Monday, 30 September 2013

My response to the latest nonsense from BSBV: Why it is unsafe to close A&E, paediatrics and maternity for first time mothers!

Dear Editor,

The letter (24th September) to the Guardian from BSBV staff, quoting the Birthplace Study as showing stand alone midwife led units and home births as safe if proper assessment of risk is carried out, did not include other findings of the study which we copy here. 
It is true that the study found advantages in these settings for women who had already had a baby but you will see there are risks for first time mothers.
From the very outset, BSBV staff have glossed over these risks. At one public meeting we were told there were "just a few" transfers needed. Please see the figures below -36%-45% are not a small number. Not all these transfers will be life threatening but some will be so it is important to know how long such transfers would take.
This is why we published SECAmb data, which shows that, as admitted by BSBV staff, at least 30minutes is involved if people from the area served by Epsom are taken to alternative hospitals.
This is also why we published the Royal College guidance used in the Darzi report, which states clearly that maximum transfer time is 15-20 minutes from the time things start to go wrong in labour.
Again, responses from BSBV have been to question the validity of our ambulance data, to insist it is the time taken to get to the patient that is important (not until paramedics can carry out Caesarean sections) and vague promises of "lounges" for people who have a longer distance to travel!!
The reality is that BSBV do not want to consider points, which show our area’s residents, would be at risk if we lost Maternity and Paediatrics.
We agree a lot of adult care can be safely centralised and would provide better outcomes for patients. It is hard to understand why BSBV cannot make provision for the services that are more safely provided locally.
Even worse, they don't seem to have looked at the Darzi report, which was a massive piece of research with a whole section on Maternity.
From the Birthplace Study;
“ For women having a first baby, a planned home birth increases the risk for the baby
         For nulliparous women, there were 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.
         For multiparous women, birth in a non-obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.

For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth.
For nulliparous women, the peri-partum transfer rate was 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births

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