Subverting the assembly-line: childbirth in a free-standing birth centre.

Across the world, concern is being expressed about the rising rates of birth interventions. As a result, there is growing interest in alternative organisational models of maternity care. Most of the research to date on these models has examined clinical outcomes. This paper, discussing key findings from an ethnographic study of a free-standing birth centre in the UK, explores organisational dimensions to care. It suggests that the advantages of scale have been under-recognised by policy makers to date. The birth centre displays organisational characteristics that contrast with the dominant Fordist/Taylorist model of large maternity units. These characteristics allow for greater temporal flexibility in labour care and tend to privilege relational, 'being' care over task-orientated, 'doing' care. In addition, features of a bureaucracy are much less in evidence, enabling entrepreneurial activity to flourish. There may be lessons here for other heath services as well as maternity services in optimising the advantages of small-scale provision.