Sarah Denham’s PhD looked at community maternity units in Scotland, which has considerable rural and remote areas. Outcomes were also found to be very good. I can’t remember whether she had much detail on transfer issues but quite possibly, so worth contacting her. I’m not sure whether she is on the list so I can try contacting her otherwise.
Although England is a small and very urbanised country, the FMUs are mainly in the more rural areas and small. The birthplace findings reflect that as the study looked at things as they are. I find it curious that often people want to dismiss the findings re FMUs (very safe, very cost effective, & enhanced maternal safety) on the basis that their local unit is small and rural.
Perhaps we need to “take back control” (Brexit pun) of the language a bit and talk about MUs as a way of improving safety, as most of the discourse is focused on an implict assumption that they are more risky and the risk must be managed and mitigated. (Risk needs to be managed of course, but our cultural understandings of risk do not reflect the science with respect to childbirth.)
From: "[log in to unmask]" <[log in to unmask]> on behalf of "Sandall, Jane" <[log in to unmask]>
Reply to: "[log in to unmask]" <[log in to unmask]>, "Sandall, Jane" <[log in to unmask]>
Date: Tuesday, 22 October 2019 at 07:09
To: "[log in to unmask]" <[log in to unmask]>
Subject: Re: distance to hospital
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Is there anything in Australian birthplace?
Jane sandall
Please text me for urgent contact 07713743150
Sent from my iPhone
Professor Jane Sandall
King’s College, London
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On 22 Oct 2019, at 00:33, Pauline Dawson <[log in to unmask]> wrote:
Thanks Christine,
I was just thinking that there might be observational studies where transfer time is related to outcomes for all that has occured in the last few years.
I know in the national maternal morbidity work that I was part of here delayed transfer was a factor in poor outcomes but we are talking numbers of hours. Also there is some Australian research where Born Before Arrival (BBA) is a measurement proxy but again very long distances there. These BBA data are around just getting to ANY maternity facility not transfers.
I have found a lot of the things you might want to study here in NZ eg transfer time and BBA aren't routinely collected in national datasets.
Fascinating conversation - thank you
Pauline
On Tue, Oct 22, 2019 at 11:59 AM McCourt, Christine <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Pauline - to my knowledge no, and it would be a rather challenging thing to research.
The Birthplace data are the most detailed I can think of without searching systematically, but our findings showed particularly good outcomes from freestanding midwifery units and the distance/travel time to hospital was higher than that for home births.
We were not able to assess the actual time to get to hospital but the time to being assessed in hospital, as the data available didn’t allow the distinction to be made – how long women waited on arrival before being seen.
The median overall transfer time, including time spent arranging transfer, waiting for the ambulance to arrive, travel time and any wait before first assessment in the OU, was 60 minutes for transfers from FMUs and 49 minutes for transfers from home.
It seems likely that time to be seen on arrival in a well-functioning system would be related to urgency of reason for transfer. In two cases of urgent transfer from FMU observed directly in the Birthplace qualitative case studies, the OU staff were ready to receive and take on care straight away having been briefed by a midwife by telephone. This is no doubt a benefit of having an integrated maternity system under the NHS, as compared with experiences in some countries.
The key source with details on transfers from Birthplace is this follow-on analysis paper:
Rachel E Rowe, John Townend, Peter Brocklehurst, Marian Knight, Alison Macfarlane, Christine McCourt, Mary Newburn, Maggie Redshaw, Jane Sandall, Louise Silverton and Jennifer Hollowell. Duration and urgency of transfer in births planned at home and in freestanding midwifery units in national prospective cohort study. BMC Pregnancy and Childbirth 2013, 13:224 http://www.biomedcentral.com/1471-2393/13/224<https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.biomedcentral.com%2F1471-2393%2F13%2F224&data=01%7C01%7Cjane.sandall%40KCL.AC.UK%7C9e2d0cef8d0d4f4deedd08d7567f16f6%7C8370cf1416f34c16b83c724071654356%7C0&sdata=rR9%2FMoWN8psoImUr0%2Fz5qmeZaQSx9Rk6rXQNbiv1DnI%3D&reserved=0>
On 21/10/2019, 19:54, "A forum for discussion on midwifery and reproductive health research. on behalf of Pauline Dawson" <[log in to unmask]<mailto:[log in to unmask]> on behalf of [log in to unmask]<mailto:[log in to unmask]>> wrote:
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This is great data!
Further to my email though I don't think anyone has found an optimal time?
Am I wrong??
Pauline
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From: A forum for discussion on midwifery and reproductive health research.
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