Barriers to women's access to alongside midwifery units in England

Article


Rayment, J., Rance, S., McCourt, C. and Sandall, J. 2019. Barriers to women's access to alongside midwifery units in England. Midwifery. 77, pp. 78-85.
AuthorsRayment, J., Rance, S., McCourt, C. and Sandall, J.
Abstract

Background

Alongside midwifery units (AMUs) are managed by midwives and proximate to obstetric units (OUs), offering a home-like birth environment for women with straightforward pregnancies. They support physiological birth, with fast access to medical care if needed. AMUs have good perinatal outcomes and lower rates of interventions than OUs. In England, uptake remains lower than potential use, despite recent changes in policy to support their use. This article reports on experiences of access from a broader study that investigated AMU organisation and care.
Methods

Organisational case studies in four National Health Service (NHS) Trusts in England, selected for variation geographically and in features of their midwifery units. Fieldwork (December 2011 to October 2012) included observations (>100 h); semi-structured interviews with staff, managers and stakeholders (n = 89) and with postnatal women and partners (n = 47), on which this paper reports. Data were analysed thematically using NVivo10 software.
Results

Women, partners and families felt welcome and valued in the AMU. They were drawn to the AMUs’ environment, philosophy and approach to technology, including pain management. Access for some was hindered by inconsistent information about the existence, environment and safety of AMUs, and barriers to admission in early labour.
Conclusions

Key barriers to AMUs arise through inequitable information and challenges with admission in early labour. Most women still give birth in obstetric units and despite increases in the numbers of women birthing on AMUs since 2010, addressing these barriers will be essential to future scale-up.

JournalMidwifery
Journal citation77, pp. 78-85
ISSN0266-6138
Year2019
PublisherElsevier for Churchill Livingstone
Accepted author manuscript
License
Digital Object Identifier (DOI)doi:10.1016/j.midw.2019.06.010
Web address (URL)https://doi.org/10.1016/j.midw.2019.06.010
Publication dates
Online22 Jun 2019
Publication process dates
Accepted20 Jun 2019
Deposited03 Jul 2019
FunderNational Institute for Health Research, Health Services and Delivery Research programme
Copyright holder© 2019 Elsevier.
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Accepted author manuscript

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