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Hi Carolyn I am in the final few weeks of writing up a funded remote rural study on maternity experience in New Zealand that certainly explores sustainability of local services across multiple perspectives. The report adopts a transdisciplinary lens. I am happy to share the report once done. I am also presenting some of this work at Joan Donnelly symposium in Napier NZ next month. If you are going we can discuss there as well. It is not directly responding to your questions yet it may provide more context of a very complex living system that includes our primary units. Your own work to date has contributed also to my discussions! Go well Susan Dr Susan Crowther “Those finding themselves at birth need to pause and allow the profundity of its meaning to surface and inspire their actions” Senior Lecturer midwifery | Associate Head of Research | School of Clinical Sciences | Faculty of Health and Environmental Sciences AUT North Campus | Rm AB206 | Private Bag 92006 | Auckland 1020 | New Zealand |A: 09 921 9999 - ext. 7558 | Mob: 021 229 4858 Blog: http://drsusancrowther.wordpress.com Twitter: http://twitter.com/SusanCrowtherMW -----Original Message----- From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of MIDWIFERY-RESEARCH automatic digest system Sent: Friday, 14 August 2015 9:04 p.m. To: [log in to unmask] Subject: MIDWIFERY-RESEARCH Digest - 10 Aug 2015 to 14 Aug 2015 - Special issue (#2015-21) There are 2 messages totaling 68246 lines in this issue. Topics in this special issue: 1. Primary birthing units (2) ---------------------------------------------------------------------- Date: Fri, 14 Aug 2015 12:19:36 +1200 From: Carolyn McIntosh <[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 ------------------------------ Date: Fri, 14 Aug 2015 09:04:04 +0000 From: "Sandall, Jane" <[log in to unmask]> Subject: Re: Primary birthing units 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 [log in to unmask]<mailto:[log in to unmask]> | 020 7188 8149 | Skype | jsandall PA Fiona George | [log in to unmask]<mailto:[log in to unmask]> | 020 7188 3639 https://kclpure.kcl.ac.uk/portal/jane.sandall 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 ------------------------------ End of MIDWIFERY-RESEARCH Digest - 10 Aug 2015 to 14 Aug 2015 - Special issue (#2015-21) ****************************************************************************************