What's happening in the world of midwifery research? Two lead authors summarise their work.
A three-part research programme was designed to evaluate a new freestanding midwifery unit in London.
To compare local women’s preferences and experiences of maternity care, surveys were conducted in two phases, before and after the opening of the inner-city Barkantine Birth Centre.
Eligible local women (620) were interviewed by telephone, first in late pregnancy and again six weeks after birth. The replies showed marked differences in experience between the model of care in the Barkantine Birth Centre and that in the Royal London Hospital’s obstetric unit.
Women who chose care at the midwifery unit were significantly more likely to rate their overall care as ‘good’ or ‘very good’. They were also more likely to find antenatal classes useful, and were less likely to be induced.
Women who started labour care in spontaneous labour at the midwifery unit were significantly more likely to be cared for by a midwife they had already met, have one-to-one care in labour and have the same midwife with them throughout labour. They were also significantly more likely to report that the staff were kind and understanding, and that they were treated with respect and dignity.
Women who started labour care at the midwifery unit in spontaneous labour were more likely to use non-pharmacological methods of pain relief, most notably water, and less likely to use pethidine than women who started care at the hospital. They were more likely to be able to move around in labour and less likely to have their membranes ruptured or have continuous CTG. The majority of women who had a spontaneous onset of labour delivered vaginally.
Primiparous women who delivered at the midwifery unit were less likely to have an episiotomy. Most women who delivered at the midwifery unit reported that they had chosen whether or not to have a physiological third stage, while a considerable proportion reported that they had not had a choice at the hospital. A higher proportion of women at the midwifery unit reported skin-to-skin contact with their baby in the first two hours after birth.
Costs for eligible women opting for the midwifery unit were also compared with those who chose birth in hospital.
The total average cost for mothers who started their intrapartum care at the midwifery unit and their babies was £1296.23, approximately £850 less than the average cost for those who received all their care in hospital. These figures included the costs for women who transferred from the midwifery unit to the hospital but excluded occupancy rates and the related units’ running costs.
The third component – to use routinely collected data to assess the uptake, outcome and appropriateness of midwifery unit care for women in the catchment area – proved unsuccessful because of the inadequacies of the new hospital and community IT systems.
Alison Macfarlane is professor of perinatal health and Lucia Rocca-Ihenacho is a research fellow at City, University of London
Macfarlane AJ, Rocca-Ihenacho L, Turner LR, Roth C. (2014) Survey of women’s experiences of care in a new freestanding midwifery unit in an inner city area of London, England: 1. Methods and women’s overall ratings of care. Midwifery 30(9): 998-1008.
Macfarlane AJ, Rocca-Ihenacho L, Turner LR. (2014) Survey of women’s experiences of care in a new freestanding midwifery unit in an inner city area of London, England: 2. Specific aspects of care. Midwifery 30(9): 1009-20.
Schroeder L, Patel N, Keeler M, Rocca-Ihenacho L, Macfarlane AJ. (2017) The economic costs of intrapartum care in Tower Hamlets: a comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications. Midwifery 45: 28-45.