Why midwifery-led units and homebirths are good for midwives as well as women

Choice for women in where to give birth has hit the headlines and took social media by storm, as the below press release was issued by National Institute for Health and Care Excellence (NICE) yesterday:-

“Women who are healthy and experiencing a ‘straight forward’ (low risk) pregnancy should be encouraged to give birth in a midwife-led unit rather than a traditional labour ward, according to draft proposals from NICE. It also provisionally says that a home birth may be just as safe as hospital for low risk pregnant women who have already had at least 1 child, and that midwives should discuss all options with the women in their care. The proposed changes to the institute’s guidance could affect hundreds of thousands of births.”

This is a real victory for many of us, who have been promoting midwife-led units (MLU’s) and home births as an option for well and healthy women with straightforward pregnancies for many years.

But not only is this fantastic news for women (their babies and families), but it’s also great news for midwives.  As a newly qualified midwife at the turn of the millennium, I worked for two years in a community midwifery team alongside one of the UK’s first and pioneering stand-alone MLU’s, the Edgware Birth Centre. Working in an environment where I was supported by other experienced midwives and also able to practice autonomously gave me an excellent grounding in the ‘normality’ of birth. Water births, physiological third stages, women giving birth in whatever position they felt most comfortable and unhurried skin to skin contact after birth were neither luxuries nor exceptions – they were the norm.

After my two years there, I felt confident enough to work in a one-to-one midwifery team, in which each team member had a caseload of women. Women therefore saw the same midwife right the way through their pregnancies until six weeks postnatal. They could call their named midwife any time of day or night if they had any concerns, and that same named midwife was also on the end of the phone when they went into labour. Our team had an unusually high homebirth rate, of around 10 percent. This was partly due to the fact that we offered healthy women who had uncomplicated pregnancies home assessments in early labour. The women could then decide at that stage whether they wished to transfer in to hospital or whether they wished to continue at home. Many of our women who had home births had not planned to do so, but simply didn’t opt to go into hospital!

Working in both these contexts was exceedingly rewarding for both myself and my colleagues. We felt that we were truly able to partner with women to offer them choice, continuity of carer and control. (To those who were around in the 90’s, these three themes will of course ring bells – they are key themes from the 1993 ‘Changing Childbirth’ report.) Morale was higher than any other midwifery context in which I’ve worked and we experienced high levels of job satisfaction as we saw not only improved tangible outcomes (such as fewer inductions of labour and instrumental deliveries and increased breastfeeding rates, to name a few), but we also saw women empowered and gaining confidence on their journey to motherhood. Additionally, we worked very closely and well with our medical colleagues when women or their babies experienced complications, and truly felt that we were part of a well-functioning multi-disciplinary team.

So the news of NICE’s draft proposals is of course wonderful news for women, but it should also be great news for the midwifery profession if both maternity service commissioners and providers take the proposals to heart.


Featured photo credit: Alison, Flickr Creative Commons


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