Local guidelines for admission to UK midwifery units compared with national guidance: A national survey using the UK Midwifery Study System (UKMidSS)
Variation in local midwifery unit admission criteria represents a potentially confusing and inequitable landscape for women making choices about planned place of birth.
A new UKMidSS study, published in PLOS ONE and funded by the NIHR Policy Research Unit in Maternal and Neonatal Health and Care, aimed to explore and describe variation in local maternity service guidelines for planned admission for intrapartum care ('admission guidelines') to alongside and freestanding midwifery units across the UK. National guidance, in the form of the NICE Intrapartum Care Guideline CG190, was used as a reference against which to measure variation. The survey also asked whether alongside midwifery units were considered to be the default option for eligible women.
Admission criteria were categorised as 'more restrictive', i.e. effectively excluding more groups of women from admission to the midwifery unit than NICE guidance, or 'less restrictive', i.e. admitting women to the midwifery unit who wouldn't necessarily be admitted according to NICE guidance. The key findings were:
Over half (59%) of responding NHS services reported their alongside midwifery unit was the default option for healthy women with straightforward pregnancies.
Overall, 92% of local admission guidelines varied from national guidance, with 76% containing both some admission criteria that were 'more restrictive' and some that were 'less restrictive'.
The most common 'more restrictive' admission criteria, occurring in around 30% of guidelines, excluded women who: declined blood products; had experienced female genital cutting; were less than 16 years old; or had not attended for regular antenatal care.
The most common 'less restrictive' criteria, occurring in 40-80% of guidelines, were: explicit admission of women with parity ≥4, aged 35-40 years, or with a BMI 30-35kg/m2; selective admission of women with a BMI 35-40kg/m2, Group B Streptococcus carriers and those undergoing induction of labour.
The extent of variation from national guidance found in this study indicates that a review of that guidance may be required to help women make birth placed decisions with confidence.