Task shifting Midwifery Support Workers as the second health worker at a home birth in the UK: A qualitative study

Abstract

TITLETask shifting Midwifery Support Workers as the second health worker at a home birth in the UK: a qualitative study ABSTRACT -318 words ObjectiveTraditionally two midwives attend home births in the UK. This paper explores the implementation of a new home birth care model where births to low risk women are attended by one midwife and one midwifery support worker (MSW). Design and settingThe study setting was a dedicated home birth service provided by a large UK urban hospital. Participants73 individuals over three years: 13 home birth midwives, 7 MSWs, 7 commissioners (plan and purchase healthcare), 9 managers, 23 community midwives, 14 hospital midwives. MethodQualitative data was gathered from 56 semi-structured interviews (36 participants), 5 semistructured focus groups (37 participants) and 38 service documents over a three year study period. A Rapid Analysis approach was taken: data were reduced using structured summary templates, which were entered into a matrix, allowing comparison between participants.Findings were written up directly from the matrix (Hamilton, 2013). FindingsThe midwife-MSW model for home births was reported to have been implemented successfully in practice, with MSWs working well, and emergencies well-managed. There were challenges in implementation, including: defining the role of MSWs; content and timing of training; providing MSWs with pre-deployment exposure to home birth; sustainability (recruiting and retaining MSWs, and a continuing need to provide two midwife cover for high risk births). The Service had responded to challenges and modified the approach to recruitment, training and deployment. ConclusionsThe midwife-MSW model for home birth shows potential for task shifting to release midwife capacity and provide reliable home birth care to low risk women. Some of the challenges tally with observations made in the literature regarding role redesign. Others wishing to introduce a similar model would be advised to explicitly define and communicate the role of MSWs, and to ensure staff and women support it, consider carefully recruitment, content and delivery of training and retention of MSWs and confirm the model is cost-effective .They would also need to continue to provide care by two midwives at high risk births.

The association between midwifery staffing and reported harmful incidents: a cross-sectional analysis of routinely collected data

“…Policy makers should exercise caution in substituting unregistered staff to cover midwifery tasks as the effects of this change are not clear and may be detrimental. Our findings contribute to the debate about task shifting in maternity care which has seen the expansion of midwives’ scope of practice [ 9 ] and an increased number of tasks undertaken by maternity assistants [ 34 ]. The effectiveness and safety of this change has not been confirmed in robust clinical studies and there is no evidence to support this from our study.…”