Assessing the consequences of changing childbirth

Better data are needed

Pregnancy care in Britain is changing,1 and the results of these changes need to be monitored. At first sight this seems easy. Obstetricians and midwives have always led the way in clinical audit. The confidential enquiry into maternal deaths was established over 40 years ago,2 and perinatal mortality is carefully reviewed locally.3 In research, perinatal medicine stands out from other specialties in its systematic reviews of randomised controlled trials.4 5

Nevertheless, standards of audit and data collection are falling, not rising. In the most recent report on maternal deaths6 medical information was missing in 4% of cases, compared with 0.4% in the previous report. The maternity hospital inpatient inquiry has been replaced by a hospital episode system, which is notoriously incomplete, and we now lack reliable figures for such basic …