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

Objective To assess the degree and nature of women's involvement in the decision to deliver by caeDesign Observational study. SettingThe maternity unit in a large teaching hospital.Sample One hundred and sixty-six women undergoing caesarean section.Methods Interviews with the women on the third or fourth day postpartum, questionnaires sent to the women at 6 weeks and at 12 weeks postpartum, and extraction of information from the women's medical records. Main outcome measuresWomen's knowledge, satisfaction, and involvement in making the decision concerning their caesarean section. ResultsThe majority of the women were satisfied with the information they received during pregnancy on caesarean section and with their involvement in making the decision, but the proportions were significantly higher for elective than emergency sections. For 7% of the women, maternal preference for caesarean section was a direct factor in making the decision. Just over half of the 166 women reported that they were not debriefed on the reasons for their caesarean section before their discharge from hospital. Almost a third of the women undergoing emergency caesarean section expressed negative feelings towards their delivery, compared with 13% of those undergoing elective caesarean sections. ConclusionWomen are not a homogeneous group in terms of their requirements for information, nor their desire to be involved in the decision on mode of delivery. Health professionals need to be responsive to this variability and to agree on standards for communicating with women during pregnancy about the possibility of operative delivery and for debriefing women after caesarean section.sarean section, and women's satisfaction with this involvement.

The introduction of clinical governance challenges healthcare providers to improve the care they deliver. There are huge opportunities for Trusts to invest in developing staff knowledge and use of research. However, staff will only seize these opportunities if there is an appropriate, enabling environment--an environment that delivers intensive interventions and is sensitive to the wider structural factors in the NHS affecting staff morale and commitment. In the absence of this environment, what may be seen as opportunities to managers may be regarded as just another burden by staff.

Objective 1. To explore whether there are differences in women's satisfaction with care in a midwifemanaged delivery unit compared with that in a consultant-led labour ward. 2. To compare factors relating to continuity, choice and control between the two randomised groups.Design Apragmatic randomised controlled trial.Setting Aberdeen Maternity Hospital, Grampian.Sample 2844 women, identified at booking as low risk, were randomised in a 2: 1 ratio between the Main outcome measures Satisfaction, continuity of carer, choice, and control.Results Satisfaction with the overall experience did not differ between the groups. Satisfaction with how labour and delivery was managed by staff was slightly higher in the midwives' unit group, but this did not reach the 0.1% level of significance. Women allocated to the midwives' unit group saw significantly fewer medical staff and were less likely to report numerous individuals entering the room. They were more likely to report having had a choice regarding mobility and alternative positions for delivery and were significantly more likely to have made their own decisions regarding pain relief. ConclusionsThe issues surrounding the measurement of satisfaction with childbirth need further investigation. Until this area is clarified it would be unwise to use an overall measure of satisfaction as an indicator of the quality of maternity service provision. In particular, the current measures are not sensitive enough to examine the specific factors which affect women's satisfaction. Further research is required to assess which factors are important to women if they are to have a positive experience of childbirth and how these priorities change over time.midwives' unit and the labour ward.

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