Take Part

Take part

If you or your health service are interested in using the MUSA Framework, please contact us at musa@city.ac.uk or complete the following form.

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"We were delighted to be part of the Midwifery Unit Self-Assessment. The tool allowed us to benchmark our service against the standards. Being part of the advisory group enabled our team to interact with our European Colleagues and share the learning across all sites. The results of the self-assessment highlighted the need for more service-user involvement in decision-making and we have addressed this in our current Waterbirth Working Group."

Gráinne Milne

Director of Midwifery, Louth Hospitals, Ireland

What is a midiwfery unit?

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Midwifery units (also known as birth centres) offer maternity care to women and people with straightforward pregnancies, supporting physiological birth through a social model of care and providing a birthing environment that is calm, welcoming, comfortable and relaxing.

In midwifery units, midwives take primary professional responsibility and carry out most of the care, alongside maternity support workers, whom they manage. Interdisciplinary working with medical colleagues, ambulance service, community colleagues and service users is based on mutual respect to provide high quality, evidence-based care and smooth transfer to obstetric units, as required.

Alongside midwifery units (AMUs) are located in a hospital that provides obstetric care, close to the labour ward or on the same site in a different building. AMUs are close to medical facilities and personnel should a woman or birthing person need them. This may include access to interventions that can be carried out by midwives, for example electronic fetal heart monitoring. To access such services, women and birthing people will need to transfer to the obstetric unit, which will normally be by walking, trolley, bed or wheelchair.

Freestanding midwifery units (FMUs) are on a separate site from obstetric services, in an independent building or on the site of a community hospital. If a woman or birthing person transfers to the obstetric unit during labour they will usually travel by car or ambulance.

What is the MUSA Framework?

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The Midwifery Unit Self-Assessment (MUSA) provides a structured framework to guide the self-assessment and improvement of midwifery units (MUs).

The implementation of the MUSA Framework includes the principle of co-production with stakeholders in the creation of an advisory group which contributes to the identification of strengths and area for improvement for the midwifery unit, based on the results of the completion of a self-assessment tool.

The framework provides a step-by-step guide supporting service improvement, emphasising co-production, stakeholder engagement and interdisciplinarity, particularly through strong service user input.

The MUSA Framework involves establishing a synergic partnership between midwifery units, key stakeholders and Midwifery Unit Network. This type of stakeholder engagement is highly effective because it combines insider knowledge with the benefit of gaining the fresh eye of an external facilitator.

How was the MUSA Framework produced?

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The MUSA Framework was developed from the Midwifery Unit Standards, in collaboration with City, University of London, Midwifery Unit Network and international expert stakeholders, between 2019 and 2021.

In 2020, we conducted a rapid appraisal with four midwifery units in the UK and Europe. We gathered the views of service providers and users on the self-assessment tool and the stakeholder engagement process to identify the degree of support needed by services in the process of self-evaluation and co-creation of an improvement plan.

In 2021, we conducted a six case studies with midwifery units located in the UK and Europe to evaluate the self-assessment tool in practice, to identify barriers and facilitators for midwifery unit implementation and improvement within maternity services across Europe and to inform the development of the framework for this self-assessment process.

Through this time period, we have worked with an advisory group of healthcare professionals, service users, policymakers and academics, who have reviewed and supported us to refine the framework.

How do I use the MUSA Framework, and what are the different steps?

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The MUSA Framework can be used by midwifery unit teams working in the UK and Europe. We recommend one or two midwives lead on using the framework. The framework is used alongside a self-assessment tool and with bespoke support from our MUSA team. There are three different phases to the framework: Prepare, Implement and Re-assess, with different steps are completed over 52 weeks.

During Prepare, your leads will attend an introductory meeting and training sessions, conduct a situation analysis using the self-assessment tool and organise wider stakeholder engagement in order to generate an improvement plan of impact actions for the midwifery unit.

The Implement phase involves implementing these  impact actions and receiving ongoing support from the MUSA team.

Finally, during Reassess, your midwifery unit will be asked to conduct a re-evaluation using the self-assessment tool and to revise your improvement plan based on the outcomes.