Management of labour in an isolated rural maternity hospital

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Abstract
Objectives: To evaluate the use of a maternity unit run by general practitioners and midwives, describing the outcome of labour in an unselected group of women and quantifying the contribution made by general practitioners. Design: Retrospective population based review of obstetric patients who had access to an isolated rural maternity unit. Setting: Rural area 120 km from a consultant maternity unit. Subjects: 997 consecutive women delivered between January 1987 and May 1991. Main outcome measures: Mode of delivery and complications by place of booking and place of delivery; need for medical intervention and transfer. Results: 530 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 the low risk unit, 25 (5%) required a forceps delivery; postnatal complications requiring emergency medical support occurred in a further 33 (7%). Conclusions: Risk characterisation is possible, but medical support 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. Key messages Intervention and complication rates were considerable (30%), although caesarean section in active labour was rare Complications were primarily postpartum haemorrhage and low Apgar score; these were all dealt with at the general practitioner unit Involvement of general practitioners is valued by women and improves safety in isolated units; the key element in success is an enthusiastic motivated medical community