Turning the tide of childbirth: Are we still adrift?
The Birthplace Study should have provided the catalyst to change the planned place of birth for nearly half of the women in England. However 4 years on, only 10% of women give birth in a midwife-led setting. Using the evidence from national studies, new initiatives focusing on improving informed choice and the knowledge and confidence of midwives were implemented in one large maternity unit. The strategies have, in part, been successful, with approximately 30% of local women planning to give birth in a midwifery-led setting. This work has demonstrated the challenging task of changing current perceptions around the safety of planned birth outside an obstetric unit demanding strong leadership supported by an effective marketing campaign. The publication of the recent National Institute for Health and Care Excellence Intrapartum Guidelines should provide further impetus in transforming the culture around childbirth.
The findings of the Birthplace Study (Birthplace in England Collaborative Group, 2011) should have resulted in a significant increase in the numbers of low-risk women giving birth either at home or in alongside and free-standing birth centres (Boseley, 2011; Rogers et al, 2012; Warwick, 2012). If the percentage of home births is a barometer for the number of women giving birth outside obstetric units, then sadly we are adrift and the findings have not been translated into practice. Data from the Office for National Statistics (2013) showed a continuing decrease in the percentage of homebirths from 2.4% in 2011 to 2.3% in 2012. According to data published by National Institute for Health and Care Excellence (NICE, 2014), 90% of women giving birth in the UK continue to do so in designated consultant/consultant GP units. This leads to the question of why so many women continue to choose to give birth in a consultant unit considering the evidence (Birthplace in England Collaborative Group, 2011). Compare this with women's decision-making following the publication of the Hannah et al's (2000) term breech trial (Lawson, 2012). The less favourable outcomes for babies of women having vaginal breech deliveries resulted in an immediate change in the management of breech births. It is inconceivable why the Birthplace Study did not lead to a similar response given the significantly increased serious morbidity for low-risk mothers planning birth in an obstetric unit. Nevertheless, Rogers et al (2012) argued that translating the Birthplace findings into practice would present challenges given the deeply entrenched belief among women and professionals that birth in obstetric units was safest. To address this, Rogers et al (2012) argued that maternity providers and commissioners would need to develop a robust strategy with strong leadership to drive the realisation of the evidence. The purpose of this paper is to present a strategy and experience of encouraging low-risk women to plan to give birth in a midwife-led setting.
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