Barriers to women's access to alongside midwifery units in England

Rayment, J; Rance, S; McCourt, C; Sandall CBE RM, J

Barriers to women's access to alongside midwifery units in England

Rayment, J Rance, S McCourt, C Sandall CBE RM, J

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Publication Type:: Journal Article
Citation:: Midwifery, 2019, 77 pp. 78 - 85
Issue Date:: 2019-10-01

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Field	Value	Language
dc.contributor.author	Rayment, J	en_US
dc.contributor.author	Rance, S	en_US
dc.contributor.author	McCourt, C	en_US
dc.contributor.author	Sandall CBE RM, J https://orcid.org/0000-0003-2000-743X	en_US
dc.date.available	2019-06-20	en_US
dc.date.issued	2019-10-01	en_US
dc.identifier.citation	Midwifery, 2019, 77 pp. 78 - 85	en_US
dc.identifier.issn	0266-6138	en_US
dc.identifier.uri	http://hdl.handle.net/10453/135571
dc.description.abstract	© 2019 Background: Alongside midwifery units (AMUs) are managed by midwives and proximate to obstetric units (OUs), offering a home-like birth environment for women with straightforward pregnancies. They support physiological birth, with fast access to medical care if needed. AMUs have good perinatal outcomes and lower rates of interventions than OUs. In England, uptake remains lower than potential use, despite recent changes in policy to support their use. This article reports on experiences of access from a broader study that investigated AMU organisation and care. Methods: Organisational case studies in four National Health Service (NHS) Trusts in England, selected for variation geographically and in features of their midwifery units. Fieldwork (December 2011 to October 2012) included observations (>100 h); semi-structured interviews with staff, managers and stakeholders (n = 89) and with postnatal women and partners (n = 47), on which this paper reports. Data were analysed thematically using NVivo10 software. Results: Women, partners and families felt welcome and valued in the AMU. They were drawn to the AMUs’ environment, philosophy and approach to technology, including pain management. Access for some was hindered by inconsistent information about the existence, environment and safety of AMUs, and barriers to admission in early labour. Conclusions: Key barriers to AMUs arise through inequitable information and challenges with admission in early labour. Most women still give birth in obstetric units and despite increases in the numbers of women birthing on AMUs since 2010, addressing these barriers will be essential to future scale-up.	en_US
dc.relation.ispartof	Midwifery	en_US
dc.relation.isbasedon	10.1016/j.midw.2019.06.010	en_US
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject.classification	Nursing	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Midwifery	en_US
dc.subject.mesh	Qualitative Research	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Birthing Centers	en_US
dc.subject.mesh	Obstetrics and Gynecology Department, Hospital	en_US
dc.subject.mesh	State Medicine	en_US
dc.subject.mesh	Health Services Accessibility	en_US
dc.subject.mesh	England	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Patient Preference	en_US
dc.title	Barriers to women's access to alongside midwifery units in England	en_US
dc.type	Journal Article
utslib.citation.volume	77	en_US
utslib.for	1114 Paediatrics and Reproductive Medicine	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	closed_access	*
pubs.publication-status	Published	en_US
pubs.volume	77	en_US

Abstract:

© 2019 Background: Alongside midwifery units (AMUs) are managed by midwives and proximate to obstetric units (OUs), offering a home-like birth environment for women with straightforward pregnancies. They support physiological birth, with fast access to medical care if needed. AMUs have good perinatal outcomes and lower rates of interventions than OUs. In England, uptake remains lower than potential use, despite recent changes in policy to support their use. This article reports on experiences of access from a broader study that investigated AMU organisation and care. Methods: Organisational case studies in four National Health Service (NHS) Trusts in England, selected for variation geographically and in features of their midwifery units. Fieldwork (December 2011 to October 2012) included observations (>100 h); semi-structured interviews with staff, managers and stakeholders (n = 89) and with postnatal women and partners (n = 47), on which this paper reports. Data were analysed thematically using NVivo10 software. Results: Women, partners and families felt welcome and valued in the AMU. They were drawn to the AMUs’ environment, philosophy and approach to technology, including pain management. Access for some was hindered by inconsistent information about the existence, environment and safety of AMUs, and barriers to admission in early labour. Conclusions: Key barriers to AMUs arise through inequitable information and challenges with admission in early labour. Most women still give birth in obstetric units and despite increases in the numbers of women birthing on AMUs since 2010, addressing these barriers will be essential to future scale-up.

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http://hdl.handle.net/10453/135571