Fatima Allam Birth Centre Project

Project Description

Giving birth is generally very safe and it is effectively demonstrated that midwifery-led care in a non-obstetric environment is safe for women and neonates, cost effective and has positive associations with both user and staff satisfaction (Brocklehurst, Hardy et al. 2011). For women having a second or subsequent baby, there is no significant difference in adverse perinatal outcomes for them birthing in a home or midwifery-led unit setting in contrast to obstetric units, furthermore, non-obstetric unit settings significantly reduce the odds of having an intrapartum caesarean section, instrumental delivery and episiotomy. NICE guidance on Intrapartum care (2014) now endorses the findings from the Birthplace study recommending that women may choose their birth setting and that women should be supported in that choice. Practitioners are encouraged to provide advice that planning to give birth at home or in a midwifery led birthing unit is particularly suitable for low-risk women having a second or subsequent baby. Despite increase in the provision of midwifery units in England the clear majority of women still give birth in obstetric units (Hollowell, Li et al. 2016). Moreover, the cost effectiveness of birth centre birthing over alternative planned places of birth in woman at low risk of complications highlight more cost effectivity for birth centre birthing than in obstetric units (Schroeder, Petrou et al. 2011, Schroeder, Petrou et al. 2012). In a context where healthcare trusts continually look toward improving quality and safety within financial constraints this remains a key challenge and where mode and place of birth are ways trusts could effectively make financial gains in ensuring the birth centre is utilised to its full potential.

This year, the Fatima Allam midwifery-led birth centre opened at the Women and Children’s Hospital (Hull and East Yorkshire Hospitals NHS Trust 2017) and offers women the choice of birthing environments that NICE guidance on intrapartum care (2014) recommends. Considering most women opt for obstetric unit care, there is need to understand the preferences of women eligible to book to the birth centre facility in the Hull and East Yorkshire Trust, their perceptions of midwifery-led care and what their expectations are in relation to this provision of care. Understanding this is a key element to ensure the birth centre operates to its full potential and the positive associations with this birth environment can be shared by women, practitioners and service provision.

A key longer term aim is to understand locally what factors help or hinder both women in the choices they make, and midwives in promotion for ‘opting into’ and ‘opting out of’ services to increase the proportion of eligible women opting into the birth centre service. This can be explored through approaches which focus on the individual, community, and environmental influences on behaviour. Behaviour change is a central objective in public health interventions (World Health Organization 2002) in line with best health policies based on evidence that enables the public to choose healthier behaviours, especially when they have accurate information from professionals they trust. The midwife-woman relationship is synonymous with one another (Hunter, Berg et al. 2008) and midwives are ideally situated to endorse the positive associations of this birth setting.

The aim of this project is to explore the preferences of women who are eligible to book to the Fatima Allam birth centre facility and to determine their knowledge, preferences, views and experiences of the concept of midwifery-led care. This is not only paramount to understanding why women might make certain choices regarding ‘opting into’ midwife-led care but through encouraging greater use of the birth centre within the local maternity community there is potential for Hull and East Yorkshire healthcare Trust to make possible key financial gains.