Confidence: Fundamental to midwives in free freestanding midwifery-led units!

Confidence: Fundamental to midwives in free freestanding midwifery-led units!

Midwives can appreciate the importance of freestanding midwifery-led units. A recent publication of Midwifery Research Review ( Number 14 in 2018) explores the question of what enables safeguards and sustains midwives in free standing midwifery-led units.

”The findings from this important study from New Zealand provide valuable information to operationalise the restoration of rural maternity services in Australia and return birthing to country for our First Australian women.

One of the barriers often cited by service providers to enabling birthing services in rural and remote areas is a lack of midwives who are competent and confident to work is these settings. Another is an unwillingness of obstetricians to support these services due to a perception that they are unsafe.

This study reports that in order to build confidence, midwives need to be immersed in low-risk settings, where anticipation of normal birth is the culture, but importantly where that culture is supported by obstetric colleagues and senior more experienced midwives.

It was heartening to read of the confidence-building support provided to a midwife by an obstetrician in this study, reassuring her that when problems arise they can be managed appropriately, confirming to her that birth in small freestanding units is safe.

Some midwives reading this paper may feel that anticipating normality may result in missing warning signs and subsequently put women at risk. This is refuted by midwives in the study who are immersed in low-risk settings, who say that seeing healthy babies and good outcomes the majority of the time heightens their ability to detect when things are not normal.

The excellent relationships the midwives had with obstetric colleagues, and the provision of on-site obstetric consultation, are all important points for those planning or initiating these services, to take on board. Immersion of the future workforce in these settings is vital in order to build confidence. We should work to ensure that midwifery students and obstetricians in training have the opportunity to experience working in these settings in order to build the interdisciplinary relationships and respect that are essential if we are to provide services that truly put women first.


This hermeneutic phenomenological study conducted in New Zealand interviewed 11 midwives and three obstetricians to identify what enables, safeguards and sustains midwives when providing labour care in freestanding midwifery-led units.

Analysis of the interviews identified themes underpinned by the confidence necessary to provide intrapartum care, which is cultivated by believing the unit is an appropriate space for healthy women to labour and birth. Normal labour and birth are commonplace, which reinforces confidence. Maintaining confidence requires trusting relationships in the midwifery team and mutually respectful relationships with obstetric colleagues.Those with less experience may need support when providing labour care in freestanding midwifery units.

Reference: Midwifery 2018;66:176-81 Authors: Hunter M et al.” You can access the abstract here>>

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