Evidence map›Paper›PMID 32071182›Full record

ArticleBMJ open2020

Factors influencing the utilisation of free-standing and alongside midwifery units in England: a qualitative research study.

Denis Walsh, Helen Spiby, Christine McCourt, Celia Grigg, Dawn Coleby, Simon Bishop, Miranda Scanlon, Lorraine Culley, Jane Wilkinson, Lynne Pacanowski and 1 more

Erratum issuedOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
1.8field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.

  1. Pooled it
  2. Observational
  3. Article
  4. Article
  5. Article
  6. Review
  7. Article
  8. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 1 country.

Denis WalshSchool of Health Sciences, University of Nottingham, Nottingham, UK denis.walsh@ntlworld.com.ORCID 0000-0002-5435-6403
Helen SpibySchool of Health Sciences, University of Nottingham, Nottingham, UK.
Christine McCourtSchool of Health Sciences, University of Nottingham, Nottingham, UK.
Celia GriggSchool of Health Sciences, University of Nottingham, Nottingham, UK.
Dawn ColebySchool of Health Sciences, University of Nottingham, Nottingham, UK.
Simon BishopBusiness School, University of Nottingham, Nottingham, Nottinghamshire, UK.
Miranda ScanlonSchool of Health Sciences, City University, London, London, UK.
Lorraine CulleySchool of Health Sciences, University of Nottingham, Nottingham, UK.
Jane WilkinsonWest Cheshire CCG, Chester, UK.
Lynne PacanowskiGuys & St Thomas NHS Foundation Trust, London, UK.
Jim ThorntonFaculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom.
University of Nottingham · GBCheshire West and Chester · GBCity, University of London · GBGuy's and St Thomas' NHS Foundation Trust · GB

Funding

Department of Health HS&DR/14/04/28
6 · The paper itself

Abstract

objectiveTo identify factors influencing the provision, utilisation and sustainability of midwifery units (MUs) in England.

designCase studies, using individual interviews and focus groups, in six National Health Service (NHS) Trust maternity services in England. SETTING AND

participantsNHS 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).

main outcome measuresFactors influencing MU use.

findingsThe 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.

conclusionsThere 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.

Indexed as

Maternal Health ServicesPatient Acceptance of Health CareBirthing CentersDelivery, ObstetricEnglandFemaleFocus GroupsHealth Services AccessibilityHumansInterviews as TopicMidwiferyPregnancyQualitative ResearchState Medicinehealth policyobstetricsorganisation of health services

Identifiers

PMID32071182
PMCPMC7045002
OpenAlexW2999888770

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.