ABSTRACT

The Maternity Services of Wiltshire and Swindon Health Care NHS Trust.

Our maternity service remains one of the most unusual in the UK. We deliver 5200+ babies per annum, with the highest proportion of deliveries in Community (as opposed to Consultant-led) maternity units in the UK (30%), In addition, in Bath we believe that we deliver the highest proportion of women at home of any city in the UK (13+%). We have pioneered the transition from GP units to isolated Midwife-led units, and have led the way in training midwives to perform ventouse extractions in the Community units. At a time when 25% of maternity services in the UK are unable to recruit midwives to staff their units, we have a waiting list of midwives wishing to work with us. We have extensive experience of risk management in this challenging arena of numerous and very different maternity environments, and particularly in the development of seamless care between groups of professionals working together in an integrated service. The Maternity Service was most favourably commented on by the report of the House of Commons Select Committee on Health (Winterton Report) in 1991.

In 1992, I began to work for the World Health Organisation (WHO) as temporary adviser to the European Office on maternity care in Russia and Romania. In 1994, I co-authored (with Patricia Stephenson) a report on the maternity services in St Petersburg, with particular reference to the exceptionally high maternal mortality rates, and in 1995 I wrote a training manual for 'Management of High-Risk Deliveries', as part of the WHO CARAK project (Azerbaijan, Kazakhstan, Kyrgyzistan, Tadjikistan, Turkmenistan and Uzbekistan). Workshops based on this manual began in these countries in September 1996. Since then I have visited and run workshops in all of these countries apart from Azerbaijan, and have also advised in Belarus and Lithuania. Further lecturing visits have also taken place in Russia and Romania. I have recently lectured as a WHO adviser in Italy, and will be part of a multidisciplinary workshop looking at Italian maternity services in November.

RISK: A SERIOUS CARE OF CONCEPT ABUSE, arose out of the sideways view of maternity services that necessarily follows from running a service such as we do, as well as from seeing the services that exist in several other countries. Iconoclasm has to be a by-word for us, and this applies not only to what we do but also to how we see things.

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This page last updated 8 OCT 1999.

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