Birthing service closure: what are the next steps?
BBCPregnant women living in a rural area of Devon say the suspension of a maternity services has left them feeling anxious about their birthing plans.
The Royal Devon University Healthcare NHS Foundation Trust has suspended standard birthing services at North Devon District Hospital (NDDH) in Barnstaple.
The trust said it was the "only safe course of action" due to staffing issues despite "extensive efforts" to maintain them.
Why has it closed?
It comes after the trust began planning for a potential temporary suspension to services in July due to serious staffing issues.
At the beginning of August, the trust said it had explored and exhausted every option, including securing locum cover and mutual aid support from partner organisations, and concluded a temporary suspension was the best solution.
It said had carefully reviewed its staffing levels against clinical safety requirements.
Carolyn Mills, the Royal Devon trust's chief nursing officer, said: "We have worked tirelessly alongside our partners, including NHS Devon, Cornwall and the Isles of Scilly Integrated Care Board and NHS England regional colleagues, to explore every possible option to avoid this outcome."
Where will people go?
The trust said it had contacted more than 300 women who were 34 weeks pregnant or more, as well as those identified as vulnerable or clinically high-risk.
Rebekah Hester, from Ilfracombe, is classed as high-risk due to having pre-eclampsia, a complex condition which causes high blood pressure that can put both baby and mother at risk, and said she was looking at tutorials on giving birth and home deliveries.
Hester, who is 22-weeks pregnant, said coming to the realisation having a birth which may be not as planned was "terrifying".
She said: "You turn to midwives and you turn to Google, and Google is saying an hour-and-a-half drive is too far, you need to find a closer maternity unit, or you need to watch these tutorials on giving birth and home deliveries."
Her due date is in December, so said she has had time to work out a plan, adding she felt for women due a lot sooner.
Hannah Winne-Dennis said her pregnancy had to be a lot more controlled due to it involving a high-risk in vitro fertilisation (IVF) process.
She said the plan was always to have an induction at 39 weeks on Monday 17 August, originally at the north Devon hospital, but she was now facing having to travel to Royal Devon and Exeter Hospital.
The trust said the last planned inductions and caesarean sections would go ahead on Friday, while the last day for NDDH would be able to accept those in spontaneous labour would be Sunday.
Members of the Unison union for the South Western Ambulance Service and Allied Health said losing local provision meant people in labour and other patients needing urgent maternity care faced "significantly longer journeys to Exeter".
A union spokesperson said: "Given the rural geography of north Devon, and the road network in the area, this isn't just an inconvenience, it adds real travel time at moments when minutes matter."
Devon County Council's Health and Adult Care Committee is due to discuss the closure on Monday 17 August, looking at how expectant parents could face travelling more than one hour to give birth.
Council leader Julian Brazil has criticised the closure, saying: "Some remote parts of North Devon are a two-hour drive from Exeter - and that's when there is no traffic or road closures.
"This closure is extremely concerning. It is not a decision which would be countenanced in other parts of the country and we should not accept second-rate NHS provision here."
Next steps
Chief medical officer at the trust Dr Vanessa Purday said fears the unit would not reopen were unfounded.
She said: "Our priority is we reopen in north Devon in the soonest time frame that we can and that reopening is safe and sustainable for the women in north Devon."
She also said she completely understood concerns raised.
She said: "I'm a mum myself. I've had three children born in Devon, so, for me and my colleagues here at Royal Devon Hospital, our commitment is to get this service reopened.
"Recognising the need of women in north Devon is a decision we've taken a huge amount of consideration and the balance.
"The absolute priority is that women have the right level of safe staffing from our specialist obstetricians when they arrive... That is why we've had to take this decision."
Mills said the trust was "fully committed" to reopening birthing services at the north Devon as soon as possible.
She added a dedicated recovery programme was under way with intensive work focused on recruitment, workforce planning, staff retention and service resilience.
The trust said other maternity services including scans and antenatal outpatient clinics would remain Barnstaple.
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