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Midwifery units
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New study investigates decisions behind where women give birth

New project explores why usage varies and why many maternity services have never developed Midwifery Units

by George Wigmore (Senior Communications Officer)

Academics from City University London and the University of Nottingham are investigating the factors influencing the uptake and sustainability of midwifery units for birth.

Using a mixed methods approach the new study has the potential to significantly improve the experience of maternity care for thousands of women and make considerable cost savings - estimated at 3% of maternity care budget - for the NHS. The research is funded by the National Institute for Health Research (NIHR) Health Service and Delivery Research (HSDR) Programme, and at City the project will be led by co-investigator Professor Christine McCourt and Senior Research Fellow Miranda Dodwell.

Currently women in England have three choices for where to have their baby: in traditional labour wards in a maternity hospital, in midwifery units (MUs) or at home. MUs are run by midwives and are suitable for women having a normal pregnancy and expecting a normal birth. There are two types of MUs: alongside midwifery units (AMUs) attached to a maternity hospital and freestanding midwifery units (FMUs) geographically separate from a maternity hospital. They are often known as Birthcentres.

Only 11% of women in England have their baby in a MU. This is despite very good evidence that having a baby in a MU results in better outcomes than having a baby on a traditional labour ward and is cheaper. For example, the risk of caesarean section is reduced by two thirds and mothers’ satisfaction with care is significantly improved. Not all maternity services have MUs and of those that do, some are not being fully utilised.

Speaking about the new study, Professor Christine McCourt said:

“The reasons why changes in service provision occur are complex but in this new project we want to explore why usage varies so much and why many maternity services have never developed MUs. We will address this by examining two areas of England where 20% or more of women are having their babies in MUs, two areas where 10% or less of women give birth in MUs, two areas where there are no MUs and other maternity services that have opened a MU and then closed it. We estimate that by increasing provision so that 20% of all women give birth in MUs, the caesarean section rate for these women would reduce and the normal birth rate increase. Care would also be cheaper and mothers’ satisfaction with childbirth would improve.”

The new study follows on from the Birthplace Programme, in which City University London and partner institutions looked at evidence on safety and quality of care in different settings for women with health pregnancies, according to where they planned their care at the start of labour.

This evidence contributed to the 2014 updated NICE guidelines on intrapartum care, which recommended that women should be offered these choices, and as a result this new study should contribute to implementation of these guidelines. This study also follows on from a NIHR funded AMU study led by Professor McCourt, which looked at issues around the organisation and management of Alongside Midwifery Units and explored what it is like for professionals to work in and alongside them, and for women and their families who used AMU care. That research, as with the earlier Birthplace Case Studies, identified some organisational and professional challenges that need to be addressed to help these units to be sustainable, and the new study will explore these challenges further.

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