Mapping midwifery and obstetric units in England

Walsh, Denis; Spiby, Helen; Grigg, Celia; Dodwell, Miranda; McCourt, Christine; Culley, Lorraine; Bishop, Simon; Wilkinson, J. P. D.; Coleby, Dawn; Pacanowski, Lynne; Thornton, Jim; Byers, Sonia

doi:10.1016/j.midw.2017.09.009

Cited by 41 publications

(65 citation statements)

References 19 publications

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“…However, there was little evidence of plans to scale up provision of midwife-led care across the system and to cater for a larger proportion of women who are considered low-risk. Sandall et al's study of maternity workforce indicated that around 45% of women would be eligible to plan labour in a midwife-led setting (Sandall, Murrells et al 2014), yet in the services we studied, only 10-14% of women were accessing midwifery unit care and nationally, the proportion remains similar (Walsh et al 2018). This may be a reflection of the perceptions expressed by many of our respondents, across all four sites, that despite expressions of support and national policy directives, the AMU continued to be regarded as marginal and additional to the OU, rather than as a core service.…”

Section: Discussionmentioning

confidence: 71%

“…At the time of the data collection, professionals had access to the evidence from the Birthplace in England programme, but NICE guideline update was still in process. Nonetheless, recent mapping work indicates that change in practice has been limited, and confirms that managers continue to face challenges in providing, sustaining and scaling-up of midwifery units in England (Walsh et al 2018).…”

Section: Discussionmentioning

confidence: 97%

“…In addition to AMUs, in some areas women are able to access an FMU. However, the proportion of births in freestanding units has remained limited in recent years, at only 2% compared with 14% in AMUs (Walsh, Spiby et al 2018).…”

Section: Introductionmentioning

confidence: 99%

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Organising safe and sustainable care in alongside midwifery units: Findings from an organisational ethnographic study

et al. 2018

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The units studied had been developed to form a key part of the maternity service, and their role was increasingly being recognised as valid and as maintaining the quality and safety of care in the maternity service as a whole. However, each was providing birth care for only about a third of women who had been classified as eligible to plan birth outside an obstetric unit at the end of pregnancy. Developing midwifery units involves aligning physical, professional and philosophical boundaries. However, this poses challenges when managing the service, to ensure it is sustainable, of high quality and safe. In order to fulfil evidence-based guidelines on providing midwifery unit care, further attention is needed to staff training and support; the development of integrated, continuity-based staffing models; and ensuring AMUs are positioned as a core service rather than a marginal one.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 97%

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Organising safe and sustainable care in alongside midwifery units: Findings from an organisational ethnographic study

et al. 2018

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“…Follow-on research projects from the Birthplace in England study 3 add that AMUs should be able to accurately identify their admissions and births in their record systems. 87 However, these criteria allow for a number of hybrid arrangements, for example: l midwifery-led rooms within the physical space of a traditional labour ward l a midwifery-led area adjacent to a labour ward, but with no separate staffing or management l a midwifery-led area that allows for labour interventions, such as continuous fetal monitoring l a midwifery-led area that is regularly used for labour ward overflow l no separate data collections of processes or outcomes within the MU.…”

Section: Definition Of Alongside Midwifery Unitsmentioning

confidence: 99%

“…A transfer time in excess of 30 minutes was given as another rationale for closure, despite the fact that audits of transfers from FMUs suggest that more than half are non-urgent. 87 In addition, there was no evidence from the Birthplace in England study 3 of poorer neonatal or maternal outcomes from FMUs 132 that are rurally located, and birth outcomes in countries with very rural populations, including Scotland, 135 New Zealand, 51 Canada 38 and Australia, 24 indicate that careful risk assessment and judicious decision-making that anticipates complications can ameliorate this. 136 In fact, none of the FMU closures from the media analysis or the HoM interviews had been precipitated by clinical incidents.…”

Section: Risk and Safetymentioning

confidence: 99%

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

Walsh

Spiby

McCourt

et al. 2020

Health Serv Deliv Res

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Background Midwifery-led units (MUs) are recommended for ‘low-risk’ births by the National Institute for Health and Care Excellence but according to the National Audit Office were not available in one-quarter of trusts in England in 2013 and, when available, were used by only a minority of the low-risk women for whom they should be suitable. This study explores why. Objectives To map the provision of MUs in England and explore barriers to and facilitators of their development and use; and to ascertain stakeholder views of interventions to address these barriers and facilitators. Design Mixed methods – first, MU access and utilisation across England was mapped; second, local media coverage of the closure of free-standing midwifery units (FMUs) were analysed; third, case studies were undertaken in six sites to explore the barriers and facilitators that have an impact on the development of MUs; and, fourth, by convening a stakeholder workshop, interventions to address the barriers and facilitators were discussed. Setting English NHS maternity services. Participants All trusts with maternity services. Interventions Establishing MUs. Main outcome measures Numbers and types of MUs and utilisation of MUs. Results Births in MUs across England have nearly tripled since 2011, to 15% of all births. However, this increase has occurred almost exclusively in alongside units, numbers of which have doubled. Births in FMUs have stayed the same and these units are more susceptible to closure. One-quarter of trusts in England have no MUs; in those that do, nearly all MUs are underutilised. The study findings indicate that most trust managers, senior midwifery managers and obstetricians do not regard their MU provision as being as important as their obstetric-led unit provision and therefore it does not get embedded as an equal and parallel component in the trust’s overall maternity package of care. The analysis illuminates how provision and utilisation are influenced by a complex range of factors, including the medicalisation of childbirth, financial constraints and institutional norms protecting the status quo. Limitations When undertaking the case studies, we were unable to achieve representativeness across social class in the women’s focus groups and struggled to recruit finance directors for individual interviews. This may affect the transferability of our findings. Conclusions Although there has been an increase in the numbers and utilisation of MUs since 2011, significant obstacles remain to MUs reaching their full potential, especially FMUs. This includes the capacity and willingness of providers to address women’s information needs. If these remain unaddressed at commissioner and provider level, childbearing women’s access to MUs will continue to be restricted. Future work Work is needed on optimum approaches to improve decision-makers’ understanding and use of clinical and economic evidence in service design. Increasing women’s access to information about MUs requires further studies of professionals’ understanding and communication of evidence. The role of FMUs in the context of rural populations needs further evaluation to take into account user and community impact. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information.

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Cultivating Emotional Safety, the Cornerstone of Safe, Relational Care

Feeley

2023

Skilled Heartfelt Midwifery Practice

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Mapping midwifery and obstetric units in England

Abstract: Both the availability and utilisation of midwifery units in England could be improved.

Cited by 41 publications

References 19 publications

Organising safe and sustainable care in alongside midwifery units: Findings from an organisational ethnographic study

Organising safe and sustainable care in alongside midwifery units: Findings from an organisational ethnographic study

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

Cultivating Emotional Safety, the Cornerstone of Safe, Relational Care

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