Changing misconceptions, making sure new mothers-to-be are informed and reinvesting in Paulton’s Birthing Centre were all pleas made by local people who attended a consultation event on transforming maternity services in B&NES, Swindon and Wiltshire last Saturday in Paulton.

The event explained proposals for major changes to maternity services in our area, which could see the end of babies being born at Paulton or Chippenham.

The CCG, local commissioners and health professionals from the Local Maternity Service, says it will replace the community birthing and postnatal beds with support closer to, or in, women’s homes.

In Paulton’s case, there would be a new hub on the hospital site – a pilot model providing ‘wrap around care’. Whilst the design of this and its final form is still being looked at, it could be open seven days a week, potentially from 8 a.m. – 8 p.m. for local families to access and receive support from midwives, physiotherapists, speech therapists and other health and care professionals.

However, women giving birth would have to go the RUH, Bath, or Frome’s Freestanding Midwifery Unit under the proposals, or they would be supported to have a home birth if they chose. The RUH and Salisbury would have new Units created for midwife-led births. Community midwives will continue to be on call in the local area.

Despite the proposed hub, the changes would mean mothers would not be able to give birth at Paulton’s Birthing Centre or spending time recovering with their new baby there. But critics argue that this model is outdated, and that post-natal support can be provided through new hubs, clinics and at home.

The CCG Local Maternity Service representatives say the proposals are not about saving money, reducing staff or closing any buildings. Rather, they argue that it will mean more choice for women, better continuity of care, and to use their resources more efficiently. They argue that centres such as Paulton, which are busy with antenatal and post-natal clinics, but not delivering babies, are not able to make best use of staff’s time or expertise and that this is demotivating.

Those attending the meeting were told that this is a good opportunity to transform maternity services; one that has not come around for over 25 years. Because of this, they argue that the needs of the population have changed, and that women are having babies later in life. There are also greater high risk pregnancies, such as through high blood pressure or diabetes, that require medical experts on hand. Low-risk pregnancies and mums to be will also be informed about home births – currently only 2% of babies are born in this environment.

A group of ex-Paulton midwives attended the meeting last week and spoke out against the proposals. One said: “This is all very sad. I used to work at Paulton maternity and back then, we called it a five star hotel.

“I do accept that women are getting older. But I feel really sad that it has come to this.”

The CCG Commissioners have also come under fire for their use of statistics, accused of ‘manipulating’ them; however, they argue that these figures have been analysed independently by Bath University, as will the consultation responses.

Local campaigner, Grant Johnson, who was born at Paulton Hospital, says: “Whilst the claim that only 6% of births take place at Freestanding Midwifery units (such as Paulton) in the Local Maternity System is a true statement, the problem is that when you include the birth rate figures for Swindon, Salisbury and Wiltshire, you start to get a dilution of the figures. The figure for the NHS Trust is more like 14%.

“The claim that 95% of the time, beds in Freestanding Midwifery Units are unused or empty does not, in my opinion, truly reflect how often a FMU might be caring for mothers and their families.

“If we take Paulton as an example, they have five community post-natal beds – if four of these are in use and one is empty, then that bed goes into this statistic.

“What we are failing to get is the percentage of time that these beds are actually used.”

Members of the public called for committed investment in Paulton instead, asking to make options clear to local women. One expectant mother told the audience that she had had four points of contact and had only been made aware of the proposals through a local petition, which has received over three thousand signatures.

However, the CCG said that although it shows strength of feeling, the petition was unlikely to be accepted in the consultation, and it was more important that the questionnaire is filled out in greater detail to understand the reasons why the respondent disagrees. Around 900 responses have been received so far.

At the meeting, a maternity services spokesperson said: “Doing nothing is not an option. We have to do something differently. This is a once in a thirty year opportunity to unlock staff and resources and make a change.

“We’ve had rich feedback already, but we really do need more for our families and our staff.”

Once the consultation period closes, a business case will be put forward, expected in June, and will be reviewed by hospital Directors, the CCG’s governing body and NHS England. A decision could be announced by September, with a potential new unit at the RUH in place by 2021 if the proposals go ahead.

One of the mothers present at the meeting said that having Paulton’s birthing centre close by had been essential for her. She said: “Without Paulton, I would have had my daughter in the car.

“I was supposed to go to Bath afterwards, but they were too busy, so I ended up having all of my checks in Paulton.

“I can’t be supported for a home birth for medical reasons, and I would not have made it to Bath in time.”

Feelings ran high in the meeting, with campaigner, Gillian Johnson, adding: “How can you argue there is more choice for local women if you are closing a ward?

“It should be about women and what they want – you’re just talking about models and figures. It’s always rural resources that go first, and that makes me really angry.

“You can’t measure what it means to a community to have a full range of medical resources.”

A spokesperson for local maternity services said that she did believe that overall, there will be more options for women.

Arguments to keep Paulton’s birthing unit open included investing and promoting the service so that it ‘earns its keep’; to continue to promote busy antenatal and post-natal services, and even to ask locals if they would pay more Council Tax to invest in Paulton Hospital – but the CCG health leaders say this is not about money, but transforming the current service.

Other arguments included staffing all local midwives in Bath, but sending them to Paulton if necessary. The CCG said it was open to all ideas and encouraged the audience to offer solutions and alternatives.

There was also a discussion about the perception of Paulton Hospital being inferior to the RUH when it came to giving birth, and if this could be changed. The CCG argues that 50% of first-time mothers could need to transfer from a unit such as Paulton to the RUH for extra medical support with their birth, and as a result, many new mothers are choosing to go to the RUH, rather than risk being moved mid-labour.

The Journal approached Paulton Hospital’s League of Friends, who have raised thousands of pounds over the years for the Hospital, for comment on the proposals. A spokesperson said: The League of Friends has supported the Maternity Unit in the past, and will continue to do so.

“At this stage, all we have are proposals, and we feel that the consultation period, which runs until the end of February, should run its course. We should then be told the definite plans for Paulton Maternity.”

Commenting after the event, a spokesperson on behalf of the Local Maternity Service said: “We know that many women in our area who have a low risk of complications in labour and are otherwise fit and healthy could give birth in a Freestanding Midwifery Unit (such as Paulton), but choose not to.

“Looking specifically at birth rate figures for B&NES, between April 2017 and March 2018, 84% of births were at the RUH, and 14% of births took place at a Freestanding Midwifery Unit – 3% of all births took place at Paulton.

“Over the past ten years, we have used a number of strategies to promote and encourage Freestanding Midwifery Units, such as Paulton, as a place of birth, but despite this, the number of births in these settings has continued to reduce.

“Many women and families tell us they want to be able to quickly access surgical support or anaesthetic care if needed, and they do not want to have to transfer to an obstetric unit once they are in labour.

“We are proposing to offer an Alongside Midwifery Unit, where care is still provided by midwives, but if the support of a doctor is needed, there is direct access to an Obstetric Unit. As part of this proposal, women will still have the choice of giving birth at a Freestanding Midwifery Unit in Frome or Chippenham.

Antenatal and post-natal care will continue in Paulton.

“Post-natal beds at Paulton are significantly underused, and we are proposing to provide this kind of care in a better way. We use the standard NHS definition of bed occupancy – the proportion of available (open and staffed) beds occupied at midnight on a bedded ward. For example, as Paulton has five post-natal community beds, if just one bed is occupied at midnight, that would equate to a 20% occupancy rate for that day.

“Whilst there are up to 1,825 bed days available at Paulton annually, during 2017, these spaces were only occupied on 67 occasions – around 4% occupancy, meaning skilled staff are often looking after empty beds and buildings.

“This proposal is exactly that, a proposal, and nothing has been decided yet. Please take part in the consultation by completing the survey at: www.transformingmaternity.

org.uk, writing to us, or coming along to one of our public events. There are details for these on our website. The survey and events have been designed to make sure everyone’s views can be fully considered before any decisions are made.”

The consultation closes on 24th February.