Management of labour in an isolated rural maternity hospital

BMJ 1996;312:223-226 (27 January)

General practice

Management of labour in an isolated rural maternity hospital

A G Baird, general practitioner,^a D Jewell, senior lecturer,^b Jj Walker, professor in obstetrics and gynaecology ^c

^a The White House, Sandhead, Stranraer, Wigtownshire DG9 9JA, ^b Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ^c University Department of Obstetrics and Gynaecology, St James's University Hospital, Leeds LS9 7TS

Correspondence to: Dr Baird.

Abstract

Objectives: To evaluate the use of a maternity unit run by generalpractitioners and midwives, describing the outcome of labourin an unselected group of women and quantifying the contributionmade by general practitioners.
Design: Retrospective population based review of obstetric patientswho 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 1987and May 1991.
Main outcome measures: Mode of delivery and complications byplace of booking and place of delivery; need for medical interventionand transfer.
Results: 530 women (53%) were booked for delivery in the ruralunit; this group had a caesarean section rate of 3.8% and anunplanned transfer rate of 12.8% to the consultant unit in labour.Of the 462 who delivered in the low risk unit, 25 (5%) requireda forceps delivery; postnatal complications requiring emergencymedical support occurred in a further 33 (7%).
Conclusions: Risk characterisation is possible, but medicalsupport from general practitioners and obstetricians is requiredin almost a third of women at low risk for complications ofdelivery. Results of this study support the team approach toobstetric management but not the move towards isolated unitswithout organised medical support.

Key messages

Key messages
Intervention and complication rates were considerable (30%), although caesarean section in active labour was rare
Complications were primarily postpartum haemorrhage and low Apgar score; these were all dealt with at the general practitioner unit
Involvement of general practitioners is valued by women and improves safety in isolated units; the key element in success is an enthusiastic motivated medical community

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