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How Maternity Services are organised in Northern Ireland

Revised July 2023

There are two main types of maternity care for women and pregnant people in Northern Ireland: 

  1. Midwife-led care with the woman birthing at home or in a midwife-led unit. 

  2. Consultant-led with the woman birthing in an obstetric unit (hospital). 

 

In December 2022 the Department of Health made the decision under coroner's recommendation to withdraw 2 regional guidelines on admission to Midwife-led units (MLUs) and support for home births, stating a number of clinically significant omissions and discrepancies when compared to the National Institute for Health and Care Excellence (NICE) Intrapartum care guidelines for healthy women and babies CG190. This means that women require more antenatal consultations if they choose to give birth under midwife-led care in NI, either in hospital or at home.  As a result of the Covid pandemic and this more recent decision, all freestanding MLUs are now closed down in NI.

 

Strategic direction for maternity care in NI 

The Department of Health determines the maternity model of care in Northern Ireland, and in July 2012  launched the maternity strategy,  adopting a health improvement approach:

  • give every baby and family the best start in life; 

  • effective communication and high-quality maternity care; 

  • healthier women at the start of pregnancy (preconception care); 

  • effective, locally accessible, antenatal care and a positive experience for prospective parents; 

  • safe labour and birth (intrapartum) care with improved experiences for mothers and babies; and 

  • appropriate advice, and support for parents and baby after birth. 

 

A Strategy for Maternity Care in Northern Ireland 2012-2018 (DHSSPS, 2012) places a strong emphasis on the normalisation of pregnancy and birth as a means of improving outcomes and experiences for mothers and babies.  The strategy is overdue for renewal and there has been a call by the director of the Royal College of Midwives Northern Ireland for ‘The case for a new maternity strategy for Northern Ireland’ dated May 2021. 

Maternity services in the UK have slowly been moving towards a more consistent model of care since the publication of Better Births in 2016.   Research has shown that women have better outcomes if they have maternity care from the same midwife throughout their pregnancy, birth and postnatally.  Up until recently, most women usually see numerous midwives, doctors, obstetricians at their appointments, during labour and birth, and in the postnatal period.

With the gradual introduction of the Continuity of Midwifery Carer (CoMC) model, women are assigned a named midwife at their booking appointment, who will be with them continually throughout their pregnancy journey, and on into the postnatal period.  This model was launched in May 2023, with small teams in each Trust providing consistent care to those at higher risk of having poorer outcomes, eg living in under-privileged areas, smokers, under 20s, Black, Asian and mixed-ethnicity.  As the roll-out continues, it should become available to more pregnant women in Northern Ireland.

 

Recent Developments in Maternity Care: 

 

There are 6 Health and Social Care Trusts in NI:

Belfast – Royal Jubilee Maternity Hospital has 13 rooms in the delivery suite + 4 midwifery-led rooms known as the Active Birth Centre (ABC).  There are 2 rooms with pools, one in the delivery suite and one in the ABC unit. A new maternity hospital is due to be opened on site later in 2023.  There are approximately 5000 babies born in the Royal per year. The freestanding Midwifery Led Unit in the Mater Hospital has been closed to births since the beginning of the COVID-19 pandemic. 

Southern – Craigavon Hospital has 8 birthing rooms in the delivery suite with one pool, and 8 rooms in the alongside midwifery-led unit with baths available for water births.   Daisy Hill Hospital in Newry has 4 rooms in the delivery suite, and 2 midwifery-led rooms with pools.  

A dedicated  homebirth team was established in 2022.  There are approximately 5,300 babies born each year.

South Eastern – Ulster Hospital has 7 rooms with one pool in the delivery suite and an alongside midwifery-led unit known as Home from Home, with 7 rooms and a pool in each room. 4500 babies are born on average each year.  The freestanding MLUs at both the Lagan Valley Hospital and the Downe Hospital have been closed since 2022.

Northern – Antrim Area Hospital has 6 rooms in the delivery suite with one pool.   Coleraine Hospital closed 17th July 2023.  3700 babies are born each year.

Western – South West Acute Hospital in Enniskillen has 5 rooms in the delivery suite, plus an alongside midwifery-led unit with 6 rooms, and 2 pools. Altnagelvin Hospital in Londonderry has 5 rooms in the delivery suite, plus an alongside midwifery-led unit with 7 rooms and 2 pools. Approximately 3700 babies are born each year.

 

Each of these Trusts has an allocated Consultant Midwife, Perinatal Mental Health Midwife and Continuity of Midwifery Carer Lead Midwife.

 

There is a Maternity Services Liaison Committee for each Trust.  The forums are made up of local maternity service users and representatives of organisations who work with the maternity services. The aim is to work together and improve services in response to the needs of women. 

 

Northern Ireland Ambulance Service is one of the Health & Social Care Trusts.

 

In situations where mum has mental health issues, NI is the only country in the UK not to have a Mother-Baby unit, although there are ongoing discussions and campaigns to establish one.

 

The mother’s ‘green notes’ – her maternity file, allows her to easily transfer and choose to have her care in any Trust.

 

There are no independent midwives in NI.

 

Women can pay to have private antenatal obstetric care.

 

The NI Assembly

Is the devolved legislature for NI, responsible for making laws on transferred matters, [eg health,]  and for scrutinising the work of ministers and NI government departments

 

NI Executive 

Comprises First Minister, deputy First Minister and 8 departmental Ministers, one of which is the Health Minister. 

 

NHS in NI

In NI, the NHS is referred to as HSC – Health & Social Care. It is the publicly funded healthcare system in NI, and one of the 4 systems which make up the National Health Service in the UK (including NHS England, NHS Scotland & NHS Wales)

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Key:

HSCB: Health & Social Care Board – commissions services, manages resources & performance improvement

LCGs: Local Commissioning Groups, one for each trust, responsible for the commissioning of health and social care by addressing the needs of their local population.

HSC Trusts: Provide health and social services across NI

PHA: Public Health Agency, major organisation in NI for health improvement and health protection w

RQIA: Regulation and Quality Improvement Authority is the independent health and social care regulatory body for NI.


 

Resources:

Regional Quality Improvement Agency (RQIA) Guideline for planning to birth at home in Northern Ireland

Guidelines and Audit Network (GAIN) Guideline on admission to midwife-led units (MLUs) in NI

Strategy for maternity care in NI 2012-2018 can be found at www.health-ni.gov.uk 

State of maternity services report 2018: https://www.rcm.org.uk/media/2825/state-of-maternity-services-report-2018-northern-ireland.pdf

www.nidirect.gov.uk Information and services on any government department and services.

NICE guidelines: https://www.nice.org.uk/guidance/cg190

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Prepared by Anne Glover, NI volunteer representative on AIMS Campaigns Team. Anne is also the Doula UK Area Representative for NI, with over 8 years’ experience, and has to date supported over 100 births.

 

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Regional Guidelines
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