The national lead for maternity has said her local healthcare system will look to more than double its rate of midwife led births by 2020, but suggested it would see a decrease in standalone unit births.
Sarah-Jane Marsh is NHS England’s lead for women’s and children’s care, as well being chief executive of both Birmingham Women’s NHS Foundation Trust and and Birmingham Children’s Hospital NHS Foundation Trust.
“Most people will say that the safest option or least risk is midwifery alongside”
The Birmingham and Solihull area will look to increase the total proportion of midwifery led births – at home, in midwifery units alongside doctor led units, and in standalone midwifery units – from 13 to 30% over the next three years, she told Nursing Times’ sister title Health Service Journal.
Ms Marsh noted that it would be a “big challenge” to decrease the number of women needing obstetric led births to below 70%, because of the “risk factors” involved. She also indicated that Birmingham would see a decrease in standalone unit births.
In October, organisations in Birmingham and Solihull published their sustainability and transformation plan (STP), which revealed the intention to increase home births from 0.8% to 5% over the next three years, and to increase midwife led births in standalone and alongside units from 11.7% to 15%.
Ms Marsh said the plan was broadly based on the national maternity review’s “better births” model, which said matching maternity services to meet women’s choices would result in an increase of births at home or in standalone and alongside units.
According to the NHS England commissioned review, published last February, 9% of births are currently carried out in “alongside” midwife units, while 2% are carried out at home or in standalone units.
“If you up your [number of] home births, you’re probably going to decrease your standalone unit births”
Talking about planned increases in home births across Birmingham and Solihull, Ms Marsh said: “If you up your [number of] home births, you’re probably going to decrease your standalone unit births because there are only so many women who are safe to be not close to an obstetrician.”
She added that standalone units and home births were a “similar level of service”, but for home births “you get more intense support because there has to be two midwives present”.
However, she predicted that the biggest increase in midwife led births would come from alongside units “where you get the best of both worlds”.
“I think, if you ask experts in the field to do an analysis, most people will say that the safest option or least risk is midwifery alongside,” she said.
Ms Marsh also suggested that conversations about the type or place of birth need only take place six to seven months into pregnancy.
The national maternity review suggested that providers and commissioners organise care in “local maternity systems”. Ms Marsh said these would likely be mapped onto the 44 STP regional footprints across England.
When asked about the rollout of personal health budgets for maternity, she said they would “force a conversation about choice” but that they did not “in themselves bring about a better outcome”.