Background Alongside midwifery units (AMUs) provide care for women deemed ‘low-risk’ and Birthplace in England found that low risk women received significantly fewer interventions in AMUs compared to obstetric units with no difference in perinatal outcomes. The number of AMUs are increasing, however, little is known regarding

How to organise services to improve quality, safety and women’s experiences.

Women’s experiences

Aim and Methods A Birthplace follow-on study investigated AMU organisation from users’ and professionals’ perspectives. Case study of AMU in 4 NHS Trusts across England. Data collected November 2011 - October 2012: observations (>100 hours); semi-structured interviews with staff, managers and stakeholders (n = 89) and postnatal women and birth partners (n = 47).

Results We found several critical touchpoints. Women had unequal access to information enabling them to choose and engage with midwife-led care. Women often experienced care inside AMUs as excellent, but system and provider generated issues in admission and transfer led to difficulties for some in gaining access in early labour. Factors enabling women to feel safe included accompaniment by partners; perception of personalised assessment of progress in labour; being assured of appropriate pain relief, timely transfer if required, and staff prepared to listen, inform, and acknowledge their concerns and needs.

Conclusion Greater attention needs to be given to woman-centred care at the critical interface between midwife led settings with antenatal services and OUs.