Midwives magazine: November 2002
As midwifery-led units, birth centres are managed, run and staffed by midwives. They are organised to provide family-centred maternity care for women deemed to be low risk. Valued as personal and informal environments, women are respected and supported throughout their normal delivery. By its very nature, technological intervention at birth centres is very low, if at all. That is why women with any form of obstetrical complications are encouraged to give birth within a maternity unit. This is particularly important for those centres regarded as ‘stand alone’ units where obstetric care is some distance away.
The benefits of birth centres
Reducing intervention rates For women with seemingly uncomplicated pregnancies and forseeably uncomplicated births, a birth centre seems an ideal alternative to an obstetric unit. Constant midwifery presence throughout labour has proved to be an effective way of stalling — and invariably preventing — the need for intervention. Barnet Health Authority (2000) evaluated Edgware birth centre in north London and found a dramatic reduction in intervention rates among women in the same risk category who delivered there, as opposed to those who gave birth in hospital.
Preserving and respecting the right to choose The birth centre philosophy is based on the preservation of individual choice, as well as dignity and privacy. A partnership develops between midwife and mother that is always open to discussion and compromise — this can only be seen as beneficial to all involved.
Reducing the cost of maternity care Unsurprisingly, the less intervention in the birthing process, the cheaper the cost. Birth centres are modest in their expenditure, with no expensive technology to maintain and no obstetricians or anaesthetists to employ. Perhaps those saved finances could be poured into the pockets of midwives?
Improving postnatal care Birth centres offer an excellent quality of postnatal care. The environment created and facilities available are all condusive to a successful mother/baby bond — one-toone assistance with feeding, ‘home-from-home’ touches, time and space. The length of stay varies, but women can choose and wait until they feel ready to return home. The six hour postbirth period that obstetric units tend to adhere to is too short for some women, hence some birth centres offer support to those women and admit them. Additional support may also help those women who, although capable of a normal delivery, have a social or physical problem — such as women suffering abuse or blind women.
Promoting healthy mothers and babies Birth centres promote confidence in women in the natural birthing process, encourage and support breastfeeding and in turn reduce visits to the GP (Rookes et al, 1992;Waldenstrom et al, 1997; Barnet Health Authority, 2000). Midwives offer advice and assistance to the whole family, so every member can function and create a stronger unit.
Improving morale At a time when morale among midwives is low, the birth centre approach offers those midwives frustrated by the technologised, interventionist methods of most obstetric units a return to the base skills of midwifery. As Penny Jedrzejewski, unit coordinator of the Dover birthing centre, said: ‘Working in a midwifery-led unit enables midwives to provide individual holistic care for women and their families. Midwives are empowered to practise to their full potential, thus increasing job satisfaction and self-esteem.’
Barnet Health Authority. (2000) Evaluation of Edgware Birth Centre. Barnet Health Authority: London. Rooks JP,Weatherby NL, Ernst E. (1992) The National Birth Center Study: part II - intrapartum and immediate postpartum and neonatal care. J Nurse Midwifery 37: 301-30. Rosser J. (2001) Birth centres across the UK: A win/win strategy for saving normal birth. RCM Midwives Journal 4(3): 88-9. Waldenstrom U, Nilsson C,Winbladh B. (1997) The Stockholm Birth Centre Trial: maternal and infant outcome. Br J Obstetrics and Gynaecology 104: 410-18. Bibliography Gowers D. (2002) Crowborough Birthing Centre: the pursuit of excellence. MIDIRS Midwifery Digest: 12(2): 264-8.
The Crowborough Birthing Centre (CBC), winner of the Tesco midwifery millennium award in association with the RCM, was once an undersubscribed GP unit threatened with closure in the 1990s. Now it is a thriving midwifery-led birth centre. CBC is a stand alone midwifery unit in Sussex.
As well as postnatal beds, the centre has two birthing rooms, each with a birthing pool. Statistics indicate that the centre attracts a wide range of women — teenage mothers, new age travellers and women who have been physically or mentally abused. As with many centres, CBC has very little intervention.
Fetal heart monitoring is carried out by pinard or handheld Doppler. CBC is supportive both to mothers and babies with their open-door policy and to midwives, particularly those from obstetrics units — who can apply for an internal rotation post at the centre for six months. A midwife with experience of both work and birth at CBC said: ‘It is a joy to work there and a joy to give birth there too.’
The Dover Family Birthing Centre is a midwifery-led unit, situated behind Buckland Hospital. Until two-and-a-half years ago, it was a consultant-led unit, but there was concern that doctors were not receiving adequate training, so the unit was transformed into the midwifery-led centre of today.
The centre has ten beds and three delivery rooms, one of which accommodates a birthing pool. Staffed 24 hours a day by core midwives, nursery and auxiliary nurses, the centre offers a wide range of services — free parent education sessions, weekly ‘drop-in’ coffee mornings, opportunities to talk one-to-one with a midwife, massage courses and an aromatherapy service available for all mothers.
Delivery at another hospital does not prevent a new mother form returning to the centre as soon as she is well enough, and she can stay as long as necessary. Since April this year there have been 63 births at the centre, with a total of 196 last year.
The Victoria Maternity Unit emerged ten years ago, when the maternity team inherited a maternity unit operating as a GP unit. The number of deliveries had decreased to around 150 a year and fewer women were using the facility.
After several refurbishment projects, including a visit from the BBC’s Real Rooms, the centre developed into a relaxing birthing environment. As a stand alone unit within the community hospital in Lichfield, the Victoria Maternity Unit has six postnatal beds and two birthing suites with whirlpool baths. It provides 24- hour care with one-to-one support and has a growing reputation for aromatherapy and reflexology therapies.
Lichfield supports the training of student midwives by offering two-week placements during their third year. Birthing rates over the last few years have remained around the 300 mark, but this year so far there have been 190 with a normal birthing rate of 92.1%.
The Alexandra Birthing Centre (ABC), which has had 245 births to date, is a small self-contained unit within the maternity block at Watford General Hospital. Situated on an adjacent floor to the central delivery suite, the ABC opened on 2 April 2001. It consists of six en-suite birthing rooms, with separate poolroom and sensory room. Because it is an integrated unit, its criteria for admission can also be broader than stand alone units, allowing a wider variety of women access to midwifery-led care.
Alternative therapies are encouraged at the unit — aromatherapy, homeopathy and reflexology are all implemented if desired. Midwives and midwifery assistants staff the centre 24 hours. The majority of midwives are Advanced Life Support in Obstetrics and/or Neonatal Advances Life Support trained and several are undertaking the N96 examination of the newborn course to further enhance the holistic care of women.