East London

Criteria for using Birth Centres in East London – information for women and their families

Birth centres are maternity units that are usually staffed by midwives. They aim to offer a homely, rather than clinical, environment.
Birth centres are especially good at supporting women who want a birth without medical interventions. Most are set up with furniture and facilities designed to help you feel calm and in control.
The aim for birth centres is to treat labour and birth as a straightforward, normal thing to happen, rather than a risky event.

The list below indicates women who are encouraged to book their care in either one of our alongside midwifery-led units (AMU) or one of our two freestanding midwifery-led units (FMU)

Agreed birth centre criteria

• An uncomplicated pregnancy, with no medical, pregnancy or complications in a previous pregnancy
• Age 40yrs or less at booking
• Having 1st, 2nd, 3rd, 4th baby
• Singleton Pregnancy
• Booking body mass index (BMI) is between: 17 -35. This is calculated by your midwife
• If known to be Group B Streptococcus (GBS) positive
• Baby is head down (cephalic presentation)
• Spontaneous onset of labour between 37-42 weeks
• Haemoglobin (iron) levels are > 90 g/L when 34 weeks pregnant
• Booked late for care in current pregnancy but have had good A/N care and scans in another hospital (i.e. transferred care from another hospital)
• If there has been a history of reduced fetal movements this has been investigated and there are no current or ongoing concerns
• Previous birth had a 3rd or 4th degree tear
• Labour started following Prostaglandin outpatient induction of labour (& normal trace of babies heart rate on admission)
• Previous stillborn baby, or neonatal death or baby with abnormality with no known recurrent cause

Discussions and questions

Individualised discussion with your maternity team is required for the following:

• Expecting 5th baby or more
• Haemoglobin levels are between 85-90g/L at 34 weeks
• Have been identified as having fibroids

Questions you might like to ask when you are discussing where to have your baby

• What are the different places where I can choose to have my baby?
• What are the advantages and disadvantages of these different places?
• Where can I find more information or support for my choice about where I have my baby?
• Can I change my mind about where to have my baby?
• How likely am I to have a midwife I know looking after me during labour?
• What different types of pain relief are available in the different places?
• Can I use water in my labour if I am having my baby in an obstetric unit?
• Can my birth companion(s) stay with me after the birth?
• What types of serious medical problems can affect babies, and how common are they?

If concerns have been identified about your pregnancy and baby you may wish to ask:

• What are the concerns?
• What does that mean might happen?
• Will these things definitely happen or is there an increased chance compared to someone without this problem?
• How likely is it that problems occur? E.g. does this happen to three women in a thousand or 2 out of every 10 women?
• Can I talk to someone else about this?

Boroughs and maternity services

East London has seven Clinical Commissioning Groups (CCGs), those responsible for funding NHS services in your area and who commission maternity services, these are:

• Barking & Dagenham
• Havering
• Waltham Forest
• Tower Hamlets
• City & Hackney
• Newham

Maternity services are provided by:

Barking Havering & Redbridge University Hospitals NHS Trust (BHRUT) – Queen’s Hospital, Romford

The Trust provides maternity care to around 8200 women each year, making it one of the largest maternity services in the country. Recognising that pregnancy and birth are important times for women and their families and will provide support for your individual birth choices with up-to-date facilities, information and highly trained staff treating you with compassion and respect.

www.bhrhospitals.nhs.uk/maternity-services

Homerton University Hospital, Hackney

The Trust provides maternity care for more than 6000 women and their babies each year, during pregnancy, labour, birth and up until one month after birth.

Our philosophy of care is based on respect for pregnancy as a state of health and childbirth as a normal, healthy physiological process. The aim is to keep women informed at all times of the progress of their pregnancy and likewise any issues that arise during their care. The Trust encourage decision-making as a shared responsibility between the woman, her family and her caregivers. To facilitate this, care provision must include evidence based information, education and counselling support to enable the woman to make informed choices.

www.homerton.nhs.uk/our-services/services-a-z/m/maternity-services

Barts Health

We recognise that expectant mothers require very special attention. Our dedicated teams are here to help you through your pregnancy and birth and provide you with the best care to suit your individual needs.

You can choose to access maternity care in any of our units:

• Barkantine Birth Centre
• Barking Community Birth Centre
• Newham University Hospital
• The Royal London Hospital
• Whipps Cross University Hospital

Our information will help you to access care from our expert maternity teams, who will support you to plan and prepare for pregnancy, birth and beyond.

From pregnancy through to postnatal care, our team of midwives and medical staff will help you to make informed choices.

As part of your journey with us, you can choose to have your baby at one of our tranquil birthing units led by experienced midwives; in one of our labour wards with leading consultants close at hand; or in the comforting surrounding of your own home.

We are very proud of our maternity units at The Royal London Hospital and Newham University Hospital – and refurbishment at Whipps Cross University Hospital is currently underway.

We hope that you will have a straightforward pregnancy, but if you do experience any complications, then you will have access to a wide range of experts who can provide specialist advice. Our team includes obstetric and gynaecology consultants, specialist nurses and anaesthetists. We will ensure that you are kept fully informed and treated with care and dignity at every stage of your journey.

www.bartshealth.nhs.uk/maternity

Neighbourhood Midwives (Waltham Forest)

Neighbourhood Midwives is an NHS provider offering continuity of care to women having a straightforward pregnancy in Waltham Forest. You will have the same dependable, experienced midwives at your side throughout your pregnancy, birth and for up to six weeks of postnatal care. Your midwife is available to you 24 hours a day and all your antenatal visits will be at home. You can choose to give birth at home, in a birth centre or hospital obstetric unit.

Our midwives currently offer a caseload service (where a woman receives all of her care from one midwife and her practice partner) to women in Waltham Forest only.

We work closely with our NHS colleagues in the local hospitals and, if you or your baby need additional medical attention, we will refer you to the relevant clinicians and remain involved in your care.

If you live in Waltham Forest, you can choose Neighbourhood Midwives as your choice of provider.

www.neighbourhoodmidwives.org.uk/nhs-care/

Your maternity pathway

Antenatal (before the birth of your baby)

Booking antenatal care

Each provider offers antenatal care for women both in and out of their designated ‘catchment areas’. Women can either self-refer or seek referral via their GP.

Women who live out of area will often be seen by their chosen maternity service in the antenatal clinic, at the hospital whereas women who live in the catchment area of the hospital can be seen at their local community hubs and children’s centres for their antenatal care.

What are my choices for care?

In East London, you can choose to have your baby:

• At home — a homebirth, which means planned care at home with a midwife providing care during labour and support to you during labour and following birth. Midwives are trained to help you give birth at home safely and will also advise you if transferring into a hospital would be best
• In a birth centre run by midwives. There are two types, an alongside birth centre which is located in a hospital close to a labour ward and will support you to have a normal birth, and the second is a freestanding birth centre which is situated away from a main hospital and midwives take responsibility for your care during labour, and also support you to have a normal birth. We have two freestanding midwifery led units Barkantine birth centre in Canary Wharf and Barking Birth centre in Barking.
• In a hospital labour ward also known as an obstetric unit – provides 24-hour services. Obstetricians provide specialist care during pregnancy and birth. Midwives also provide care to all women in an obstetric unit and lead your care if you have a straightforward pregnancy and birth.

During the birth of your baby (labour or intrapartum)

Each maternity service provides a combination of services, facilitating birth in different settings. Each provider has an obstetric labour ward, an alongside midwifery led birth centres and the provision of homebirth services, as well as two freestanding birth centres in Barts Health.

Postnatal maternity pathway (after birth of your baby)

Wherever you have your baby postnatal care is provided to you by the hospital whose catchment area you live in. You will see midwives at home and in community hubs and children’s centres.

Maternity Transformation Programme and our local maternity priorities

Maternity services are currently undergoing big changes in England. The report Better Births has provided a framework for improving maternity services across all providers.

From this report, a national programme of improvement called the Maternity Transformation Programme is in place with the target of bringing together services locally to widen choice and personalisation for women. The link to details of this programme can be found here: https://www.england.nhs.uk/mat-transformation/

The East London LMS has developed a work plan to address the priority areas of the programme with a focus on safety and includes specific work areas of:

• Safety ‘Halve It’ ambition – to reduce stillbirth, maternal death, neonatal death and brain injury
• Improve personalised care planning for all women and their families
• Improve choice for all women and their families
• Improve continuity of carer
• Increase out of obstetric unit births (midwife-led birth centres and homebirths)
• Co-designing services with local women
• Increasing maternity workforce
• Encourage centralised procurement across East London to save money
• Encourage the use of digital technology
• Improve the provision and accessibility of perinatal mental health services
• Improve access to neonatal services

Breastfeeding services

Each provider has its own specialised infant feeding service offering antenatal classes, inpatient support following birth and postnatal support at home and in our local children’s centres. Information on these services can be provided by your midwives and health visitors when you see them.

Tongue-tie reversal services

Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby’s tongue to the floor of their mouth is shorter than usual.

Some babies who have tongue-tie don’t seem to be bothered by it. In others, it can restrict the tongue’s movement, making it harder to breastfeed.

Tongue-tie is sometimes diagnosed during a baby’s routine newborn check but it’s not always easy to spot. It may not become apparent until your baby has problems feeding.

See your health visitor, midwife or GP if you are concerned about your baby’s feeding and think they may have tongue-tie

Continuity of carer

This means seeing fewer midwives and doctors for your care and all maternity services in East London are trying to make this happen for more women, so that you get to know the people looking after you and they know you better.

All the hospitals currently provide continuity of care in the antenatal, birth and postnatal periods for women for very small groups of women, usually those who have particular needs.

Neighbourhood Midwives do offer this approach but at the moment, this is only for women who are living in Waltham Forest and are generally well. If you would like to speak to someone to see if you could be looked after by Neighbourhood Midwives, please ring 020 8874 6624.

Personalised care and choice

Three of our CCGs (Clinical Commissioning Groups) are involved in a national pilot site programme called the Maternity Pioneer programme.

This programme aims to:

• Provide choice of service or provider in each stage of the maternity pathway.
• Provide access to high quality, meaningful information explaining the choices and providing information to support the choices, including information on the maternity tariff amounts.
• Ensure the woman has a personal care plan, owned by the woman, which records her choices in each stage of maternity care and she feels empowered to make these choices.
• Ensure a woman’s choices are supported by a review and sometimes reshaping of payment mechanisms and transfers between providers to ensure that the tariff and payment flows support a woman’s choices.
• That a woman’s choices are honoured, where possible and where there is a change due to clinical needs, this take place through a new conversation about the new range of choices available to the woman

Specialist services

Some women will need more support in the pregnancy because of their health needs or those of their baby. All the local hospital provide specialist services and for some more unusual issues you may be referred to one of them who have particular expertise in your health needs.

Barkantine Birth Centre – Antenatal care after 36 weeks; 1:1 midwife support; birth pools; 24 hour telephone support; if required transfer to Royal London Hospital services

Barking Birth Centre – Antenatal care after 36 weeks; 1:1 midwife support; birth pools; 24 hour telephone support; if required transfer to Newham Hospital services

Barking Havering & Redbridge (BHRUT) – Screening, mental health, diabetic, endocrinology, neurology, cardiac, fetal medicine unit

Homerton Hospital – Fetal medicine services; High risk antenatal clinic including diabetic clinic; Birth options clinic; Breastfeeding support including tongue tie clinic; Perinatal mental health services; Substance and alcohol misuse midwife; Smoking cessation services; Birth after caesarean section clinic (group session); Clinic for women with high BMI (group session)

Neighbourhood Midwives – Offers a continuity of care service including homebirth for women who live in Waltham Forest and who are having a straightforward pregnancy. You will have two named midwives to care for you throughout pregnancy, birth and for six weeks after birth. Our homebirth rate is currently 56% and you can decide your place of birth at any stage in your pregnancy

Newham Hospital – Fetal medicine services; High risk antenatal clinic including diabetic clinic; Birth options clinic; Breastfeeding support including tongue tie clinic; Perinatal mental health services; Substance and alcohol misuse midwife; Smoking cessation services; Birth after caesarean section clinic (group session); Clinic for women with high BMI (group session); bereavement service

Royal London Hospital – Consultant Midwife clinics (birth options, birth reflections, VBAC), Consultant Obstetric clinic. Specialist genitourinary clinic, FGM, diabetes, fetal medicine, breastfeeding specialist, bereavement midwife, perinatal mental health team, vulnerable women’s team, anaesthetic clinic

Whipps Cross Hospital – Consultant Midwife clinics (birth options, birth reflections, VBAC), Consultant Obstetric clinic. Specialist genitourinary clinic, FGM, diabetes, fetal medicine, breastfeeding specialist, bereavement midwife, perinatal mental health team, vulnerable women’s team, anaesthetic clinic

Mental health support

It is not unusual for women to need extra support with their mental health around the time of having a baby, and particularly afterwards. Services to help you at this time are called ‘perinatal mental health services’.

To help you if you need it every London borough has an IAPT (Improving Access to Psychological Therapies) which offers free, confidential talking therapy for people who have for example symptoms of anxiety or depression.

Perinatal mental health services and consist of a team of specialist mental health nurses and psychiatrists for women with complex mental health needs. Click here for more information of these services in boroughs of East London:

• Newham
• City & Hackney
• Tower Hamlets
• Barking & Dagenham, Havering, Redbridge and Waltham Forest 

Smoking cessation services

Local stop smoking services can be found to help you quit smoking in pregnancy by entering your postcode at the website link: www.nhs.uk/smokefree/help-and-advice/local-support-services-helplines

Also Kick It stop smoking service details can be found here: kick-it.org.uk

Languageline

LanguageLine is a telephone interpretation line that you can use to communicate with your maternity team. They can be contacted 24 hours a day, 365 days a year.

Languageline Telephone 0800 169v2879

www.languageline.com/uk