UK childbirth delivery options in 2001-2002: alternatives to consultant unit booking and delivery.
BACKGROUND
Government policy advocates maternal choice in pregnancy care. Two key issues are place of birth and type of lead professional. Anecdotal evidence suggests there is variation in both these issues across the UK, but there has been no recent national assessment of whether maternal options are in line with government policy.


OBJECTIVE
To establish the range of women's childbirth delivery options, degree of midwife autonomy, and supporting training and governance mechanisms.


METHODS
Two postal questionnaires.


METHODS
UK maternity units.


METHODS
Questionnaires were sent to maternity services managers.


METHODS
number and type of units and births, transfers and care types; midwifery procedures; clinical governance and training activities.


RESULTS
Completed questionnaires were received from 301 out of 308 (97.7%) units in 2002 and from 258 out of 309 (83.5%) units in 2001. Midwife-led care is available in 186 English (76.9%), 15 Welsh (78.9%), 18 Scottish (48.6%) and three Northern Ireland (30.0%) units. There are 73 (24.3%) stand-alone, 22 (7.3%) alongside, 127 (42.2%) integrated and 79 (26.2%) consultant units (for definitions of unit types, see main text), with a median 2215 hospital, 25 home and 210 midwife-led births. The median antenatal and labour transfers from midwife-led units are 25.5% (interquartile range [IQR] = 18.5-36.5%) and 18.0% (IQR = 13.4-24.8%) respectively; transfers are independent of distance to nearest consultant unit, country and unit type.


CONCLUSIONS
Despite government policy promoting greater parental choice, this is not in evidence in many parts of the UK. The wide variations in home birth, midwife-led care and maternity-unit types merit further exploration. If more midwife-led units are to be established as a way of promoting parental choice and dealing with junior doctor rota problems, then such units must have adequate governance and training activities in place.
Smith
Lindsay Fp
LF
East Somerset Research Consortium, Somerset. Research@esrec.nhs.uk
Smith
Caroline P
CP
D001071:Appointments and Schedules; D003253:Consultants; D036861:Delivery, Obstetric / Q000379:methods* / Q000451:nursing / Q000706:statistics & numerical data; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006771:Hospitals, Maternity / Q000458:organization & administration* / Q000600:supply & distribution; D006801:Humans; D008880:Midwifery / Q000706:statistics & numerical data; D009721:Nurse Midwives / Q000600:supply & distribution; D010360:Patient Transfer / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D014852:Wales