An analysis of media reporting on the closure of freestanding midwifery units in England

Rayment, Juliet; McCourt, Christine; Scanlon, Miranda; Culley, Lorraine; Spiby, Helen; Bishop, Simon; de Lima, Layara Avila

Abstract

Problem
Despite clinical guidelines and policy promoting choice of place of birth, 14 Freestanding Midwifery Units were closed between 2008 and 2015, closures reported in the media as justified by low use and financial constraints.

Background
The Birthplace in England Programme found that freestanding midwifery units provided the most cost-effective birthplace for women at low risk of complications. Women planning birth in a freestanding unit were less likely to experience interventions and serious morbidity than those planning obstetric unit birth, with no difference in outcomes for babies.

Methods
This paper uses an interpretative technique developed for policy analysis to explore the representation of these closures in 191 news articles, to explore the public climate in which they occurred.

Findings and discussion
The articles focussed on underuse by women and financial constraints on services. Despite the inclusion of service user voices, the power of framing was held by service managers and commissioners. The analysis exposed how neoliberalist and austerity policies have privileged representation of individual consumer choice and market-driven provision as drivers of changes in health services. This normative framing presents the reasons given for closure as hard to refute and cultural norms persist that birth is safest in an obstetric setting, despite evidence to the contrary.

Conclusion
The rise of neoliberalism and austerity in contemporary Britain has influenced the reform of maternity services, in particular the closure of midwifery units. Justifications given for closure silence other narratives, predominantly from service users, that attempt to present women’s choice in terms of rights and a social model of care.

Citation

Rayment, J., McCourt, C., Scanlon, M., Culley, L., Spiby, H., Bishop, S., & de Lima, L. A. (2020). An analysis of media reporting on the closure of freestanding midwifery units in England. Women and Birth, https://doi.org/10.1016/j.wombi.2018.12.012

• Journal Article Type: Article
• Acceptance Date: Apr 3, 2019
• Online Publication Date: Apr 11, 2019
• Publication Date: Feb 1, 2020
• Deposit Date: Apr 29, 2019
• Publicly Available Date: Apr 12, 2020
• Journal: Women and Birth
• Print ISSN: 1871-5192
• Electronic ISSN: 1878-1799
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1016/j.wombi.2018.12.012
• Keywords: Freestanding midwifery units; Media analysis; ‘What’s the problem represented to be?’ analysis; Neoliberalism; Birth Centres
• Public URL: https://nottingham-repository.worktribe.com/output/1848422
• Publisher URL: https://www.womenandbirth.org/article/S1871-5192(18)30214-2/fulltext