In 2012, only 11% of women gave birth in dedicated midwifery units (MUs) (also known as birth centres), with 87% giving birth in hospital obstetric units (OUs) and 2% at home. This is despite strong evidence that MUs reduce caesarean section rates by two thirds, are very safe, improve patient satisfaction and are 20% cheaper than OUs.
Dr Denis Walsh is leading a study by members of the Maternal Health and Wellbeing Research Group to investigate the reasons why most low-risk women give birth in OUs, when there’s no clinical indication that they need to and where care is more expensive.
Identifying barriers and facilitators to MU births, as well as producing guidance for developing and sustaining MUs, would improve women’s clinical and psychological outcomes and be more cost effective for the NHS.
Based on the Birthplace study, our researchers estimate that increasing provision by an extra 10% of all women giving birth in MUs (to 20% overall), the caesarean section rate should reduce by around 7%. Also, normal birth rates should increase by nearly 20%, resulting in a significant cost saving (around 3% of total maternity care budget) with no reduction in standard of care.
Supporting future maternity service commissioning and provision
The research, funded by the National Institute for Health Research’s Health Services and Delivery Research programme, is using a mixed-method design, incorporating a comparative case study design.
Stage one maps the existing national configuration, organisation and operation of MUs. Stage two will include work at six case study sites and investigates the complex interrelation of variables of potential importance in understanding the provision of MUs in England.
Using documentary analysis, focus groups, interviews and analysis of local media coverage of maternity care provision, the team’s in-depth case study data will provide not only detailed context-dependent knowledge, but also identify what can be transferred to other NHS sites.
Service users are actively involved throughout all stages of the research process.
The final phase will include a multidisciplinary stakeholder workshop, which will collaboratively generate interventions, develop service guidance to support future maternity services, and start the dissemination process.
Read more on the project website.