Mary Reilly, clinical midwifery manager, MLU and Dympna McConnell, midwife, relax in the comfortable relaxation lounge at the unit. Photo: Lorraine Teevan
The Midwifery-led Unit (MLU) in Cavan General Hospital - one of only two in the country - has received a huge thumbs up from a major report and according to the Health Services Executive (HSE), is here to stay.
A major trial comparing midwifery-led and consultant-led maternity care at Cavan General Hospital has concluded that midwifery-led care is as safe as consultant-led care, results in less intervention, gives birthing mothers greater satisfaction and overall is more cost-effective.
The study was carried out in the MLU in Cavan General from 2004 to 2007. Cavan, along with Our Lady of Lourdes Hospital in Drogheda participated in the project, which involved 1,653 women having babies in the HSE North-Eastern region during the period concerned. The project was commissioned by the Health Services Executive (HSE) and conducted by the School of Nursing and Midwifery, Trinity College Dublin, and the findings were recently presented to the HSE.
The two integrated midwifery-led units were opened in response to recommendations made in the Kinder Report in 2001, to provide more choice in maternity care in the North East. The study was carried out with the full support and co-operation of medical and midwifery staff in both units in the region.
The Midwifery Unit (MidU) study showed that midwifery-led care, as practised in these units, is as safe as consultant-led care but uses less intervention in pregnancy and childbirth. The model of care used in the two MLUs is one where midwives, working in partnership with the woman, are the lead professional. They provide care in pregnancy, shared with the woman's GP if desired, and refer any problems to the GP or obstetrician as necessary. When the woman commences labour, she comes to the MLU, which is a separate unit within the maternity hospital, and is welcomed into her private room where she stays for the labour, birth and postnatal resting time. Each room has a bed, pull-out couch for her partner to sleep on, a birthing pool, birthing aids, television, and tea/coffee-making facilities available.
Women's satisfaction with the facilities was apparent in the study and 85% of those attending the MLUs said they would recommend the care they had received to a friend, compared with 70% of those having usual care. Although facilities in the MLUs were quite luxurious, the cost of care for each woman was €332.80 less than in the usual hospital system.
Choosing the MLU
Mary Reilly, the clinical midwifery manager attached to the MLU in Cavan, told The Anglo-Celt that she was delighted with the study's findings. She said that the midwives finally have the evidence to back up what they believe - that midwifery-led care is best for low-risk mothers and frees up consultant-led services allowing them more time and attention to devote to mothers and babies who may face complications.
Ms. Reilly, who delivered the MLU's first baby in Cavan, emphasises that the MLU could not operate without the back-up and support of the consultants and the traditional maternity ward and its staff. "Obstetric care is fundamental," she said. In Cavan, the MLU is an integrated part of the maternity services - located side-by-side in the hospital. So in the event that any emergency may develop with MLU mothers during pregnancy or during labour, they can be quickly and seamlessly transferred to the consultant and midwives in the maternity ward.
Now that the unit has the research and evidence, Ms. Reilly says they're hoping to raise awareness of midwifery-led care and encourage low-risk pregnant women to choose the MLU for their ante-natal care, labour and delivery and post natal care. She estimates that about 48% of women having their babies in Cavan fall into the low risk category and on an expectant mother's first visit to the hospital, an assessment is carried out to determine whether or not the patient is low risk.
In general, Ms. Reilly explains: "A low risk mother is a healthy lady who has no predictable risk of complications."
She's emphasising that pregnant women can be directly referred by their GP to the MLU, where an assessment will be carried out. "If a patient turns out to be of higher risk, we just transfer them to the consultant and book their next appointment for them. They don't need to go through the assessment again."
Ms. Reilly also added that any expectant mothers are free to visit the MLU, take a look at the facilities and talk to any of the midwives about the differences between midwifery-led and consultant-led care. There are six whole time equivalent (WTE) midwives attached to the MLU.
In 2009, there were 89 babies born in the MLU in Cavan out of 1,945 total births in the hospital. The MLU is hoping to take a greater proportion of the low-risk mothers in future, with potential for expanding the midwifery-led services at the hospital and freeing up overflowing labour wards.
Professor John Bonnar, Emeritus Professor of Obstetrics and Gynaecology in Trinity College Dublin, welcomed the results of this study. "Midwifery-led care has potential to provide greater choice for the majority of low-risk women, better continuity of personal antenatal care and a more satisfying birth experience," he said. "Women are also in hospital for a much shorter time and then have supportive follow-up midwifery care in their homes for the first seven days. This model of care will enable consultant obstetricians to devote more time to caring for women with pregnancy complications."
The results of this study agree with those from international research, and the Cochrane review of midwifery-led care concludes that most women should be offered midwife-led models of care.
Fionnuala Duffy, assistant national director, Reconfiguration, accepted the report on behalf of the HSE.
"This comprehensive MidU study provides further evidence to support the need for development and expansion of such units as an integral part of a comprehensive maternity service offering appropriate range of services for women."