Duration and urgency of transfer in births planned at home and in freestanding midwifery units in England: secondary analysis of the Birthplace national prospective cohort study

BMC Pregnancy and Childbirth

Jennifer Hollowell⁴  Louise Silverton³  Jane Sandall¹  Maggie Redshaw⁴  Mary Newburn⁶  Christine McCourt²  Alison Macfarlane²  Marian Knight⁴  Peter Brocklehurst⁵  John Townend⁴  Rachel E Rowe⁴ 

[1] Division of Women’s Health, King’s College London, London, UK;Department of Midwifery and Child Health, City University London, London, UK;The Royal College of Midwives, London, UK;National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK;Institute for Women’s Health, University College London, London, UK;The National Childbirth Trust, London, UK

关键词: Patient transfer;    Midwifery;    Home birth;    Birthing centres;   

Others  :  1131945
DOI  :  10.1186/1471-2393-13-224

 received in 2013-09-10, accepted in 2013-11-27,  发布年份 2013

【 摘 要 】

Background

In England, there is a policy of offering healthy women with straightforward pregnancies a choice of birth setting. Options may include home or a freestanding midwifery unit (FMU). Transfer rates from these settings are around 20%, and higher for nulliparous women. The duration of transfer is of interest because of the potential for delay in access to specialist care and is also of concern to women. We aimed to estimate the duration of transfer in births planned at home and in FMUs and explore the effects of distance and urgency on duration.

Methods

This was a secondary analysis of data collected in a national prospective cohort study including 27,842 ‘low risk’ women with singleton, term, ‘booked’ pregnancies, planning birth in FMUs or at home in England from April 2008 to April 2010. We described transfer duration using the median and interquartile range, for all transfers and those for reasons defined as potentially urgent or non-urgent, and used cumulative distribution curves to compare transfer duration by urgency. We explored the effect of distance for transfers from FMUs and described outcomes in women giving birth within 60 minutes of transfer.

Results

The median overall transfer time, from decision to transfer to first OU assessment, was shorter in transfers from home compared with transfers from FMUs (49 vs 60 minutes; p < 0.001). The median duration of transfers before birth for potentially urgent reasons (home 42 minutes, FMU 50 minutes) was 8–10 minutes shorter compared with transfers for non-urgent reasons. In transfers for potentially urgent reasons, the median overall transfer time from FMUs within 20 km of an OU was 47 minutes, increasing to 55 minutes from FMUs 20-40 km away and 61 minutes in more remote FMUs. In women who gave birth within 60 minutes after transfer, adverse neonatal outcomes occurred in 1-2% of transfers.

Conclusions

Transfers from home or FMU commonly take up to 60 minutes from decision to transfer, to first assessment in an OU, even for transfers for potentially urgent reasons. Most transfers are not urgent and emergencies and adverse outcomes are uncommon, but urgent transfer is more likely for nulliparous women.

【 授权许可】

   
2013 Rowe et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Birthplace in England Collaborative Group: Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011, 343:d7400.
• [2]Hollowell J, Puddicombe D, Rowe R, Linsell L, Hardy P, Stewart M, Newburn M, McCourt C, Sandall J, Macfarlane A, et al.: The Birthplace national prospective cohort study: perinatal and maternal outcomes by planned place of birth. Birthplace in England research programme. Final report part 4. London: NIHR Service Delivery and Organisation programme; 2011.
• [3]Hodnett ED, Downe S, Walsh D: Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev 2012, (8):CD000012. DOI: 10.1002/14651858.CD000012.pub4
• [4]Walsh D, Downe SM: Outcomes of free-standing, midwife-led birth centers: a structured review. Birth 2004, 31(3):222-229.
• [5]National Collaborating Centre for Women’s and Children’s Health: Intrapartum care: care of healthy women and their babies during childbirth. London: RCOG; 2007.
• [6]Lindgren HE, Radestad IJ, Christensson K, Hildingsson IM: Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. A population-based register study. Acta Obstet Gynecol Scand 2008, 87(7):751-759.
• [7]Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK: Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ 2009, 181(6–7):377-383.
• [8]Argent VP: Pre-hospital risks of the reconfiguration of obstetric services. Clinical Risk 2010, 16(2):52-55.
• [9]Fell G, Haroon S: Learning from a rapid health impact assessment of a proposed maternity service reconfiguration in the English NHS. BMC Public Health 2008, 8:138. BioMed Central Full Text
• [10]Independent Reconfiguration Panel: Advice on proposals for changes to maternity services in Scarborough and North East Yorkshire. Submitted to the secretary of state for health, 30 June 2008. London: Independent Reconfiguration Panel; 2008.
• [11]Norfolk A: Baby dies after drive to hospital. There was a lack of facilities at new hospital and no ambulance for the mother. In The Times. London: Times Newspapers Ltd; 2004.
• [12]Campbell R, Macfarlane A: Where to be born? The debate and the evidence. 2nd edition. Oxford: National Perinatal Epidemiology Unit; 1994.
• [13]RCOG statement on the results of the NPEU birthplace study. http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/statement/rcog-statement-results-npeu-birthplace-study webcite
• [14]RCOG statement on BMJ paper looking at cost-effectiveness of alternative planned places of birth in low risk women. http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/statement/rcog-statement-bmj-paper-looking-cost-effectiveness-al webcite
• [15]McCourt C, Rance S, Rayment J, Sandall J: An organisational study of alongside midwife units: a follow-on study from the Birthplace in England programme. London: NIHR Health Services & Delivery Research Programme; In press
• [16]McCourt C, Rance S, Rayment J, Sandall J: Birthplace qualitative organisational case studies: how maternity care systems may affect the provision of care in different settings. Birthplace in England research programme. Final report part 6. NIHR Service Delivery and Organisation programme: London; 2011.
• [17]Rowe R: Transfer from midwifery unit to obstetric unit during labour: rates, process and women’s experience. DPhil thesis. Oxford: University of Oxford; 2011.
• [18]Rowe RE, Kurinczuk JJ, Locock L, Fitzpatrick R: Women’s experience of transfer from midwifery unit to hospital obstetric unit during labour: a qualitative interview study. BMC Pregnancy Childbirth 2012, 12:129. BioMed Central Full Text
• [19]Hogg M, Penney G, Carmichael J: Audit of care provided and outcomes achieved by community maternity units in Scotland 2005. Final report. Aberdeen: SPCERH; 2007.
• [20]Google maps. http://maps.google.co.uk webcite
• [21]StataCorp: Stata statistical software: release 11. In College station. TX: StataCorp LP; 2009.
• [22]Chamberlain G, Wraight A, Crowley P: Birth at home: a report of the national survey of home births in the UK by the national birthday trust. Practising Midwife 1999, 2(7):35-39.
• [23]Olsen O, Jewell MD: Home versus hospital birth. Cochrane Database Syst Rev 1998., 3CD000352
• [24]Stewart M, McCandlish R, Henderson J, Brocklehurst P: Review of evidence about clinical, psychosocial and economic outcomes for women with straightforward pregnancies who plan to give birth in a midwife-led birth centre, and outcomes for their babies. Oxford: National Perinatal Epidemiology Unit; 2005.
• [25]Rowe RE: Local guidelines for the transfer of women from midwifery unit to obstetric unit during labour in England: a systematic appraisal of their quality. Quality and Safety in Health Care 2010, 19(2):90-94.
• [26]National Institute for Health and Clinical Excellence: Caesarean section. London: Royal College of Obstetricians and Gynaecologists (RCOG); 2011.
• [27]David M, Berg G, Werth I, Pachaly J, Mansfeld A, Kentenich H: Intrapartum transfer from a birth centre to a hospital - reasons, procedures, and consequences. Acta Obstet Gynecol Scand 2006, 85(4):422-428.
• [28]Stapleton SR, Osborne C, Illuzzi J: Outcomes of care in birth centers: demonstration of a durable model. J Midwifery Womens Health 2013, 58(1):3-14.
• [29]Mahmood TA: Evaluation of an experimental midwife-led unit in Scotland. Journal of Obstetrics & Gynaecology 2003, 23(2):121-129.
• [30]Cheyne H, Dalgleish L, Tucker J, Kane F, Shetty A, McLeod S, Niven C: Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgment and signal detection analysis. BMC Med Inform Decis Mak 2012, 12(1):122. BioMed Central Full Text
• [31]Harris FM, van Teijlingen E, Hundley V, Farmer J, Bryers H, Caldow J, Ireland J, Kiger A, Tucker J: The buck stops here: midwives and maternity care in rural Scotland. Midwifery 2011, 27(3):301-307.