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Health Series: Research Spotlight

New standards launched to boost midwifery unit presence in Europe

The aim of the standards is to guide midwives, managers and commissioners across Europe in creating and developing midwifery units

by George Wigmore (Senior Communications Officer)

Researchers at City, University of London have launched new midwifery standards in partnership with the Midwifery Unit Network (MUNet) to support the growth of midwifery units and enable them to becoming the main care pathway for healthy women with straightforward pregnancies in Europe.

Announced at the Midwifery Unit Network Conference today, the aim of the standards is to guide midwives, managers and commissioners across Europe in creating and developing midwifery units, which provide a safe and cost effective  alternative to hospital obstetric unit care for healthy women with  uncomplicated pregnancies. The standards also have the aim of improving the quality of midwifery unit care and reducing variability in practice.

Endorsed by the European Midwives Association (EMA), the list of 29 standards around 10 themes focus on philosophy of care and the organisation of services, and involved a robust and inclusive co-production process, including evidence-based process, a systematic review and study, interviews and stake holder meetings.

Covering specific aspects - such as women’s pathway of care as well as environment and facilities, and leadership - the standards will help to provide a framework for quality improvement and facilitate the advancement of the midwifery-led units and to scale up their implementation.

More than five million women give birth each year across the European Union, yet despite a significant improvement in maternity care - and a large number of well-educated midwives - inequalities in access to women’s health care persist in the EU.

There has been a huge increase in evidence and policy documents indicating the appropriateness of midwifery-led care settings for healthy women with uncomplicated pregnancies, but there are still too few facilities to provide consistent, high-quality care for women in all countries.

A recent collaborative mapping study of midwifery units in England, carried out as a collaboration between City and the University of Nottingham in 2017, found that a quarter of the 134 NHS trusts in England have no midwifery unit. Furthermore, only one in six trusts have both an alongside midwifery unit (AMU) on the same site as the obstetric unit and at least one freestanding unit (FMU) in the community.

The City University Centre for Maternal and Child Health Research (CMCHR) is an internationally renowned centre of excellence for research on birth places and midwife-led models of care. Professors Macfarlane and McCourt were co-investigators on the Birthplace in England research programme, which contributed to the creation of strong evidence in support of midwifery units.  For women with straightforward pregnancies, planning to give birth in an FMU was associated with better clinical outcomes and less morbidity, with equally good health for their babies. Some of these women transferred as appropriate to obstetric unit during labour in order to receive the necessary medical care.

Since 2016 the latest national policy, Better Births, has reinforced the importance of offering women personalised care, including choice of birth place. It also set an agenda for introducing continuity of midwifery carer in the NHS. In February 2018, The World Health Organisation also published guidance on the need for more holistic maternity care. They recommended a need to focus on providing respectful care, emotional support, continuity of relationships with carers, encouragement of mobility and other measures to address this problem.

The creation of the Midwifery Unit Standards responds to the needs highlighted by national and international policies. Dr Lucia Rocca-Ihenacho, a Research Fellow and midwifery lecturer in the School of Health Sciences at City who led the project, said:

“We’ve development these standards on the philosophy and organisation of care in midwifery units throughout Europe as there is still a huge potential for growth considering the benefits of midwifery-led care. There has been a huge increase in evidence and policy   documents indicating the appropriateness of such care settings for healthy women with uncomplicated pregnancies, but there are still too few facilities to provide consistent, high-quality care for women in all countries.

Franka Cadée, President of the International Confederation of Midwives said:

“If midwives, other healthcare professionals and policymakers can show leadership in Europe in developing the kind of services these Standards represent, this will be a powerful model and incentive for change in low-income countries across the world”.

Soo Downe, Professor in Midwifery Studies and Jacky Nizard, President of the European Board and College of Obstetrics and Gynaecology, said:

“We congratulate Midwifery Unit Network in taking this initiative and developing Standards using an inclusive, co-production methodology. We would encourage professional organisations and individual leaders to use this tool for quality improvement and take the initiative forward.”

Mary Newburn, Midwifery Unit Network Executive Manager and Research fellow, City, University of London, said:

"There is huge potential to develop more birth centres run by midwives, called 'midwifery units' in our new standards document, following the Birthplace in England study and NICE. I am in no doubt that when women have the opportunity to find out about and arrange their care in freestanding or an alongside midwifery unit, hundreds of thousands of women in the UK and across Europe will jump at the chance.  But it is essential that they receive relevant information early in pregnancy, have a chance to visit the facilities, and to talk to others who have had this kind of care”.

“Zara Tindall, chose the freestanding Stroud Birth Centre, her local maternity unit, as the place to give birth to the Queen's seventh grandchild just a few weeks ago in June. Commissioners must listen to what women and their partners want and make sure they know the public health evidence."

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