Place of Birth and Concepts of Wellbeing

Abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version. Unit -FMU). Midwifery units have been designed and intended specifically as locations of wellbeing and although the meaning of the term is used very loosely in public discourse, this claim is supported by a large epidemiological study, which found that they provide safe care for babies while reducing use of medical interventions and with better health outcomes for the women. Our research indicated that midwifery units function as a protected space, one which uses domestic features as metaphors of home in order to promote a sense of wellbeing and to re-normalise concepts of birth, which had become inhabited by medical models and a preoccupation with risk. However, we argue that this protected space has a function for midwives as well as for birthing women. Midwifery units are intended to support midwives' wellbeing following decades of professional struggles to maintain autonomy, midwife-led care 2 and a professional identity founded on supporting normal, healthy birth. This development, which is focused on place of birth rather than other aspects of maternity care such as continuity, shows potential for restoring wellbeing on individual, professional and 2 community levels, through improving rates of normal physiological birth and improving experiences of providing and receiving care. Nevertheless, this very focus also poses challenges for health service providers attempting to provide a 'social model of care' within an institutional context. Permanent repository link

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

“…Since publication of the overall study report (McCourt et al 2014) service managers and commissioners have raised concerns in personal communications and public forums about sustaining provision, and around optimum staffing models. Issues relating to women's experiences in relation to information and access will be published elsewhere, while women's and midwives' experiences of MU care have been reported in earlier publications (McCourt et al 2016).…”

“…While the development of AMUs was generally achieved as part of wider service redesign, midwifery managers on all sites had a clear view of the proposed philosophy of the unit and its aims to provide a more homely birth environment that would be woman-and family-centred and facilitate normal physiological birth practices, and midwife-led care for low-risk women. In effect, the managers and consultant midwives developing these units were engaged in materialising a philosophy of birth as a biopsychosocial event (Jordan 1992, McCourt et al 2016,…”

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

“…25 They are also more cost-effective than AMUs in relation to the primary outcome of neonatal adverse outcome and the secondary outcome of maternal morbidity, although this is reduced if only low-risk women without complications at the onset of labour are compared. 46 In addition, organisational research has found that midwifery satisfaction is very high in these settings 95 and they are much less prone to problems of staff recruitment and retention, which are a contemporary challenge to the sustainability of the maternity workforce. 96 The aim of this part of the project was to explore what an analysis of media coverage of the closure of FMUs might tell us about the reasons given for the closures, how are these closures presented publicly and by whom, and whether media representations support or disrupt pervading cultural norms around place of birth in England.…”

“…low birth numbers in a FMU) without examining how this could be addressed collaboratively. Douglas's theory 163 of grids and groups in organisation refers to enclaves: autonomous, non-hierarchical small spaces, which McCourt et al 95 liken to MUs. Though enclaves can create a therapeutic space in which both staff and clients can flourish, they tend to have an uneasy relationship with their host organisations, which operate hierarchically.…”

“…Having core staff, especially in AMUs, may contribute to better utilisation and although this is an established principle in recent Australian maternity care reform, 177 there is very little mention of it in the UK maternity care literature. McCourt et al 95 commented on the presence of core staff in MUs in their case studies of AMUs, reporting that managers saw an appropriate level of core staffing as vital to maintain skills and continuity of care in the unit. Our mapping revealed almost universal presence of core staff in AMUs, perhaps reflecting the wisdom of promoting ownership of AMUs by their presence.…”