Freestanding midwifery unit – the first year's experience

Abstract

Aim To determine transfer rates, reasons for transfer and outcomes for mothers and babies at our Freestanding Midwifery Unit (FMU) with 800 births in the first year of opening and compare this with available literature. This is one of the largest birth rates in the country for a FMU. Method Retrospective analysis of maternal and neonatal transfers from FMU to Consultant led maternity unit. Results There were 145 maternal transfers, with a transfer rate of 18.2% Antenatal intrapartum and postnatal transfer rates were 1.9%, 12.01% and 5.3%. Slow progress and retained placenta were the main reasons for transfer. Of the women booked at FMU, 92%had vaginal birth, 3.9% instrumental delivery and 3.25% Caesarean Section. 25 neonates were transferred (3.1%). Main reasons for neonatal transfers were respiratory distress, poor condition at birth, low birth weight and minor abnormalities on newborn examination. Perinatal mortality and intrapartrum related morbidity was 5 per 1000 births. Conclusion With almost 1000 births/year in our Midwifery Unit, we have seen that our transfer rate for maternal and neonatal transfers and perinatal outcome are comparable with available literature and the recently published Birthplace Study. We have identified main reasons for neonatal transfers and have clear guidelines for managing these. Antenatal transfer rate is much lower than published figures, which may be the result of excellent collaboration between the units resulting in appropriate patient selection With careful selection of patients, clear referral pathways and good communication, our FMU provides a very safe and effective service for low risk women.