title: 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.
abstract: 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.
authors: National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK. rachel.rowe@npeu.ox.ac.uk.
authors: Rachel E
authors: RE
authors: Rowe
authors: John
authors: J
authors: Townend
authors: Peter
authors: P
authors: Brocklehurst
authors: Marian
authors: M
authors: Knight
authors: Alison
authors: A
authors: Macfarlane
authors: Christine
authors: C
authors: McCourt
authors: Mary
authors: M
authors: Newburn
authors: Maggie
authors: M
authors: Redshaw
authors: Jane
authors: J
authors: Sandall
authors: Louise
authors: L
authors: Silverton
authors: Jennifer
authors: J
authors: Hollowell
mesh_terms: D000328:Adult; D016550:Birthing Centers / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric; D004630:Emergencies; D004739:England; D005260:Female; D006297:Health Services Accessibility; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D008880:Midwifery / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000175:diagnosis; D011247:Pregnancy; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D055815:Young Adult