Preston Birth Centre, Lancashire Teaching Hospitals NHS Trust
Three NHS Trusts have been selected as ‘beacon sites’ for their midwife-led birth centres by the Midwifery Unit Network (MUNet), a leading UK initiative committed to women having positive birth experiences and an optimal start in life for babies.
Supported by an expert professional Advisory Board and involving researchers at City, University of London, the birth centre beacon sites are in the Lancashire Teaching Hospitals Foundation NHS Trust, Sandwell and West Birmingham Hospitals NHS Trust and Lewisham and Greenwich NHS Trust.
In these Trusts in 2016, 23.5%, 31.8% and 18.8% of women, respectively, gave birth in a birth centre (midwifery unit) rather than on the hospital labour ward, compared with a national average for England of around 14%. The two Trusts with the highest percentage of birth centre births had a ‘freestanding’ birth centre in a community setting as well as one ‘alongside’ the hospital labour ward.
Beacon site criteria included a high percentage of the Trust’s births taking place in a birth centre, having a clear philosophy of care consistent with attention to physical, social and psychological needs, midwifery development and multi-disciplinary learning, support for research and audit, strategies for community involvement, clear communication about the service and evidence of sharing learning with other maternity services.
Birth centres share a number of important characteristics. The midwives running them want women to feel empowered and supported to give birth using their own resources. They also have an in-depth knowledge of pregnant women’s physiology and clear understanding about what is a deviation from normal requiring transfer to medical care.
Care in midwifery-led facilities is particularly suitable for women who are less likely to experience complications because their health is good, their obstetric history is uncomplicated and their pregnancy is progressing well.
Birth centres provide a welcome haven for women who want to give birth with as few interventions as possible, and the social and emotional support provided can help to overcome any anxieties for women who are worried about coping with labour and birth. Birth rooms are designed for maximum comfort and providing women with a sense of respect, privacy and security.
Most women use a birth-pool during labour, as immersion in water is calming, helps with relaxation and eases contractions. En-suite facilities, walk-in showers, beautiful artwork, sensitive lighting, quiet voices and so on are all part of the birth environment that is deliberately created.
Each woman has her own room that she is able to share as she chooses with her partner and family members, adding to the personalisation of the service. The aim is for a home-like atmosphere, where they ‘own’ the space, rather than being in a place that feels unfamiliar, with numerous rules and restrictions, which can be inhibiting.
The aim is for women to have a positive experience as well as a safe, straightforward labour and birth and a healthy, alert baby. This includes ensuring a safe and positive experience if women do need to transfer for medical care.
Giving birth is just the start. Birth centres and hospitals should all provide support to new mothers in the first hours and days after birth, according to their individual needs, with community services providing on-going care and support.
NICE evidence-based recommendations for place of birth, say that women with a low-risk pregnancy should be encouraged to consider midwifery unit care as it is ‘particularly suitable for them’. This is consistent with the Government’s Five Year Forward View for maternity, Better Births (2016). The National Maternity and Neonatal Audit (2017) also recently described increasing access to midwife-led birth settings as ‘a national priority’.
Kathryn Gutteridge, President of the Royal College of Midwives and birth centre pioneer, said:
“Birth centre midwives have confidence in a woman’s ability to give birth. We develop the skills and experience of midwives to build that confidence, to listen to women and to work closely with medical colleagues to ensure optimal and safe care.”
Mary Newburn, Research Fellow at City, University of London, co-founder of Midwifery Unit Network, and member of the NHS England Stakeholder Council advising on the implementation of Better Births, said:
“Birth centres develop in different ways, but the essence of what they are about is having respect for the woman’s autonomy and right to choose, as well as making sure every woman gets emotional support and encouragement, and the information she needs.”
Professor Christine McCourt at City, University of London, who was an investigator in the Birthplace study and has led studies of the organisation and provision of care in midwifery units, said:
“Midwifery units share a philosophy of care that is ‘woman-centred’, focusing the woman and her partner’s experience of care as an important priority. Research from City, University of London shows that services with freestanding birth centres as well as having a birth centre alongside their obstetric unit are able to provide more choices to women and families and to optimise the skills and confidence of midwives to work in these settings. They can become the basis for the Community Hubs recommended in Better Births. Others could learn a great from these units about how to develop and sustain optimal care for women, families and communities.”