Barber T, Rogers J, Marsh S The Birth Place Choices Project: Phase One. British Journal of Midwifery. 2006; 14:(10)609-13

Barber T, Rogers J, Marsh S The Birth Place Choices Project: Phase two initiative. British Journal of Midwifery. 2006; 14:(11)671-5

Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ. 2011; 343

Women with low-risk pregnancies ‘should have birth choices’. 2011. (accessdd 16 December 2014)

Care Quality Commission. Maternity Services Survey. 2010. (accessed 10 December 2014)

Compassion in Practice. Nursing, Midwifery and Care staff: Our Vision and Strategy.Leeds: Department of Health; 2012

The Mandate. A mandate from the Government to NHS England: April 2014 to March 2015.London: DH; 2014

Recorded delivery: a national survey of women's experience of maternity care 2006. Audit Commission, London. 2006. (accessed 17 December 2014)

Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR Planned caesarean section versus planned vaginal birth for breech presentation at term: A randomised multicentre trial. Lancet. 2000; 356:(9239)1375-83

Towards better births: a review of maternity services in England.London: Commission for Healthcare Audit and Inspection; 2008

Houghton G, Bedwell C, Forsey M, Baker L, Lavender T Factors influencing choice in birth place – an exploration of the views of women, their partners and professionals. Evidence Based Midwifery. 2008; 6:(2)59-64

Hollowell J, Pillas D, Rowe R, Linsell L, Knight M, Brocklehurst P The impact of maternal obesity on intrapartum outcomes in otherwise low risk women: secondary analysis of the Birthplace national prospective cohort study. BJOG. 2014; 121:(3)343-55

Home birth ‘carries higher risk’ for first-time mothers. 2011. (accessed 16 December 2014)

Lawson GW The Term Breech Trial Ten Years On: Primum Non Nocere?. Birth. 2012; 39:(1)3-9

Levy V How midwives used protective steering to facilitate informed choice in pregnancy.Basingstoke: Palgrave Macmillan; 2004

Li Y, Townend J, Rowe R, Knight M, Brocklehurst P, Hollowell J The effect of maternal age and planned place of birth on intrapartum outcomes in healthy women with straightforward pregnancies: secondary analysis of the Birthplace national prospective cohort study. BMJ Open. 2014; 4:(1)

Lukasse M, Rowe R, Townend J, Knight M, Hollowell J Immersion in water for pain relief and the risk of intrapartum transfer among low risk nulliparous women: secondary analysis of the birthplace national prospective cohort study. BMC Pregnancy and Childbirth. 2014; 14:(1)

McCourt C, Rayment J, Rance S, Sandall J Organisational strategies and midwives’ readiness to provide care for out of hospital births: An analysis from the Birthplace organisational case studies. Midwifery. 2012; 28:(5)636-45

Mead MMP, Kornbrot DE The influence of maternity units intrapartum intervention rates and midwives risk perception for women suitable for midwifery led care. Midwifery. 2004; 20:(1)61-71

National Institute for Health and Care Excellence. Intrapartum Care (update). 2014. (accessed 10 December 2014)

Nolan M Information giving and education in pregnancy: A review of Qualitative studies. J Perinat Educ. 2009; 18:(4)21-30

O'Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, Entwistle VA, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2009; 3

Office for National Statistics. Births in England and Wales by Characteristics of Birth 2, 2013. 2013. (accessed 16 December 2014)

Maternity survey, Maternity survey 2013 Barnet and Chase farm hospitals NHS Trust.: Pickers institute Europe; 2013

Pilley Edwards N Why can't women just say No? And does it really matter?.Basingstoke: Palgrave Macmillian; 2004

Read. London LSA Annual Report To The Nursing & Midwifery Council. 2014. (accessed 16 December 2014)

Recorded delivery: a national survey of women's experience of maternity care 2006. 2007. (accessed 10 December 2014)

Rogers I Freedom of choice in childbirth: women need time to make a decision. British Journal of Midwifery. 2009; 17:(8)

Rogers C, Yearley C, Littlehales C The Birthplace Study: Turning the tide of childbirth. British Journal of Midwifery. 2012; 20:(1)28-33

Rowe RE, Townend J, Brocklehurst P Service configuration, unit characteristics and variation in intervention rates in a national sample of obstetric units in England: an exploratory analysis. BMJ. 2014; 4:(5)

Safer childbirth: minimum standards for the organisation and delivery of care in labour.London: RCOG Press; 2007

Sandell J The contribution of continuity of midwifery care to high quality maternity care.London: The Royal College of Midwives; 2014

Schein EH Organizational culture and leadership, 4th edn. San Francisco: Jossey-Bass; 2010

Stephens L Improving the service: working together to promote normal birth. British Journal of Midwifery. 2010; 18:(6)

Safe Births: Everybody's business. An independent enquiry into the safety of maternity services in England.London: The King's Fund; 2008

Warwick C Outcomes by planned place of birth: Implications of the Birthplace Study. British Journal of Midwifery. 2012; 20:(1)20-1

Turning the tide of childbirth: Are we still adrift?

02 January 2015
Volume 23 · Issue 1


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.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month