THE number of neonatal intensive care units in Scotland should be cut from eight to three within five years to deliver "safer care" for the sickest babies, according to recommendations which have also backed wider access to home births and a personal midwife for each expectant mother.
Very premature infants and those with serious breathing difficulties or extremely low birth weights would be among those treated in the highly specialised centres.
The plan has been outlined in a review of Scotlands' neonatal and maternity services carried out on behalf of the Scottish Government.
The 'Best Start' report said a smaller number of neonatal intensive care units would "lead to improved staff competencies and best clinical practice in these units and safer care for the babies most at risk". The overall number of neonatal units in Scotland would remain unchanged at 15, however, with the remaining 10-12 units becoming either "special care" facilities or "local" neonatals for the majority of babies requiring low-risk intensive care.
The report added that the shift from eight to three intensive neonatal units "will require further detailed work to consider and develop capacity for additional babies and facilities for parents".
Newborns charity, Bliss Scotland, welcomed the "progressive vision" for neonatal services, but called for improvements to family facilities. The charity said a third of units lack even the basic equipment to allow families to warm up food or prepare simple meals, with only one in six units offering meal vouchers to parents. One couple who contacted Bliss had spent £2000 over four months on parking and meals in order to be close to their baby, while another mother who had undergone a C-section faced a 70-mile round trip to visit her newborn because there was no in-house accommodation.
Caroline Lee-Davey, chief executive of Bliss, said: “Services are already overstretched, and we are calling on the Scottish Government to demonstrate its commitment by introducing minimum standards on the level of free accommodation and other practical support for families that should be available.”
The report also outlined plans to allocate a primary midwife to each expectant mother to ensure continuity of care through pregnancy, childbirth and the postnatal period. The move was welcomed as a "seismic shift" by the Royal College of Midwives and a "a momentous step" by the National Childbirth Trust.
Under the plan, one midwife will be responsible for around 35 women at any one time and should be the "first point of contact" throughout pregnancy. The same midwife "will then be with the woman for labour and birth, whether at home or in a midwife or obstetric unit".
The report adds that for women on a second or subsequent pregnancy, without complications, giving birth at home was "as safe" as birth in a midwife-led or obstetric unit, yet "very few NHS Boards actively promote home birth as a realistic choice". It said all boards, including islands, should offer the "full range of choices" to mothers.
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