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TCD study supports more midwife-led units

The study involved 1,635 low-risk women cared for in the HSE Dublin North-East region between 2004 and 2009. It found that the average cost of caring for a woman in midwife-led units (MLUs) was €2,598, compared to €2,780 in consultant-led units (CLUs).

The research looked at the mean difference in clinician salaries, cost of care based on managers’ data, known costs of postnatal bed days and costs of key interventions.

The findings, recently published in the journal Midwifery, have significant implications for policymakers and funders of maternity care.

Prof Charles Normand, Professor of Health Policy and Management and a lead author, commented: “For every 1,000 women cared for in an MLU, almost €200,000 will be saved. Consultant obstetricians will be able to devote more time to caring for women with pregnancy complications, so that all women in Ireland benefit from midwife-led care.”

The research is the second major publication from the MidU study, commissioned by the HSE and conducted by the School of Nursing and Midwifery at Trinity.

It set out to compare consultant-led maternity care with a new model of care provided by midwives in two integrated MLUs in Our Lady of Lourdes Hospital, Drogheda and Cavan General Hospital.

These two integrated MLUs were established in 2004 to provide more choice in maternity care in the North East. Despite the positive results of this randomised trial, no further such units have been established.

The overall conclusion of the MidU study is that midwife-led care, as practised in this study, is a safe, cost-effective, alternative method of delivering maternity services for healthy women who have no risk factors for labour and birth.

Previous findings from the same study showed that care provided in MLUs is as safe as that in CLUs and results in less intervention. In labour, fewer women in the MLU group chose to have epidurals (19 per cent) than did those in the CLU (25 per cent).

Other methods of pain relief chosen included immersion in warm water in a birthing pool (24 per cent in MLU compared with 3 per cent in CLU). Despite having fewer epidurals, 83 per cent of women in the MLUs expressed satisfaction with their pain relief, compared with 68 per cent of women in the CLU.

Professor of Nursing and Midwifery at Trinity, Cecily Begley, principal investigator of the MidU study, commented: “When women are supported by one-to-one midwifery care, and they are encouraged to labour gently at their own pace and have the pain-relieving benefits of relaxing in warm water, they are far better able to tolerate pain, and labour more effectively.”

Ms Krysia Lynch, Chairperson of the Association for the Improvements of Maternity Services in Ireland, welcomed the results. “Given these findings, more midwife-led units should be incorporated into maternity care in Ireland so that scarce resources are used more effectively,” she said.

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