Ambulance transfer of women during pregnancy & childbirth

Objectives

To ensure consistent high quality maternity care.

Scope

This guideline provides support for clinical decision making when supporting women who require ambulance transfer.

Audience

This guideline applies to all members of staff providing care within maternity services.

Transferring antenatal mothers should be arranged through ScotSTAR on 03333 990222

NB There are separate guidelines for SAS patient transport services for elective admissions or appointments.  The office is based in BGH phone - 26062.  Alternatively, in limited circumstances a taxi can be arranged through the hospital bleep holder on # 1412.

Guidelines for SAS emergency ambulance service

The contact number to call is 03333 990154.

The level of urgency is determined by the referring clinician.

Ambulance services may be required for the following reasons:

1.  Home to hospital transport.

When a mother requires non-elective admission and it has been established that she has no suitable means of personal or public transport, the labour ward midwife to whom the referral was made will arrange ambulance transport. The level of urgency will be determined by the midwife. Circumstances may include:

• Labour, Ruptured membranes, Reduced or lack of fetal movements

2.  Emergency transfer from home to hospital

When a mother requires emergency (immediate) transfer from home to hospital this may be arranged in the following ways:

• The mother or her partner calls the ambulance service direct on 999
• The community midwife in attendance calls the ambulance direct on 999 and escorts the mother in.
• The labour ward midwife calls the ambulance service on 03333 990154

3.  Inter-hospital transfer.

When a mother requires to be transferred to another hospital, the consultant in charge will determine the level of urgency and the need for an escort, they should contact ScotSTAR on 0333 399 0210 (in utero coordination service).

The senior midwife in charge of labour ward or consultant will arrange ambulance transport by calling:

SAS on 0333 399 0111 (immediate time critical transfer required for a level of care not available at the BGH). 

Circumstances may include:

• In-utero transfer – for tertiary antenatal care or where there is a risk of premature labour or delivery
• Postnatal transfers – for tertiary postnatal care
• Postnatal transfer - to a unit where the mother can be reunited with her baby

A Consultant Obstetrician MUST be involved in any discussions regarding in-utero transfer.

It is important to note that if the CTG is abnormal, or if a senior obstetrician feels that there are sufficient fetal concerns such that the delay caused by transfer to another hospital would not be appropriate, then delivery should be at the BGH irrespective of gestation.

4. Mothers at home in threatened pre-term labour less than 32 weeks

In general, these should be dealt with at the BGH and, in the majority of cases, assessment at the hospital will be required. If the mother is felt to be in rapid labour however, and delivery is felt to be highly likely based on the phone call, diversion of the ambulance to the Royal Infirmary of Edinburgh (RIE) may be appropriate.

Actions:

• Phone ambulance (03333 990154) to explain situation and to plan to bring the mother to the BGH
• Liaise with senior obstetrician in BGH (registrar or consultant) who should phone RIE and ideally speak to:
  • 8.30am-9.30pm – the on call consultant (0131 536 1000, bleep 1617)
  • 9.30pm-8.30am, to the LW band 7 coordinator (07483315205) or ST6/7 (bleep 1616)

If Edinburgh are in a position to accept, then phone ambulance control again on 03333 990154 to divert there.