NMH

NMH | 2024 81 Maternity & Obstetrics their GPs. It must be acknowledged that many GP practices do not offer combined care to women choosing a homebirth due to medical insurance limitations. In 2024 we are delighted to report all women are offered a dating scan which takes place in The National Maternity Hospital Ultrasound Department. In addition to the dating scan, women also receive an anatomy scan which is scheduled between 18-22 weeks. We work closely with our liaison Consultant Obstetrician Dr Zara Fonseca-Kelly, who provides support and clinical review for women if needed. Women are offered a postdates point of care scan for liquor volume, either in our clinic at NMH or at community Domino clinics with our midwives who have been trained to provide same, using portable tablet scanners. Domino and Homebirth Service Bookings Over 500 women booked into the service in 2024, with 359 birthing with our service. Reasons for this reduction are similar to previous years, either women suffered a miscarriage or where the woman's risk profile changed and assisted or specialised care became the appropriate pathway for them, as per the National Maternity Strategy. Domino Service Intrapartum Care Of the 359 women who birthed through the Domino and Homebirth scheme, 32.3% required induction of labour. The indications for induction align with national guidelines and The National Maternity Hospital policy. Table 4 outlines the primary reasons for induction, which include prolonged spontaneous rupture of membranes (PSROM), fetal distress, advanced maternal age, Group B Streptococcus (GBS), and postdates. The Robson Ten Groups Classification of Caesarean Section (Table 3) shows that the Group 1 LSCS rate is 5.7%, with our overall LSCS rate being 13.9%. This rate is in line with the World Health Organization (WHO) 'ideal acceptable' LSCS rate of 10-15%. This occurs in the context of national and global trends, where there is an increasing rate of LSCS year on year. It is also worth noting that 75.2% of Domino women experienced a spontaneous vaginal delivery. The table for the Community Midwives Robson Ten Groups Classification of Caesarean Section is provided at the end of this section. of midwifery in the intrapartum period. This initiative was made possible by the collaboration of key stakeholders from across the hospital including our Consultant Neonatologists, Obstetricians and management teams. We are currently researching women's experiences with hydrotherapy, and the feedback has been overwhelmingly positive from those who have used the birthing pool. Our total epidural rate stands at 44%, with the majority of this rate being accounted for by nulliparous women. While we actively promote the hydrotherapy pool, it's important to note that some women are excluded from using it due to the need for continuous fetal monitoring, which is often a result of the overall higher induction rates. Perineal Outcome The perineal outcomes for women who had a vaginal birth are displayed in Table 5 and 5b. The episiotomy rate for women last year was 15%, which includes instrumental deliveries. For the spontaneous vaginal delivery (SVD) group, the episiotomy rate is 9.6%, and the OASI (Obstetric Anal Sphincter Injury) rate is 2.2% Breastfeeding Breastfeeding Rates Total % Breastfeeding at delivery 333 92.8% Breastfeeding at discharge 324 90.3% One of the key success indicators for our service is that 90% of women are breastfeeding upon discharge from the Domino service. We believe this success is largely attributed to the effectiveness of our antenatal breastfeeding classes, combined with the promotion of colostrum harvesting. These initiatives are empowering women with the knowledge and confidence to choose breastfeeding as their preferred method of feeding. Additionally, the home visits provided up In 2024 we are delighted to report all women are offered a dating scan which takes place in The National Maternity Hospital Ultrasound Department. In addition to the dating scan, women also receive an anatomy scan which is scheduled between 18-22 weeks." Epidural and Birthing Pool Use Tables 6 and 7 outline the mode of birth, epidural rates, and our use of the hydrotherapy pool. In June 2024, waterbirth was introduced as an option for women who wish to remain in the birthing pool for birth. One in five Domino women chose to use the hydrotherapy pool for labour, with 30 women going on to have a waterbirth. This has been an incredibly positive development, offering women more birth options. This has been an incredibly positive achievement not only for women but for midwives to be able to practice the supportive care model

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