Take a population catchment area of over 100,000 people with approximately 1,000 births a year, and plan maternity services for them. Factor in the dangerous A96 and the geographical location.
This is Moray, the “thorn in the flesh” to NHS Grampian. Nevertheless, it’s a growing community with new houses being built all the time, two military bases attracting young people, and the prospect that the Moray Growth Deal will bring jobs to the area.
Experts tell us that no reasonable health board, in the context of modern maternity care, would set up a stand-alone, midwife-led unit 65 miles from the specialist unit. Yet, that’s been the reality since the consultant-led maternity unit was downgraded in 2018.
Pregnant women dread blue light ambulance journeys along the A96. Even many with “straightforward” pregnancies are suffering severe anxiety – for example, if they don’t give birth in Elgin by a certain deadline, they must travel to Aberdeen for induction, and that could be at any time of the day or night.
Latnem, a Grampian-based mental health charity, has said that they are supporting more mums in Moray with antenatal anxiety and tokophobia (fear of giving birth) than in any other area. It’s not difficult to understand why.
Women say that the lack of a consultant obstetric unit at Dr Gray’s Hospital is causing them to miss out on enjoying the last weeks of their pregnancies. What should be a joyfully anticipated life event is turned into a terrifying ordeal to be feared.
Some women believe that this crippling anxiety is preventing them from having a spontaneous delivery.
An already flawed plan
NHS Grampian has a duty of care to provide specialist maternity services for Moray. The current plan is to send about 350 Moray women per annum to Inverness – these are the women who are at most risk of developing complications.
The plan, in the medium to long-term, is to increase the number of births in Elgin by linking a midwifery-led unit in Elgin to Raigmore, but that plan will fail
The plan is flawed. Raigmore Hospital is already very short-staffed and does not have capacity for Moray women, as has been said repeatedly by some of their own senior clinicians. Furthermore, the numbers don’t add up. Currently, about 750 Moray women a year give birth in Aberdeen Maternity Hospital.
Take the Moray birth numbers for April 2022. Forty-seven expectant mums were booked to deliver in Elgin, but there were only 12 births in Dr Gray’s Hospital. Twenty-five expectant mums were booked to deliver in Aberdeen, but there were 63 Moray births in Aberdeen Maternity Hospital.
Raigmore Hospital is not going to manage all these births but, in any case, it is still a substantial journey from Moray to Inverness on the problematic A96.
The plan, in the medium to long-term, is to increase the number of births in Elgin by linking a midwifery-led unit in Elgin to Raigmore, but that plan will fail.
This kind of set-up in Elgin is too remote to be compared, in safety terms, to other midwifery-led units, which are either alongside a specialist-led unit, or much closer to a specialist unit. Birth numbers in Elgin will, inevitably, remain low.
More clarity is needed now
NHS Grampian has to urgently address what must happen at Dr Gray’s Hospital to restore the consultant-led service – proper investment in staffing, 24-hour on-call for obstetrics and anaesthetics, appropriate facilities for women needing unexpected high-dependency care, and rapid availability of blood for transfusion. The specifics required need to be made crystal clear, and then work must begin.
We have been promised that the consultant-led service will be restored ever since the downgrade, but we now need far more clarity to be content that these promises will come to fruition.
Otherwise, the burden of risk remains on expectant mums. They are being failed by two health boards – Grampian, for abdicating responsibility for them, and Highland, for taking on a project which is likely to end in disaster.
We need a detailed account from all the key players – the health boards and the Scottish Government – of what happens next and why. Meanwhile, women, babies and families continue to pay the price for their inertia.
Kirsty Watson is spokesperson for the Moray Keep Mum campaign
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