Evaluation of the Albany Midwifery Practice

An evaluation of the Albany Midwifery Practice was undertaken by King’s College, London in 1999-2001 (Sandall et al 2001). It was commissioned by King’s College Hospital as “an independent review of the operation and outcomes of the Albany Practice.” The aims and objectives of the evaluation were to:

  • Investigate processes of inter-professional working since integrating into King’s NHS Trust
  • Examine the implications of self-employment for the midwives and the Trust
  • Describe the processes of care
  • Examine the outcomes of care

The Evaluation included a questionnaire sent to 447 women who gave birth in King’s Health Care Trust in 1999, including 106 women cared for by the AMP. This enabled comparison with women receiving care from other midwifery group practices, which do not provide such a high rate of continuity of carer and where the midwives are not self-employed, and women receiving care in the conventional hospital system.

There were a number of important differences in the findings for women cared for by the AMP. Women booked with the AMP reported being given more choice over where to have their babies, including a choice of home birth. 97% of AMP women stated that they felt fully involved in the decision about where to have their babies, compared to 83% of other women. Women cared for by AMP were less likely to describe their midwives as “rushed” and more likely to describe them as “kind” and “warm.” They were also less likely to describe their midwives as “unhelpful”, “offhand”, “condescending”, “bossy”, “inconsiderate” or “insensitive”. 95% of AMP women reported that they were given an opportunity to discuss their wishes about labour and birth, compared to 80% of other women. More AMP women also reported being given more information about pain relief, monitoring of the baby and emergency back-up during home birth than other women.

When asked about continuity of carer, 73% of AMP women said that it mattered that they had met their midwives before. 97% of AMP women had met their midwife before, and were almost twice as likely as other women to have done so. In fact, during the evaluation period 98% of AMP women had their primary midwife or another Albany midwife with them in labour and 93% of AMP women had the same midwife throughout labour. Significantly more AMP women said it was very important to receive care from someone they knew (58% compared to 35% in the other midwifery group practices).

Reflecting on the care they received during labour, more AMP women reported that their midwife explained what was happening, told them enough about necessary interventions, took enough notice of their views and were kind and understanding. It is notable that during the evaluation period, 69% of AMP women did not use pharmacological pain analgesia, compared with 18% of women cared for by the other midwifery group practices. This figure is in line with the rate of non-pharmacological analgesia use reported later in this chapter. Importantly, significantly more AMP women said that “no pain relief was required” than other women (49% vs. 24%), suggesting that AMP women may have been either better prepared for labour or better supported to cope with pain in labour.

Albany midwives were more likely to arrange to visit women postnatally at a specific time than other midwives. 89% of AMP women saw only 1 or 2 midwives postnatally, compared to 44% of women with the other practices. AMP women were also much more likely to have met these midwives before and to say that this mattered to them (78% vs. 43% of other women). 90% of AMP women reported being given enough information about feeding their babies, compared to 76% of other women.

The evaluation comments that ‘‘throughout the women’s responses, there is a clear pattern of woman centred care being offered and of partnership with women, which may contribute to the positive evaluations of antenatal care and good clinical outcomes’’ (Sandall et al 2001). The evaluation concludes that the aims and objectives of the practice are being met, and that the Practice is providing a form of maternity care that women feel positive about, as well as producing good clinical outcomes.