MANAGEMENT OF LABOR IN AN ISOLATED RURAL MATERNITY HOSPITAL

Objectives-To evaluate the use of a maternity unit run by general prac titioners and midwives, describing the outcome of labor in an unselect ed group of women and quantifying the contribution made by general pra ctitioners. Design-Retrospective population based review of obstetric patients who had access to an isolated rural maternity unit. Setting-R ural area 120 km from a consultant maternity unit. Subjects-997 consec utive women delivered between January 1987 and May 1991. Main outcome measures-Mode of delivery and complications by place of booking and pl ace of delivery; need for medical intervention and transfer. Results-5 30 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 t he low risk unit, 25 (5%) required a forceps delivery; postnatal compl ications requiring emergency medical support occurred in a further 33 (7%). Conclusions-Risk characterisation is possible, but medical suppo rt 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.