This leaflet sets out the range of maternity services available for women and their families across Barnet, Enfield and Haringey.

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2 2 This leaflet sets out the range of maternity services available for women and their families across Barnet, Enfield and Haringey. It describes what care you can expect to receive and the choices you have through your pregnancy, birth and beyond. Throughout your pregnancy you may be under the care of a midwife or obstetrician. Both are specially trained to provide care during pregnancy, birth and after your baby is born. We want you to feel safe, confident and totally involved in all aspects of your care: Your doctor and midwife will talk to you about how to keep you and your baby healthy during your pregnancy and give you information on: > care during your pregnancy (ante-natal care); > care during birth (birthing care); > care in the first two weeks after your baby is born (post natal care).

3 3 Planning your baby's birth It is very important that as soon as you know you are pregnant (the best time is before you are 12 weeks pregnant) you book an appointment to see either your GP or local midwife who will arrange for you to be booked at the local hospital of your choice. It is important because the earlier we see you the sooner we can make sure both you and your baby are healthy and well. Your midwife or GP can talk to you about your options and what might be best for you, depending on where you live and your individual circumstances. Preparing to become a parent Your doctor and midwife will talk to you about how to keep you and your baby healthy during your pregnancy and give you information on: Supplements such as folic acid and vitamin D Eating healthily Avoiding alcohol and cigarettes Seasonal flu vaccine Screening tests to check that the baby is healthy The importance of booking into a hospital early Reviewing what medicines you are taking Whooping cough vaccine

4 4 Care during your pregnancy Generally, most women are young, fit and healthy when they become pregnant and so are low risk. All low risk women are cared for by the local community midwifery team. Your GP will put you in touch with your midwives who will look after you throughout your pregnancy at a clinic close to your home. You will be booked under an obstetrician (specialist consultant for pregnancy and childbirth) and have mainly hospital care if you have either an existing medical condition, for example high blood pressure or diabetes, or your baby/babies need extra monitoring, for example twins and triplets. This will ensure you receive the additional expert help to take care of you and your baby throughout your pregnancy.

5 5 The BEH Clinical Strategy Programme is planning changes to services and working towards implementation in November A final decision about the timing of the implementation will be taken by local Clinical Commissioning Groups in September Local maternity care is changing We are proposing to change local maternity services so that we continue to ensure that all women and their babies get a safe, equitable and high-quality service. This means that Chase Farm Hospital will offer ante-natal and post natal care but may no longer have facilities for mothers giving birth. The two local options for women delivering in Enfield will be Barnet Hospital and the North Middlesex University Hospital. There will be a brand new maternity unit at North Middlesex University Hospital including an eight bedded Birth Centre, 18 bedded labour ward, new ante-natal clinic, new ultrasound suite and a newly refurbished maternity ward. Barnet Hospital will also have an expansion of their maternity services including the labour ward, the Birth Centre and maternity ward. These proposed changes will ensure that the women of Enfield will have state of the art maternity facilities. There will be more beds across both maternity services than there are at present. This will ensure that we can manage the current birth with confidence. More importantly it will also ensure we are able to have senior doctors at both hospitals who will be able to act immediately in the case of any emergency with either you or your baby. Talk to your GP or midwife to find out more as they can explain these changes and how they might have an impact on you. Hospitals have to prioritise women from their local area (catchment) so you will only be able to give birth at a hospital outside your local area if there is space for you or if there is a particular clinical reason. As far as possible, we want you to be able to have the type of birth that you want whether at home, in a Birthing Centre, or in a hospital and you will be able to choose all of these options at either hospital. We will support you in your choices.

6 6 Giving birth Your Choices Please ask your midwife for the North Central London Birth Choices leaflet for more in depth information. There is a range of birth settings. You could have your baby in hospital, either on the labour ward or in a midwife-led unit within hospital. You could also give birth in a midwife-led community birth centre (Edgware Hospital) or at home. Barnet Hospital Chase Farm Hospital Edgware EDGWARE birth centre North Middlesex University Hospital

7 7 Giving birth at home Any woman can choose to have a home birth, including women having their first baby. However, there may be instances when a home birth would be unsuitable, for example if you have serious medical conditions. Your midwife or doctor can discuss these with you. Evidence shows that giving birth at home is safe for women having a normal pregnancy. Giving birth in a Midwifery Led Unit Birth Centre Midwifery Led Unit/Birth Centres are run by midwives who are experts in normal childbirth. Birth Centres offer women who are enjoying a healthy pregnancy and expecting an uncomplicated birth the opportunity to give birth in a home from home environment. Birth Centres are good at supporting women who want a birth with no or fewer interventions. Birth Centres can be stand alone. This means they are on separate sites from the main maternity hospital (Edgware Community Hospital has a stand-alone Birth Centre). Midwives and midwifery care assistants run stand-alone Birth Centres 24 hours a day and there are no doctors on site. If you or your baby were to need medical care you would be transfered by ambulance to either Barnet Hospital or North Middlesex University Hospital. Both North Middlesex University Hospital and Barnet Hospital will have Birth Centres which are alongside (co-located) with the hospital labour ward and offer the same benefits as stand alone units. Giving birth on a labour ward/delivery suite (Obstetric Led Unit) In the UK, most women choose to give birth in hospital for a range of different reasons. If you choose to give birth in a hospital Obstetric Led Unit you will still be looked after by midwives in addition to doctors. There are some factors relating to your health or your baby s health that may increase your risks during pregnancy and labour. In these cases your midwife or doctor may recommend that you give birth in an Obstetric Led Unit at the hospital.

8 8 If baby is premature Barnet Hospital and North Middlesex University Hospital are both level 2 units. This means we can look after babies that: > are over 27 weeks gestation > need short term intensive care > have breathing difficulties and require support > are receiving continuous positive airway pressure (CPAP) > are receiving parenteral nutrition (intravenous feeding) > need feeding through a tube Babies who are born extremely prematurely (before 27 weeks gestation) or have other serious medical complications will need to be transferred to one of the level 3 units that specialise in looking after these babies. In Enfield our local specialist units are Homerton Hospital, The Royal London Hospital and University College Hospital.

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10 10 Maternity services available to residents of Barnet, Enfield and Haringey Barnet Hospital Wellhouse Lane Barnet Hertfordshire EN5 3DJ Chase Farm Hospital The Ridgeway Enfield EN2 8JL Main switchboard North Middlesex University Hospital Sterling Way London Greater London N18 1QX Main switchboard See a video and find out lots more about having a baby at: conditions/pregnancyand-baby/pages/ services-support-forparents.aspx

11 11 Communication Standards (based on London Health Programme Maternity Services) High level description Communication Prepregnancy care Ante-natal care Labour and delivery For all women planning pregnancy. First contact with healthcare professional. Seven to 10 ante-natal appointments according to individual need. 1:1 support in labour from midwife known to woman. Transfer of woman according to individual need, with midwife. GP/midwife (and specialists if appropriate) informed of planning pregnancy and health needs assessment. GP/midwife (and specialists if appropriate) informed of pregnancy and dynamic risk assessment. GP/midwife (and specialists if appropriate) informed of birth, dynamic risk assessment, transfer plan and postnatal care plan. Appropriate level of communications between midwife and GP to meet woman's needs Postnatal care First visit home. Frequency and location of care based on woman's individual need. GP/midwife (and specialists if appropriate) and health visitor informed of woman's dynamic risk assessment and postnatal care. Source: Clinical Working Group, team analysis

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