"I believe that the Albany practice is unique in the United Kingdom, but I hope that that uniqueness is quickly lost and that its example can spread throughout the country."

Hansard: 19 April 2000: Column 214WH Mr Winterton.

  The Albany Midwifery Practice is a self-employed, self managed, midwifery practice subcontracted to Kings College Hospital. Since 1997 they have provided midwifery care to over a thousand women.

  "Please consider how satisfying it might be for a midwife to be the mistress of her employment. The Albany practice operates on a contractual basis unique in the UK."

Hansard: 15 January 2003: Column 284 The Earl of Listowel

  The Practice provides individual caseload midwifery care at all times to women in Peckham in South-East London, an area of recognised high deprivation (Jarman index 64.31) with a multicultural population, 43% of the women are not in paid employment. Women are referred by groups of local G.Ps and are "all risk". Choice over place of birth is offered throughout pregnancy and in labour, giving women the option to choose a home birth at any time, unless there are clear indications for giving birth in hospital, the home birth rate for the Practice is 37%.

  There are seven midwives in the practice. Each midwife is on call 24 hours a day, seven days a week (except for 12 weeks holiday a year) for her individual caseload of women. Each woman has two midwives that she is able to get to know throughout her pregnancy. The Practice achieves a rate of 95% attendance at each birth of one, or both of these two midwives.

  During the five years that the midwifery practice has worked in Peckham the practice has provided care for over 1,000 women and has collected data and compiled statistics on these women. Of the 79% of the women who had spontaneous vaginal deliveries (SVD's) about half of them gave birth at home. 76% of the women who had SVD's had a physiological birth. A physiological birth is when a woman goes into labour at term, doesn't have her labour stimulated or augmented, labours without an epidural, pushes out her baby without an episiotomy and pushes out her placenta without the use of oxytocics.

  This midwifery group practice finds itself at the heart of the struggle that British midwives face: the struggle to keep birth normal. Through a shared philosophy of non-interventionist midwifery, these midwives are changing the culture of birth in their inner city community. Through understanding physiological birth and the wish to facilitate it the midwives encourage women to consider home as an appropriate and safe place to give birth.

  A recent evaluation of the Albany midwifery practice shows that women think highly of the care they receive. It also concludes that clinical outcomes compare favourably with those of other midwifery practices working with a similar population.

  Rates of homebirth are significantly higher. Overall rates of vaginal birth and breastfeeding are also higher while caesarean section rates, use of pethidine and epidurals, episiotomies and inductions are lower (Sandall et al. 2001).

  In 1985, WHO issued a consensus statement suggesting there were no additional health benefits associated with a CSR above 10-15% . . . "Other factors that could be associated with the CSR are the organisation and availability of resources, the provision of one-to-one support in labour, women's choices about childbirth and the characteristics and views of obstetricians" The National Sentinel Caesarean Section Audit Report RCOG Clinical Effectiveness Support Unit, October 2001.

February 2003