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Health Series: Research Spotlight

Major increase in midwifery unit births since 2010

Births in midwifery units in England have trebled over the last six years

by George Wigmore (Senior Communications Officer)

Births in midwifery units in England have trebled, up from five per cent to 14 per cent over the last six years, a new study by researchers at City, University of London and The University of Nottingham has shown.

The research, led by a team of academics in Nottingham’s School of Health Sciences, revealed that the number of midwife units alongside hospital obstetric units almost doubled from 53 to 97 during the period 2010 to 2016.

However, despite this increase, 25 per cent of all NHS trusts in England still have no midwifery units, denying women the opportunity to access this type of care, which has been shown to provide personalised care to women, to decrease caesarean birth rates and costs per birthing. In addition, the number of freestanding midwife units, which were found to have the most optimal results, has increased very little.

Professor Christine McCourt, who is a co-investigator in the study and a Professor of Maternal and Child Health at City, said:

“Midwife units are safer for mothers and for babies and cheaper for the NHS. This evidence is now reflected in NICE guidelines. This is good news for society as a whole, but there is still a great deal of work to do in making good quality information available about the benefits of this form of care.”

The new study charts the change in birth trends since a 2010 survey which was carried out by researchers from City, University of London, as part of the Birthplace in England programme.

The increase in provision of midwifery unit care is a response to a national policy, in place since 2007, that all women should be able to choose their place of birth. A woman’s right to book into a midwifery unit for their care has been reinforced by the Government’s Five Year Forward View for maternity, and recommendations by NICE, the National Institute for health and Clinical Excellence, which was updated in 2014 in response to the emerging evidence that care in midwife-led settings for birth is optimal for mothers and babies.

The latest research also found a marked difference between the prospects for ‘alongside’ midwifery units and those which are ‘freestanding’ in the community. There has been stagnation in numbers of freestanding midwifery units (FMU), up just four from 58 to 61, despite robust research showing they offered even better outcomes than ‘alongside’ midwifery units.

FMUs have been prone to opening and closing cycles and were put under strain by small numbers and financial pressures. FMUs varied widely in terms of their numbers of births each year. Five freestanding units had more than 400 births each year, with the largest providing care in labour to 650 women and babies.

However, many had much smaller numbers; more than half of FMUs (58 per cent) had fewer than 200 births a year and 37 per cent had fewer than 100. The Birthplace in England Programme economic study showed that even though these units are typically small, and perceived to be expensive by many people, they offer the most cost-effective form of care.

A local case study also conducted by researchers at City, University of London, showed that the Barkantine freestanding birth centre in East London fits the national picture of good clinical outcomes, cost effectiveness and a more satisfying experience for families.

Over the period studied, the number of hospital obstetric units reduced by 10 per cent from 177 to 159. Three of the five largest freestanding midwifery units replaced obstetrics units.

Cathy Warwick, Chief Executive of the Royal College of Midwives, said:

“This is very valuable research. It is very encouraging that more women are making the choice to give birth in midwife-led units. It suggests that when women have real choice about where they want to give birth, that midwife-led care is a choice they want to make.

“It is disappointing to see that a quarter of trusts do not have midwifery units. It is also disappointing that there has been such a small increase in the number of freestanding midwife-led units. I hope this will begin to change as a result of the Government’s National Maternity Review in England. This promises much more maternity care right in the heart of our communities. I think there is also an onus on trusts and the Government to raise awareness of freestanding midwifery led units, and of midwife-led care in general, so that women are aware that this choice exists and can make that choice.”

The results are launched at a Royal College of Midwives-accredited conference, Implementing the National Maternity Review in Rural Areas, on Monday February 13 hosted by Shrewsbury and Telford Hospital NHS Trust. (#SaTHFMU.)

Organiser, Wendy Cutchie, Lead Midwife for Midwifery Led Units and Community Midwifery Services at The Shrewsbury and Telford Hospital NHS Trust, said:

“Midwifery units provide women and their families with more personalised care, possibly because of their small scale, possibly because of the particular philosophy of care, which is sometimes called a 'social model of care'. We deliberately focus on responding to social and emotional needs and helping women to feel confident to give birth and become a mother.”

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City, University of London is an independent member institution of the University of London. Established by Royal Charter in 1836, the University of London consists of 18 independent member institutions with outstanding global reputations and several prestigious central academic bodies and activities.