Midwifery-led care in birthing units is proven as safe as consultantled care and requires fewer interventions. Ann Keating reports

Giving birth is the most powerful event in a woman’s life according to Mary Reilly, clinical midwife manager and practice development facilitator in the midwiferyled unit (MLU) at Cavan General Hospital (CGH).

CGH and Our Lady of Lourdes Hospital, Drogheda, are the only hospitals in Ireland with an MLU. These units were established in response to the Kinder Report 2001, which showed that midwifery-led care as practiced in these units is as safe as consultant-led care and uses fewer interventions.

The 2009 MidU (Midwifery Unit) study compared consultant-led care with the new model of care provided by midwives in the two hospitals. In this context, midwifery-led units (MLUs) are seen as an important and necessary development in the future organisation of maternity care – the benefits for women are immeasurable.

Originally from Cavan, Mary trained as a general nurse in St James’s Hospital, Dublin. She did her midwifery training in The Coombe, where she worked for nine months before returning to Cavan in 1995. She later did a midwifery degree in Trinity College, Dublin and is also now a trainer in perineal suturing.

In order to complete the picture she did the ‘Midwifery Examination of the Newborn’ course in Queen’s University, Belfast, in 2009. This means she can do the baby discharge examination.

Mary Reilly, clinical midwife manager and practice development facilitator in the midwifery-led unit (MLU) at Cavan General Hospital (CGH)

The MLU in Cavan has two suites, where a women’s partner and other children can be present for the birth. There is a sofa bed, TV, bathroom and a large bath where the mother can labour.

The midwife works as an autonomous and holistic practitioner in the MLU. She facilitates the birth and will be in the room at all times, but is as unobtrusive as possible. The midwife acts as the gatekeeper of normality. Her role is to be vigilant and if the normal labour changes, the mother is transferred to the appropriate caregiver, ie. an obstetrician located three minutes away.

The MLU caters for low-risk pregnancies and there is very strict criteria for eligibility, which has been drawn up in a three-page list. Factors such as age (over 40 or under 16) and a BMI over 30 would be considered high risk and therefore ineligible. As practitioners, some very difficult decisions have to be made and it is difficult to turn someone away if, for example, they have had babies there already and are over 40 for their next pregnancy, they are ineligible.

In the nine months of preparation for the birth, a team of six midwives will get to know the mother. During the preparation period, the mother is educated with all the information she needs to use the MLU. Women must be convinced that they can do it for themselves.

Mary commented: “You need the nine months antenatal time with the mothers in order to talk to them about keeping fit, healthy, eating well, sleeping well and preparing mentally for the baby. It is a mental as well as physical journey. If fear takes over during the birth process it can make it more difficult.”

She added: “A midwife should be able to empower a mother so that she feels she is the most important person in the room.”

The role of the midwife at a birth in the MLU is to observe and ensure wellness. Coaching of the birth is not led or driven by the midwife.

Once the baby is six-hours-old it can be discharged. However, first-time mums may need a little more feeding support. There is follow-up care by the midwives from the unit for five days (down from seven due to cutbacks). After this time, they are discharged to the public health nurse.

There were 134 births last year in the MLU. Some 48% of women attending the unit were transferred to an obstetrician for various reasons. The midwife’s expertise is normality, so if mothers deviate from that (eg. bleeding etc) during their pregnancy, the midwife must seek obstetric care.

To highlight the service of the MLU in CGH, a new Facebook page was set up and the HSE website is also being updated.

Mary – who is mother to three daughters – has also visited GPs in Cavan, Monaghan, Navan, Kells and Leitrim to advise them of the MLU service, so that their patients can make an informed choice.

The unit takes GP referrals and direct referrals from women, as long as they meet the eligibility criteria.

A day in the life - Mary Reilly: Clinical midwife manager