RESUMEN
OBJECTIVE: in 1997, The Albany Midwifery Practice was established within King's College Hospital NHS Trust in a South East London area of high social disadvantage. The Albany midwives provided continuity of care to around 216 women per year, including those with obstetric, medical or social risk factors. In 2009, the Albany Midwifery Practice was closed in response to concerns about safety, amidst much publicity and controversy. The aim of this evaluation was to examine trends and outcomes for all mothers and babies who received care from the practice from 1997-2009. DESIGN: a retrospective, descriptive analysis of data routinely collected over the 12.5 year period was undertaken including changes over time and outcomes by demographic features. SETTING AND PARTICIPANTS: all women booked with the Albany Midwifery Practice were included. FINDINGS: of the 2568 women included over the 12.5 year period, more than half (57%) were from Black, Asian and Minority Ethnic (BAME) communities; one third were single and 11.4% reported being single and unsupported. Almost all women (95.5%) were cared for in labour by either their primary or secondary midwife. There were high rates of spontaneous onset of labour (80.5%), spontaneous vaginal birth (79.8%), homebirth (43.5%), initiation of breastfeeding (91.5%) and breastfeeding at 28 days (74.3% exclusively and 14.8% mixed feeding). Of the 79% of women who had a physiological third stage, 5.9% had a postpartum haemorrhage. The overall rate of caesarean section was 16%. The preterm birth rate was low (5%). Ninety-five per cent of babies had an Apgar score of 8 or greater at 5minutes and 6% were admitted to a neonatal unit for more than two days. There were 15 perinatal deaths (perinatal mortality rate of 5.78 per 1000 births); two were associated with significant congenital abnormalities. There were no intrapartum intrauterine deaths. KEY CONCLUSIONS: this analysis has shown that the Albany Midwifery Practice demonstrated positive outcomes for women and babies in socially disadvantaged and BAME groups, including those with complex pregnancies and perceived risk factors. IMPLICATIONS FOR PRACTICE: consideration should be given to making similar models of care available to all women.
Asunto(s)
Continuidad de la Atención al Paciente , Partería , Evaluación de Resultado en la Atención de Salud , Pautas de la Práctica en Enfermería , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Bases de Datos Factuales , Etnicidad , Femenino , Humanos , Londres/epidemiología , Área sin Atención Médica , Persona de Mediana Edad , Embarazo , Resultado del Embarazo , Atención Prenatal/normas , Atención Prenatal/tendencias , Estudios Retrospectivos , Factores Socioeconómicos , Adulto JovenRESUMEN
The effects of budgetary changes on midwives' practice environment have raised concerns in many settings. A survey of midwives and student midwives in the UK and Republic of Ireland in 2014 produced 280 responses. Staffing shortages were regarded as underpinning many changes, one of which was that of previously optional 'extra' activities, such as unpaid overtime, becoming mandatory. Shortages were aggravated in less acute areas by the transfer of midwives to more acute settings. One of the fears expressed by midwives was that a permanent change in the culture of midwifery would result. These phenomena are the everyday experiences of practising midwives, but they have failed to be addressed in the documents published by regulatory and review bodies.
Asunto(s)
Servicios de Salud Materna , Partería/estadística & datos numéricos , Admisión y Programación de Personal/estadística & datos numéricos , Pautas de la Práctica en Enfermería/estadística & datos numéricos , Presupuestos , Humanos , Irlanda , Servicios de Salud Materna/economía , Partería/economía , Rol de la Enfermera , Personal de Enfermería/provisión & distribución , Admisión y Programación de Personal/economía , Pautas de la Práctica en Enfermería/economía , Reino Unido , Recursos HumanosRESUMEN
Changes in the culture of health care require that, to be effective, midwifery practice should become more woman-centred. This may be facilitated by adopting a stronger community orientation. In this way the hegemony of maternity care may be addressed. This paper seeks to draw readers' attention to political developments and to inspire midwives to greater awareness and, possibly, activity.