Objective-To examine whether intrapartum care and delivery oflow risk women in a midwife managed delivery unit differs from that in a consultant led labour ward.Design-Pragmatic randomised controlled trial. Subjects were randomised in a 2:1 ratio between the midwives unit and the labour ward.Setting-Aberdeen Maternity Hospital, Grampian. Subjects-2844 low risk women, as defined by existing booking criteria for general practitioner units in Grampian. 1900 women were randomised to the midwives unit and 944 to the labour ward.Main outcome measures-Maternal and perinatal morbidity.Results-Of the women randomised to the midwives unit, 647 (34%) were transferred to the labour ward antepartum, 303 (16%) were transferred intrapartum, and 80 (40/%) were lost to follow up. 870 women (46%) were delivered in the midwives unit. Primigravid women (255/596, 43%) were significantly more likely to be transferred intrapartum than multigravid women (48/577, 8%). Significant differences between the midwives unit and labour ward were found in monitoring, fetal distress, analgesia, mobility, and use of episiotomy. There were no significant differences in mode of delivery or fetal outcome. Conclusions-Midwife managed intrapartum carefor low risk women results in more mobility and less intervention with no increase in neonatal morbidity. However, the high rate of transfer shows that antenatal criteria are unable to determine who will remain at low risk throughout pregnancy and labour. IntroductionIf women are to have choice in the location for their delivery, the maternity services must provide a safe and acceptable range of options. In Aberdeen we have developed a midwife managed delivery unit that aims

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Conclusions Our approach has demonstrated a significant reduction in the number of falls without impacting on patients' independence. Quality of life and increased confidence in patients and staff is marked. We have seen a culture change within our team, where all falls and near miss falls are treated with the same importance.

This was complemented by input from a Clinical Nurse Specialist over a total of six months. Results Between 1 January and 31 May 2021, 56 patients were referred. 69% from the hospital palliative care team. 46% of patients had cancer. Four patients died before they were assessed. 68% of patients were seen within seven days of referral. 29 patients died during the project timescale and 93% of deaths were in a care home. The only hospital admission was precipitated by an acute event. We found evidence that documentation of ACP and escalation of treatment plans improved by our intervention. Potential hospital admissions were avoided in 14 cases due to ACPs. There were challenges for carers in attending education, with 172 attendees over 34 sessions. With regard to visiting during a time of societal restrictions, 28% of review appointments took place face-toface. Conclusions Education was well-received but further work is required to improve accessibility and to assess longevity of benefit. We responded clinically in a more timely manner, as compared to 'normal care'. We identified a theme of inadequate and inconsistent documentation of future care planning.