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Dear Andrew and Denis This is a thread of great interest to me as we work in a unit which is some 20 miles from the nearest tertiary unit. We are always aware of potential threat - the trust wants the money currently spent on units in the community and is carping on about the distance as a safety issue. My argument is that small community units like ours should be retained, not only as a much-loved, needed and wanted community resource, but also as a safety net for women who would otherwise not make the twenty mile trip! We of course have our own booked clients, but a percentage of our births each year are women who have booked elsewhere and turn up, panting, on our doorstep, with no chance whatsoever of going anywhere (undelivered, anyway!). This particular issue does seem to be being taken seriously, but we are also well supported by the local community, which could be relied upon to make an unholy row if suggestions were made to close us. At the moment, all seems to be well, but we have to be certain that all reasonably anticipated eventualities can be accommodated in terms of training and expertise, and that stakeholders know this. As far as I'm concerned, the concept of transfer is part of safe practice. The essential points are that nothing has been attempted which could not be defended, or acknowledged to be in line with available evidence and that all documentation is comprehensive and, again, defensible. Centralising maternity care appears to convey no benefit for the population, at least my reading hasn't encompassed any convincing arguments, whilst the benefits of small units in terms of client satisfaction, low intervention rates and low PMR (vide Tew) are well known. Perhaps this is another issue for the proposed maternity action group (see ukmidwifery) to take under its wing. Lesley ---------- >. I guess though, if you argue for a local > midwifery-led unit, you still have to answer the query of whether the > midwifery-led unit could deal with the problem when it turns up at their > unit or could you envisage the problem not arising because of an earlier > intervention at the midwife-led unit? > > Does anyone out there have any information on the incidence of obstetric > complications related to distance to the nearest maternity unit? > This is in relation to closing down 'unviable' units and centralising > obstetric-led care in large units. Bearing in mind differences in geography > and population, we would like to know if anyone has come up with an estimate > of an 'safe' distance to travel. > Many thanks > Andrew Symon > %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%