Development of accreditation criteria for freestanding midwife-led birth centres in South Africa

Abstract

In recent years, privately owned, freestanding midwife-led birth centres have been established in South Africa, in addition to the existing hospital and obstetrician-led facilities. Midwife-led birth centres aim at individualised care and natural birth in a home-like setting. Still, in South Africa, there were no standardised criteria for the accreditation of privately owned, freestanding midwife-led birth centres by an independent midwife network at the time of this research. Accreditation of such centres has the potential to set a benchmark for high-quality, safe care that could lead to the expansion of birth-centre care and more equitable access to those centres for South African families. The aim of this study was to develop accreditation criteria through a three-phase multimethod study. Ménage’s model for evidence-based decision-making in midwifery served as a guidepost. The first phase consisted of a scoping review of research articles, guidelines, legislation and the scope of practice of midwives to explore factors that contribute to good outcomes and positive experiences for women and newborns at midwife-led birth centres. The results were collated, summarised, and used to contribute to the formulation and verification of accreditation criteria in Phase 3. Phase 2 began with input from couples or individuals who had experienced care at privately owned midwife-led birth centres. Through semi-structured focus groups and postpartum written narratives, clients from three distinct birth centres discussed their experiences and perceptions of safety and support at those facilities. Following this, a stakeholder analysis was conducted to identify experts in midwife-led birth centres and maternity care in South Africa and abroad. Fourteen stakeholders took part in a nominal group technique session to reach consensus on quality measures that should be incorporated into the accreditation criteria. In Phase 3, accreditation criteria were drafted based on the insights gathered from the preceding phases. Subsequently, consensus on the formulated accreditation criteria was obtained from the stakeholders involved in Phase 2 through the e-Delphi technique. Criteria deemed 'very important' or 'essential' by a minimum of 70% of participants were included in the final version. The final accreditation criteria include governance-, staff-, facility-, clinical care-, and quality control- aspects that prioritise the safety of women and newborns. Adopting these criteria on a national or provincial level might lead to more research on safety, client experiences and the economic viability of these birth centres.