Evidence to improve the quality and safety of midwifery-led intrapartum care

Summary

Background

Midwifery-led settings for birth (midwifery units and at home) are increasingly important in UK maternity care policy. National guidance recommends that healthy women with straightforward pregnancies, who are at ‘low risk’ of complications during labour and birth, are advised that they may choose any birth setting. Midwifery units are particularly recommended because ‘low risk’ women who plan birth in these settings are more likely to have a straightforward birth without needing medical intervention. Care in a midwifery unit is as safe for a ‘low risk’ woman and her baby as care in a hospital obstetric unit (or labour ward).

Of the ~800,000 women who give birth each year in the UK an estimated 350,000 are eligible for midwifery unit care and the number of midwifery units is increasing. Because care in midwifery units is becoming increasingly important, more evidence is needed to improve care and ensure safety for women and their babies.

Aim

Using national data on perinatal deaths and two studies involving primary data collection through a novel midwifery research and reporting system, this research programme aims to provide evidence and a research infrastructure to strengthen the development of safe, high quality midwifery-led intrapartum care and improve outcomes for mothers and babies.

Objectives

1. To describe labour and delivery complications, mode of birth and causes of death in intrapartum stillbirths and early neonatal deaths occurring in births planned in midwifery units and at home, and compare with a sample of similar perinatal deaths occurring in births planned in obstetric units in the same NHS trusts/health boards.
2. To develop and establish a new national midwifery reporting and research system (UKMidSS)
3. To use UKMidSS to estimate the current prevalence of obesity in women planning birth in alongside midwifery units (AMUs) and describe their maternal and clinical characteristics, management, labour complications and outcomes compared with women of normal weight
4. To use UKMidSS to determine the incidence of and risk factors for neonatal unit admission in births occurring in AMUs
5. To use UKMidSS to describe labour care in mothers of babies admitted to neonatal care following birth in an AMU, with particular reference to national clinical guidelines
6. To develop a funding system and structure to ensure further development and sustainability of UKMidSS to include other midwifery-led settings for birth

Funding

National Institute for Health Research Post Doctoral Fellowship (PDF-2014-07-006)

Publications

Journal Articles

• Rowe R, Kurinczuk JJ, Hollowell J, Jokinen M, Knight M, on behalf of UKMidSS. The UK Midwifery Study System: Investigating uncommon events and conditions in midwifery-led settings. British Journal of Midwifery. 2015;23(11):823-4.
• Rowe R, Kurinczuk JJ, Hollowell J, Jokinen M, Knight M. The UK Midwifery System (UKMidSS): a programme of work to establish a research infrastructure to carry out national studies of uncommon conditions and events in midwifery units. BMC Pregnancy Childbirth. 2016;16(1):77.
• Rowe R, Jokinen M. UKMidSS: Engaging in Research. Midwives. 2015;18(4):47.