23/03/2026
Were you offered the option of a midwife-led unit for your most recent birth? Did it seem like a valid option?
From the author: "So, births in midwifery-led units in the UK have more than halved since 2016, with most of that decline happening since 2021. In 2023-4 around 5% of births took place in midwifery-led units, compared with around 12% in 2016. Findings from this study, based on unique data from the UK Midwifery Study System, and funded by the NIHR (National Institute for Health and Care Research) through the Policy Research Unit in Maternal and Neonatal Health and Care, were published a few days ago - still in pre-proof, and are available here https://lnkd.in/eJfrgbGp
In discussing these research findings, I have often been told that births in midwifery-led units are reducing because the birthing population is 'more complex'. The nature of this increased complexity is not well-evidenced and seems unlikely to fully explain the scale and pace of the changes we have seen. Note that of the UK nations, Wales has not followed the same pattern in terms of midwifery-led unit births, and their rates are now close to pre-pandemic levels. It seems unlikely that women giving birth in Wales are much less 'complex' than those giving birth in England.
We have a public health crisis in UK maternity (and particularly in England) with caesarean birth rates that are higher (and increasing more rapidly) than in pretty much any other comparable nation. Outcomes for babies have improved somewhat (we are pretty much in the middle compared with other European countries), but women are being exposed to ever increasing levels of intervention. Planned birth in a midwifery-led unit, for women who are eligible, is pretty much the best option available to us to reduce intervention, without increasing the risk for babies. In our UKMidSS studies, caesarean birth rates for women admitted to midwifery-led units are typically around 5%. And for carefully selected women with complexity (e.g. BMI>35, previous PPH, diet-controlled diabetes) admitted to midwifery-led units we also see really good outcomes (https://lnkd.in/em9gzxZg).
The International Union for Conservation of Nature has a 'Red List' of threatened animal and plant species - the criteria for considering a species as 'endangered' are: (i) a population reduction of at least 50%, (ii) over the past 10 years, and (iii) where the causes or reduction many not have ceased or may not be understood. If birth in a midwifery-led unit was an animal or a plant, we would be considering how to make conditions more favourable for it's continued existence. What are we doing to ensure that women still have this option in years to come?"
https://www.sciencedirect.com/science/article/abs/pii/S026661382600080X