Project 3: Exploring changes in midwifery care over time and differences across the country
Background
Since 2014, national guidance has advised that healthy pregnant women, who are at lower risk of experiencing complications during labour and birth, be offered a choice about where to give birth. This choice should include a midwifery unit (MU) where care is provided by midwives, rather than doctors. 'Low risk' women who plan birth in a MU are less likely to have a caesarean birth or one that's assisted with instruments (such as ventouse or forceps). Their babies are no more likely to have problems than those born to women who plan birth in a hospital obstetric unit or 'labour ward'.
Between 2010 and 2015 the number of MUs, and the number of women giving birth in MUs, increased. We now think that the number of women giving birth in MUs may have decreased in recent years, but there is no national evidence about this change. The COVID-19 pandemic, a national shortage of midwives, and more low risk women having labour started artificially (or 'induced') who are then advised to plan birth in an obstetric unit, are possible reasons for any decrease. At the same time, we know that some MUs are offering labour and birth care for low risk women who have had their labour started artificially. We do not know how many MUs are doing this, and what the outcomes are for women and their babies are as a result.
Aims and objectives
We will answer four questions:
- How has the number of MUs and the number of women giving birth in MUs changed since 2015?
- Can we carry out research to describe changes in the characteristics and outcomes of women planning birth in MUs since the last research on this topic was carried out in 2010?
- How many MUs care for women who have had their labour started artificially?
- What are the outcomes for women and their babies when they plan birth in an MU after having their labour started artificially?.
Methods
We will use a national research platform called the UK Midwifery Study System (UKMidSS) which collects information from all MUs. For the first question, we will use information already collected using UKMidSS since 2016. For the other questions we will collect new information using UKMidSS.
Policy relevance & dissemination
This research will help ensure that women have choice about their care, as well as safe care that meets their individual needs. We will publish the results in academic journals, at conferences and in easy to read plain language documents for midwives and women.
Team
Principle Investigator: Rachel Rowe
Other PRU team members: Tabitha Newman
Contact: ukmidss@npeu.ox.ac.uk
