Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study Ngai Fen Cheung, PhD, MSc, RGN, RM (Professor) a,n , Rosemary Mander, PhD, MSc, RGN, SCM, MID (Honorary Professorial Fellow) b , Xiaoli Wang, BSc, RM (Manager) c , Wei Fu, MSc, BSc (Dean, Associate Professor) a , Hong Zhou, BSc, RM (Midwifery Manager) d , Liping Zhang, BSc (Associate Professor) a a Nursing College, Hangzhou Normal University, 16 Xuelin Road, Xiasha, Hangzhou 310036, China b School of Health, University of Edinburgh, Edinburgh, UK c Nursing Department, Hangzhou First People’s Hospital, Hangzhou, China d Labour Ward, Hangzhou First People’s Hospital, Hangzhou, China article info Article history: Received 28 November 2009 Received in revised form 24 April 2010 Accepted 21 May 2010 Keywords: Chinese midwives Midwife-led care Normal birth Cohort abstract Aims: to report the clinical outcomes of the first six months of operation of an innovative midwife-led normal birth unit (MNBU) in China in 2008, aiming to facilitate normal birth and enhance midwifery practice. Setting: an urban hospital with 2000–3000 deliveries per year. Method: this study was part of a major action research project that led to implementation of the MNBU. A retrospective cohort and a questionnaire survey were used. The data were analysed thematically. Participants: the outcomes of the first 226 women accessing the MNBU were compared with a matched retrospective cohort of 226 women accessing standard care. In total, 128 participants completed a satisfaction questionnaire before discharge. Main outcome measure: mode of birth and model of care. Findings: the vaginal birth rate was 87.6% in the MNBU compared with 58.8% in the standard care unit. All women who accessed the MNBU were supported by both a midwife and a birth companion, referred to as ‘two-to-one’ care. None of the women labouring in the standard care unit were identified as having a birth companion. Discussion: the concept of ‘two-to-one’ care emerged as fundamental to women’s experiences and utilisation of midwives’ skills to promote normal birth and decrease the likelihood of a caesarean section. Conclusion: the MNBU provides an environment where midwives can practice to the full extent of their role. The high vaginal birth rate in the MNBU indicates the potential of this model of care to reduce obstetric intervention and increase women’s satisfaction with care within a context of extraordinary high caesarean section rates. Implications for practice: midwife-led care implies a separation of obstetric care from maternity care, which has been advocated in many European countries. & 2010 Elsevier Ltd. All rights reserved. Introduction This paper reports the clinical outcomes of the first six months of operation of an innovative midwife-led normal birth unit (MNBU) in 2008, known locally as ‘ (homely birthplace)’. It was developed in response to the high rate of caesarean sections in China and a prevailing view that midwives were ‘unnecessary’ to normal birth (Li et al., 2003; Cheung et al., 2005a,b, 2006a,b; Mander and Cheung, 2006). The study was the result of a major action research project. There is no evidence to support the claim that hospital is the safest place for healthy women to give birth (Zander and Chamberlain, 1999; Sinclair, 2002), and the increase in caesarean section rates cannot be fully explained by increases in hospital births in China (Guo et al., 2007). MNBUs in the developed world have been reported to facilitate vaginal birth, promote the role of midwives and empower women (Law and Lam, 1999; Janssen et al., 2002; Contents lists available at ScienceDirect journal homepage: www.elsevier.com/midw Midwifery 0266-6138/$ - see front matter & 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.midw.2010.05.012 n Corresponding author. E-mail address: nfcheung@btinternet.com (N.F. Cheung). Midwifery 27 (2011) 582–587