Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 1996 Jan 27;312(7025):223–226. doi: 10.1136/bmj.312.7025.223

Management of labour in an isolated rural maternity hospital.

A G Baird 1, D Jewell 1, J J Walker 1
PMCID: PMC2350026  PMID: 8563590

Abstract

OBJECTIVES--To evaluate the use of a maternity unit run by general practitioners and midwives, describing the outcome of labour in an unselected group of women and quantifying the contribution made by general practitioners. DESIGN--Retrospective population based review of obstetric patients who had access to an isolated rural maternity unit. SETTING--Rural area 120 km from a consultant maternity unit. SUBJECTS--997 consecutive women delivered between January 1987 and May 1991. MAIN OUTCOME MEASURES--Mode of delivery and complications by place of booking and place of delivery; need for medical intervention and transfer. RESULTS--530 women (53%) were booked for delivery in the rural unit; this group had a caesarean section rate of 3.8% and an unplanned transfer rate of 12.8% to the consultant unit in labour. Of the 462 who delivered in the low risk unit, 25 (5%) required a forceps delivery; postnatal complications requiring emergency medical support occurred in a further 33 (7%). CONCLUSIONS--Risk characterisation is possible, but medical support from general practitioners and obstetricians is required in almost a third of women at low risk for complications of delivery. Results of this study support the team approach to obstetric management but not the move towards isolated units without organised medical support.

Full text

PDF
223

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brown D. J. Opinions of general practitioners in Nottinghamshire about provision of intrapartum care. BMJ. 1994 Sep 24;309(6957):777–779. doi: 10.1136/bmj.309.6957.777. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bull M. J. Ten years' experience in a general practice obstetric unit. J R Coll Gen Pract. 1980 Apr;30(213):208–215. [PMC free article] [PubMed] [Google Scholar]
  3. Cavenagh A. J., Phillips K. M., Sheridan B., Williams E. M. Contribution of isolated general practitioner maternity units. Br Med J (Clin Res Ed) 1984 May 12;288(6428):1438–1440. doi: 10.1136/bmj.288.6428.1438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Lowe S. W., House W., Garrett T. Comparison of outcome of low-risk labour in an isolated general practice maternity unit and a specialist maternity hospital. J R Coll Gen Pract. 1987 Nov;37(304):484–487. [PMC free article] [PubMed] [Google Scholar]
  5. MacVicar J., Dobbie G., Owen-Johnstone L., Jagger C., Hopkins M., Kennedy J. Simulated home delivery in hospital: a randomised controlled trial. Br J Obstet Gynaecol. 1993 Apr;100(4):316–323. doi: 10.1111/j.1471-0528.1993.tb12972.x. [DOI] [PubMed] [Google Scholar]
  6. Marsh G. N., Channing D. M. Audit of 26 years of obstetrics in general practice. BMJ. 1989 Apr 22;298(6680):1077–1080. doi: 10.1136/bmj.298.6680.1077. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Reynolds J. L., Yudkin P. L., Bull M. J. General practitioner obstetrics: does risk prediction work? J R Coll Gen Pract. 1988 Jul;38(312):307–310. [PMC free article] [PubMed] [Google Scholar]
  9. Rosenblatt R. A., Reinken J., Shoemack P. Is obstetrics safe in small hospitals? Evidence from New Zealand's regionalised perinatal system. Lancet. 1985 Aug 24;2(8452):429–432. doi: 10.1016/s0140-6736(85)92747-3. [DOI] [PubMed] [Google Scholar]
  10. Street P., Gannon M. J., Holt E. M. Community obstetric care in West Berkshire. BMJ. 1991 Mar 23;302(6778):698–700. doi: 10.1136/bmj.302.6778.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Taylor G. W., Edgar W., Taylor B. A., Neal D. G. How safe is general practitioner obstetrics? Lancet. 1980 Dec 13;2(8207):1287–1289. doi: 10.1016/s0140-6736(80)92348-x. [DOI] [PubMed] [Google Scholar]
  12. Tucker J., Florey C. D., Howie P., McIlwaine G., Hall M. Is antenatal care apportioned according to obstetric risk? The Scottish antenatal care study. J Public Health Med. 1994 Mar;16(1):60–70. doi: 10.1093/oxfordjournals.pubmed.a042937. [DOI] [PubMed] [Google Scholar]
  13. Young G. Are isolated maternity units run by general practitioners dangerous? Br Med J (Clin Res Ed) 1987 Mar 21;294(6574):744–746. doi: 10.1136/bmj.294.6574.744. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. van Alten D., Eskes M., Treffers P. E. Midwifery in The Netherlands. The Wormerveer study; selection, mode of delivery, perinatal mortality and infant morbidity. Br J Obstet Gynaecol. 1989 Jun;96(6):656–662. doi: 10.1111/j.1471-0528.1989.tb03279.x. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES