Publication - Independent report
Moray Maternity Services Review: report
Report of the independent review into maternity services for the women and families of Moray, commissioned by Cabinet Secretary for Health and Sport, Jeane Freeman in March 2021.
Appendix F: Service Features by Model
| Service Features | Model 3: Community Midwifery Unit | Model 4: Moray Networked Model | Model 5: Rural Consultant-supported Maternity Unit | Model 6: Consultant–led Maternity Unit |
|---|---|---|---|---|
| Antenatal care at Dr Gray's: | Yes (should be available by visiting consultant) | Yes | Yes | Yes |
| Obstetric sonography, etc. | Yes | Yes | Yes | Yes |
| Fetal medicine | No | No | No | Yes (could have fetal medicine specialist) |
| Midwife-led antenatal care | Yes | Yes | Yes | Yes |
| Obstetric antenatal care (at Dr Gray's) | Yes | Yes | Yes | Yes |
| Antenatal triage (Queries in labour / assessment to avoid unnecessary travel) | Yes (midwife provided) | Yes (midwife provided and extended to 24 hour service) | Yes (midwife provided supported by consultant - 24 hour availability) | Yes (midwife provided supported by consultant - 24 hour availability) |
| Day-care assessment - fetal heartrate monitoring, etc. (as per MLU+) | Yes (could be provided on a planned basis by visiting consultant to avoid excess travel) | Yes (could be provided on a planned basis by visiting consultant to avoid excess travel) | Yes | Yes |
| Antenatal transfer of responsibility for consultant care | Yes To Aberdeen where clinically required | Yes To Raigmore/Aberdeen based on choice / clinical risk assessment | Yes To Raigmore/Aberdeen based on choice / clinical risk assessment (lower number required for clinical risk) | Yes Only for limited number of high risk pregnancies births Location dependent on neonatal cot availability |
| Elective sections delivered in Dr Gray's | No | Yes (based on risk assessment) Requires flexible 24/7 midwife staffing* | Yes (based on risk assessment) | Yes |
| Consultant obstetric input to intrapartum care at Dr Gray's | No | No | Yes (numbers required are lower than in Model 6) | Yes |
| Resident obstetric cover at Dr Gray's | No | No | No | Yes (though it may not be a consultant; it could be a middle grade tier doctor) |
| Consultant obstetrician(s) on call from home for intrapartum care at Dr Gray's (24/7) | No | No | Yes | Yes |
| Consultant paediatrician available in hours/out of hours for neonatal resuscitation and stabilisation (midwives / other staff available to do so) | Not required (stabilisation and resuscitation is led by midwives) | Not required (stabilisation and resuscitation is led by midwives) | Yes (initial stabilisation and resuscitation is led by midwives / access to on-call paediatrician is required) | Yes (initial stabilisation and resuscitation is led by midwives / access to on-call paediatrician is required) |
| Resident obstetric anaesthetic cover at Dr Gray's | No | No | No | Yes (though it may not be a consultant; it could be a middle grade tier doctor) |
| Consultant anaesthetist(s) on call from home for intrapartum care at Dr Gray's (24/7) | No | No | Yes (nos. needed lower than Model 6) | Yes |
| Epidural service at Dr Gray's | No | No | No | Yes |
| Emergency / urgent intrapartum transfer | To Aberdeen | Yes Assumed Raigmore (women's choice / risk based) | Yes Assumed Raigmore (women's choice / risk based) | No Should not be required (age of gestation dependent) |
| Service Features | Model 3: Community Midwifery Unit | Model 4: Moray Networked Model | Model 5: Rural Consultant-supported Maternity Unit | Model 6: Consultant–led Maternity Unit |
|---|---|---|---|---|
| Postnatal care at Dr Gray's: | Yes ("Low Risk" mothers) | Yes | Yes | Yes |
| Inpatient | Yes | Yes | Yes | Yes |
| Community care | Yes | Yes | Yes | Yes |
| Transitional care for baby | Yes | Yes | Yes | Yes |
| Postnatal transfers of mothers and babies back to Dr Gray's | Depends on pathways of care | Expected (depends on pathways of care - to be developed) | Expected (depends on pathways of care - to be developed) | Yes (but limited requirement for transfers back) |
| Postnatal emergency transfers out of Dr Gray's: | To Aberdeen | Yes To Raigmore/Aberdeen (based on choice / clinical risk assessment / cot availability | Yes To Raigmore/Aberdeen (based on choice / clinical risk assessment / cot availability | Yes To Raigmore/Aberdeen (based on choice / clinical risk assessment/cot availability - expected reduced number required) |
| Special Care Baby Unit (SCBU) required | No | No | No (due to robust antenatal risk assessment / subject to transfer by ScotSTAR. Transitional care available.) | Ability to provide flexible special care, as required |
Contact
Email: Kirstie.Campbell@gov.scot
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