What makes a successful home birth service: an examination of the influential elements by review of one service

Abstract

Objective: to evaluate and gain understanding of the service factors that contribute to the relatively high home birth rate found in one inner city NHS Trust providing maternity services in England.

Design: a multi-faceted approach encompassing narrative, historical, structural, demographic and cultural elements.

Setting: an inner city maternity service provided in a large metropolis in England.

Participants: stakeholders including clinical staff and managers in the service.

Methods and findings: a review of service provision using secondary quantative data analysis 2005-2009, structural review of the service and semi-structured interviews with staff.

Key conclusions: the structure of a service with multiple self-managed midwifery practices, mainly operating caseload models strongly supported by senior midwifery leaders, and senior obstetricians enabled the delivery of a responsive, flexible service that was able to deliver choice to women. One element of interest was home assessment in early labour, which kept open the choice around place of birth for women until they were in labour.

Implications for practice: the organisation of care into multiple small midwifery group practices, providing care using a caseload model, appears to support home birth as a choice for women. In addition the offer of home assessment in early labour whilst poorly researched may be relevant to a flexible woman centred service that can respond to women's choices in realistic way.