Letter to the Editor: No basis for “eight minute” claim when labour goes wrong

BSBV was instigated by GPs, hospital doctors, midwives and other clinicians across this area who were not happy with current quality of services and wanted to take the lead on redesigning safe high quality services that will be fit for the 21st century.

A key aim for maternity services is to provide 24 hour-a-day, 7 day-a-week consultant presence on acute labour wards, given the strong association between better outcomes for women and their babies and the presence of a senior experienced doctor.

We would like to reassure your readers that the vast majority of women are cared for safely by a midwife throughout their labour and delivery, and do not require any intervention from an obstetrician.

BSBV is committed to promoting midwife-led care wherever possible and to increasing the number of women who are able to deliver their babies at home or in midwifery units.

In your article, you have quoted a campaigner who claims that Mr Hassan Shehata had said that "once a labour starts to go wrong" women should be seen by an obstetrician "within 8 minutes".

It is not clear where this assertion has come from but, taken out of context, it has no basis and only serves to scare people unnecessarily.

Mr Shehata is a very well-respected obstetrician and gynaecologist and is the Clinical Director for Women's Services at Epsom Hospital.

He has also served on advisory panels of the Royal College of Obstetricians & Gynaecologists and has been a valued member of the BSBV Clinical Working Group for Maternity and Newborn.

We think it is very unlikely that he would want anyone to infer that there is some kind of eight-minute cut-off point for saving lives of mothers and babies.

It is true that things can, unfortunately, go wrong in labour very quickly and that is why it is essential to have continuous presence in the labour ward of a consultant obstetrician, experienced in assessing high risk situations, making the right decisions in a timely way, and able to intervene where needed to get a better outcome for the mother and her baby.

However, when doctors and midwives say that there may be only a matter of minutes to intervene at a critical point in labour, it does not and cannot apply to women who are still at home.

There are very few women in this country who live within eight minutes of an obstetric-led maternity unit, and we cannot believe that the campaigners that you interviewed for your article would suggest that anything else is unsafe.

The Royal College produces clinical guidelines and quality standards for all aspects of maternity care, but none of these offers a time-bound recommendation for obstetric review of women in labour.

Even for women who have elected to deliver at home or at standalone midwifery-led units, the vast majority of transfers are non-life threatening so actually the timing is not critical.

In true emergencies, there are no target transfer times, but the key issues are stabilisation, no delays in decision making and excellent care on arrival in the obstetric-led unit.

We look forward to an informed debate on the BSBV proposals for maternity care during the public consultation.

Meanwhile, the full details of our proposals are published on the BSBV website www.bsbv.swlondon.nhs.uk including the best practice methodology employed by BSBV for analysing travel times for people to reach hospital by private car, public transport and blue light ambulance.

Our analysis shows that all women will be able to reach their nearest major acute hospital within 30 minutes by blue light ambulance, should this be necessary.

It should be noted though, that only a tiny proportion of pregnant women would ever need to be conveyed from home to hospital by blue light ambulance for clinical reasons.

Dr Jane Wilson, Consultant Obstetrician and Dr Mike Lane, GP - Joint Chairs, BSBV children’s services clinical working group

• What do you think? Send your letter to: letters@epsomguardian.co.uk.

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