In 2012, the Irish government outlined a strategic framework for reform of the health service. Ensuring patients are treated at the lowest level of complexity is a major tenet of this reform. Within the Irish health care system, maternity care remains heavily medicalised. Depending on obstetric risk, maternity care may be provided in one of two locations at hospital level: a consultant-led unit (CLU) or a midwifery-led unit (MLU). Care in a MLU is sparsely provided in Ireland, comprising as few as two units out of a total 21 maternity units. Given its potential for greater efficiencies of care and cost-savings for the state, there has been an increased interest to expand MLUs in Ireland. Yet, very little is known about women’s preferences for midwifery-led care, and whether they would utilise this service when presented with the choice of delivering in a CLU or MLU.
A recent study sought to involve women in the future planning of maternity care by investigating their preferences for care and subsequent motivations when choosing place of birth. It is the first qualitative study to explore women’s preferences for alternative models of maternity care in Ireland. Overall, the results suggest that women may prefer MLUs when co-located with existing CLUs. While safety concerns largely influenced women’s preferences, the results also suggest that women do not have a clear preference for either model of care, but rather a hybrid model of care which encompasses features of both consultant and midwifery-led care. This suggests that the DOMINO (Domiciliary Care In and Out of Hospital) scheme may be preferred by maternity users as it closely resembles the preferences revealed in this study.
The full paper has recently been published in Health Policy and can be accessed here. This study precedes a broader, quantitative exploration of demand for alternative models of maternity care. The results of which will inform policymakers on whether an expansion of midwifery-led care reflects demand and value for money.
I would like to acknowledge all my co-authors on this paper, in particular, Dr. Christopher Fawsitt who undertook this work as part of PhD dissertation, and Prof. Richard Greene, the clinical lead on this project. This research was supported by the National Perinatal Epidemiology Centre of Ireland.