Controversial potential changes to health services in Pembrokeshire could seriously affect the care provided to women in labour, a senior retired consultant obstetrician fears.

Following a period of consultation Hywel Dda Health Board is due to announce its planned changes to services, including proposals for a complex obstetrics unit at its preferred location of Carmarthen.

Despite assurances that consultant obstetric services will continue at Withybush Hospital, retired consultant Ruth Howells fears that the reduction of births at the hospital will mean the unit becomes unsustainable.

Miss Howells was previously South Wales Regional College Adviser for the Royal College of Obstetricians and Gynaecologists and retired last year after 23 years at Withybush.

She has voiced concerns that, if more complex pregnancies are transferred to a new unit at Glangwili, the number of normal deliveries planned in Haverfordwest could be as low as 600, making a consultant led service non-viable because of the need to maintain skills and recruitment of the medical staff.

"If there are only normal deliveries at Withybush, consultants could rotate to the new unit to keep skills up, but for how long, how often, and what effect would that have on continuity of care, for the gynaecology patients as well as the maternity patients, at Withybush?" said Miss Howells.

Referring to a recent case in east Wales where a baby died while being transferred from a midwife led unit, Miss Howells added: "There is an old saying that the first and last days of your life are the most dangerous.

"Whatever type of unit you have it is sadly inevitable that some babies don't make it, you cannot get away from that, but if you have certain emergencies such as the baby becoming distressed, or major haemorrhage in a midwifery led care unit which is detached from a consultant-led unit, and the patient can't just be wheeled down the corridor to obstetricians, but has to travel for an hour, you could be turning a retrievable emergency into a tragedy.”

The distance and travel time to a possible unit in Carmarthen is of concern especially as "a lot can go wrong in obstetrics in an hour" and having a consultant only available over the phone is "not acceptable in obstetrics", she added.

"There was no discussion about maternity at all at the public meeting [held in September by the health board]. I had submitted questions and I know other people had submitted questions but they weren’t addressed at all.

"To think that there will be a consultant led unit remaining long term at Withybush if a complex obstetrics is moved to Glangwili, is, I think, probably a forlorn hope despite the Health Board’s assurances".

“I cannot understand why Glangwili is the preferred option for both a complex obstetric and Level 2 neonatal unit. Glangwili is so close to existing facilities in Swansea, particularly if the obstetric services move to the Morriston site, and access for so many more people in the far west will be worse if everything is concentrated in Glangwili, whereas families from the east of Hywel Dda Board area would have the option of access to Swansea as an alternative if the new units were in Withybush.”

 

 

'We do not take risks with baby safety'

Hywel Dda said that it has to consider the best position for accessibility for all residents of the health board area and it was agreed that only one neonatal unit can be developed.

A spokesperson added: "All views raised during the consultation process will be considered by the board as part of the decision making process. Any changes the health board supports will need to be viable and sustainable, clincially safe and demonstrate improved outcomes for our patients.

"We do not take risks with - nor compromise - the safety of our babies, mothers and children. Clinical practice is constantly evolving and becoming more complex and our clinicians consider this when planning service development for the future."

Glangwili, which has the highest number of births in the health board area, is considered the preferred option for a level two neonatal unit for a number of reasons including access for families and the proximity to the level three unit in Swansea.

"The health board was clear during consultation that our preferred option was to provide and retain a consultant-led obstetric and midwifery service at Withybush Hospital.

"Obstetric and paediatric doctors, led by a team of five consultants in each speciality, will remain at Withybush Hospital, as at present, supported by highly trained paediatric nursing staff. They will continue to have the ability to stabilise and transfer as they do now. Staff would maintain their skills by continuing the resuscitation training they receive regularly and spending time in the new complex obstetric and neonatal units on a regular basis."