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.

The Midwifery Unit Self-Assessment (MUSA) is a structured framework aimed at guiding quality and continuous improvement of midwifery units across the United Kingdom and Europe. As a team, we are passionate about providing holistic, person-centred care and enhancing the safety of maternity services.

The MUSA Framework was developed from the MidwiferyUnit Standards, in collaboration with City St George's, University of London, Midwifery Unit Network, international expert stakeholders and service users. 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, servicer users, stakeholders and the 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.

The MUSA Framework was developed from the Midwifery Unit Standards, in collaboration with City St George's, 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 United Kingdom 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 United Kingdom 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.

The MUSA Framework can be used by midwifery unit teams working in the United Kingdom and Europe. The framework is used alongside a self-assessment tool and with bespoke support from a local facilitator and the MUNet/MUSA team. There are eight steps to the framework: Prepare, Assess, Engage, Plan, Implement, Support, Reassess and Celebrate, which are completed over one year.