A day in the life of York's maternity unit: “It’s a privilege to be there at the start of a newborn’s life”

Cradled in the arms of her adoring mother Julia, and watched over by her father Jonathan, Bethany is a much wanted baby for the couple.

"I want Bethany to have everything she should and to grow up to be happy," Julia says about the life she wants for her daughter. 

"I want her to be whatever she wants. Whatever she chooses to be in her life she will be supported by me and Jonathan."

Two years ago the couple were devastated when they lost their daughter Skylar-Mae Hope from a rare health condition at four days old. Bethany shares the name, Hope with her older sister.

Understandably, Julia and Jonathan are not quite ready to leave the reassurance of their private room in York Hospital’s maternity unit.

"Her little sister Bethany has been given VIP treatment," Julia, 34, said, "We have been given a lot of support this time until we feel ready to go home.

"It's a rollercoaster of emotions as we have the memories of her sister."

Gazing at Bethany, she said: "We've got this bundle of joy. Today is a big milestone."

Listening from the edge of the room, Liz Ross (pictured above, right, with labour ward manager, Tricia Fowler) is visibly moved by Julia’s story. The emotional side of being a midwife isn’t something you become immune to, the head of midwifery at the hospital trust says.

"It's a very, very moving job. It can be very sad," Liz says, "On the whole it's a lovely job as you are with mothers at the start of their newborn's life and starting the journey."

Although there’s a practised sense of calm in the long, brightly lit, corridor of the labour ward, it’s still a fairly busy day, if nothing like as hectic as yesterday, midwife Jane McFee says from behind reception.

A total of 5000 babies a year are delivered by York Teaching Hospital NHS Foundation Trust, in the maternity wards of York and Scarborough Hospitals. The York unit averages ten births a day and today there are currently six women in labour on the ward, with two considered high dependency, Jane says.

The ward is seeing increasing numbers of women with more complicated pregnancies.

This is for a variety of reasons, Jane says, including much older women having children. With that comes a higher incidence of obesity, which is rising anyway, and has an increased risk. Other complications include women having twins through IVF and more mothers with pre-existing health conditions such as diabetes or heart conditions. It seems the norm that many women are in their mid 30s, with many having their first baby in their 40s, Tricia Fowler, labour ward manager, says.

And not only are women getting older, but the numbers of pregnancies at York seem to be rising. While the most recently published NHS statistics showed national birth rates were marginally down in 2014-15, they rose by 146 to 4,938 at the York Hospital trust.

Over in the hospital’s antenatal clinic, there’s a busy waiting room of expectant mums, partners and children, with many of the women waiting for scans.

Midwife Petra Mullen is cheerfully rushed off her feet. They’re steadily busy, and in the last year she’s noticed an increase in numbers, she says, “We used to have peaks and troughs but now it's busy all the time.”

In a room off the busy waiting area, Karen Dennis, 39, from Haxby, is laying eyes on her baby for one of the first times.

Beside her in the darkened room, and gazing up at the image of the new addition to their family is her partner Steve, and children William, nine, and Amy, seven.

As the sonographer carefully examines the baby, her face clearly comes into view on the screen, to the amusement of her brother and sister.

"She's looking at us Ames," Karen says to her delighted daughter.

Working with people at such a life changing time is a privilege, Petra says. She loves what she does. "It's a very varied job. It's one of the best jobs in the world being a midwife and looking after people at such an exciting time in their lives.”

Back in the labour ward, Liz carries out a quick tour. The ward is a combination of the old and new – the brand new reception desk, paid for by the hospital charity, wouldn’t look out of place in a hotel, and the new birthing pools are extremely modern (a newly decorated birthing room is pictured above).

“Water is a really good form of pain relief", Liz says, adding that nearly ten per cent of women use water for pain relief in labour, and about nine per cent give birth in the pool. Meanwhile, the doors are all monitored, with visitors buzzing in and out and newborns tagged with tiny trackers which automatically sound alarms and lock the doors of the unit if they pass through (pictured below).

Elsewhere, a few of the other 12 delivery rooms are awaiting a revamp. Not that it would cross your mind in labour. Some deliveries are over astonishing quickly, with the baby delivered hours after the mum has gone into labour, Liz says. But others can last over 24 hours. It has been known that babies have arrived so swiftly they have been born in the carpark outside.

The York unit is midwife-led, which means many women who give birth don’t give birth with the assistance of a doctor, although a consultant is always at hand should they be needed.

“Normal births” account for 60 per cent of the babies delivered in York, with 25.8 per cent delivered by caesarean and 14 per cent counting as assisted births, where forceps or a ventouse suction cup are used to help deliver the baby’s head.

Two per cent of women opt for home births, supported by community midwives.

The still birth rate has been lowered at York, where the latest figures show 2.3 per 1000 babies are stillborn. Mums with stillborn babies are taken to another area of the unit, away from the labour ward, Liz said. A lot of work is being carried out to reduce the rate of still births, with a government initiative aiming to reduce levels by 50 per cent by 2030.

Particularly, they want to reduce smoking in pregnancy, which increases the risk of stillbirth. The national figure is 11.4 per cent of women smoking through pregnancy, but in York it is higher at 12.5 per cent, and in Scarborough it’s much higher at 20 per cent. Carbon monoxide monitoring is carried out during pregnancy and mums given help to stop smoking if needed.

Mums need to be aware if there is any reduction in movement from their baby, Liz says.

Back in the labour ward, a sign on the wall for May 2016, shows 99 per cent of the new mums questioned in York would recommend the labour ward to friends and family if they needed similar care or treatment.

In her room in the unit, a tired but delighted Julia, a HR consultant, is also full of praise for the team.

"I was under the care of Miss Mitchell who has managed my anxieties by doing an induction of labour," Julia said, "It was really good to have that support. The whole experience has been so positive."

She’d like to thank midwife Beverly Ingle and paediatrician Liz Baker as well, she says, adding "I'd like to thank all the staff really".

The relief that his daughter and wife are doing so well is clear on the face of her husband Jonathan, 33, a data analyst, who has finally felt relaxed enough to briefly return to their home in Rufforth.

"I'm really thankful to everyone for looking after her,” he says, "It's given me peace of mind to go back and have some sleep."

"We are trying to support women to make an informed decision about breast feeding."

In an impromptu classroom in York Hospital, Michelle Larkman is teaching a group of care workers and midwives how to support new mums to breastfeed.

It’s an important issue for the hospital as breastfeeding is one of the best things you can do for your baby at the start of their lives, Michelle (pictured above, right, with health assistant Wendy Flintoft) says. But while 74 per cent of women are initiated to breastfeed in York, nationally, only one per cent of women actually do exclusively for the recommended six months.

Some women don’t breastfeed because their friends and family don’t, others because they are worried about the response they will get, Michelle says.

"It's free and the most natural thing for the baby", Michelle says, "We are trying to support women to make an informed decision about breast feeding."

The hospital meets UNICEF Baby Friendly Initiative standards to promote, protect and support breast feeding and bonding with your baby.

Breastfeeding is proven to protect babies against a wide range of serious illnesses including gastroenteritis and respiratory infections in infancy as well as asthma, cardiovascular disease and diabetes in later life. It’s also known to reduce the mother’s risk of some cancers.

On a table in front of them, collection of knitted breasts, which look fairly comical at first glance, but are used by hospital staff to teach women how to breastfeed their babies.

"The way women learn is copying,” Michelle says, “If you don't have a society where women can copy, what do you do?"

And even if you can’t exclusively breastfeed for long, Michelle says "even one feed makes a difference, every feed counts."

Feedback wanted

- The NHS is leading a national review of maternity services and York Hospital would like public input. Better births 2016 is a report from the NHS England commissioned national review of maternity services led by independent experts and chaired by Baroness Julia Cumberlege – this sets out wide-ranging proposals designed to make care safer and give women greater control and more choices in pregnancy.

The recommendations in the report are being looked at locally in York and the hospital has said it welcomes any women who have used its maternity services within the last two years to be part of planning to develop services in the future.

Please contact Liz Ross if this is something you would like to be part of: Elizabeth.ross@york.nhs.uk