Do you know someone who has given birth on the roadside or in a car park? In the rural North-East of Scotland, this is a scary reality for some and a worrisome possibility for many.
In recent years, the maternity ward in Dr. Gray’s Hospital, Elgin, was redesignated to being a midwife-led unit, following medical staffing and culture problems within the unit. This has led to many women needing to travel to Raigmore Hospital, Inverness or the Royal Aberdeen Infirmary to give birth. Although some women plan this , so they are not taking a journey unexpectedly, other women do not make the choice and are transferred during labour due to complications that Dr. Gray’s Hospital are not set up to handle. To put this into context, there are 37 miles between Dr. Gray’s Hospital and Raigmore. However, Raigmore is often at capacity, so instead a woman will have to travel the 65 miles to the Aberdeen Royal Infirmary, and a further 71 miles to Ninewells, Dundee if Aberdeen is also full.
Unfortunately, these huge distances, coupled with other factors, can lead to women giving birth on the side of the road before they are able to reach hospital. Journey times can be very varied due to the day, time or season a woman is being transferred. There is heavy traffic most mornings and evenings, yet it is very quiet on a Sunday and at night. The changing weather, like snow and heavy rain, can also have a massive effect on the transfer journey time.
These situations, referred to as “Born Before Arrival” (BBA) or born ‘elsewhere’, can severely affect Moray women and families. Not only may they feel very stressed during pregnancy, if this does happen to a woman and her family it can be very traumatising.
One student midwife who was on placement in Dr. Gray’s Hospital remembers a woman near her birth due date ringing the community team in tears because her friend had given birth on the side of the road on the way to Aberdeen after being transferred and she was scared the same would happen to her.
Even though this can severely impact the lives of women and families, why are these statistics not being recorded in full and why is nothing being done with this information to improve services for women and their families?
In our recent article ‘Capturing the Correct Data for Births at Home’, Dr. Jenny Hall raised some very important concerns about the recording of ‘elsewhere’ births and the statistics it doesn’t have. For example, it doesn’t specifically tell us how many women didn’t get to hospital on time, giving birth neither at home or in hospital.
Not recording this important information is glossing over the fact that this happens to some women. It is extremely important to have all the information so changes can be made, affected women and families can receive the help they need, and pregnant women are able to have informed conversations with their midwife about the true choices and possibilities.
Transfers also have an effect on midwives and the midwifery Unit, which is not always taken into consideration when centralising services. When a woman is transferred, a midwife has to accompany her, taking them away from the already short-staffed ward. These situations may also increase stress for a midwife during labour, constantly watching for signs that a woman may need to be transferred and the unknown that lies ahead with that. Midwives may also feel they are not doing their job properly or have ‘let-down’ the women they care for, if they are unable to go with her to another hospital due to being over her regulated hours. In addition, the midwife may be worried about the return journey home; the ambulance will take the Midwife back to the hospital if they are travelling there, but if they are called somewhere else, the midwife will be dropped off somewhere and forced to either get a taxi or have family come to pick them up. The safety of individual staff in these circumstances should be considered.
The reported independent review of services due to take place in the summer is to be welcomed. However, it will take some time before any changes are implemented. For now, there is potential increased risk of BBA with additional stress to families and midwives alike. Situations like this do not just impact rural Scotland, it can happen anywhere and to anyone, so why is more not being done about this?