Why It Worked

Reasons that we believe contributed to our excellent results:

  • Shared philosophy
  • Individual caseloads
  • Commitment to normal birth, home birth where appropriate, and breastfeeding
  • Antenatal and Postnatal groups
  • Belief in women’s ability to give birth with minimal assistance
  • Belief in women’s ability to work with pain in labour
  • The 36 week birth talk
  • Visiting women at home in labour and keeping decision about place of birth open

All the midwives in the AMP had a fundamental belief in its philosophy and were committed to achieving the best possible outcomes for the women, the babies and their families. It is worth reviewing the aspects of the model that we believe contributed to our remarkable statistics.

We worked with individual caseloads, not a shared team caseload. We were able to build a relationship with each woman for whom we provided care, enabling the development of mutual trust and respect. We shared a commitment to helping women to have as normal a birth as possible. Knowing the woman’s family, history and social context helped us to support her in her choices throughout her pregnancy, birth and the postnatal period. The woman benefited from having two midwives who not only knew her but were on call for her 24 hours a day, 7 days a week, and who were also committed to being there for her in labour. Looking after individual women enabled us to work with them throughout pregnancy, helping them to prepare for their individual labour and birth. We believe that as a result women feel more confident as they approach their labours, thus increasing the likelihood of starting labour normally, and using their own resources (and those of their chosen birth supporters) to cope with labour positively.

Women told us that the antenatal groups had a powerful influence on the way they felt about their birth. Listening to real women telling their birth stories helped them and their partners to think about their options in many different situations. We believe that our high home birth rate was partly due to women learning from each other in these groups; women were discovering what was possible for them and making it happen. Starting with the first visit in the woman’s home, we were able to offer her an ongoing level of support that is impossible in any other system of care. It is difficult to measure the effect this has on a woman’s confidence in her ability to give birth, but the following example illustrates this well. One of the midwives was booking a Vietnamese woman pregnant with her third baby. She had had two ‘normal’ births in two different hospitals, and in both labours had had an epidural. When told that the midwife this time would be with her in labour, her immediate response was “I won’t need an epidural then, will I?” After further discussion, she decided that she would like to give birth at home, and eventually had a beautiful water birth, so very different from her previous experiences.

Not every woman discovers quite so quickly and easily what is right for her. But with the same two midwives seeing her for her antenatal care and discussing her choices in a positive way, each woman has the opportunity to make truly informed decisions about what is best for her and her baby. We discovered that by altering the usual pattern in the UK and actively promoting homebirth, many women were choosing to have their babies in their own homes, where they felt both comfortable and safe. We showed that the Albany model of midwifery care worked for both women and midwives, achieving remarkable outcomes and reversing trends in the increasing medicalisation of childbirth.