Labour ward forums
Labour Ward Forums (LWFs) aim to ensure that there is a clear documented system for management and communication throughout the key stages of maternity care. LWFs were established after publication of Towards Safer Childbirth: minimum standards for the organisation of labour wards – report of a joint workign party in 1999. It recommended that all labour wards should have a LWF to 'review labour ward activity and develop guidelines'. Through multidisciplinary working and co-operation LWFs work to ensure the best possible quality care for women and their baby within the Labour Ward environment.
The purpose and work of labour ward forums
In England LWFs support the work of the CNST (Clinical Negligence Scheme for Trusts), established for NHS Trusts to fund the cost of any clinical negligence litigation. The Maternity Clinical Risk Management Standards introduced by CNST to reduce litigation related to maternity services support Labour Wards Forums, meaning that NHS Trusts with functioning Labour Ward Forums obtain discounts to their insurance premiums. In Wales, Labour Ward Forums support the work of the Welsh Risk Pool (WRP), the equivalent organisation of the CNST in England. In Scotland there is no CNST equivalent but groups similar to LWFs operate, sometimes known as labour ward committees or intrapartum groups. In Northern Ireland LWFs are not well established.
CNST Maternity Clinical Risk Management Standards state that LWFs must review all aspects of Labour Ward activity. This involves looking at professional (clinical) and organisational issues. Subjects could therefore range from specific aspects of care (such as policies and guidelines or research) to staff issues (eg levels, training), to operational aspects (eg security, visiting). Incident reports might be considered on a summarised basis, or as feedback from the Maternity Risk Management Group along with other relevant reports, eg audit, standards development or governance (CNST, 2006).
Membership of Labour Ward Forums
Labour Ward Forums are multi-disciplinary groups. Towards Safer Childbirth and CNST Maternity Clinical Risk Management Standards include the following guidance:
- the lead obstetrician
- the clinical midwife manager
- an obstetric anaesthetist
- a neonatal paediatrician
- a risk manager
- junior medical staff
- junior midwifery staff
- a consumer representative (which the RCOG recommends should be from the MSLC)
- supervisor of midwives
Labour Ward Forums should hold meetings quarterly and if core members of the forum are not available they should send representation from their area. Welsh LWFs often meet more frequently. Minutes of meetings should be sent to all members to ensure effective communication.
Labour Ward Forums - The importance of user perspectives
Carolyn Markham, a long-standing LWF user rep in Northampton tells us about her experience of working on a Labour Ward Forum and what she has achieved as the only lay representative on the group.
Following the birth of my second baby in 2003 I was really keen to get involved as a user rep at my local unit so I asked about sitting on the MSLC. I was told that the future of the MLSC was uncertain but that they needed a consumer for Labour Ward Forum. At that point I didn't have a clue what LWF was but I agreed to go along anyway! At the first meeting I felt a bit overwhelmed as I didn't know who anyone was but everyone was very welcoming. The format was quite straightforward, representatives from different areas all gave a report and then various matters were discussed, such as whether a funding bid for new monitors should be put in, who should attend training sessions, hand over meetings etc.
The meetings are quarterly and I manage to attend the vast majority of them. In fact to the embarrassment of the Consultant Obstetrician the inspector for CNST commented that the most regular attendee on the group was the consumer rep! Having a Labour Ward Forum with representatives from each department is seen as good practice and is taken into consideration by CNST from a risk management point of view.
Over the last three and a half years I have grown in confidence and I now have no reservations about speaking at meetings. I have a standing slot on the agenda and can give my own report if I want to. I have also given a presentation on the importance of skin to skin contact. This was particularly effective and well received. It is very satisfying to see that the skin to skin posters I took in are displayed on every labour ward room door.
When I first started I felt a bit disappointed that I was on LWF when I really wanted to be on the MSLC but I really enjoy the meetings now and hope that I can make a difference. Unfortunately the MSLC did fold which is a real shame but at least we still have a rep on the "inside" so to speak.
Sometimes the topics may seem as if they do not need user involvement but it is still important to be there and to be on first name terms with the Heads of Departments is no bad thing either. When new people come into the group they sometimes seem surprised that I join in and say my piece but fortunately the Consultant Obstetrician in charge of Labour Ward is a great advocate. He knows it is important to have a user rep and he also knows how hard it can be to get them!
So if you get a chance to sit on LWF why not give it a go? I cannot say how different it is from being on a MSLC as I haven't been on one but I would guess that the main difference is that the remit is more focused around Labour Ward. Having said that we do discuss antenatal clinics, postnatal wards, neonatal unit and community visits. Unfortunately I have not managed to "train" them very well yet to copy me in on correspondence between meetings particularly regarding things like draft guidelines or new patient information leaflets. Still I am working on it and as they say Rome wasn't built in a day!
With thanks to NCT for this section.