Barriers to women's access to alongside midwifery units in England.
Adult
Birthing Centers
/ organization & administration
England
Female
Health Services Accessibility
/ standards
Humans
Midwifery
/ organization & administration
Obstetrics and Gynecology Department, Hospital
Patient Preference
/ psychology
Qualitative Research
State Medicine
/ organization & administration
Alongside midwifery units
Birth centres
Birthplace
Informed choice
Midwifery units
Place of birth
Journal
Midwifery
ISSN: 1532-3099
Titre abrégé: Midwifery
Pays: Scotland
ID NLM: 8510930
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
30
01
2019
revised:
18
06
2019
accepted:
20
06
2019
pubmed:
5
7
2019
medline:
25
2
2020
entrez:
5
7
2019
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 31271963
pii: S0266-6138(19)30133-0
doi: 10.1016/j.midw.2019.06.010
pii:
doi:
Types de publication
Journal Article
Langues
eng
Pagination
78-85Subventions
Organisme : Department of Health
ID : 10/1008/35
Pays : United Kingdom
Informations de copyright
Copyright © 2019. Published by Elsevier Ltd.