Tuesday, 18 February 2020
A high number of pregnant women in England cannot access the maternity care most appropriate for them, according to a new study, which could be costing the NHS millions of pounds a year.
The research, which is published in the BMJ Open, reviewed NHS maternity services in different areas of England and identified a number of key factors that limit the availability and use of Midwifery Units, (home-like settings run by midwives).
The study, which was led by experts at the University of Nottingham, with collaborators from City, University of London and De Montfort Universities, and was funded by the National Institute for Health and Clinical Excellence, looked at six geographical areas in England.
Findings from the study showed that in a quarter of local maternity services in England, MUs are not available, or women have trouble getting information or access to them.
This is surprising given that there is strong evidence that it is safer and cheaper for healthy women with straightforward pregnancies to give birth in a Midwifery Unit (MU), rather than in an Obstetric Unit (OU) in a hospital.
This is surprising given that there is strong evidence that it is safer and cheaper for healthy women with straightforward pregnancies to give birth in a Midwifery Unit (MU), rather than in an Obstetric Unit (OU) in a hospital.
The Birthplace in England study published in 2011 found that women who planned birth in MUs had around one third the rate of caesarean births and less than half the rate of forceps births, with no difference in safety outcomes for their babies.
Qualitative studies have also shown that families using these services tend to have more positive experiences and satisfaction with their care.
Research from the National Audit Office in 2013 found that if 20% of births occurred in MUs, savings to the NHS maternity budget could be around £85m a year.
Current maternity policy supports choice for women in their maternity care and NICE clinical guidelines recommend MU care for women with healthy pregnancies but there is still a relatively low proportion of women (only 15%) who give birth in MUs, while the vast majority continue to give birth in OUs.
As part of their research, the team studied the current availability of MUs in England to see whether this low use was because they were not available, whether there was a lack of information about them, a lack of interest amongst users of maternity services, or other factors.
Information was collected using individual interviews and focus groups with a range of NHS staff and users of maternity services from six NHS Trusts with varying rates of MU births.
A workshop was held with a range of stakeholders to discuss the research findings and to identify priorities that could increase the availability and use of MUs.
Although there are more MUs now than six years ago, the research identified that:
- Some maternity service staff remain unconvinced of their value;
- Some believe incorrectly that MUs are more expensive and less safe than OUs and therefore do not encourage pregnant women to use them;
- Some women were unaware of such units and were unable to ask providers of maternity care about their use.
Unless the barriers to midwifery units are addressed, including providing women with information about these units, use will remain low and pregnant women’s access to midwifery units will continue to be restricted.
For English maternity services to realise the full benefit of midwifery units, they must be far more proactive in promoting them locally as an equal and complementary provision alongside their standard labour wards.”
Christine McCourt, Professor of Maternal Health and lead for the Centre for Maternal and Child health research at City said “This study has highlighted that many services are failing to provide women with full and balanced information about the optimal place for them to give birth. It identifies that a structural shift is needed to locate most maternity care in midwifery settings in the community and to educate professionals as well as the public about the evidence.”
The full study can be found here.
Story credits
More information is available from Charlotte Anscombe, Media Relations Manager for the Faculty of Medicine and Health Sciences in the Press Office at The University of Nottingham, on +44 (0)115 74 84417, charlotte.anscombe@nottingham.ac.uk; to speak to Professor Christine McCourt contact Shamim Quadir on +44 (0)207 040 8782 or at shamim.quadir@city.ac.uk.
Alternatively, contact the City, University of London Press Office at pressoffice@city.ac.uk or on +44 (0)20 7040 8788.
Notes to editors:
About the University of Nottingham
Ranked 32 in Europe and 16th in the UK by the QS World University Rankings: Europe 2024, the University of Nottingham is a founding member of the Russell Group of research-intensive universities. Studying at the University of Nottingham is a life-changing experience, and we pride ourselves on unlocking the potential of our students. We have a pioneering spirit, expressed in the vision of our founder Sir Jesse Boot, which has seen us lead the way in establishing campuses in China and Malaysia - part of a globally connected network of education, research and industrial engagement.
Nottingham was crowned Sports University of the Year by The Times and Sunday Times Good University Guide 2024 – the third time it has been given the honour since 2018 – and by the Daily Mail University Guide 2024.
The university is among the best universities in the UK for the strength of our research, positioned seventh for research power in the UK according to REF 2021. The birthplace of discoveries such as MRI and ibuprofen, our innovations transform lives and tackle global problems such as sustainable food supplies, ending modern slavery, developing greener transport, and reducing reliance on fossil fuels.
The university is a major employer and industry partner - locally and globally - and our graduates are the second most targeted by the UK's top employers, according to The Graduate Market in 2022 report by High Fliers Research.
We lead the Universities for Nottingham initiative, in partnership with Nottingham Trent University, a pioneering collaboration between the city’s two world-class institutions to improve levels of prosperity, opportunity, sustainability, health and wellbeing for residents in the city and region we are proud to call home.
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