit a pleasant one. The actual birth centre itself is a beautiful place to be. The rooms are spacious and very well presented with music, dimmed lights and relaxing aromas. It was wonderful and such an incredible experience so thank you to Meadow Birth Centre for allowing myself and my family to celebrate the birth of my daughter together.”
All I know is that two or three hours later my granddaughter, Emilia Grace, came into the world! It was all so special and beautiful but two things stick in my mind.
Firstly, I know many of the staff well… and they knew me as the Chaplain. But in that Centre on that day they didn’t treat me as anything other than Emilia’s Granddad – which is exactly what I wanted!
Secondly, I will never forget standing by the Tree of Life next to my daughter and granddaughter as we put up the leaf with her name on. Truly special. So I have seen the Meadow Birth Centre as a colleague and been inspired and impressed. And I have seen it as a Granddad and been humbled by the care, kindness, and love shown.
Emilia continues to grow, bringing us magic day by day. And none of us will forget where she started her days.
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