Impact of midwifery-led units in Spain: lessons from the first 5 years

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2025-09-15 DOI:10.1016/j.healthpol.2025.105441

Roser Palau-Costafreda , Lluna Orus-Covisa , Edgar Vicente-Castellví , Xavier Espada-Trespalacios , Albert Medina Català , Carlota Alcover , Noemí Obregón Gutiérrez , Ramon Escuriet , Eva Padrosa

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引用次数: 0

Abstract

Background

There has been a growing concern over rising medical interventions during childbirth, particularly caesarean sections, without corresponding improvements in maternal or neonatal outcomes. Midwifery-led units (MLUs) offer a model that promotes physiological birth while reducing unnecessary interventions. In Spain, where maternity care is predominantly hospital-based and obstetrician-led, the first public MLU opened in Catalonia in 2017. Its temporary closure after five years offers a unique opportunity to assess its impact on interventions and outcomes.

Objective

To evaluate the MLU’s implementation and its effect on childbirth interventions within the unit and across the host hospital.

Methods

A retrospective cross-sectional trend study of childbirth data (2018–2023) from all public Catalan hospitals, and a retrospective cohort study of women contacting the MLU (2017–2022).

Results

MLU demand tripled between 2018 and 2022. Among 1286 attendees, 64.8 % were nulliparous and predominantly had low risk pregnancies. Half who planned an MLU birth began labour there, achieving 92.3 % spontaneous vaginal births and 4.1 % caesareans. Hospital-wide, caesarean rates fell from 23.5 % to 13.5 % (2019–2021), while spontaneous births rose to 78.7 %, suggesting a spill-over effect beyond the MLU. These trends reversed after closure in 2022.

Conclusion

Spain’s first public MLU was successfully implemented, safely reducing interventions and influencing wider hospital practices. Its closure and subsequent regression in birth outcomes highlight the need for sustained support and investment. MLUs can be an effective strategy for lowering intervention rates in highly medicalised systems, benefiting both unit users and the broader maternity care environment.

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西班牙助产单位的影响：前5年的经验教训

背景：越来越多的分娩期间的医疗干预措施，特别是剖腹产，没有相应改善产妇或新生儿的结局，这一点日益引起人们的关注。助产士主导的单位（MLUs）提供了一个模式，促进生理分娩，同时减少不必要的干预。在西班牙，产科护理主要以医院为基础，由产科医生主导，2017年在加泰罗尼亚开设了第一家公立MLU。它在五年后暂时关闭，为评估其对干预措施和结果的影响提供了一个独特的机会。目的评价MLU的实施情况及其对分娩干预的影响。方法对加泰罗尼亚所有公立医院的分娩数据（2018-2023）进行回顾性横断面趋势研究，并对2017-2022年接触MLU的妇女进行回顾性队列研究。结果smlu需求在2018年至2022年间增长了两倍。在1286名参与者中，64.8%的人没有生育，主要是低风险妊娠。一半计划在MLU分娩的人在那里开始分娩，实现了92.3%的自然阴道分娩和4.1%的剖腹产。在医院范围内，剖宫产率从23.5%降至13.5%（2019-2021年），而自然分娩率上升至78.7%，这表明其溢出效应超出了产妇死亡率。在2022年关闭后，这些趋势发生了逆转。结论西班牙首个公共MLU成功实施，安全减少了干预措施并影响了更广泛的医院实践。它的关闭和随后的生育结果倒退突出了持续支持和投资的必要性。在高度医疗化的系统中，mlu可以成为降低干预率的有效策略，使单位用户和更广泛的产妇护理环境都受益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.