Barriers to new innovation in the UK’s NHS – and how to overcome them – Part 2

In Part 1 of this blog I discussed how companies need to build innovative products together with clinicians, in order to work out what helps them and their patients, rather than companies making assumptions about medical needs which may not actually be valid, which can create barriers to innovation.

Another barrier to innovation in the NHS which was raised in the Nuffield Trust’s report (link) was that, “Products are sought which lead to short-term savings, rather than transforming care pathways leading to more efficient services”.

Stories of NHS managers introducing cheaper versions of products which turn out to be more expensive overall are rife: examination gloves which split, and two or three are wasted before a useful pair is found. Paper towels which don’t come out of the dispensers properly, and end up being wasted on the floor. But far more worryingly – spending money on areas which do not improve care, and can actually hinder it.

Last year, Jeremy Hunt announced that he would be putting millions of pounds of investment into more CTG machines, despite there being zero evidence that continuous monitoring is safer than intermittent monitoring. Imagine instead if that money had been allocated to increasing midwife numbers to implement Continuity of Carer? Unlike CTG machines, Continuity of Carer has been shown to reduce stillbirth, as well as costs to the NHS such as caesarean births.

Far cheaper investments, such as birth pools, also leads to significant cost savings. Labouring in water increases the rate of spontaneous vaginal births, reduces the need for instrumental delivery, reduces the numbers of 3rd and 4th degree tears, lowers the chance of a woman wanting opiate pain relief or an epidural, and increases women’s positive experiences of birth which might lead to lower levels of PND. (1)  ALL of these mean that the NHS spends less money on fixing the consequences of these interventions, as well as the cost of the intervention itself.

Let’s see the NHS looking at the wider picture with every new innovation or investment. We call upon commissioners to look past the cost of installing new equipment which supports women to birth more easily, and instead see the full spectrum of ways that an investment in a birth pool, or other normal birth promoting products, can save the cash-strapped NHS money, while leading to better outcomes for women and their babies.

References:

(1) Evidence Based Birth: Waterbirth

 

 

Oldham Birth Centre: Nurturing Families

Oldham Birth Centre – A Place to Want to Labour!

Aquabirths birth poolOldham, in Greater Manchester, UK, has created the most stunning, supportive and effective birth centre which is family-centred and woman friendly. Designed to nurture women and birth, creating a safe, positive and caring space for the whole family – including other children, who can be present at the birth of their sibling.

Designed to support the physiology of birth from the ground up, the Birth Centre rooms do not centre around an obstetric bed. Instead, they feature slings, balls, mats, Softbirth couches, adjustable lighting and the stunning Aquabirths birth pool, with a large family bed available for parents and baby to rest in after their little one is born.

The Oldham Birth Centre’s philosophy of care is key to the success of this midwife-led maternity unit. Midwives are trained in hypnobirthing techniques, aromatherapy, acupuncture and using water to support positive, safe, physiological birth. Minimising adrenaline is key to maximising oxytocin, and maximising oxytocin is key to birth progressing well, so the whole room is designed to be calm and to help everyone to relax. An aromatherapy diffuser by the door greets the birthing family as they arrive, and the scents in the air, the dimmed lights offset by coloured bubble lamps and the Aquabirths birth pool gives a sense of walking into a spa.

Oldham Birth Centre Wall Painting
Oldham Birth Centre Wall Painting

Midwives describe seeing women sitting in a chair and looking around, and visibly relaxing. A kitchen is available for all to use, so birth partners can help themselves to drinks, and they can make their own snacks. Midwives make it quite clear that this space is for them to use, which is an important part of helping everyone to relax and continue to reduce any adrenaline levels.

The Oldham Birth Centre is not an extension of the labour ward, but instead is designed as a birth centre for the families of the city. While there are strict criteria for straightforward access to the unit, if a woman wants to birth there she can attend a Birth Options Clinic where their choice of place of birth is discussed, and the woman will be supported by the midwives.

The unit itself is nothing without its midwives, and the midwives at Oldham are hand picked for their inbuilt nurturing nature – not a trait which can be taught. Diane watches the student midwives who show an interest in physiological birth and support women’s choices. Those who wish to become part of the community/birth centre team are encouraged to apply.

Oldham Birth Centre is not unique, but it is unusual and it is beautiful. The women and families of Greater Manchester are extremely lucky to have this wonderful facility with its fabulous midwives.
The unit has a video on You Tube which showcases the birth pool and other facilities: https://www.youtube.com/watch?v=2wOHqJfLhGg

Choices-in-Childbirth January 2018

#Waterbirth – what can we learn from each other? Free Softbirths Mini Birth Couch, CFM: nothing but damage? A Year in Doula-ing, Women’s Art & News

https://mailchi.mp/ac16926a98f0/b0cx24sjnh-3125301?e=2ded6ce75b

Choices for Midwives January and February 2018

 

A New Midwifery Regulator? Bedside re-sus on the cord, Hungary jails Midwife Agnes, Birth Trauma feedback through theatre, Worldwide Midwifery News

https://mailchi.mp/cd4d1bb1b2b7/jq5x2zqwmx-3125929?e=957a92dac2

 

Installing a Birthing Bath

professionally installed birthing pool

There is no mystery to installing a birthing bath.  In may ways they are simpler than domestic baths because our baths are one-piece Single -Surface baths.  Midwives designed the bath from the top down, and plumbers designed it from the bottom up!

Usually, the bath arrives into a near-finished room.  Plumbing should already been in place behind an IPS panel.  All that should be visible is a small piece of 40mm solvent weld pipe protruding from the very bottom of the IPS (or no more than 25mm from the floor).  Taps are in place by this stage too.

In terms of taps, we don’t recommend any, but have a short guide sheet (pdf).  We know taps from the Ideal Bluebook range are commonly used.  For example, one Trust repeatedly favoured using two of the following so that there was a double supply of mixed supply hot water.  The reason being that 22mm taps that are HTM compliant are very difficult to source and a 15mm tap would take too long to fill the bath.  http://www.idealspec.co.uk/catalogue/bluebook/brassware/contract/contour-21/contour-21-single-control-mixer-and-15-23cm-spout_p351.html

Rada Sensor taps are also very popular.

  Looking in through the hatch, the finished pipe work should look like this.  The valve should be as close to the hatch door as possible so that the midwives are not having to reach right in under the bath.  The valve is supplied with the bath.  The pipe either side of the valve must be clamped to support the valve and to stop the pipework being twisted by the constant use of the valve.

Anyway, first things first.  This is a 2-3 person job – you’ll see why.  When we install a bath, we put down lots of padding and tip the bath on its side onto the padding.  This way, we can, using a long level or straight edge, adjust the feet to match the base of the pool.  The bath is designed to sit both on the basal rim of the bath and on the feet.  This is why our baths are so good at spreading the load.  If you don’t think you can put the pool on its side without scratching it, don’t – the warranty doesn’t cover it.

It is also easier to silicone in place the waste and, if ordered, the LED lights. The latter are fitted in the same way as a waste – a backnut and a lot of silicone!  Once all that’s done, carefully turn the bath back onto its base.

Offer up the end of the bath to the IPS.  This way, you’ll see where the waste pipe will come through the end of the bath.  mark and drill it out.

First to go on the tail of the waste is an elbow and the waterless trap.  The Hepworth vO is a good choice but other versions are now available.  Do  not use a U-bend or shower trap.  They hold water which will just become a source of infection issues.

ideal pipe bends
Avoid sudden 90 degree corners in the pipe run.

 

 

Next comes the valve and the remaining piperun to join on to the piece of 40mm pipe protruding through the base of the IPS (and through the end of the bath you’ve just drilled!).  Don’t glue the pipework before you’ve tried it all in place.  You may want to mark where the clamps either side of the valve are to go.  It is easier to pull the bath back, drill and then put it in place.  Finish the pipework.

Screw the bath to the IPS and, through flanges on the base in the hatch area, to the floor.  Silicone round.

Better Births in Powys – Supporting Women, Improving Care

Powys delivering better births
Ruth Weston of Aquabirths in the new Aquabirths birth pool installed in one of Powys’ birth centres.

Powys: Supporting women and supporting Better Births.

In the heart of Wales, in one of the most rural areas of the United Kingdom, lies the beautiful county of Powys. In this stunning region the recommendations of The Birthplace Study and Better Births are being wholeheartedly implemented. In extraordinary contrast to some areas of the UK, Powys has determined to ensure that Midwife Led Units are recommended as the optimal birth place for healthy women and babies, provided they are happy to birth there – supporting women in their decisions and supporting Better Births.  20% of women give birth in a midwife led unit in this area, compared to 14% for the rest of the UK.

Powys has 6 midwife led units across the county, limiting the distance that women need to travel in labour, increasing safety for women and babies and reducing the stress on families at a time where the birthing woman needs to be able to focus on her job at hand.  In addition, Newtown, one of Powys’ towns with a birth centre, has recently celebrated  the huge achievement of obtaining funding to run sonographer services local to where women are, reducing the travelling distances for women by 3000 miles a year!

Newtown has also used its funding to add in a permanent Aquabirths birth pool, and a double bed so that new parents can snuggle up together with their baby after the birth, rather than being separated at one of the most profound times of their lives.

Well done Powys – you are an inspiration!

Guest blog by Emma Ashworth

Birth Baths in the Netherlands – Geboortebaden in Nederland

 

Aquabirths birthing baths have been installed in several hospitals across the Netherlands such as the Saint Lucas Andreas in Amsterdam.  Now we have an agent/distributor in the Netherlands.  We’ve partnered with the established Dutch company VAB so that customers in the Netherlands can discuss the baths and get support locally.  Their Mobypool range is here.  You can contact Maks and Hans here.

Also, we now price our baths in Euros and pounds so that customers in the rest of the EU can choose the currency that suits them.

Free Mini Birth Couch Kit with Birthing Pool

Birthing Couch Kit for Smaller Birth Rooms

The SoftBirth birthing couch kit has a new little sis!  A shorter version for smaller rooms at a smaller price.  A HoM asked us to design a smaller birth couch kit for smaller rooms, so we did and will even fit in the back of a small hatchback. Anyway, with all our birth couches we offer very large discounts when more than one of the same couch is bought. So, this is £600+VAT but 3 or more would be at £500 each.  As with the larger SoftBirth couch, this is a kit – the stool and kneeler are included.  The mini is also FREE with Aquabirths’ Canberra, Venus and Heart-shaped birth baths.

Mini birth couch kit

Waterbirth : Part of a World Movement

Revisiting WaterbirthBarbara Harper, founder/director of Waterbirth International reviews the second edition of Dianne Garland’s textbook ‘Revisiting Waterbirth: An Attitude to Care’ in the context of waterbirth practice around the world.

It is no secret that water is healing and that the use of water is an effective medium to facilitate changes in actual brain wiring. It is with excitement and great pleasure that I welcome the publication of the second edition of Revisiting Waterbirth: An Attitude to Care. Dianne Garland has continued to provide waterbirth education and training not only throughout the UK, but around the world. Our mutual passion brought us together for conferences, workshops and presentations many times. It has been my privilege to work closely with Dianne as a teaching partner in China, Spain, the Czech Republic, Israel, India and the United States. Her excitement about demystifying waterbirth is contagious, and the reader, whether midwife, doctor or mother, will experience that enthusiasm within the pages of this book.

There has never been a time in our combined history when the message and knowledge within Revisiting Waterbirth: An Attitude to Care has been more necessary. The misinformation surrounding waterbirth that Dianne and I have witnessed in different parts of the world is sometimes distressing and occasionally humorous. This book gives every practitioner an effective, informative guide to start a waterbirth practice and integrate that practice into any clinical setting. It also provides concrete examples and stories from those with whom Dianne and I have worked. The inclusion of detailed stories from practitioners and parents is a wonderful supplement to the new edition of Revisiting Waterbirth.

The use of water for labour and birth has increased exponentially since Dianne and I first started writing letters to one another in 1989. When we finally met in person 26 years ago in Kobe, Japan, at the International Confederation of Midwives conference, we excitedly shared documentation of the efficacy and safety of waterbirth. The demand for accurate, useful information and descriptions of experiences has also increased. When we first started our collaboration, waterbirth was referred to as a fad or a trend that would soon be gone. Women seeking the ease and comfort of water will continue to increase in every part of the world. Waterbirth is part of a world movement that seeks a more humane and gentler approach to childbearing.

The use of warm water immersion has long been seen as an aid for labour, making it easier for the mother to enter into and remain in a state of hormonal bliss. Today, there are well-designed studies that prove the efficacy of water for labour and the safety of water for the birth of the baby. Dianne’s experience as a hands-on midwife attending waterbirths, as well as her design and documentation of research, makes her the perfect person to lay the foundation of education for those who want to incorporate the use of water into maternity care settings. This book is also a guide for those who have already started waterbirth practice to improve their experience.

The message in this book is simple, straightforward and very hopeful. It is hopeful in the sense that more and more women are asking how to make labour less about ‘enduring the pain’ and more about creating a good, healthy and loving experience of birth for the baby. Women understand that creating a new human being is one of the most important jobs on the planet. The providers who serve those women need the encouragement that this book offers to step out of the routine medical care and become open to the possibilities that water can, indeed, change the course of a labour and should be utilized as a valuable tool for almost all women. The attitude with which professionals view a woman’s ability to give birth can either enhance or detract from her experience.

In 2014, the American Congress of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatricians (AAP) launched a campaign to put doubt about the usefulness of waterbirth into the minds of nurses, doctors, midwives and the public. Some US hospitals paid attention to the published and widely distributed ACOG opinion paper and halted their successful and incident-free waterbirth programs. Dianne and I travelled together to hospitals in Cleveland, Ohio, and Minneapolis, Minnesota, shortly after the article was published, to educate hospital staff and help reinstate waterbirth policies in these facilities. We were welcomed in these places and our efforts were rewarded when the practices were put back into place.

It is my sincere hope and desire that practitioners throughout the world are guided by the message in Revisiting Waterbirth: An Attitude to Care and start implementing protocols in more hospitals. All women should be offered the choice and opportunity to labor in water and birth their babies with the ease, safety and pleasure that water so beautifully provides. I also hope that our tandem careers continue to bring this message to every corner of the globe. As founder and director of Waterbirth International, I have relied on Dianne Garland to provide a multitude of research and documentation from the UK and have used this book in its earlier editions as a teaching tool and recommended reading for nurses, midwives and doctors.

Barbara Harper, RN, CLD, CCCE, CKC, Midwife
Founder/Director of Waterbirth International

Follow Ruth Weston’s BornStroppy Blog

ABOUT RUTH AND ‘BORNSTROPPY’

Ruth Weston, BornstroppyBiog:

Ruth Weston mother, business woman, lactivist. Ruth is the mother of five children, four born at home and in water. She liked her waterbirths so much she took over Aquabirths as a small Yorkshire birth pool hire firm 15 years ago.

Since then she and her husband have grown the business, now, with midwives and doulas, designing pools and soft furniture for the NHS and around the world.

Ruth is passionate about women having good care and a good birth: she set up  ‘Choices in Childbirth’ childbirth group in her home 14 years ago which became a network of similar groups across Yorkshire and beyond with a regular monthly E-newsletter which you can subscribe to.

Ruth helped set up the MSLC in Bradford and Airedale and became its first chair. Ruth is now turning her considerable determination and energy to the delivery of continuity of midwifery carer and the reform of regulation for midwives – structural reforms she believes necessary for the delivery of humane maternity care for women.

For 25 years now I’ve been campaigning along side others to improve women’s experience of childbirth. Part of my work has been to provide the means and equipment for better birthing experiences: that may be knowledge and training or it may birth room equipment.
If you would like to sign up the monthly newsletter ‘Choices in Childbirth’ or ‘Choices in Childbirth for Midwives’, fill in the form below. Or click on the image below.

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