Objective: to determine what impact the changes from consultant-led care to midwife-led care in a local maternity service have had on women using that service.
Design: case study, data were collected by postal questionnaire, semi-structured, tape-recorded interviews, observations and scrutiny of records.
Setting: a small town in rural England.
Participants: all pregnant women eligible for a midwife-managed unit (MMU) birth in a small rural town in England.
Findings: the women using the MMU were satisfied with the care they received and the MMU style of care. Women giving birth at the MMU and at home required less pain relief and were more likely to have an intact perineum than a similar group of women giving birth in hospital. Continuity of carer did not appear to be an issue for women as long as they felt supported by a known team of midwives. Transfer for complications during the birthing process was a cause for anxiety and stress for women and their partners. Women, whilst satisfied with the MMU, would prefer the consultant-led maternity hospital to be re-established in the town. The home-birth rate rose by 28% when the consultant unit closed.
Implications for practice: while the establishment of a midwife-managed unit has provided increased choice for a minority of women, the removal of the consultant unit in the town has disadvantaged the majority of pregnant women. While guidelines are needed when establishing these units the application of restrictive inclusion and exclusion criteria can sometimes force women to make less appropriate birth choices.