Dear Carolyn

I am one of the investigators of Birthplace in England and also a co-lead of the organisational case studies on organisation of midwife led units in the study. I have attached a short summary.

I also attach a toolkit London has just developed to support out of OU births and a decision toolkit based on birthplace findings.

The results of these studies are here.

http://www.nets.nihr.ac.uk/projects/hsdr/081604140 and please see final report 6

http://www.nets.nihr.ac.uk/__data/assets/pdf_file/0008/84950/FR6-08-1604-140.pdf

Chris McCourt led a second study looking at alongside midwife units.

The results of these studies are here

http://www.nets.nihr.ac.uk/projects/hsdr/10100835

There is also a new network to support midwifery units.

http://www.midwiferyunitnetwork.com/

There are key issues that are important in terms of relevance to other countries. 1) provision of home and midwife units is run by the acute NHS trust. This means that all midwives and medical staff are employed by the same organisation and that referral and transfer occurs within the same organisation, and governance of all settings is the responsibility of the acute trust. However, community midwives are based in community settings and midwife units but employed by the acute hospital, and midwifery group practices (MGP) are community based but provide an and pn care in community and can attend births of their women at home in a MLU or an OU. MGP can and do look after a group of women in their locality who may be straightforward or have medical and social complications. They provide midwifery care for these women as part of the multidisciplinary team. Likewise some MGP are hospital based and provide midwifery care for women who need specialist OB and medical input (heart disease, diabetes etc), usually in a one stop ANC, attend the birth and provide PN care in community.

It is important to know that apart from some new schemes the majority of midwives are employed by an NHS trust and not self-employed .

I am visiting New Zealand in the next three weeks and happy to catch up more of this is helpful.

Regards

Jane sandall

Jane Sandall
Professor of Social Science and Women's Health

NIHR Senior Investigator
Division of Women’s Health | Faculty of Life Sciences & Medicine | King’s College London |Women’s Health Academic Centre | St. Thomas' Hospital

London| SE1 7EH

http://www.kcl.ac.uk/lsm/research/divisions/wh/index.aspx

Latest publication: Poston, Lucilla, et al. "Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial." The Lancet Diabetes & Endocrinology (2015) http://www.sciencedirect.com/science/article/pii/S2213858715002272

From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Carolyn McIntosh
Sent: 14 August 2015 01:20
To: [log in to unmask]
Subject: Primary birthing units

We have long harboured the desire for primary birthing unit options for all women in New Zealand. Currently this is mostly only available to rural women, who are a distance from secondary care facilities. One of the arguments against such units is that secondary care facilities need the throughput of women birthing, which attracts government funding, to ensure financial sustainability.

Financial viability is obviously a key component and models of funding vary around the world however I am looking for supporting evidence, from any location, which supports the concept of primary birthing units alongside sustainability of the secondary/tertiary sector. Is it possible for these two to exist together in harmony and is there any evidence which demonstrates this? What are the factors that contribute to sustainability. Equally important is to identify the circumstances which lead to failure and closure of primary birthing units, so we can hopefully put measures in place to avoid these challenges.

Any feedback or help would be welcomed.

Carolyn McIntosh

Senior midwifery lecturer

School of Midwifery - Te Kura Atawhai Ka Kaiakapono Te Hakuitaka
Otago Polytechnic - Te Kura Matatini Ki Otago
Mobile 021705809
Free phone 0800 762 786