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Sir,

We welcome the two recent commentaries (December 1993) about the Changing Childbirth Report. In particular, we endorse the recommendations for auditing and monitoring of changes in maternity service provision, and the need for inter-professional co-operation. While reviews of the research conclude that midwife-led care results in achieving good perinatal outcomes and greater satisfaction (Robinson 1990), the Cochrane Pregnancy and Childbirth Database (Renfrew 1992) indicates a paucity of large prospective randomised trials.

The aim of the Midwifery Development Unit is to address this issue. This unit, which is the first of its kind in the United Kingdom, is funded for a period of three years by the Scottish Office. The aim of the unit is to introduce and evaluate a midwifery care programme for women experiencing a normal healthy pregnancy. The research hypothesis being addressed is that Midwifery Development Unit care offers women a lower rate of intervention with the same (or more favourable) outcomes, the same complication rates, and greater continuity of care and carer.

The unit consists of a clinical midwifery team and research team, overseen by a multidisciplinary steering committee, which includes professionals from midwifery, general practice, obstetrics, the social sciences, nursing, and women's health. The programme of care was designed by senior clinical midwives in consultation with obstetricians. Care is provided by a group of 20 midwives who share a common philosophy, work in the same rotational pattern and provide peer support. Service specifications have been developed to describe the standards of care for the unit. They have been generated through a lengthy process of consumer consultation using the Quality Assurance Model of Midwifery (WHO 1991). These standards are continuity of care and carer, individual informed care planning, and information and choice. A randomised controlled trial of about 650 women is being conducted to compare the outcome of care utilising the Midwifery Development Unit with shared care of a similar number of women. The programme of care is being evaluated by a research team with a range of professional backgrounds including social science, research midwifery, public health and health economics.

This multidisciplinary approach allows us to collect a range of clinical, psychosocial and economic outcomes, thus ensuring a comprehensive evaluation. In addition, in comparison with another recent study which evaluated an intervention restricted to the antenatal and intrapartum periods (MacVicar et al. 1993), this trial evaluates a total care programme. While the Changing Childbirth Report is important in providing policy recommendations about future provision of services, results of this study will help to provide data so that informed debate can take place.

References

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  2. References
  • Anderson M. (1993) Changing childbirth. Commentary I. Br J Obstet Gynaecol 100, 10711072.
  • Dunlop W. (1993) Changing childbirth. Commentary II. Br J Obstet Gynaecol 100, 10721073.
  • MacVicar J., Dobbie G., Owen-Johnstone L., Jagger C., Hopkins M. & Kennedy J. (1993) Simulated home delivery in hospital: a randomised controlled trial. Br J Obstet Gynaecol 100, 316323.
  • Renfrew M. J. (1993) Midwife vs medical/shared care. In Pregnancy and Childbirth Module (M. W.Enkin, M. J. N. C.Keirse, M. J.Renfrew & J. P.Neilson, eds), Cochrane Database of Systematic Reviews. Review No 03295, 12 August 1992. Oxford : Cochrane Updates on Disk, Update Software, Disk Issue 2.
  • Robinson S. (1990) The role of the midwife: opportunities and constraints. In Effective Care in Pregnancy and Childbirth, Vol. I. (I.Chalmers, M.Enkin & M. J. N. C.Keirse, eds), Oxford University Press, Oxford , pp. 162180.
  • World Health Organisation (1991) Midwifery Quality Assurance Report of a World Health Organisation Workshop. Regional Office for Europe.