Information provided by Royal Devon and Exeter NHS Foundation Trust; Senior Midwife for Community Services & Named Safeguarding Lead for Midwifery
Community Midwives have predominantly carried and been responsible for their own homebirth bags when attending women in labour at home. However, this has inevitably meant that every midwife frequently has a different bag, laid out in a different way, possibly with slightly different equipment.
Consequently, a ‘buddy’ or second midwife, when joining the lead midwife who has been attending the labouring woman at home, can potentially have difficulty in locating the exact equipment that she may need. This is because she would be unfamiliar with the layout of the equipment within the bag belonging to the other midwife. Midwives attending as second midwives to homebirths not being able to find pieces of equipment in a timely way due to every bag being different, and therefore laid out in a different way, has the potential to lead to delays in treatment particularly in emergency situations.
Following an audit, it was also identified that stock was not being rotated to ensure best use, and often equipment was expiring before it was able to be used. There was also no audit trail of homebirth equipment being checked on a regular basis. Often equipment can be thrown away for infection control purposes due to it becoming contaminated with, for example blood, because the midwife can inadvertently touch something she didn’t specifically require whilst looking for another piece of equipment with gloves on – particularly if something needs to be found in a hurry. This is clearly a potential infection control risk.
It also means that community midwives are required to carry heavy kit in their cars at all times, something that some community midwives find difficult, or when on annual leave, the equipment is often stored in the midwife’s home as she relinquishes the boot of her car back for ‘everyday life’ during this period. Again, not an ideal solution.
The introduction of standardised homebirth bags.
Rather than every midwife having an individualised bag, a Trust can purchase a set amount of standardised homebirth bags – kept in various locations – the labour ward, community hubs etc – that can be accessed on a ‘need’ basis rather than being carried individually in the boot of a car. Midwives when attending a homebirth can pick up one of these standardised bags to take with them, and then re-stock it from the checklist once returned following the birth. Bags can be signed in and out for audit purposes and because there would be a set amount of these bags, stock would be used prior to its expiration date.
Everything would be laid out in the same way for familiarity, and individual pouches for equipment are clearly labelled whilst being protected from contamination thereby negating the disposal of stock not used.
The expense to a Trust to equip every single community midwife with an individual bag, where stock is often becoming contaminated or out of date is excessive when compared to having a set number of identical bags, that are accessible to all midwives.
The bags also have the potential to make homebirths for women safer, as every midwife would be familiar with the standardised homebirth bag, the layout, and the equipment used. This in turn means that midwives are able to find the equipment they need, and therefore provide the care in a timelier way for the mother or baby – especially in an emergency situation. Consistent checks of the bags can be more formalised – meaning that rotation of stock is more robust and stock should never be out of date, therefore further improving safety for both mothers and babies.