8 May 2019
We have heard that the relationship between a family and their midwife is incredibly important.
The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland lays out best practice and what we should expect from maternity services.
Our motion highlights that provision is underfunded.
As we read the report, it becomes more and more obvious that that is the case.
The report talks about multidisciplinary teams in communities following the mother and family through the stages of pregnancy, birth and beyond.
However, only 10 per cent of Caithness births take place in the county; the rest take place in Inverness, which is more than 100 miles south, over treacherous roads.
A similar situation arose with Dr Gray’s hospital in Elgin.
The situation there has slightly improved because of interim paediatric cover, but that cover cannot be guaranteed and the situation remains precarious, with about 60 per cent of births still taking place in Aberdeen.
In Caithness, there was no attempt to provide paediatric cover.
Previously, there was obstetric cover, but there was no paediatrician.
Tragically, a baby died.
Had paediatric cover been available, that might have been prevented.
Rather than the lack of paediatric cover being addressed, obstetric cover was also removed.
The argument was that having obstetric cover gave a false sense of security, and that mothers were not transferred to Raigmore hospital quickly enough.
The arguments were also made that midwives were being deskilled and that birth was being overmedicalised.
However, with only 10 per cent of Caithness births now taking place in Caithness, it is difficult to see how midwives can hone their skills under the new system.
The truth is that the distances are so great that clinical staff will transfer the mum if there is any concern about the birth.
I do not blame them for that, because they do not have local back-up.
Many mums will, if it is thought that there might be complications or risks during the pregnancy, opt for an elective caesarean section.
That is the only way that they can plan for when they will be away from home, organise childcare for older children and organise for their families.
Sadly, that involves even greater medicalisation of birth and, as with all major surgery, risks are attached.
That flies in the face of what the best start approach states—an approach that also says nothing about giving birth in the back of an ambulance.
I have already raised in Parliament the case of a mum who gave birth to one of her twins en route to Inverness.
The twins were born 50 miles apart, in different counties.
That is distressing and unsafe.
If it is unsafe to give birth to a child in Caithness maternity unit, surely it is much more unsafe to do so at Golspie community hospital, which does not have a maternity unit or facilities.
The first twin travelled to Inverness, separate from its mother, who travelled in another ambulance and gave birth to the second twin in Inverness.
NHS Highland has not risk assessed that journey, and I fear that a tragedy will occur before it does.
If the Scottish Government is committed to best start, it needs to address that.
Another point of concern is the journey home with a newborn baby.
The journey is a long three-hour one by bus, four and a half hours by train, or at least two and a half hours by car.
Caithness health action team discovered that it is dangerous for a newborn baby to travel such long distances in a car seat.
For a journey of that length home to Caithness, specialist baby cots should be used to allow the child to lie down during the journey.
That surely would have been picked up, had NHS Highland carried out a risk assessment of the new pathway.
The community had to raise funds to purchase appropriate travel cots, and Tesco stepped in and offered to store cots for families when the NHS refused to do so.
The truth is that current practice does not reflect what is proposed in the best start plan.
That is unacceptable for the parent and the midwife.
I ask that a risk assessment of the current practice at Caithness maternity unit be urgently carried out, whether in relation to the physical journey to hospital and back home, or the large increase in elective caesarean sections.
The whole patient journey needs to be safe.