Nottingham Maternity Research Network
University of Nottingham

Factors influencing the utilisation of free-standing and alongside midwifery units in England: A mixed methods research study

Only 11% of women in England have their baby in a Midwifery Unit (MU). This is despite very good evidence that having a baby in a MU results in better outcomes than having a baby on a traditional labour ward and is cheaper. Not all maternity services have MUs and of those that do, some are not being fully utilised. The project explored why usage varies so much and why many maternity services have never developed MUs.

The research was led by Dr. Denis Walsh and funded by the  National Institute for Health Research (NIHR). A mixed method study design was used to map the availability and usage of midwifery units in England, and to conduce comparative case studies of six areas with different levels of MU utilisation. More details of the study methods can be found on the project website.

A service-user reference group, including four Network members and chaired by Melissa Thomas, advised on all aspects of service user involvement in the project. This included the development of all participant information resources, participation in a stakeholders workshop, and co-facilitating focus groups for women at each of the case study sites.

We estimate that by increasing provision so that 20% of all women give birth in MUs, the caesarean section rate for these women would reduce and the normal birth rate increase, resulting in fewer babies needing neonatal care. Care would also be cheaper and mothers’ satisfaction with childbirth would improve.

The involvement of four members of the Network throughout the Midwifery Units study had really positive impacts on what we were able to achieve in this research.  Their input improved the quality of information materials, increased the number of women involved in the focus groups, and enabled women’s participation in those group discussions. Their involvement in the stakeholder event towards the end of the project ensured that women’s perspectives rightly remained  a high profile when findings were discussed. 
Professor Helen Spiby


Walsh, Denis, Spiby, Helen, McCourt, Christine et al. (2020) Factors influencing the utilisation of free-standing and alongside midwifery units in England: a qualitative research study. BMJ Open 

Walsh, D., Spiby, H., McCourt, C. et al. (2020) Final report: Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study. HS&DR 

Rayment, Juliet, Christine McCourt, Miranda Scanlon, Lorraine Culley, Helen Spiby, Simon Bishop,Layara Avila de Lima. (2020) An analysis of media reporting on the closure of freestanding midwifery units in England. Women & Birth 33(1): e79-e87. 

Walsh, D., Spiby, H., Grigg, C., Dodwell, M., McCourt, C., Culley, L., Bishop, S., Wilkinson L., Coleby, D., Pacanowski, L., Thornton, J. and Byers, S. (2018) Mapping Midwifery and Obstetric Units in England Midwifery 56: 9-16. Open access version is available here.

Nottingham Maternity Research Network

Contact us