In England, there is a policy of offering healthy women with low risk pregnancies a choice of birth setting. Choices may include an obstetric unit (OU), an alongside midwifery unit (AMU) situated on the same site as an OU, a freestanding midwifery unit (FMU) situated on a site without an OU, or at home. For ‘low risk’ women, planned birth in a midwifery unit or at home is associated with benefits for the mother in terms of fewer interventions [1–7]. Outcomes for babies of women who plan birth outside an OU are comparable with those for babies of women who plan birth in an obstetric unit, with the exception of babies of nulliparous women planning birth at home, for whom adverse perinatal outcomes are more common [1, 2].
National clinical guidelines for intrapartum care in England recommend referral for obstetric advice, with transfer to an obstetric unit where appropriate, when certain clinical complications occur, including diagnosed delay in the first or second stage of labour, abnormal fetal heart rate, “significant” meconium staining, fresh bleeding, maternal pyrexia, maternal hypertension, retained placenta and suspected postpartum haemorrhage . In planned home and FMU births, obstetric, anaesthetic and neonatal care are only available if the woman is transferred, usually by car or ambulance, to an obstetric unit. Overall transfer rates from these settings are around 20%, but rates for nulliparous women are substantially higher (36% in FMUs and 45% in planned home births) [1, 2].
Transfer from planned home births and FMUs raises concerns about safety, in part because of the potential for delay [8–12]. In the UK, it has also been suggested that high transfer rates from FMUs pose “logistical problems” and that more AMUs should be developed [13, 14]. While there may be a perception that AMUs are safer than FMUs, presumably because of the speed with which obstetric and neonatal care are potentially available if needed, evidence from a recently completed study of AMUs indicates that transfer from AMUs may not be straightforward, with delays occurring because of staffing and resource constraints and intra-professional tensions . Analysis of the Birthplace primary outcome (a composite measure of adverse perinatal outcomes) also found similar event rates in the two midwifery unit settings [1, 2]. Transfer is also an issue which can influence women’s decision-making about place of birth [16–18]. Some women describe choosing birth in an AMU to avoid the possibility of transfer by car or ambulance . Those planning birth at home or in an FMU want information about transfer, may be concerned or ill-informed about journey time and may find longer journeys more difficult .
This study aimed to estimate the overall duration of transfer from planned births at home and in FMUs, to explore and describe the association between urgency and transfer duration from both settings and the association between distance to the nearest OU and transfer duration from FMUs.