View Full Version : Re-think on Caithness births

01-Oct-15, 17:40
New arrangements follow death of baby at mattie unit

NHS Highland has put in place new arrangements to ensure the safety of mothers and babies during labour and birth in the Caithness Maternity Unit with immediate effect.
The temporary move comes following the recent tragic death of an infant delivered at the maternity Unit.

Dr Rod Harvey, Medical Director for NHS Highland, said: “This is a very tragic case and our thoughts and condolences are with the family.

“Regrettably our preliminary investigations have determined that this death was potentially avoidable had different arrangements been in place to ensure more timely and immediate access to advanced paediatric support facilities at Raigmore Hospital.

“Having considered the events leading up to the death and in order to ensure that as far as is possible these circumstances do not happen again, the clinical team have made a number of recommendations that have already been put in place. These changes are to improve the safety of mothers and babies during labour and birth in the Caithness Maternity Unit while we await the outcome and implications of a more detailed review of this case.

“While our initial review did not find any failings in the care provided by individual staff it did highlight a number of issues concerning the current arrangements and protocols for neonatal paediatric risk assessment and support, which now need to be reviewed to ensure the safety of both mothers and new born babies in the future.

“In the short term, with the exception of elective caesarean sections, the maternity unit will operate on a basis equivalent to that of a community midwife-led unit albeit still retaining access to urgent locally based consultant obstetrician support if required. Local consultant obstetric clinics and scanning will continue as usual.”

In practical terms this means that the threshold for transfer to Raigmore Hospital pre-birth, during labour, birth and the post natal period will be lower with the result that more mothers will be transferred than under the current arrangements. For instance, where it is apparent that a baby requires enhanced monitoring it will be transferred to Raigmore for surveillance. As far as possible such needs will be anticipated in advance with the intention that the majority of transfers will be planned before the baby is born.

Dr Harvey added: “These arrangements will remain in place pending the outcome of a Significant Adverse Event Review which is already underway. I have personally met with the family and have explained to them our preliminary findings and how we plan to conduct the review.”

The Significant Adverse Event Review will involve the board medical director, clinical director for north and west, local clinical staff including midwives and obstetricians and experts from outside Highland. The family will also be invited to contribute.

These immediate but temporary arrangements bring Caithness in line with other midwifery led community maternity units within NHS Highland.

A mother presenting with the same circumstances at a community midwifery unit would have transferred to Raigmore for labour and birth. The delivery criteria in Caithness is different because of the presence of consultant obstetricians on site, and in this case the decision, as per local protocol and procedures, was made to keep the mother in Caithness and deliver her baby there.

In 2014, there were 254 births to Caithness women; of these two thirds were born in the Maternity Unit in Caithness General with the remainder born in the Maternity Unit in Raigmore. The majority of babies born in Raigmore fell into the high risk category.

Caithness General is classed as a consultant-led maternity unit with no neonatal intensive care unit facility. Care is delivered by midwives supported by three consultant obstetricians. While there are monitoring facilities for new born babies and anaesthetic support there are no paediatric facilities on site.