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Evidence backs safety and cost effectiveness of midwife-led units

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Midwives have called for greater choice in maternity services in response to a landmark study showing births outside obstetrics are safe and require fewer interventions.

The Birthplace Study of almost 65,000 “low risk” births compared those in hospital obstetric units with those at home or in midwifery-led units.

Overall, the rate of adverse outcomes was low in all birth settings – 4.3 per 1,000 births – and there were no significant differences in the odds of an adverse outcome for any of the non-obstetric unit settings compared with obstetric units, according to the study authors from Oxford University.

Births at home or in midwifery units had substantially fewer interventions – such as epidurals and forceps assisted deliveries – than obstetric units. There were slightly poorer outcomes for babies of first-time mothers who had planned home births compared with an obstetric unit, but this risk disappeared for subsequent births.

The researchers also found the cost of midwifery units was lower than obstetric services. But they said 50% of trusts had no midwifery units in 2010 and this “is likely to have limited the choices available to women”.

The findings, published last week in the BMJ, follow a long standing debate over the safety of midwife-led units and home birth versus consultant-led units, and come at a time when some non-medically led services are under threat of closure due to financial cuts.

Royal College of Midwives general secretary Cathy Warwick said: “Why, in times of limited financial resources, is a decision often made to curtail or cut a homebirth service or close a free standing midwife led-unit?

“The right response for mothers and babies is to keep these services open, making sure women understand the advantages associated with homebirth and midwife-led units, thus ensuring their greater use and cost effectiveness.”

  • Independent midwives may be able to get professional indemnity if they practise together in “legal entities”, such as social enterprises, according to research commissioned by the RCM and the Nursing and Midwifery Council. European Union rules will, from 2013, require all health professionals to be insured. However, cover is currently unavailable to independent midwives because the risk is deemed too great to insurers.   
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