Empowering women,
empowering midwives:
Pilot midwifery-led units in the
Republic of Ireland
Bernadette Flannagan Helen Murray
Clinical Midwife Manager Clinical Midwife Manager
Midwifery-led Unit Midwifery-led Unit
Cavan General Hospital Our Lady of Lourdes Hospital
Drogheda
Declan Devane
Doctoral Student/Midwifery Research Assistant
Trinity College Dublin
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.’
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
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
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
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.
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
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
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
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
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
What about pain coping
strategies?
Everything including water except
epidural
If epidural is requested this will be
provided in the consultant-led unit
Summary of care pathways
Antenatal care shared with GP
Strict inclusion/exclusion/transfer
criteria
Any Questions?
Thank you
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