Great expectations – can maternity services deliver more home births?

17 Sep 2015 12:41:38.260

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In December 2014, the National Institute for Health and Care Excellence (NICE) produced new guidelines for thecare of healthy women and their babies during childbirth. If women are healthy and their pregnancy is low-risk, planning a home birth or delivery in a midwifery-led unit is now considered “particularly suitable”. 

Lisa Common, a Midwife and Doctoral Researcher at the 'Centre for Health Innovation, Leadership & Learning', within Nottingham University Business School, is setting out to study how midwifery teams with higher home birth rates are organised and supported. The aim is to help teams with low numbers of home births to learn from their success and understand how change can be achieved and sustained. 

Lisa said: “Until recently it was common to ask; why are women still bothering to have home births? Compelling research into both the safety and cost-effectiveness of home birth is now demanding that we ask; why are so few women aware of the benefits that home birth may have for them?”

Lisa said:
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Giving birth is now the most common reason for admission to hospital. Around 800,000 babies are born in the UK each year – and around two per cent of these births happen at home. The new national guidelines have the potential to change maternity services in the UK and affect hundreds of thousands of births each year.

Why choose a home birth?

Currently, around two per cent of births are at home, but there is huge variation nationally - in some areas the figure is as low as 0.4 per cent; in others it can be as high as eight per cent. 

Lisa said: “In the 20th century home birth went from being the norm, to being a minority activity. Generally, many people have come to assume that home birth is dangerous; that it is illegal; that you need permission from a doctor; that home birth is just too gruesome and messy; or that only new age hippies, the ill-informed or just selfish experience-hunting birth enthusiasts would consider it. Yet up and down the country all sorts of women and families are beginning to choose home birth.”

Recent healthcare reforms create new opportunities

Lisa Common’s doctoral study will develop new theoretical and empirical insight into the strategies and activities involved in making and inhibiting localised or 'bottom-up' institutional change within healthcare settings. With specific reference to home birth she will look at the new opportunities created by recent healthcare reforms, the different forms of evidence and knowledge pertaining to home birth, and the development of new inter-organisational networks and supplier confederations to introduce new services. 

These strategies highlight the important 'institutional work' of various leaders to confront, change and maintain established institutions.

Three research sites that may have changed and improved their home birth service over time, or have significantly different levels of home birth when compared to their geographical neighbours, or are in areas where women have a choice of different providers will be studied using a range of qualitative research methods including interviews, focus groups, documentary analysis and online discussion forums.  

What does this research hope to achieve?

This study will provide meaningful lessons for health service leaders, policy-makers and innovators who wish to embrace evidence that supports home birth. It also seeks to inform academic communities interested in the dynamic processes and priorities that frame the allocation and management of health service resources. 

Lisa said: “If the UK is to have a healthcare system of the highest possible quality then providers of under-developed or under-performing home birth services need evidence that will help them to hasten the diffusion of success so that women and families can reap the benefits.”

Who is supporting this research?

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Notes to editors: The University of Nottingham has 43,000 students and is ‘the nearest Britain has to a truly global university, with campuses in China and Malaysia modelled on a headquarters that is among the most attractive in Britain’ (Times Good University Guide 2014). It is also one of the most popular universities in the UK among graduate employers and the winner of ‘Research Project of the Year’ at the THE Awards 2014. It is ranked in the world’s top one per cent of universities by the QS World University Rankings, and 8th in the UK by research power according to REF 2014.

The University of Nottingham in Malaysia (UNMC) is holding events throughout 2015 to celebrate 15 years as a pioneer of transnational education. Based in Semenyih, UNMC was established as the UK's first overseas campus in Malaysia and one of the first world-wide.

Impact: The Nottingham Campaign, its biggest-ever fundraising campaign, is delivering the University’s vision to change lives, tackle global issues and shape the future. More news…

Story credits

More information is available from Professor Justin Waring in the Nottingham University Business School at The University of Nottingham on +44 (0)115 951 5117,; or Lisa Common,
Lindsay Brooke

Lindsay Brooke - Media Relations Manager

Email: Phone: +44 (0)115 951 5751 Location: University Park

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