First alongside midwifery led unit in a high complexity public hospital in Spain: Maternal and neonatal outcomes

Alcaraz-Vidal, Lucía; Velasco, Inés; Pascual, Montse; i Gomez, Roser Gol; Escuriet, Ramón; Comas, Carmina

doi:10.1016/j.wombi.2024.01.003

Cited by 3 publications

(2 citation statements)

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“…As such, establishing additional MLUs could enable more women to opt for midwifery-led care without having to compromise their preference due to distance (Hermus et al, 2015). Lastly, the fact that women's interest in the MLU stalled in 2022 was possibly related to saturation in awareness and acceptance of the MLU, the opening of more MLUs in the area (Alcaraz et al, 2024), or the organisational challenges that led to the unit's closure at the end of 2022, as women potentially sought more stable and long-term options for their childbirth care (Pelak, Dahlen & Keedle, 2023). Indeed, with the closure of the MLU, fewer women chose HM for childbirth, indicating a clear preference for the supportive environment provided by the MLU.…”

Section: Discussionmentioning

confidence: 99%

Impact of Midwifery-led units in Spain: lessons from the first 5 years

Palau-Costafreda,

Orus-Covisa,

Vicente-Castellví

et al. 2024

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IntroductionThe global rise in medical interventions during childbirth, such as caesarean sections, has raised concerns regarding their necessity and impact on maternal and neonatal outcomes. Midwifery-led units (MLUs) have demonstrated lower intervention rates and higher maternal satisfaction.This study evaluates the implementation and effects of the first MLU in the Spanish National Health System.MethodsA retrospective cross-sectional trend study and a cohort study were conducted to compare childbirth interventions and outcomes at XX with other hospitals of varying complexities.ResultsThe introduction of the MLU at XX resulted in a significant reduction in caesarean sections, decreasing from 23.5% to 13.5%, and an increase in spontaneous vaginal births, rising from 64.2% to 78.7%. These trends reversed following the MLU’s closure in 2022, with caesarean sections increasing to 22.9% and spontaneous births dropping to 69.0%. The MLU served 1286 women, with the majority classified as low-risk pregnancies. Obstetric emergencies in the MLU were low and comparable to those in countries with established MLUs.DiscussionThis study highlights the potential benefits of integrating MLUs into traditionally medicalized healthcare systems to promote physiological childbirth and reduce unnecessary interventions. The positive outcomes achieved at HM are comparable to those in countries with more established MLU practices, reflecting the unit’s commitment to evidence-based care. The increasing interest among women in midwifery-led care indicates a broader demand for supportive, less medicalized childbirth environments.ConclusionsMLU can lead to lower caesarean section rates and higher spontaneous vaginal birth rates, contributing to more positive maternal and neonatal outcomes. However, sustained support and investment in these units are crucial to maintain these benefits. Policymakers and healthcare providers should consider expanding the integration of MLUs within the Spanish National Health System to enhance maternal care quality and align with best practices.

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Section: Discussionmentioning

confidence: 99%

Impact of Midwifery-led units in Spain: lessons from the first 5 years

Palau-Costafreda,

Orus-Covisa,

Vicente-Castellví

et al. 2024

Preprint

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“…Spain’s approach to childbirth care is undergoing a transformative shift through the implementation of MLUs in its National Health System 17, 18 . This approach presents a unique opportunity to explore the impact of this on women’s birth experiences in Spain, given the country’s prevailing medicalized healthcare environment 19 .…”

Section: Introductionmentioning

confidence: 99%

Beyond the numbers: A phenomenological analysis of women’s childbirth experiences in Spain’s evolving healthcare system

Palau-Costafreda,

Nar-Devi,

Gil-Poisa

et al. 2024

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BackgroundChildbirth is a transformative experience, yet a considerable percentage of women worldwide encounter negative birth events, affecting maternal wellbeing and mental health. The choice of birth setting significantly impacts outcomes, with midwifery-led units often associated with lower intervention rates and higher satisfaction levels. The recent introduction of midwifery-led units in Spain presents a unique opportunity to explore the impact of this model within a medicalized healthcare context.AimTo capture the depth and diversity of women’s voices, understanding factors influencing their perceptions of childbirth experiences following the introduction of the first midwifery-led unit in the Spanish Healthcare System.MethodsA qualitative study with a phenomenological approach within the constructivist paradigm. Four focus groups were conducted including nineteen women who gave birth in a hospital with both an obstetric and a midwifery-led unit.FindingsThree main themes were identified; ‘Shaping birth expectations’, highlighting the influence of cultural and social contexts on women’s childbirth expectations; ‘The childbirth essentials’, incorporating fundamental characteristics related to the model of care; and ‘Navigating the protective factors’, considering the pivotal role of midwives in delivering compassionate and respectful care.ConclusionThese findings offer valuable insights into childbirth experiences, advocating for a transformation of the medicalized healthcare system in Spain through the integration of midwifery-led units. By prioritising women’s voices and addressing systemic inequalities, healthcare policymakers can enhance maternal care practices and foster positive childbirth experiences for all women.

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