From compliance to engagement: A tale of Participatory Action Research, resistance and love

Background, including element of originalityStrong evidence suggests that for healthy women with uncomplicated pregnancies midwifery units are safer than obstetric units, because associated with lower rates of interventions,... [ view full abstract ]

Background, including element of originality

Strong evidence suggests that for healthy women with uncomplicated pregnancies midwifery units are safer than obstetric units, because associated with lower rates of interventions, at least as safe as obstetric units for newborn babies and cost-effective.

The NICE intrapartum guidelines (2014) as well as the NICE Quality Standards (2015) recommended offering healthy women with uncomplicated pregnancies choice between four possible places of birth: Freestanding Midwifery Unit (FMU), Alongside Midwifery Unit (AMU), home and the Obstetric Unit (OU).

A purpose built freestanding midwifery unit (FMU) was opened in inner London in 2008. This FMU has five birthing rooms, all with birth pools and rooms designed to offer a home from home environment. The midwives work as an integrated team, booking women for antenatal care through to antenatal appointments, intrapartum care and postnatal care. The midwives work long days at the birth centre and on community shifts. The unit has developed an excellent reputation for offering an exemplary service of care. Despite this the freestanding midwifery unit has been under pressure for several causes, including competition from a newly built facility for its referral obstetric unit nearby in 2012, negative publicity as a consequence of negative Care Quality Commission reports, being under financial Special Measures and the opening of an AMU in 2016. 

In 2017 a Participatory Action Research project started as part of a Post Doc NIHR Knowledge Mobilisation Fellowship started a stakeholder engagement at the FMU. The NICE Birthplace Action Study is the first study which explores theoretically informed strategies of how to implement NICE recommendations of birthplace in practice.

Method

A Participatory Action Research methodology was used involving all stakeholders including staff, service users, commissioners, management and key experts in implementation science.

A modified version of the Promoting Action on Research Implementation In Health Services (PARIHS) framework was used to guide implementation design and evaluation.

Engagement events were organised, including the assessment of barriers and facilitators for the well-functioning of the FMU. A staff developmental needs assessment was conducted and training arranged. Time for team building activities was negotiated with the NHS trust senior management as well as a strategy focused on shifting the barriers that were inhibiting the FMU.

Results

Data collection and analysis is in progress and findings will be ready to be presented by September 2017.

Biography - Catherine Reeve-Jones

I qualified as a midwife in 2000 and worked at The North Middlesex Hospital until 2008. I then worked as a senior midwife at the Birth Unit at St John and st Elizabeth's until 2010. Since then I have worked as a senior midwife at the FMU. 

Biography - Jude Davis

After five years’ midwifery in Aberystwyth, Jude moved to London to work in a FMU. She also worked for one year as midwife for the Isles of Scilly.   She has keen interest in collecting and sharing active birth techniques and has written for various midwifery publications.