Thursday, 19 September 2013

In response to the latest BSBV nonsense!

There may actually only be 5 minutes!

BSBV response to our concerns raised at the suggestion that Epsom Maternity unit should be closed, is very alarming, as it appears to be so un-informed. (Letter to Guardian 19th September)

The Darzi Report recommendations by Royal Colleges states 15-20 minutes transfer time, when things go wrong in labour, is the maximum time before what they call “an adverse” incident occurs.

Our work shows that ambulance times, when one adds on 8 minutes response times, would mean a longer journey than 15-20 minutes.

We have had to counter BSBV suggestions, on twitter, that this only applies in hospital. This is nonsense- it applies whenever and wherever a mother gets to a point where the baby is in difficulties during delivery.

We have looked into the BSBV denial that 8 minutes is significant and would suggest they look up the recent references given below.

The majority of pregnancies are very straightforward and uncomplicated and they lead to the birth of a well baby. In a minority of instances a baby can get into difficulty. For example, one of these instances could be a lack of oxygen. In this instance a doctor would be required to intervene. The Royal College of Gynecology (source below) and the International Cerebral Palsy Task Force states that in the situation of a baby’s head getting stuck before delivery there are only five minutes before the baby gets a serious brain injury due to a lack of oxygen.

Source: RCOG Green-top Guideline on Shoulder Dystocia No. 42, 2nd edition published | March 2012 and Leung TYet al paper Head-to- body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review published in British Journal in Obstetrics and Gynaecology 2011; 118:474–9
There are also, of course, the contradictions that have existed throughout the plans put forward by BSBV.
If it is only safe if there are large units manned by consultants for 24 hours how are midwife only, not co-located with an obstetric unit, safe for other mothers. Their argument is that low risk mothers will be fine and will be transferred if need be. However, 40 % of first time mothers do need transfer- (Birthplace Study used by BSBV) and some of these transfers will be for serious reasons which mean the unit should be co-located with obstetric unit for safety.

There are also issues around the waste of public money spent by the various attempts by BSBV to deny evidence to the media rather than looking at proper evidence for the Epsom area.

We agree with BSBV that a lot of specialist care is centralised but they should accept that maternity services, in the main, and children’s services, must be local. Centralised children’s units need a hub and spoke system to work so sick children can be stabilised. Don’t try and remove the spokes or the Hub won’t work!!
Jane Race
Rosemary Najim
Epsom Hospital Campaign

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