WHAT happens when a normal delivery turns into an emergency and transfer is not an option?
That is the question that remains unanswered by Hywel Dda University Health Board despite repeated questioning by county councillors.
At a special joint older person and wellbeing and children and families overview and scrutiny committee last week, councillors were given the chance to question representatives of the health board.
There was consternation that chief executive Trevor Purt and chairman Chris Martin did not attend, but county director Sue Lewis and director of clinical care at Withybush Hospital Dr Iain Robertson-Steele were on hand to answer questions.
Over three hours, councillors expressed their concerns about health plans which will see 24-hour obstetric and paediatric care removed from Pembrokeshire, along with neo- natal services.
A level two neo-natal unit, complex obstetrics unit and inpatient paediatric care will be developed at Glangwili Hospital, Carmarthen, with mothers in Pembrokeshire being served by a midwife-led unit at Withybush.
Councillors Pat Davies and Sue Perkins both raised questions about what happens when a normal delivery turns into an emergency in its later stages and transfer is not feasible.
In reply to both, Mrs Lewis and Dr Robertson-Steele said that mothers would be assessed early in their pregnancy and booked into Glangwili if any risk was identified – but did not explain how a woman considered low risk would be treated if sudden problems occurred.
Plans to change services for women and children were drawn up by Hywel Dda, unanimously approved by the board, and the SCBU proposal was then referred to the health minister.
But the health board maintains that it was not its decision to move services from Withybush Hospital.
Cllr Davies said: “Transfer is not an option in the final stages of labour, can a midwife unit cope?”
Dr Robertson-Steele replied: “If we are having the right patients screened to it (the midwife-led unit), those risks are low.
“Equally, if you're a high-risk mother, the best place to have your baby is supported by obstetric service backed by neo-natal service. That’s what we are trying to achieve. Midwives are very skilled professionals and can have extended training and there will be training opportunities and skill development.
“Whatever you do, there are risks. We can’t provide everything locally, what we can do is try and plan in having a service in place to evacuate patients quickly.”
Cllr Davies repeated: “What about in final stages where a transfer would not be an option?”
He replied: “The issue we have to consider is about where deliveries occur and where people are advised. Midwife delivery and home delivery associated with a degree of risk in small number of cases. You can move pregnant ladies in an air ambulance but our preference would be to move them in a land ambulance.
“If it was affordable, staffable, deliverable, sustainable and safe, we would have services in every hospital. If we can’t provide it locally, it is at least within an acceptable amount of time.”
A air ambulance spokesman told the Western Telegraph: “Wales Air Ambulance does not currently carry labouring women. However, it is possible to reconfigure the aircraft to provide this service if required.”
Dr Robertson-Steele added that funding had been promised to fund the delivery of emergency transport and retrieval services in this area and they were due to be developed.