Empowering women, empowering midwives: Pilot midwifery-led units in the Republic of Ireland

1. Empowering women,empowering midwives:Pilot midwifery-led units in the Republic of Ireland Helen Murray Clinical Midwife Manager Midwifery-led Unit Our Lady of Lourdes Hospital Drogheda Bernadette Flannagan Clinical Midwife Manager Midwifery-led Unit Cavan General Hospital Declan Devane Doctoral Student/Midwifery Research Assistant Trinity College Dublin

2. History • 2000 • Condon Report rejected • March 2001 • Closure of maternity units in Monaghan and Dundalk • September 2001 • Report of the Maternity Services Review Group • Recommendations included • ‘Midwife-led units in Cavan & Drogheda, with the phased opening of units at Dundalk and Monaghan…’ • ‘The services provided at these units will include: antenatal, intrapartum and postnatal care to women who fulfil a set of criteria used to define low intrapartum risk.’

3. What is a Midwifery Led Unit? • It is a facility whereby: • Midwifery Led Care is offered to healthy pregnant women through ante-natal, intrapartum and postnatal periods • Co-ordinated by a midwife manager, with a discrete identity where services are planned, managed, co-ordinated and delivered by midwives • The care provided by the midwifery-led unit (MLU) is based on the philosophy of pregnancy and birth as normal physiological processes

4. Why midwifery led care? • Women want • Choice, Continuity and Control over how, where and with whom care is provided. • Development of MLUs is consistent with the objectives of the following: • NEHB Service Plan 2004 • Report of the Maternity Services Review Group 2001 • A Plan for Women’s Health, Government of Ireland 1997 • Changing Childbirth Department of Health (UK) 1993 • Vision 2000 Policy Document. Royal College of Midwives (UK) 2000

5. Why Midwifery Led Care? Cont’d • Midwifery-led care recognises, respects and safe-guards normal processes during normal pregnancy, birth and the postnatal period • Acknowledges that childbirth is a life-changing event for the whole family rather than an isolated clinical episode • Aims to ensure the safety of mother and child and promote a positive birth experience for all

6. In Midwifery led care • The woman is respected as the primary decision maker. • Midwives assist her in this process through the provision of accurate and unbiased information on which to base informed choices. • Continuity of care by a small team of experienced and motivated midwives.

7. How Does the Midwifery Led Unit Operate? • Care 24/7 • Guidelines and protocols • evidence based, developed in multi-disciplinary partnership • Midwife responsible for appropriate liaison with other professionals • As the lead professional, the midwife is responsible and accountable for ensuring women receive care as agreed in partnership • ,

8. How has it been set up? • A pilot service within the context of a two-centered randomised control trial i.e. the ‘MidU Study’ conducted by Trinity College Dublin • Process took place over 3 years! • Detailed consultation with consumers, midwives, managers, obstetricians, paediatricians, neonatologists, GPs and Public Health Nurses • Liaison with all relevant departments within the hospital e.g. X-ray, pharmacy, labs • recruitment of women commenced 5th July 2004

9. How has it been set up? Cont’d • Antenatal care shared with GP • Intrapartum care provided by midwives • Postnatal care may be provided by midwives in the MLU for up to 48 hours & in the home up to the 7th postnatal day. • Detailed inclusion/exclusion/transfer criteria

10. The MidU Study • Pilot Phase • July 2004 Feb 2005 • Main study phase • Feb 2005 - July 2007 approximately • Sample size for main study • 1500 • Randomisation • 2:1 basis (MLU:CLU) • Evaluation will help to determine the way forward for the future of maternity services

11. Who can access the service? • Women: • between the ages of 16-40 years • With 5 or less children • >5 feet tall = 152 cm • Body Mass Index 18 to 29 • No contrary medical history • Not a drug user • Smokes less than 20 a day • No contrary gynaecological or obstetric history

12. What about pain coping strategies? • Everything including water except epidural • If epidural is requested this will be provided in the consultant-led unit

13. Summary of care pathways • Antenatal care shared with GP • Strict inclusion/exclusion/transfer criteria

14. Any Questions? • Thank you

15. Contact Details • Bernadette Flanagan • 049 437 6059 • 087 9799385 • Helen Murray • 041 983 760 • 087 2584951 • Declan Devane • 087 659 6923 (ddevane@tcd.ie) • Study Website • http://nehb.ie/midu