School of Health Sciences, University of Nottingham, Nottingham, UK
School of Health Sciences, University of Nottingham, Nottingham, UK.
BMJ Open. 2020 Feb 17;10(2):e033895. doi: 10.1136/bmjopen-2019-033895.
To identify factors influencing the provision, utilisation and sustainability of midwifery units (MUs) in England.
Case studies, using individual interviews and focus groups, in six National Health Service (NHS) Trust maternity services in England.
NHS maternity services in different geographical areas of England Maternity care staff and service users from six NHS Trusts: two Trusts where more than 20% of all women gave birth in MUs, two Trusts where less than 10% of all women gave birth in MUs and two Trusts without MUs. Obstetric, midwifery and neonatal clinical leaders, managers, service user representatives and commissioners were individually interviewed (n=57). Twenty-six focus groups were undertaken with midwives (n=60) and service users (n=52).
Factors influencing MU use.
The study findings identify several barriers to the uptake of MUs. Within a context of a history of obstetric-led provision and lack of decision-maker awareness of the clinical and economic evidence, most Trust managers and clinicians do not regard their MU provision as being as important as their obstetric unit (OU) provision. Therefore, it does not get embedded as an equal and parallel component in the Trust's overall maternity package of care. The analysis illuminates how implementation of complex interventions in health services is influenced by a range of factors including the medicalisation of childbirth, perceived financial constraints, adequate leadership and institutional norms protecting the status quo.
There are significant obstacles to MUs reaching their full potential, especially free-standing midwifery units. These include the lack of commitment by providers to embed MUs as an essential service provision alongside their OUs, an absence of leadership to drive through these changes and the capacity and willingness of providers to address women's information needs. If these remain unaddressed, childbearing women's access to MUs will continue to be restricted.
确定影响英格兰助产单位（MUs）提供、利用和可持续性的因素。
在英格兰六家国民保健服务（NHS）信托机构的六家产科服务机构中进行案例研究，采用个人访谈和焦点小组的方式。
英格兰不同地理位置的 NHS 产科服务；来自六家 NHS 信托机构的产科护理人员和服务使用者：两家信托机构有超过 20%的妇女在 MU 分娩，两家信托机构有不到 10%的妇女在 MU 分娩，两家信托机构没有 MU。对产科、助产和新生儿临床领导、管理人员、服务使用者代表和专员进行了单独访谈（n=57）。共进行了 26 次焦点小组讨论，其中包括助产士（n=60）和服务使用者（n=52）。
影响 MU 使用的因素。
该研究结果确定了 MU 使用率的几个障碍。在以产科主导的服务提供和决策者对临床和经济证据缺乏认识的背景下，大多数信托机构经理和临床医生并不认为他们的 MU 服务提供与他们的产科病房（OU）服务提供一样重要。因此，它并没有作为信托机构整体产妇护理套餐的一个平等和并行的组成部分而得到嵌入。分析揭示了在卫生服务中实施复杂干预措施如何受到一系列因素的影响，包括分娩的医学化、感知到的财务限制、充分的领导力以及保护现状的机构规范。
MU 要充分发挥其潜力，尤其是独立的助产单位，还存在重大障碍。这些障碍包括提供者缺乏承诺，将 MU 作为一种基本服务提供，与他们的 OU 一起提供，缺乏领导力来推动这些变革，以及提供者满足妇女信息需求的能力和意愿。如果这些问题得不到解决，产妇获得 MU 的机会将继续受到限制。
