Evaluation of midwife-led care provided at the Royal Bournemouth Hospital

Objective: to compare the outcome of care given to women 'booking' for deli very in a midwife-led maternity unit with that for comparable women 'bookin g' for care in a consultant obstetric unit. Design and method: prospective cohort study with a quasi-experimental desig n and data extracted from case notes. Setting: east Dorset, midwife-led maternity unit at Royal Bournemouth Hospi tal and consultant-led maternity unit at Poole General Hospital. Subjects: two cohorts of women who satisfied the criteria for 'booking' at the Royal Bournemouth Hospital. Of these 794 'booked' at Bournemouth from 1 November 1992 to 30 June 1993 and 705 'booked' at Poole over the same peri od. Main process and outcome measures: care given, morbidity in women and their babies, transfers during the antenatal period and in labour. Findings: of the women who initially 'booked' for Bournemouth, 62.3% actual ly delivered there, 27.1% transferred before labour and a further 9.2% tran sferred during labour. No differences were seen between those 'booked' for Bournemouth or Poole in the proportions of low birthweight babies, babies w ho were transferred to special care or babies who had congenital abnormalit y. Higher proportions of babies whose mothers 'booked' for delivery in Pool e were resuscitated and had one minute Apgar scores below seven but there w as no difference in the five minute scores. Similar proportions of women ha d perineal tears but fewer of the women 'booked' for delivery in Bournemout h had an episiotomy. 'Booking' for Poole was associated with higher rates o f induction and augmentation of labour and greater use of anesthesia. 'Book ing' for Bournemouth was associated with a shorter first stage and a longer third stage of labour. Women 'booked' for delivery in Bournemouth were no more likely to be delivered by a midwife than those 'booked' for Poole, Conclusions: there was very little difference between the groups of women w ho intially 'booked' for delivery at the two units. There were differences in the patterns of care received, but no major differences in the outcome f or the women or their babies were detected.