Community obstetric care in West Berkshire

Abstract

Objective - To assess the effects of a revised obstetric booking policy whereby all low risk pregnant women received their antenatal care entirely in the community. Design - Comparison of the distribution of antenatal clinic attendances, transfers, and perinatal mortality rates for 1987 and 1989, before and after introduction of the revised policy. Setting - West Berkshire Health District. Subjects - All women who delivered with a registrable birth in the district in 1987 (5817 women) and 1989(5372). Main outcome measures - Attendances at community and consultant antenatal clinics; bookings transferred from community care to consultant care; perinatal mortality rates. Results - Of 5372 women delivering in West Berkshire in 1989, 3185 (58·3%) were originally booked for general practitioner-midwife care, of whom 1567 (49·2% of general practitioner-midwife bookings) were transferred to consultant care. 1618 women (30·1% of all women delivered) received their entire obstetric care from general practitioners and midwives. Attendance at hospital antenatal clinics was reduced by 16%. In 1989 the perinatal mortality rates (1987 values) for the district were 6·3 (7·6) per 1000 births overall; 8·2 (8·3) per 1000 consultant bookings; 5·0 (4·7) per 1000 for community bookings; and 10·2 (14·4) per 1000 for women transferred to consultant care. Conclusion - Antenatal care of low risk pregnant women may safely be provided by their general practitioner and midwife.