An analysis of media reporting on the closure of freestanding midwifery units in England |
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| Affiliation: | 1. City, University of London, 1 Myddelton Street, London, EC1R 1UB, UK;2. De Montfort University, The Gateway, Leicester, LE1 9BH, UK;3. University of Nottingham, University Park, Nottingham, NG7 2RD, UK;4. Universidade federal do Rio de Janeiro, 275 – Cidade Nova, Rio de Janeiro, RJ, 20071-003, Brazil;1. Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada;2. School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada;1. Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway;2. Division of General Gynaecology and Obstetrics, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway;3. Department of Obstetrics and Gynecology, Akershus University Hospital, 1478, Lørenskog, Norway;1. Department of Psychology, State University of New York at Fredonia, W357 Thompson Hall, Fredonia NY 14063, United States;2. Department of Sociocultural and Justice Sciences, State University of New York at Fredonia, W363 Thompson Hall, Fredonia NY 14063, United States;3. Department of Athletics, Georgetown University, 37th Street Northwest, Washington, DC 20007, United States;1. Epidemiology, Executive Medical Services, Western Sydney Local Health District, Sydney, Australia;2. Obstetrics and Gynaecology, Westmead Hospital, Sydney, Australia |
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| Abstract: | ProblemDespite 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.BackgroundThe 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.MethodsThis 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 discussionThe 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.ConclusionThe 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. |
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| Keywords: | Freestanding midwifery units Media analysis ‘What’s the problem represented to be?’ analysis Neoliberalism Birth Centres |
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