1. Empowering women, empowering midwives: Pilot midwifery-led units in the Republic of Ireland
Helen Murray
Clinical Midwife Manager
Midwifery-led Unit
Our Lady of Lourdes Hospital
Drogheda
Bernadette Flannagan
Clinical Midwife Manager
Midwifery-led Unit
Cavan General Hospital
Declan Devane
Doctoral Student/Midwifery Research Assistant
Trinity College Dublin

2. History 2000 March 2001 September 2001 Recommendations included
Condon Report rejected
March 2001
Closure of maternity units in Monaghan and Dundalk
September 2001
Report of the Maternity Services Review Group
Recommendations included
‘Midwife-led units in Cavan & Drogheda, with the phased opening of units at Dundalk and Monaghan…’
‘The services provided at these units will include: antenatal, intrapartum and postnatal care to women who fulfil a set of criteria used to define low intrapartum risk.’

3. What is a Midwifery Led Unit?
It is a facility whereby:
Midwifery Led Care is offered to healthy pregnant women through ante-natal, intrapartum and postnatal periods
Co-ordinated by a midwife manager, with a discrete identity where services are planned, managed, co-ordinated and delivered by midwives
The care provided by the midwifery-led unit (MLU) is based on the philosophy of pregnancy and birth as normal physiological processes

4. Why midwifery led care? Women want
Choice, Continuity and Control over how, where and with whom care is provided.
Development of MLUs is consistent with the objectives of the following:
NEHB Service Plan 2004
Report of the Maternity Services Review Group 2001
A Plan for Women’s Health, Government of Ireland 1997
Changing Childbirth Department of Health (UK) 1993
Vision 2000 Policy Document. Royal College of Midwives (UK) 2000

5. Why Midwifery Led Care? Cont’d
Midwifery-led care recognises, respects and safe-guards normal processes during normal pregnancy, birth and the postnatal period
Acknowledges that childbirth is a life-changing event for the whole family rather than an isolated clinical episode
Aims to ensure the safety of mother and child and promote a positive birth experience for all

6. In Midwifery led care
The woman is respected as the primary decision maker.
Midwives assist her in this process through the provision of accurate and unbiased information on which to base informed choices.
Continuity of care by a small team of experienced and motivated midwives.

7. How Does the Midwifery Led Unit Operate?
Care 24/7
Guidelines and protocols
evidence based, developed in multi-disciplinary partnership
Midwife responsible for appropriate liaison with other professionals
As the lead professional, the midwife is responsible and accountable for ensuring women receive care as agreed in partnership ,

8. How has it been set up?
A pilot service within the context of a two-centered randomised control trial i.e. the ‘MidU Study’ conducted by Trinity College Dublin
Process took place over 3 years!
Detailed consultation with consumers, midwives, managers, obstetricians, paediatricians, neonatologists, GPs and Public Health Nurses
Liaison with all relevant departments within the hospital e.g. X-ray, pharmacy, labs
recruitment of women commenced 5th July 2004

9. How has it been set up? Cont’d
Antenatal care shared with GP
Intrapartum care provided by midwives
Postnatal care may be provided by midwives in the MLU for up to 48 hours & in the home up to the 7th postnatal day.
Detailed inclusion/exclusion/transfer criteria

10. The MidU Study Pilot Phase Main study phase Sample size for main study
July 2004 Feb 2005
Main study phase
Feb July 2007 approximately
Sample size for main study
1500
Randomisation
2:1 basis (MLU:CLU)
Evaluation will help to determine the way forward for the future of maternity services

11. Who can access the service?
Women:
between the ages of years
With 5 or less children
>5 feet tall = 152 cm
Body Mass Index 18 to 29
No contrary medical history
Not a drug user
Smokes less than 20 a day
No contrary gynaecological or obstetric history

12. What about pain coping strategies?
Everything including water except epidural
If epidural is requested this will be provided in the consultant-led unit

13. Summary of care pathways
Antenatal care shared with GP
Strict inclusion/exclusion/transfer criteria

14. Any Questions?
Thank you

15. Contact Details Bernadette Flanagan Helen Murray Declan Devane
Helen Murray
Declan Devane
Study Website