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City academics contribute to new national birthplace guidance

Latest guidelines from the National Institute for Health and Care Excellence incorporate City research
by George

nullAcademics at City University London have contributed vital information to the most recent national guidance which suggests that thousands more babies could potentially be born in a midwife-led unit or at home instead of hospitals.

The National Institute for Health and Care Excellence (NICE) report released this week drew on research from the Division of Midwifery in the School of Health Sciences. This provided evidence on quality and safety of care for healthy women and their babies during childbirth and also addressed the challenges to implementation.

Based on an increasing number of high-quality studies about the outcomes of birth in different setting, the updated NICE guidance draws strongly on the Birthplace in England Research Programme, which was conducted by a collaborating group including Professors Alison Macfarlane and Christine McCourt.

As well as providing robust evidence relating to quality and safety, the Birthplace Programme included qualitative case studies to explore the ways in which services manage provision of birth care across different settings such as the home, midwife-led units or hospitals.

A follow-up study, also led by Professor McCourt, with research fellow Dr Juliet Rayment focused on the organisation and staffing of 'Alongside Midwifery Units' based alongside obstetric units. This study discussed the organisational and professional issues that could impact on the scaling-up of such birth centres to provide care for more of the low-risk women who could benefit from their care.

Commenting on the research Professor Christine McCourt said:

"The research identified that midwifery units provide safe and cost effective care, while the organisational case studies found that care in the birth centres was valued highly by women, their partners and families and by health professionals. One of the issues raised in the Alongside Midwifery Units study, namely the organisational and professional issues related to the scaling-up of birth centres will be a key challenge as services begin to look at how they will implement the new NICE guidelines."

A more local case study which was submitted to NICE was led by Alison Macfarlane, Professor of Perinatal Health and Lucia Rocca-Ihenacho, a NIHR doctoral research fellow at City University London, examined women's choices and experiences of maternity care before and after the opening of the Barkantine Birth Centre, a freestanding midwifery unit on the Isle of Dogs in Tower Hamlets, an inner city area of London.

Lucia Rocca-Ihenacho said:

"Women's experiences varied considerably depending whether they gave birth at the birth centre or at the hospital, with staff attitudes and communication skills having a profound impact on their birth experiences.

"Those who used the birth centre reported positive views of feeling listened to, supported and cared for by the midwives. In particular they appreciated the home-like environment at the birth centre. In general, the negative experiences reported mainly at the hospital were  linked to staff attitudes and lack of communication skills."

Professor Alison Macfarlane said:

"The national Birthplace Research Programme found that freestanding midwifery units had similar levels of safety for babies and lower intervention rates for women compared with consultant obstetric units, as well as lower rates of some postnatal health complications for women.  Our work in Tower Hamlets adds further weight to the evidence in support of birth centre care for women who are assessed as at lower risk of medical problems. As a result, the findings also support the suitability of midwifery units for inner city areas in London and other cities and refute claims that this model of care is suitable only for more affluent areas."

Suzanne Lee, a midwifery lecturer at City University London who is currently researching how women perceive risk in pregnancy particularly in relation to where they plan to give birth, said:

"Women choose where to give birth based on several factors.  They prioritise safe care and what they believe is best for their babies.  Evidence that birth centre care is a safe option will reassure women deciding on a birth location and help when they discuss their choices with healthcare professionals."

These case studies in particular should prove valuable to service commissioners, managers and practitioners who will now be focused on implementing the new guidelines and developing their provision of midwifery unit and home birth care.

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