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Enjoy and follow us on social networks for future news. Both AMUs and FMUs provide midwifery-led care for women with 'low-risk' pregnancies as defined in national clinical guidelines, 2 but AMUs are located close to (usually within the same building as) OUs whereas FMUs are on a separate site.Our service is free of charge for you. That study also found that freestanding midwifery units (FMUs) had slightly better outcomes than alongside midwifery units (AMUs). Publish your online flipbook as public or private.The Birthplace in England study 1 found that, for healthy women with 'low-risk' pregnancies, midwifery-led units (MLUs) had better outcomes for women and equally good outcomes for babies, at a lower cost than obstetric units (OUs). Change the look of your flipbook and add more interactivity.
However, the women in this study were from a wide range of backgrounds, and without exception they appreciated the experience. Some of the medical professionals interviewed for this study felt that the AMU philosophy is designed by and for affluent, white women and has less relevance for those from other social and ethnic groups. In theory, an 'opt out' system should result in equality of opportunity to experience midwifery-led care. They also observed key aspects of the service, such as staff handover meetings.Two of the four AMUs had an 'opt in' system (women had to request to birth in the AMU), and the other two an 'opt out' system (in other words it was assumed that all women with 'low-risk' pregnancies would birth in the AMU unless they requested otherwise). The researchers interviewed 136 women, partners, managers, commissioners and health workers at four NHS AMUs from different parts of the country and different types of location such as city centre and suburban. For this reason, and because it is easier and cheaper for the NHS to provide AMUs, the recent increase in the number of MLUs in England 4 may not translate to an increase in the number of FMUs.To help understand why outcomes are poorer in AMUs than in FMUs, this study aimed to explore the organisation, staffing and management of AMUs and to examine the perceptions of AMUs among women and their partners, and among those working in maternity care, and then to make recommendations about how to maximise quality of care within this environment, given financial and organisational constraints.
The study did find that lack of space in the AMU may be a factor, yet it did not find any evidence of plans to expand AMU capacity at the study sites, which does not bode well for women, who may be unable to opt for AMU care even if they want it.Most of the health professionals interviewed felt that strict criteria should be used to determine whether or not a woman should be offered an AMU birth. The study's authors question why such a small propor tion of 'low-risk' women used the AMU ratherthan the OU, and more interviews with women who had chosen an OU birth with a 'low-risk' pregnancy may have helped to understand this. Some AMUs were working towards integrating the work of AMU midwives and midwives working in the community (for example at GP surgeries) so that all midwives were able to provide accurate information about the options available to women.The fact that the study focused mainly on women who had opted for AMU care means that it did not provide much information about why women would opt out of AMU care. The differences between the options were not always clearly explained, so many women could not be said to have made an informed decision.
When women transferred from AMU to OU, sometimes the AMU midwives felt that the OU midwives judged them to have 'failed', and sometimes the labouring women noticed the resultant tension. There was, however, professional tension between AMU midwives and OU midwives. These situations raise important questions about how to maximise safety whilst not denying women the option to make their own decisions, and about the extent to which fear of legal action unnecessarily limits the range of options presented to women.Despite the history of professional tensions between midwives and obstetricians in the UK, 5 the study found that obstetricians were generally supportive of AMUs, because this model means that they can focus on caring for women with complications.
6 This study found similar issues at AMUs, which regularly sent women home due partly to a belief that home is the best place when in early labour and partly to lack of space. This caused tension because fewer midwives in the AMU could lead to it being closed due to staff shortages, thus limiting women's options.The issue of women being sent home if they arrive at an OU in early labour, and the distress that this can cause, is well-documented. Sometimes, if there were staffing shortages in the OU, the AMU midwives would get 'pulled' to work in the OU. Such cases were not viewed as priorities, which was distressing for the labouring women and the AMU midwives. Similarly, if the OU was busy, there were examples of the OU refusing to accept a transfer from the AMU for nonemergencies, such as a request for an epidural.
Brocklehurst P, Hardy P, Hollowell J et al (2011) Perinatal and maternal outcomes by planned place of birth for healthy women with low-risk pregnancies: the birthplace in England national prospective cohort study. This suggests that the expansion of access to midwife-led care will require targeted advocacy work with health service management.Andrea is a researcher and statistician with a special interest in maternal and newborn health. The study noted that the existence of the current set of AMUs was not due to any commitment to this model of care among health service managers they were simply a pragmatic response to a set of circumstances such as a perceived need to centralise all services on a single site. To make the most of this opportunity, the health service must show strong leadership, make evidence-based decisions and rise to the management challenges identified by this study. The development of MLUs presents an important opportunity to provide women with a broader range of birthplace options and a model of care that reduces the number of unnecessary interventions and avoids some of the risks associated with OU birth.
National Audit Office (2013) Maternity services in England. Doi: 10.3310/hsdr02070, 2014. McCourt C, Rayment J, Rance S, and Sandall J (2014) An ethnographic organisational study of alongside midwifery units: A followon study from the birthplace in England programme.
129–134.AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.The AIMS Journal spearheads discussions about change and development in the maternity services. Nyman V, Downe S and Berg M (2011) Waiting for permission to enter the labour ward world: First time parents' experiences of the first encounter on a labour ward. In The Politics of Maternity Care: services for Childbearing Women in Twentieth-Century Britain, 2nd ed. Kitzinger J, Green J and Coupland V (1991) Labour relations: Midwives and doctors on the labour ward.
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