For mother-to-be Harriet Knight, the suspension of maternity services at one of England’s most remote hospitals means having to face horribly stark choices.
“The next closest maternity unit is a full two hours away and we have a family history of labour taking under two hours from start to finish,” said Knight.
“So we have the option of potentially giving birth in a layby on the north Devon link road as we try to get there or opting for free-birthing at home with no access to maternity care.”
Sunday was the last day that North Devon district hospital in Barnstaple will accept women in spontaneous labour. From Tuesday, births at the hospital will be suspended because of “unsafe levels of medical staffing”.
Mothers in labour will have to trek to Exeter or Taunton, at least an hour and a half away, but usually more, especially at this time of year when the roads are thick with holiday traffic.
“It feels there is no safe option at the moment,” said Knight, who is 34 weeks pregnant. “We live in one of the most rural places in the country and this has left pregnant mothers in north Devon in a really scary situation. It feels like a complete failure by the hospital trust.”
One option she and her partner are considering is spending all their savings on temporary accommodation in Exeter as her due day approaches. “Moving out may be the only thing we can do to keep us safe,” Knight said.
Harriet Knight said pregnant women in the area had been left in a ‘really scary situation’. Photograph: Jim Wileman/The Guardian
Hannah Rulton, who is expecting her third baby in November, is to undergo a caesarean section because during her second labour she and her child suffered severe shoulder dystocia, an obstetric emergency in which the baby’s head is delivered, but the shoulder gets stuck behind the mother’s pubic bone.
“He was stuck for 11 minutes. Both my son and I very nearly died. The trauma of that birth has never left us. Every appointment during this pregnancy has brought back memories,” she said.
“I have been told there is a significant chance of shoulder dystocia occurring again and what now keeps me awake at night is the fear of going into labour before my planned surgery. The thought of making that journey knowing I have a history of one of the most time-critical obstetric emergencies imaginable is absolutely terrifying.
“Instead of looking forward to meeting our baby, I am worrying about whether I will go into labour early, whether I will make it to another hospital in time and whether I could be forced to relive the worst day of my life.”
Health officials said that temporarily suspending birth services at the site was the ‘only safe course of action’. Photograph: Jim Wileman/The Guardian
Carolyn Mills, the chief nursing officer at Royal Devon University Healthcare NHS Foundation Trust, said suspending services had been an “exceptionally difficult” decision.
She said: “Unfortunately, we have now reached the point where we cannot safely provide the level of medical cover required to continue births at North Devon district hospital.
“While we recognise the additional travel this will mean for some families, we believe that concentrating services where safe medical staffing can be guaranteed is the safest option.”
The trust said its projected consultant maternity rotas were at times 50% short, and tier 2 (registrar) doctors 40% short because of staff departures, maternity leave, absences through sickness and a scarcity of locums on short notice. It said it was continuing to work to recruit more staff.
Births and face-to-face triage will be suspended. Other services including community midwifery, scans and antenatal outpatient clinics are continuing. The trust said it would restart birthing services when it was safe but could not estimate a timeframe.
Almost 15,000 people have signed a petition started by Ian Roome, the local Liberal Democrat MP, expressing concern. He said he felt the trust had taken its eye off the ball on recruitment. “Babies are going to be born in laybys,” he said. “There may be deaths.”
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Louise Pamment, a local resident who mentors women, has set up a campaign on Instagram calling for medical staff to apply for positions in north Devon. “I’ve seen genuine fear and distress in the women in my life who are pregnant,” she said.
Dr Alison Wright, the president of the Royal College of Obstetricians and Gynaecologists (RCOG), said: “Maternity services are currently under huge pressure, and we are aware of staffing gaps on almost every obstetric rota in the country. The RCOG is calling for urgent investment in the maternity workforce – to ensure safe staffing levels, so that we can provide the compassionate care that women and families deserve.”
Chloe Ross, who is due to have her second child in October, described the situation as “utterly dangerous”. She said she had a previous bad birthing experience in Exeter and only decided to have another baby having moved to north Devon, thinking she would be able to give birth locally.
“The idea of Exeter dealing with the additional pressures of women coming from our catchment is terrifying. Any way you look at it, women will have to labour in cars on overcrowded roads for nearly two hours,” Ross said.
“The loss of triage will prevent women seeking support for things such as low movement, HG [extreme sickness] and much more.”
Chloe Ross, pictured with her son Milo, said she had only decided to have another baby after moving to north Devon because of her previous bad experience in Exeter. Photograph: Family handout
Hannah, another expectant mother, is due to have her baby in January. “But I’ve already been told to prepare for travelling to Exeter to give birth,” she said.
“As a first-time mum, it’s inevitable that questions are running through my mind. Will I make it to the hospital in time, or could I end up giving birth on the A361? At the moment, I’m feeling positive about labour and birth, but having to factor in such a long journey adds an extra source of anxiety that shouldn’t have to be there.
“Many expectant parents are already talking about booking Airbnbs or hotels near their due dates to reduce the risk of not reaching Exeter in time. My partner and I are fortunate: we have access to cars, can afford temporary accommodation if necessary and have a strong support network around us.
“But the closure of the unit will have the greatest impact on those who don’t have those advantages. How will people without reliable transport, financial flexibility or family support get to Exeter, particularly if an ambulance isn’t available?”
She is also concerned some women may feel pressure to have planned caesarean sections, “simply because it offers certainty about when and where they will give birth. A caesarean is major surgery and should be a clinical choice, not something women feel forced to consider because local maternity services are unavailable.”
