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About Birth Centres
What is a birth centre? l Philosophy of birth centres
Health implication of birth centres l What Maternal Link offers
What is a birth centre?
Birth centres are common in New Zealand and the Netherlands where the majority of maternity care is provided by midwives in the community but are still relatively rare in the UK. Here are some definitions of what a birth centre is
The Royal College of Midwives describes birth centres as follows:
“Birth centres embrace a social model of maternity care, that empower women to make their own birth decisions and promote the alternative wellness model of pregnancy and birth and are guided by the principles of prevention, sensitivity, safety appropriate medical intervention and cost effectiveness.”
(RCM, Position Statement on Birth Centres, May 2004)
The American Association of Childbearing Centres describes birth centres as follows:
"A Birth Centre is a home-like facility, existing within a healthcare system with a programme of care in the wellness model of pregnancy and birth. Birth Centres are guided by the principles of prevention, sensitivity, safety (appropriate medical intervention), and cost effectiveness. Birth Centres provide family-centred care for healthy women before, during and after normal pregnancy, labour and birth."
(American Association of Childbearing Centres, quoted in Vision 2000 into practice: Birth Centres, RCM, 2000)
UK government policy supports the development of community based midwifery and Maternal Link believes the best way to achieve this is by developing a national network of birth centres.
Philosophy of birth centres
A birth centre is not just about ‘birth’. Midwives (an early Anglo-Saxon
word ‘mit-wif’ meaning ‘with woman) provide a service that lasts for months, from pre-conception advice to supporting women postnatally.
Every woman can benefit from midwifery care, whether classified as ‘high risk’ or ‘low risk’. Midwifery care could be provided to everyone in their community, either at home or in a birth centre.
A birth centre should be a community resource, there are often more people involved in pregnancy and having a baby than just the mother.
There are 3 different types of birth centres, all of which are midwifery led.
1. Integrated – these are birth centres inside acute hospitals. These are generally used for labour and delivery and are not necessarily staffed all the time. The midwifery service is usually a separate arrangement and not necessarily provided in the community.
2. Alongside – these birth centres are usually adjacent to a hospital or occasionally a GP surgery. They are usually the base for a community midwifery team, some are staffed all the time, some are not.
3. Stand alone – these are birth centres in the community that are not attached to another service. They are invariably part of a community midwifery service, some are staffed all the time and some are not.
All birth centres promote the overall philosophy of midwifery-led care and the normalisation of pregnancy and birth. The Birth Centre Network has identified 10 important steps to promote normal birth which every maternity unit should strive towards. Because Maternal Link recognises that people are more important than places, our aim is to make these centres provide much more than just a structure in which to give birth. They embody a spirit of holistic care and information exchange.
Maternal Link birth centres are managed by local midwives and parents to ensure they meet the needs of the local community. Maternal Link facilitates the development of the centres and provides the ‘business backbone’, ensuring the birth centre remains sustainable.
Health implication of birth centres
“Research has identified that birth centres have benefits for women and midwives including, shorter labours, higher spontaneous birth rates, fewer interventions, lesser use of pharmacological pain relief, increased consumer satisfaction, appropriate use of midwifery skills and job satisfaction.”
(RCM, Position Statement on Birth Centres, May 2004)
The healthcare benefits are:
• improved midwifery care through personal service
• long term health benefits for mothers and children
• lower risks of hospital acquired infections
The social benefits are:
• reduced inequalities
• easier access
• uniform standards of care
The benefits for women are:
• greater choice for women as to where and how to have their baby
• women are not viewed and treated as patients but pregnant – less stress
• greater choice in their care, carer and setting
The benefits for midwives are:
• improved working conditions
• higher job satisfaction
• greater involvement in decisions that impact on their ability to perform
The benefits for NHS Commissioners are:
• choice of provider for midwifery care in the community
• reducing costs and unnecessary operations
• compliance with national strategy and policy
The NHS’s benefits are:
• decrease in hospital admissions and re-admissions
• increased capacity in midwifery services
• reduced shortage of midwives
The commercial benefits are:
• lower cost per birth
• reduction in expensive operations – Caesarean Sections
• better control over costs and activity
The benefits for the franchise holders are:
• structure, systems and procedures in place for support
• minimal interference and maximum flexibility to meet local needs
• clear responsibilities and rewards available locally
The philosophy of care in a birth centre means the midwife and woman get to know one another and develop a relationship of trust. This relationship is the key benefit; women are perfectly capable of giving birth, midwives exist to facilitate the moment through support to the woman and her partner which is only made possible by a relationship of trust.
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Women should be able to choose who provides their care, how it is delivered and where it is delivered. Real choice involves informing and educating people about all their options so that they have enough understanding to make up their own minds. Maternal Link aims not only to provide a physical choice by developing birth centres with midwives working in the community, but also to foster a spirit of education so that women have enough knowledge to make informed choices about that care.
Midwives based in birth centres are supportive of any woman wishing to have her birth at home with her family. The vast majority of women receiving midwifery care could receive it in the community irrespective of whether or not they plan their birth in a birth centre, at home or in hospital.
The model of care Maternal Link is aiming to create nation wide is already standard in New Zealand, The Netherlands and Germany. It is worth noting that The Netherlands has one of the lowest caesarean-section rates in the developed world (11% in 2000) and the highest home birth rate in the developed world (30.3% in 2000) .
Birth centres increase the rate of normal deliveries and reduce many forms of intervention. There are also many long term health benefits, particularly for babies, who have had a natural birth. This not only helps women and their babies but reduces the cost of maternity care to the NHS.
The use of birth centres will reduce surgical procedures and improve access for all women. It is the best value for money and a safe way of providing care that fills the gap between home and hospital deliveries. Research shows many midwives prefer to work in this environment because it provides greater autonomy for midwives to provide woman-centred care.
At the moment lots of ‘low risk’ women are using ‘high risk’ services; almost all women are being cared for in hospital. If hospital is available specifically for high risk women (not forgetting that any low risk woman could choose to use the service if she wanted) then the specialist skills and resources would be much more targeted to those in need. All women would receive higher care from professionals and services specialising in their needs.
What Maternal Link Offers
Maternal Link plans to work with communities and midwives to develop a first class maternity service. Maternal Link’s birth centres take a holistic approach to maternity care and are a base from which lots of other services can be provided.
Maternal Link’s birth centres will be a base for midwives working in the community. Many midwives have contacted Maternal Link saying they want to focus on caring for women and run their local birth centre, but do not want to be business women. Therefore, Maternal Link’s role is to be the 'Contractual interface'.
Between midwives and the NHS. Maternal Link is developing the framework to provide start-up and ongoing business support to midwives and PCTs to develop a sustainable, locally managed service tailored to the specific needs of the community.
Government policy is that by 2009 all women should have their choice of giving birth at home, in a birth-centre, or in hospital. This is a fundamental change in outlook. Commissioning this new service is a highly complex issue involving many people, services and differing views. Maternal Link has specialist knowledge of this sector and is able to assist commissioners in re-structuring their provision to comply with government policy, whilst also producing the cost data to justify the correct payments under PBR
There are two key reasons why past reform in maternity services has generally been unsustainable.
1. Staff are pulled back from the community to cover staff shortages in acute settings. This leads to disillusionment, low morale and burn out as well as disrupting the staffing statistics for both services.
2. Lack of funding after the initial start up period because the service was not properly costed and because budgets were cut.
For these reasons, amongst others, Maternal Link believes that our model of developing birth centres that are their own legal, financial and regulatory entity is so important. It ensures the birth centres can function on their own merits and not be undermined by acute sector needs.
Developing a new service does not automatically require a new building. Maternal Link believes that there are important benefits to developing a purpose built, stand alone birth centre. However, the most important issue is designing a service that is guaranteed to reach the community. Any new service must be developed in conjunction with service users, and be as accessible for the community as it is for quick transfers to acute services.
Disclaimer Notice l Environmental Policy
©2007 Maternal Link
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