NPEU

The Birthplace in England Research Programme (Birthplace)

Since the early 1990s Government policies on NHS maternity services have supported the principle that women should have a choice of setting for childbirth1, 2, 3. The current commitment is to a "national choice guarantee" that, depending on their circumstances, women and their partners will be able to choose where they wish to give birth: at home, in a midwifery unit or in an obstetric unit4.

Research reviews have identified major gaps in the evidence including whether there is a difference in the rate of any good or bad outcomes for mothers or babies depending on where birth is planned. The National Institute for Health Research (NIHR) and the Department of Health has awarded funding to a collaborative group of investigators from UK universities, professional and consumer bodies led by the National Perinatal Epidemiology Unit (NPEU) at the University of Oxford, to carry out studies designed to answer questions about how the current provision of maternity services affects women's experiences, and about the safety and quality of care around the birth of their baby.

What is Birthplace?

Birthplace is an integrated programme of research designed to compare outcomes of births planned at home, in different types of midwifery units, and in hospital units with obstetric services. Birthplace combines the Evaluation of Maternity Units in England research programme funded by the NIHR Service Delivery and Organisation (SDO) Programme, and the Birth at Home study, funded by the Department of Health's Policy Research Programme.

What will Birthplace ask?

Birthplace will evaluate important outcomes for women and babies at low-risk of complications at the start of labour in a range of planned places of birth in England. A range of techniques will be used to collect and analyse data about processes, outcomes and costs associated with different clinical locations for birth and for different systems of care. These studies will answer questions about wellbeing, safety and quality, women's experience of care, the process of transfer from planned place of birth, and the cost-effectiveness of different systems for care.

What information will Birthplace produce?

The results will:

  • provide evidence about important childbirth outcomes that women and health professionals can use to support and inform the choices and decisions that are made when planning the place of birth.
  • contribute to implementation of Standard 11 of the National Service Framework for Children, Maternity and Young People3; Better information, better choices, better health: Putting information at the centre of care5; and the NICE Intrapartum care clinical guidelines 2007.
  • support the Government's commitment to ensure that women have a choice of place of birth by 20094.

How will Birthplace be done? Outline of the studies and timetable.

The programme began in September 2006 and is funded until August 31st 2010.

Birthplace comprises six inter-related studies:

  1. Study 1:In November and December 2006 stakeholders were involved in a process to help achieve consensus about terms and definitions for place of birth to be used in the programme.
  2. Study 2: In 2007 a national survey to map service provision was embedded within the Healthcare Commission's Maternity Service Review of all NHS Trusts providing maternity services in England.
  3. Study 3: A large-scale systematic review of cost-effectiveness of the different locations for birth is underway.
  4. Study 4: A prospective cohort study is underway to collect data on planned place of birth and key clinical outcomes for women and babies at low risk of complications at the start of labour. A feasibility phase tested data collection from planned births at home in three areas from July 2007-December 2007. The feasibility phase was very successful, with more than 90% of data collection forms being returned to NPEU. Data collection will continue until April 30th 2010 to collect information from 17,000 women. This will overlap with data collection about the outcomes of 10,000 births planned in all freestanding midwifery units, all alongside midwifery units and from 30,000 women in a representative sample of 37 obstetric units. Within each unit, detailed data will be collected prospectively on throughput, staffing in labour and deliver and outcomes at discharge.
  5. Study 5: In 2009 and 2010 an analysis of national level data about safety will be carried out on information collected by the Office for National Statistics (ONS) and by the Confidential Enquiry into Maternal and Child Health (CEMACH) during 2006, 2007 and 2008.
  6. Study 6: Case studies will be carried out in a representative sub-sample of midwifery and obstetric units in 2009 and 2010 to describe women's experiences of care, management and experiences of transfer between services, organisational and workforce issues which may impact on quality of care in different locations.

Towards the end of Birthplace in 2010, stakeholders will be asked to consider the results of the whole programme to seek to establish an evidence-based consensus which will form the basis on which the NHS can commission maternity services.

Who will use the Birthplace results?

Pregnant women will use the results to inform discussions with health professionals and their decisions about place of birth. Policy makers, service managers and local communities will also use the findings both to inform which services are commissioned locally and discussions around the future development of maternity services.

Who is running Birthplace?

Birthplace was designed by the multi-disciplinary collaborative group of maternity care researchers, health professionals and service users listed below. This group is responsible for the design and governance of the programme. The day-to-day work is co-ordinated by the NPEU in Oxford.

  • Birthplace Co-Investigator Group
  • Peter Brocklehurst (Programme Lead, Director, NPEU)
  • Rona McCandlish (Managing Investigator, Epidemiologist, NPEU)
  • Stavros Petrou (Health Economist, NPEU)
  • Maggie Redshaw (Social Scientist, NPEU)
  • Jane Sandall (Professor of Women's Health, King's College London)
  • Christine McCourt (Professor in Anthropology and Health, Thames Valley University)
  • Mary Newburn (Head of Policy Research, National Childbirth Trust)
  • Alison Macfarlane (Professor of Perinatal Health, City University)
  • Alison Miller (Programme Director and Midwifery Lead, CEMACH)
  • Louise Silverton (Deputy General Secretary, Royal College of Midwives)
  • Deirdre Murphy (Chairman of Guideline and Audit Committee, Royal College of Obstetricians and Gynaecologists)
  • Rona Campbell (Professor of Health Services Research, University of Bristol)
  • Neil Marlow (Professor in Neonatal Medicine, Queen's Medical Centre)

Who to contact about Birthplace at the NPEU

  • Mary Logan
  • Project Manager
  • National Perinatal Epidemiology Unit (NPEU)
    RDB, University of Oxford
    Old Road Campus
    Oxford
    OX3 7LF
  • 01865 289756
  • 01865 289758

References

  1. ^ Campbell R, Macfarlane AJ. Where to be born? The debate and the evidence. Second edition. Oxford: National Perinatal Epidemiology Unit, 1994.
  2. ^ Hall J. Free standing maternity units in England. In Kirkham M, ed. Birth centres. Cheshire: Books for Midwives Press, 2003.
  3. ^ a, b Department of Health.National Service Framework for Children, Young People and Maternity Services. Standard 11: Maternity Services. London: Department of Health, 2004.
  4. ^ a, b Department of Health.Maternity Matters: Choice, access and continuity of care in a safe service. London: Department of Health, 2007.
  5. ^ Department of Health.Better information, better choices, better health. Putting information at the centre of health. London: Department of Health, 2004

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