Yay for the Barkantine!

small__5313577432Research carried out as part of a project designed to assess a London freestanding birth centre in collaboration with the Birthplace project has found that women who booked their care at the Barkantine Birth Centre rated their care more highly than women who booked at the hospital.  Compared to women booked for hospital care, women who began labour care at the birth centre were also significantly more likely to

  • be cared for by a midwife they had already met
  • have one to one care in labour
  • have the same midwife with them throughout their labour
  • report that the staff were kind and understanding
  • report that they were treated with respect and dignity
  • report that their privacy was respected

Compared to women who started labour at the hospital, women who started labour care at the birth centre in spontaneous labour were

  • more likely to use non-pharmacological methods of pain relief, most notably water
  • less likely to use pethidine
  • more likely to be able to move around in labour
  • less likely to have their membranes ruptured
  • less likely to have continuous CTG monitoring
  • more likely to be told to push spontaneously when they needed to rather than experience directed pushing
  • more likely to report that they had been able to choose their position for birth
  • more likely to deliver in places other than the bed
  • more likely to report that they had chosen whether or not to have a physiological third stage
  • more likely to report skin to skin contact with their baby in the first two hours after birth

One of the women interviewed said that,

“They were so super! They discussed my progress not with numbers i.e. how many hours to go or how many centimetres I was dilated but with positive encouragement and listening to me. They were so supportive and understanding to me and to my partner. They really helped me so much and gave me such a positive attitude and encouragement the whole way through.” (Macfarlane et al 2014: 1003)

One of the things that is remarkable about the Barkantine Birth Centre, in common with the Albany Midwifery Practice which ran from 1997 to 2009 in Peckham, is its inner city London location.  You can connect with the Barkantine Birth Centre on facebook.

 

Survey of women׳s experiences of care in a new freestanding midwifery unit in an inner city area of London, England – 1: Methods and women׳s overall ratings of care

Objective: to describe and compare women׳s choices and experiences of maternity care before and after the opening of the Barkantine Birth Centre, a new freestanding midwifery unit in an inner city area.

Design: telephone surveys undertaken in late pregnancy and about six weeks after birth in two separate time periods, Phase 1 before the birth centre opened and Phase 2 after it had opened.

Setting: Tower Hamlets, a deprived inner city borough in east London, England, 2007–2010.

Participants: 620 women who were resident in Tower Hamlets and who satisfied the Barts and the London NHS Trust׳s eligibility criteria for using the birth centre. Of these, 259 women were recruited to Phase 1 and 361 to Phase 2.

Measurements and findings: women who satisfied the criteria for birth centre care and who booked antenatally for care at the birth centre were significantly more likely to rate their care as good or very good overall than corresponding women who also satisfied these criteria but booked initially at the hospital. Women who started labour care in spontaneous labour at the birth centre were significantly more likely to be cared for by a midwife they had already met, have one to one care in labour and have the same midwife with them throughout their labour. They were also significantly more likely to report that the staff were kind and understanding, that they were treated with respect and dignity and that their privacy was respected.

Key conclusions and implications for practice: this survey in an inner city area showed that women who chose the freestanding midwifery unit care had positive experiences to report. Taken together with the findings of the Birthplace Programme, it adds further weight to the evidence in support of freestanding midwifery unit care for women without obstetric complications.

Macfarlane AJ, Rocca-Ihenacho L, Turner LR, Roth C (2014).  Survey of women׳s experiences of care in a new freestanding midwifery unit in an inner city area of London, England – 1: Methods and women׳s overall ratings of care. Midwifery 30(9): 998-1008. http://dx.doi.org/10.1016/j.midw.2014.03.013.

 

Survey of women׳s experiences of care in a new freestanding midwifery unit in an inner city area of London, England: 2. Specific aspects of care

Objective: to describe and compare women׳s experiences of specific aspects of maternity care before and after the opening of the Barkantine Birth Centre, a new freestanding midwifery unit in an inner city area.

Design: telephone surveys undertaken in late pregnancy and about six weeks after birth. Two separate waves of interviews were conducted, Phase 1 before the birth centre opened and Phase 2 after it had opened.

Setting: Tower Hamlets, a deprived inner city borough in east London, 2007–2010.

Participants: 620 women who were resident in Tower Hamlets and who satisfied the Barts and the London Trust’s eligibility criteria for using the birth centre. Of these, 259 women were recruited to Phase 1 and 361 to Phase 2.

Measurements and findings: the replies women gave show marked differences between the model of care in the birth centre and that at the obstetric unit at the Royal London Hospital with respect to experiences of care and specific practices. Women who initially booked for birth centre care were more likely to attend antenatal classes and find them useful and were less likely to be induced. Women who started labour care at the birth centre in spontaneous labour were more likely to use non-pharmacological methods of pain relief, most notably water and less likely to use pethidine than women who started care at the hospital. They were more likely to be able to move around in labour and less likely to have their membranes ruptured or have continuous CTG. They were more likely to be told to push spontaneously when they needed to rather than under directed pushing and more likely to report that they had been able to choose their position for birth and deliver in places other than the bed, in contrast to the situation at the hospital. The majority of women who had a spontaneous onset of labour delivered vaginally, with 28.6 per cent of women at the birth centre but no one at the hospital delivering in water. Primiparous women who delivered at the birth centre were less likely to have an episiotomy. Most women who delivered at the birth centre reported that they had chosen whether or not to have a physiological third stage, whereas a worrying proportion at the hospital reported that they had not had a choice. A higher proportion of women at the birth centre reported skin to skin contact with their baby in the first two hours after birth.

Key conclusions and implications for practice: significant differences were reported between the hospital and the birth centre in practices and information given to the women, with lower rates of intervention, more choice and significant differences in women’s experiences. This case study of a single inner-city freestanding midwifery unit, linked to the Birthplace in England Research Programme, indicates that this model of care also leads to greater choice and a better experience for women who opted for it.

Macfarlane AJ, Rocca-Ihenacho L, Turner LR (2014). Survey of women׳s experiences of care in a new freestanding midwifery unit in an inner city area of London, England: 2. Specific aspects of care. Midwifery 30(9): 1009-1020  http://dx.doi.org/10.1016/j.midw.2014.05.008.

photo credit: SpreadTheMagic via photopin cc

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