City Research Online

Relationships and trust: Two key pillars of a well-functioning freestanding midwifery unit

Rocca-Ihenacho, L. ORCID: 0000-0002-8161-3938, Yuill, C. ORCID: 0000-0002-3918-5917 & McCourt, C. ORCID: 0000-0003-4765-5795 (2021). Relationships and trust: Two key pillars of a well-functioning freestanding midwifery unit. Birth, 48, pp. 104-113. doi: 10.1111/birt.12521


Despite strong evidence supporting the expansion of midwife‐led unit provision, as a result of optimal maternal and perinatal outcomes, cost‐effectiveness, and positive service user and staff experiences, scaling‐up has been slow. Systemic barriers associated with gender, professional, economic, cultural, and social factors continue to constrain the expansion of midwifery as a public health intervention globally. This article aimed to explore relationships and trust as key components of a well‐functioning freestanding midwifery unit (FMU).

A critical realist ethnographic study of an FMU located in East London, England, was conducted over a period of 15 months. Recruitment of the 82 participants was purposive. Data collection included participant observation and semi‐structured interviews, and data were analyzed thematically along with relevant local guidelines and documents.

Twelve themes emerged. Relationships and Trust were identified as a core theme. The other 11 themes were grouped into six families, three of which: Ownership, Autonomy, and Continuous Learning; Team Spirit, Interdependency, and Power Relations; and Salutogenesis will be covered in this paper. The remaining three families: Friendly Environment; Having Time and Mindfulness; and Social Capital, will be covered in a separate paper.

A relationship‐based model of care was crucial for both the functioning of the FMU and service users’ satisfaction and may offer a compelling response to high levels of stress and burnout among midwives.

Publication Type: Article
Additional Information: This is the peer reviewed version of the following article: Rocca-Ihenacho, L. , Yuill, C. and McCourt, C. (2020). Relationships and trust: Two key pillars of a well-functioning freestanding midwifery unit. Birth, doi: 10.1111/birt.12521, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Publisher Keywords: birth center; midwifery unit; relationship‐based care
Subjects: R Medicine > RG Gynecology and obstetrics
Departments: School of Health & Psychological Sciences > Midwifery & Radiography
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