Planning birth in and admission to a midwife-led unit: development of a GAIN evidence-based guideline

Background: Women with a straightforward pregnancy are encouraged to plan their birth in any of the following birth settings:home, freestanding midwifery unit, alongside midwifery unit or an obstetric unit (NICE, 2014). Most recently published maternity strategies internationally, within the UK, and in particular, the Strategy for maternity care in Northern Ireland 2012-2018 (DHSSPS, 2012), place a strong emphasis on the normalisation of pregnancy and birth as a means of improving outcomes and experiences for mothers and babies. However, women and maternity care professionals require guidelines to assist them in their decision-making in planning their place of birth.

Aim: The aim of this paper is to outline the process involved in the development of evidence-based guidelines for the admission to midwife-led units (MLUs) through collaboration with key maternity care stakeholders including: HoMs, midwives, consultant obstetricians, consultant anaesthetists from the Health and Social Care Trusts, a GP, midwifery advisor, a representative from the Public Health Agency, Northern Ireland (NI) Practice and Education Council, a workplace union, and service users from a range of women’s and parent groups.

Method: Following approval from the RQIA’s (Regulation and Quality Improvement Authority) GAIN Operational Committee to fund the project, requests for nominations to join the Guideline Development Group (GDG) were sent to the maternity care stakeholders and organisations, as well as women’s and parent groups across NI. In total, 35 individuals became members of the GDG participating on the working or steering group, with a small number of participants taking part in both groups. The process included 12 meetings of the GDG between February 2014 and July 2015, with a specific remit to review and critically appraise relevant, up-to-date evidence relating to planning birth and the admission of a woman at the point of labour to either an alongside midwife-led unit (AMU) or freestanding midwife-led unit (FMU). The criteria were informed by the evidence and expert opinion, and made following robust inclusive discussion and challenge. Peer review was undertaken by two professors of midwifery, an obstetrician and a midwife lecturer.

Outcomes: The process outcome was an evidence-based guideline for admission to midwife-led units, including the specific criteria for planning birth within MLUs, AMUs and FMUs.

Implications for practice: The development of this evidence-based guideline will enable women and maternity care professionals in their decision to plan an MLU birth. MLUs utilising this guideline may have an increased number of women accessing their services and, therefore, will require regular review to ensure adequate midwifery staffing levels.