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Dear Ank
There is data on this in the full birthplace report.
https://www.ncbi.nlm.nih.gov/books/NBK311289/

regards
Jane Sandall

Jane Sandall CBE PhD MSc BSc RM HV RN
Professor of Social Science and Women's Health
NIHR Senior Investigator
Lead Maternal Health Systems and Implementation Research Group
Lead maternity and women's health theme NIHR CLAHRC South London
Academic leader King's Centre for Implementation Science.

Department of Women and Children's Health
School of Life Course Science l Faculty of Life Sciences & Medicine | King's College London I North Wing l St. Thomas' Hospital London| SE1 7EH
Map: https://www.kcl.ac.uk/visit/location.aspx?id=7266f96c-5094-48d3-882e-c9be6eeb6e71


[log in to unmask]<mailto:[log in to unmask]> | Skype | jsandall | mobile +44 (0)7713743150  l  02071888189  l
EA | [log in to unmask]<mailto:[log in to unmask]> | 020 7188 3639
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Adjunct Professor
Centre for Midwifery, Child and Family Health,
Faculty of Health, University of Technology, Sydney
PO Box 123, Broadway NSW 2007 Australia.

Latest publications:
Vousden, N. J., Lawley, E., Nathan, H. L., Seed, P. T., Gidiri, M., Goudar, S., Sandall, J., Chappell, L. C. & Shennan, A. H. (2018) Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings: a pragmatic stepped wedge cluster randomized-controlled trial, (Accepted/In press) In : The Lancet. Global health.

Jane Sandall, Rachel M Tribe, Lisa Avery, Glen Mola, Gerard HA Visser, Caroline SE Homer, Deena Gibbons, Niamh M Kelly, Holly Powell Kennedy, Hussein Kidanto, Paul Taylor, Marleen Temmerman, (2018) Short-term and long-term effects of caesarean section on the health of women and children.Lancet. 2018; 392: 1349-1357.
Robbins T, Shennan A, Sandall J. Modified Early Obstetric Warning Scores (MEOWS): A promising tool but more evidence and standardization required. Acta obstetricia et gynecologica Scandinavica. 2018 Aug 29.


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From: A forum for discussion on midwifery and reproductive health research.
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========================================================================Date:         Tue, 22 Oct 2019 07:48:11 +1300
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Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         Pauline Dawson <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: "Jonge, J. de (Ank)" <[log in to unmask]>
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Hello,

 

I did my masters on where women travel to birth in rural New Zealand and
simply there is no evidence. 

 

In New Zealand some women are 4 hours+ drive time from a base hospital and
even with helicopters it takes several hours to transfer. In places like
Canada and Australia these distances are even greater. 45 minutes sounds
amazing!

 

Again no evidence  even the golden hour rule for trauma care isnt based
on scientific evidence.

 

Pauline Dawson R.M., MMid  Research Midwife/Professional Practice
Fellow/PhD Candidate
Department of Womens & Childrens Health : Te Tari Hauora Whine me te
Tamariki
Dunedin School of Medicine, Section of Obstetrics & Gynaecology,
PO Box 56
Dunedin
Mobile: 027 2301522
 
[log in to unmask]
 <http://www.otago.ac.nz/dsm/wch> www.otago.ac.nz/dsm/wch 

 

From: A forum for discussion on midwifery and reproductive health 
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========================================================================Date:         Tue, 22 Oct 2019 07:54:29 +1300
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              research." <[log in to unmask]>
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Subject:      Re: distance to hospital
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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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========================================================================Date:         Mon, 21 Oct 2019 15:46:57 -0700
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              Ronnie Falcao <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
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From:         Ronnie Falcao <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: "Jonge, J. de (Ank)" <[log in to unmask]>
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Here in the US, this time interval is somewhat crudely
termed the "call to cut" time.

Here's what I've got on the subject:

<http://gentlebirth.org/archives/homsafty.html#Emergency>http://gentlebirth.org/archives/homsafty.html#Emergency 

Regards,
Ronnie Falcao
Mountain View, California, USA

At 07:19 AM 10/21/2019, you wrote:
>Dear all,
> 
>I am a member of the Dutch Health Council committee that has been asked to give advice on the 45-minute norm.  There is a rule in the Netherlands that the time between an emergency call in the community and the moment an ambulance has brought a patient/ client to hospital should be no more than 45 minutes. However, this rule has no evidence base. We have been asked to give advice to the government about keeping this norm or changing it  based on scientific evidence. 
> 
>Can you please let me know if you have information that we can use, if you have done research into this or know of people who have? And whether you have any thoughts on this matter?
> 
>Thank you very much!
> 
>Hartelijke groeten/ Best wishes,
> 
>Logo Amsterdam UMC
>
> 
>Dr. Ank de Jonge | Associate professor | Head of department of Midwifery Science | Location VUmc | Room G-116 | Van der Boechorststraat 7, 1081 BT Amsterdam T: (0031) (0) 204448196, M: (0031) (0) 621115591 | E: <mailto:[log in to unmask]>[log in to unmask], https://research.vumc.nl/en/persons/ank-de-jonge,  <http://www.amsterdamumc.nl>www.amsterdamumc.nl | www.vumc.nl / <http://www.amc.nl>www.amc.nl 
> 


Ronnie Falcao, LM, MS - homebirth midwife
Mountain View, California, near San Jose, south of San Francisco, CA, USA
[log in to unmask]
http://www.gentlebirth.org/ronnie/index.html


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========================================================================Date:         Mon, 21 Oct 2019 22:59:07 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              "McCourt, Christine" <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         "McCourt, Christine" <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: "[log in to unmask]" <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
Content-Type: multipart/alternative;
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--_000_91A8C308DC484659AE0A83E5D3B4837Bcityacuk_--
========================================================================Date:         Tue, 22 Oct 2019 12:33:17 +1300
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              Pauline Dawson <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         Pauline Dawson <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: "McCourt, Christine" <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
MIME-Version: 1.0
Content-Type: multipart/alternative; boundary="0000000000006d03de0595741cad"
Message-ID:  <[log in to unmask]>

--0000000000006d03de0595741cad
Content-Type: text/plain; charset="UTF-8"
Content-Transfer-Encoding: quoted-printable

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]> 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
>
>
>
>
>
>
>
>
>
> 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] on behalf of [log in to unmask]>
> wrote:
>
>
>
>     CAUTION: This email originated from outside of the organisation. Do
> not click links or open attachments unless you recognise the sender and
> believe the content to be safe.
>
>
>
>
>
>     This is great data!
>
>
>
>     Further to my email though I don't think anyone has found an optimal
> time?
>
>     Am I wrong??
>
>
>
>     Pauline
>
>
>
>     -----Original Message-----
>
>     From: A forum for discussion on midwifery and reproductive health
> research.
>
>
>
>
>     ########################################################################
>
>
>
>     To unsubscribe from the MIDWIFERY-RESEARCH list, click the following
> link:
>
>
> https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=MIDWIFERY-RESEARCH&A=1
>
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<div dir="ltr">Thanks Christine,<div><br></div><div>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.</div><div>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.</div><div><br></div><div>I have found a lot of the things you might want to study here in NZ eg transfer time and BBA aren&#39;t routinely collected in national datasets.</div><div><br></div><div>Fascinating conversation - thank you</div><div><br></div><div>Pauline</div></div><br><div class="gmail_quote"><div dir="ltr" class="gmail_attr">On Tue, Oct 22, 2019 at 11:59 AM McCourt, Christine &lt;<a href="mailto:[log in to unmask]">[log in to unmask]</a>&gt; wrote:<br></div><blockquote class="gmail_quote" style="margin:0px 0px 0px 0.8ex;border-left:1px solid rgb(204,204,204);padding-left:1ex">





<div lang="EN-GB">
<div class="gmail-m_1516652246727221141WordSection1">
<p class="gmail-m_1516652246727221141MsoPlainText">Pauline - to my knowledge no, and it would be a rather challenging thing to research.
<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><u></u> <u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><span>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.<u></u><u></u></span></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><span>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. <u></u><u></u></span></p>
<p class="gmail-m_1516652246727221141p1"><span style="font-size:11pt;font-family:Calibri,sans-serif">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.<u></u><u></u></span></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><span><u></u> <u></u></span></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><span>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.<u></u><u></u></span></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><span><u></u> <u></u></span></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><span>The key source with details on transfers from Birthplace is this follow-on analysis paper:<u></u><u></u></span></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><span><u></u> <u></u></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size:11pt">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
<a href="http://www.biomedcentral.com/1471-2393/13/224" target="_blank">http://www.biomedcentral.com/1471-2393/13/224</a><u></u><u></u></span></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><span><u></u> <u></u></span></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><span><u></u> <u></u></span></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><u></u> <u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><u></u> <u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">On 21/10/2019, 19:54, &quot;A forum for discussion on midwifery and reproductive health research. on behalf of Pauline Dawson&quot; &lt;<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a> on behalf of <a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>&gt; wrote:<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText"><u></u> <u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    CAUTION: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and believe the content to be safe.<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    <u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    <u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    This is great data!<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    <u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    Further to my email though I don&#39;t think anyone has found an optimal time?<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    Am I wrong??<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    <u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    Pauline<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    <u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    -----Original Message-----<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    From: A forum for discussion on midwifery and reproductive health research.<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    <u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    ########################################################################<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    <u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    To unsubscribe from the MIDWIFERY-RESEARCH list, click the following link:<u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    <a href="https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=MIDWIFERY-RESEARCH&amp;A=1" target="_blank">https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=MIDWIFERY-RESEARCH&amp;A=1</a><u></u><u></u></p>
<p class="gmail-m_1516652246727221141MsoPlainText">    <u></u><u></u></p>
</div>
</div>

</blockquote></div>
<br>
<hr>
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</p>

--0000000000006d03de0595741cad--
========================================================================Date:         Tue, 22 Oct 2019 06:08:15 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              "Sandall, Jane" <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         "Sandall, Jane" <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: Pauline Dawson <[log in to unmask]>
Comments: cc: Homer Caroline <[log in to unmask]>,
          Scarf Vanessa <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
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Cg=--_000_A1321D6C5D3A401AACC6D9B315620950kclacuk_--
========================================================================Date:         Tue, 22 Oct 2019 08:42:34 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              "McCourt, Christine" <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         "McCourt, Christine" <[log in to unmask]>
Subject:      Re: distance to hospital
In-Reply-To:  <[log in to unmask]>
Content-Type: multipart/alternative;
              boundary="_000_20DF3B9B2725435487659D880A68223Fcityacuk_"
MIME-Version: 1.0
Message-ID:  <[log in to unmask]>

--_000_20DF3B9B2725435487659D880A68223Fcityacuk_
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DQo--_000_20DF3B9B2725435487659D880A68223Fcityacuk_--
========================================================================Date:         Tue, 22 Oct 2019 21:50:27 +1300
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              Pauline Dawson <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         Pauline Dawson <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: "McCourt, Christine" <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
MIME-Version: 1.0
Content-Type: multipart/alternative; boundary="0000000000000a88cf05957be58c"
Message-ID:  <[log in to unmask]>

--0000000000000a88cf05957be58c
Content-Type: text/plain; charset="UTF-8"
Content-Transfer-Encoding: quoted-printable

Christine

A primary rural maternity unit is a lot less risky than being born in a
private car on the side of the road. BBAs rise hugely when these units
close and that's not good for anyone except the accountants. And that's
only if they are considering short term costs.

Sorry.. getting away from the original question here. I'm just doing some
work for a remote rural community whose unit has recently closed.

Pauline

On Tue, 22 Oct 2019, 21:43 McCourt, Christine, <
[log in to unmask]> wrote:

> 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
>
>
>
> *CAUTION:* This email originated from outside of the organisation. Do not
> click links or open attachments unless you recognise the sender and believe
> the content to be safe.
>
>
>
> 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
>
> [log in to unmask]
>
>
>
>
>
> 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]> 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] on behalf of [log in to unmask]>
> wrote:
>
>
>
>     CAUTION: This email originated from outside of the organisation. Do
> not click links or open attachments unless you recognise the sender and
> believe the content to be safe.
>
>
>
>
>
>     This is great data!
>
>
>
>     Further to my email though I don't think anyone has found an optimal
> time?
>
>     Am I wrong??
>
>
>
>     Pauline
>
>
>
>     -----Original Message-----
>
>     From: A forum for discussion on midwifery and reproductive health
> research.
>
>
>
>
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<div dir="auto">Christine<div dir="auto"><br></div><div dir="auto">A primary rural maternity unit is a lot less risky than being born in a private car on the side of the road. BBAs rise hugely when these units close and that&#39;s not good for anyone except the accountants. And that&#39;s only if they are considering short term costs.</div><div dir="auto"><br></div><div dir="auto">Sorry.. getting away from the original question here. I&#39;m just doing some work for a remote rural community whose unit has recently closed.</div><div dir="auto"><br></div><div dir="auto">Pauline</div></div><br><div class="gmail_quote"><div dir="ltr" class="gmail_attr">On Tue, 22 Oct 2019, 21:43 McCourt, Christine, &lt;<a href="mailto:[log in to unmask]">[log in to unmask]</a>&gt; wrote:<br></div><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex">





<div lang="EN-GB" link="blue" vlink="purple">
<div class="m_-6894932002835547994WordSection1">
<p class="MsoNormal"><span>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.
<u></u><u></u></span></p>
<p class="MsoNormal"><span><u></u> <u></u></span></p>
<div>
<div>
<div>
<div>
<div>
<p class="MsoNormal"><span style="color:black"> 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, &amp; enhanced maternal safety) on the basis that their local unit is small and rural.<u></u><u></u></span></p>
<p class="MsoNormal"><span style="color:black"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="color:black">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.)<u></u><u></u></span></p>
<p class="MsoNormal"><span style="color:black"><u></u><u></u></span></p>
<p class="MsoNormal"><span style="color:black"><u></u> <u></u></span></p>
</div>
</div>
</div>
</div>
</div>
<p class="MsoNormal"><span><u></u> <u></u></span></p>
<div style="border:none;border-top:solid #b5c4df 1.0pt;padding:3.0pt 0cm 0cm 0cm">
<p class="MsoNormal"><b><span style="font-size:12.0pt;color:black">From: </span></b><span style="font-size:12.0pt;color:black">&quot;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&quot; &lt;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&gt; on behalf of &quot;Sandall, Jane&quot; &lt;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&gt;<br>
<b>Reply to: </b>&quot;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&quot; &lt;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&gt;, &quot;Sandall, Jane&quot; &lt;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&gt;<br>
<b>Date: </b>Tuesday, 22 October 2019 at 07:09<br>
<b>To: </b>&quot;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&quot; &lt;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&gt;<br>
<b>Subject: </b>Re: distance to hospital<u></u><u></u></span></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div style="border:solid #9c6500 1.0pt;padding:2.0pt 2.0pt 2.0pt 2.0pt">
<p class="MsoNormal" style="line-height:12.0pt;background:#ffeb9c"><b><span style="font-size:10.0pt;color:#9c6500">CAUTION:</span></b><span style="font-size:10.0pt;color:black"> This email originated from outside of the organisation. Do not click links or open
 attachments unless you recognise the sender and believe the content to be safe.<u></u><u></u></span></p>
</div>
<p class="MsoNormal"><u></u> <u></u></p>
<div>
<p class="MsoNormal">Is there anything in Australian birthplace?  <u></u><u></u></p>
<div>
<p class="MsoNormal" style="margin-bottom:12.0pt">Jane sandall <u></u><u></u></p>
<div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal">Please text me for urgent contact 07713743150<u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:13.0pt">Sent from my iPhone</span><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal">Professor Jane Sandall<u></u><u></u></p>
</div>
<div>
<p class="MsoNormal">King’s College, London<u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
</div>
<div>
<p class="MsoNormal"><br>
<br>
<u></u><u></u></p>
<blockquote style="margin-top:5.0pt;margin-bottom:5.0pt">
<p class="MsoNormal" style="margin-bottom:12.0pt">On 22 Oct 2019, at 00:33, Pauline Dawson &lt;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&gt; wrote:<u></u><u></u></p>
</blockquote>
</div>
<blockquote style="margin-top:5.0pt;margin-bottom:5.0pt">
<div>
<div>
<p class="MsoNormal">Thanks Christine, <u></u><u></u></p>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal">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.<u></u><u></u></p>
</div>
<div>
<p class="MsoNormal">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.<u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal">I have found a lot of the things you might want to study here in NZ eg transfer time and BBA aren&#39;t routinely collected in national datasets.<u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal">Fascinating conversation - thank you<u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal">Pauline<u></u><u></u></p>
</div>
</div>
<p class="MsoNormal"><u></u> <u></u></p>
<div>
<div>
<p class="MsoNormal">On Tue, Oct 22, 2019 at 11:59 AM McCourt, Christine &lt;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&gt; wrote:<u></u><u></u></p>
</div>
<blockquote style="border:none;border-left:solid #cccccc 1.0pt;padding:0cm 0cm 0cm 6.0pt;margin-left:4.8pt;margin-right:0cm">
<div>
<div>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">Pauline - to my knowledge no, and it would be a rather challenging thing to research.
<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext"> <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">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.<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">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. <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141p1">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.<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext"> <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">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.<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext"> <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">The key source with details on transfers from Birthplace is this follow-on analysis paper:<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext"> <u></u><u></u></p>
<p class="MsoNormal"><span lang="EN-US">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
<a href="https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.biomedcentral.com%2F1471-2393%2F13%2F224&amp;data=01%7C01%7Cjane.sandall%40KCL.AC.UK%7C9e2d0cef8d0d4f4deedd08d7567f16f6%7C8370cf1416f34c16b83c724071654356%7C0&amp;sdata=rR9%2FMoWN8psoImUr0%2Fz5qmeZaQSx9Rk6rXQNbiv1DnI%3D&amp;reserved=0" target="_blank" rel="noreferrer">
http://www.biomedcentral.com/1471-2393/13/224</a></span><u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext"> <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext"> <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext"> <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext"> <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">On 21/10/2019, 19:54, &quot;A forum for discussion on midwifery and reproductive health research. on behalf of Pauline Dawson&quot; &lt;<a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>
 on behalf of <a href="mailto:[log in to unmask]" target="_blank" rel="noreferrer">[log in to unmask]</a>&gt; wrote:<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext"> <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    CAUTION: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and believe the content to be safe.<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    This is great data!<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    Further to my email though I don&#39;t think anyone has found an optimal time?<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    Am I wrong??<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    Pauline<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    -----Original Message-----<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    From: A forum for discussion on midwifery and reproductive health research.<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    <u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    ########################################################################<u></u><u></u></p>
<p class="m_-6894932002835547994gmail-m1516652246727221141msoplaintext">    <u></u><u></u></p>
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</blockquote>
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<p class="MsoNormal"><u></u> <u></u></p>
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<p class="MsoNormal"><u></u> <u></u></p>
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--0000000000000a88cf05957be58c--
========================================================================Date:         Tue, 22 Oct 2019 08:58:35 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              Ellen Blix <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         Ellen Blix <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: Pauline Dawson <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
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========================================================================Date:         Tue, 22 Oct 2019 11:16:32 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              Trixie McAree <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         Trixie McAree <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: Pauline Dawson <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
Content-Type: multipart/alternative;
              boundary="_000_A18ACD171B40452087D21CAB98DFE9FAbcuacuk_"
MIME-Version: 1.0
Message-ID:  <[log in to unmask]>

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--_000_A18ACD171B40452087D21CAB98DFE9FAbcuacuk_--
========================================================================Date:         Tue, 22 Oct 2019 11:54:17 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              "Macfarlane, Alison" <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         "Macfarlane, Alison" <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: Trixie McAree <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
Content-Type: multipart/alternative;
              boundary="_000_CWXP265MB000629F8BEF3E1429A706F16F6680CWXP265MB0006GBRP_"
MIME-Version: 1.0
Message-ID:  <[log in to unmask]>

--_000_CWXP265MB000629F8BEF3E1429A706F16F6680CWXP265MB0006GBRP_
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========================================================================Date:         Tue, 22 Oct 2019 12:38:31 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              "McCourt, Christine" <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         "McCourt, Christine" <[log in to unmask]>
Subject:      Re: distance to hospital
In-Reply-To:  <[log in to unmask]>
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MIME-Version: 1.0
Message-ID:  <[log in to unmask]>

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--_004_178B17DBC35D4848A6F28390B56ABC6Bcityacuk_--
========================================================================Date:         Tue, 22 Oct 2019 09:02:58 -0400
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              Patricia Burkhardt <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         Patricia Burkhardt <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: "McCourt, Christine" <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
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We recently had to address this topic in New York State
 as the Dept of Health was writing regulations for the Midwifery 
Led birth centers law that passed. A myth that surfaced 
was how quickly things are done in hospital. As was pointed out
It’s not just getting to the place but getting the care.  Is there
any data for in-hospital timing of needed care?  Pat

Sent from my iPhone

> On Oct 22, 2019, at 8:38 AM, McCourt, Christine <[log in to unmask]> wrote:
> 
> Trixie
>  
> It’s worth having a look at how care is provided in Wales as a model that works well. I can’t point you to a publication on this but Billie Hunter or Marie Lewis probably could.
>  Also, do look at the CMU studies from Scotland.
>  
> Regarding place of birth and rurality, as said earlier, the majority of freestanding midwifery units were in fact in rural areas like this. Also – re continuity -  take a look at the follow-up AMU study report as although this was mainly focused on AMU organisation and experience, we discussed how a number of services were developing integrated community or caseload and MU midwifery staffing  - still with core MU staff but with caseload or community team midwives having the MU as a base and providing cover for home births and back up for MU births – that kind of thing.
>  
> Link here: Bit.ly/amustudy
> Or http://www.journalslibrary.nihr.ac.uk/hsdr/volume-2/issue-7     
>  
> The main report of the MU study, led by Denis Walsh will be coming out soon. This looked at issues affecting uptake of MUs in England since the new guidelines were produced. As a sub-study to this project, we did an analysis of media reporting on closure of FMUs, as a number had closed in the period prior to the study. The aim was in part of learn more about prevailing discourse in relation to these units and how this might be affecting uptake or closures. We found a significant lack of awareness or reporting of the evidence – clinically or economically and media reporting was dominated by press release written by agencies that were proposing closure. Dissenting voices focused on the community impact and with some discussion about the risks to women of giving birth en-route to hospital, but these voices (mainly women and politicians) were cast in a less powerful position. You can find the paper via this link:
>  
> Rayment, J., McCourt, C., Scanlon, M., Culley, L., Spiby, H., Bishop, S., de Lima, L.A. An analysis of media reporting on the closure of freestanding midwifery units in England. Women and Birth: https://doi.org/10.1016/j.wombi.2018.12.012
>  
> In the earlier Birthplace Organisational Case Studies we found that in our more rural case study areas, the rates of unplanned home birth were higher than those of planned homebirth owing to distance to get to hospital (a kind of transfer that tends not to get counted as women have to do it themselves). This is not the case in all areas though – there are some excellent models too. Some of the issues in relation to providing an adequate service to support home birth were published here:
>  
> McCourt C, Rance S, Rayment J, Sandall J. Organisational Strategies And Midwives' Readiness To Provide Care For Out Of Hospital Births: An Analysis From The Birthplace Organisational Case Studies. Midwifery, Special Issue: Place of Birth, 2012.
> http://dx.doi.org/10.1016/j.midw.2012.07.004
> I think some areas have improved their organization to support home birth since then, especially through caseload or homebirth teams, but in many areas I don’t see signs of improvement and that is reflected in the most recent National Maternity and Perinatal Audit.
>  
>  
>  
>  
> Christine McCourt
> Professor of Maternal Health & Centre Lead
> Centre for Maternal & Child Health Research
> School of Health Sciences
> City, University of London
> 1 Myddelton Street
> London EC1R 1UW
>  
> Tel: 0207 040 5863
> Mob: 0791 235 1476
> Twitter: @ProfMcCourt
>  
> 
> Centre for Maternal and Child Health Research | City ...
> The Centre for Maternal and Child Health Research carries out high quality research that aims to improve the health and care of women, children, families and communities.
> Read more...
>  
>  
> Want to further your clinical and academic career? To find out more about City, University of London’s MSc Advanced Practice Midwifery programme please click here.
>  
>  
>  
> <image001.jpg>
>  
>  
>  
>  
> From: "[log in to unmask]" <[log in to unmask]> on behalf of Trixie McAree <[log in to unmask]>
> Reply to: "[log in to unmask]" <[log in to unmask]>, Trixie McAree <[log in to unmask]>
> Date: Tuesday, 22 October 2019 at 12:16
> To: "[log in to unmask]" <[log in to unmask]>
> Subject: Re: distance to hospital
>  
> CAUTION: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and believe the content to be safe.
>  
> I would be very interested to hear about work done for rural communities, I am frequently asked about are there quantifiable additional risks for them. This is in regard to CoC in England, Cornwall, Devon, Lincolnshire versus working  London or Birmingham where it takes an hour to travel a mile (not quite) due to traffic.
> Are there any definitive facts for me to talk about, or papers to refer to?
> Thanks
> Trixie
> 
> Professor Trixie McAree
>  
> Professor of Midwifery and Maternal Health
> City South Campus
> Birmingham City University
> B15 3TN
> 0121 3316196
>  
> Birmingham Womens and Childrens NHS Foundation Trust
> Mobil: 07894802961
>  Https://orchid.org/0000-0001-7845-2195
>  
> 
> On 22 Oct 2019, at 09:51, Pauline Dawson <[log in to unmask]> wrote:
> 
> Christine
>  
> A primary rural maternity unit is a lot less risky than being born in a private car on the side of the road. BBAs rise hugely when these units close and that's not good for anyone except the accountants. And that's only if they are considering short term costs.
>  
> Sorry.. getting away from the original question here. I'm just doing some work for a remote rural community whose unit has recently closed.
>  
> Pauline
>  
> On Tue, 22 Oct 2019, 21:43 McCourt, Christine, <[log in to unmask]> wrote:
> 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
>  
> CAUTION: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and believe the content to be safe.
>  
> 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
> [log in to unmask]
>  
>  
> 
> 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]> 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
>  
> 
>  
> 
>  
> 
>  
> 
> 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] on behalf of [log in to unmask]> wrote:
> 
>  
> 
>     CAUTION: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and believe the content to be safe.
> 
>    
> 
>     
> 
>     This is great data!
> 
>    
> 
>     Further to my email though I don't think anyone has found an optimal time?
> 
>     Am I wrong??
> 
>    
> 
>     Pauline
> 
>    
> 
>     -----Original Message-----
> 
>     From: A forum for discussion on midwifery and reproductive health research.
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<html><head><meta http-equiv="content-type" content="text/html; charset=utf-8"></head><body dir="auto">We recently had to address this topic in New York State<div>&nbsp;as the Dept of Health was writing regulations for the Midwifery&nbsp;</div><div>Led birth centers law that passed. A myth that surfaced&nbsp;</div><div>was how quickly things are done in hospital. As was pointed out</div><div>It’s not just getting to the place but getting the care. &nbsp;Is there</div><div>any data for in-hospital timing of needed care? &nbsp;Pat<br><br><div id="AppleMailSignature" dir="ltr">Sent from my iPhone</div><div dir="ltr"><br>On Oct 22, 2019, at 8:38 AM, McCourt, Christine &lt;<a href="mailto:[log in to unmask]">[log in to unmask]</a>&gt; wrote:<br><br></div><blockquote type="cite"><div dir="ltr">

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<p class="MsoNormal"><span style="mso-fareast-language:EN-US">Trixie <o:p></o:p></span></p>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US"><o:p>&nbsp;</o:p></span></p>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US">It’s worth having a look at how care is provided in Wales as a model that works well. I can’t point you to a publication on this but Billie Hunter or Marie Lewis probably could.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US">&nbsp;Also, do look at the CMU studies from Scotland.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US"><o:p>&nbsp;</o:p></span></p>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US">Regarding place of birth and rurality, as said earlier, the majority of freestanding midwifery units were in fact in rural areas like this. Also – re continuity - &nbsp;take a look at the follow-up AMU
 study report as although this was mainly focused on AMU organisation and experience, we discussed how a number of services were developing integrated community or caseload and MU midwifery staffing&nbsp; - still with core MU staff but with caseload or community
 team midwives having the MU as a base and providing cover for home births and back up for MU births – that kind of thing.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US"><o:p>&nbsp;</o:p></span></p>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US">Link here: </span><b><span lang="EN-US"><a href="http://Bit.ly/amustudy">Bit.ly/amustudy</a></span></b><b><span lang="EN-US"><o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US">Or </span><span lang="EN-US"><a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__www.journalslibrary.nihr.ac.uk_hsdr_volume-2D2_issue-2D7&amp;d=DwMGaQ&amp;c=slrrB7dE8n7gBJbeO0g-IQ&amp;r=-J1OUHafr7BSZ3jmXk6aSw&amp;m=Se2Mk1A7TabNZQrhMkoG6buQDtH0gmovq8sp1YB2fAg&amp;s=qkQRjBafymZSHsrE4RxD24ixSGlxBZYO2UfBdE2uy00&amp;e=">http://www.journalslibrary.nihr.ac.uk/hsdr/volume-2/issue-7</a><span style="color:#18376A">
</span><span style="color:#FB0007">&nbsp;</span>&nbsp;&nbsp;&nbsp;</span><span lang="EN-US"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="mso-fareast-language:EN-US">The main report of the MU study, led by Denis Walsh will be coming out soon. This looked at issues affecting uptake of MUs in England since the new guidelines were produced. As a sub-study to this
 project, we did an analysis of media reporting on closure of FMUs, as a number had closed in the period prior to the study. The aim was in part of learn more about prevailing discourse in relation to these units and how this might be affecting uptake or closures.
 We found a significant lack of awareness or reporting of the evidence – clinically or economically and media reporting was dominated by press release written by agencies that were proposing closure. Dissenting voices focused on the community impact and with
 some discussion about the risks to women of giving birth en-route to hospital, but these voices (mainly women and politicians) were cast in a less powerful position. You can find the paper via this link:<o:p></o:p></span></p>
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<h1><span style="font-size:11.0pt;font-family:&quot;Calibri&quot;,sans-serif;font-weight:normal">Rayment, J., McCourt, C., Scanlon, M., Culley, L., Spiby, H., Bishop, S., de Lima, L.A.
<span class="title-text">An analysis of media reporting on the closure of freestanding midwifery units in England. Women and Birth:
</span></span><span style="font-size:11.0pt;font-family:&quot;Calibri&quot;,sans-serif"><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__doi.org_10.1016_j.wombi.2018.12.012&amp;d=DwMGaQ&amp;c=slrrB7dE8n7gBJbeO0g-IQ&amp;r=-J1OUHafr7BSZ3jmXk6aSw&amp;m=Se2Mk1A7TabNZQrhMkoG6buQDtH0gmovq8sp1YB2fAg&amp;s=d1xdepB3SiVwe_Ne1jTHL3MQsPSM1kpruhtwrMI3D74&amp;e=">https://doi.org/10.1016/j.wombi.2018.12.012</a><o:p></o:p></span></h1>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US"><o:p>&nbsp;</o:p></span></p>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US">In the earlier Birthplace Organisational Case Studies we found that in our more rural case study areas, the rates of unplanned home birth were higher than those of planned homebirth owing to distance
 to get to hospital (a kind of transfer that tends not to get counted as women have to do it themselves). This is not the case in all areas though – there are some excellent models too. Some of the issues in relation to providing an adequate service to support
 home birth were published here:<o:p></o:p></span></p>
<p class="MsoNormal"><span style="mso-fareast-language:EN-US"><o:p>&nbsp;</o:p></span></p>
<p class="MsoNormal" style="text-autospace:none">McCourt C, Rance S, Rayment J, Sandall J.
<span lang="EN-US">Organisational Strategies And Midwives' Readiness To Provide Care For Out Of Hospital Births: An Analysis From The Birthplace Organisational Case Studies. Midwifery, Special Issue: Place of Birth</span>, 2012.
<span lang="EN-US"><o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span lang="EN-US"><a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__dx.doi.org_10.1016_j.midw.2012.07.004&amp;d=DwMGaQ&amp;c=slrrB7dE8n7gBJbeO0g-IQ&amp;r=-J1OUHafr7BSZ3jmXk6aSw&amp;m=Se2Mk1A7TabNZQrhMkoG6buQDtH0gmovq8sp1YB2fAg&amp;s=rMoh77TjLniq9g-S--ToWhoaX6K5OzlhaLkFPA4Vlmc&amp;e="><span style="color:#0000E9">http://dx.doi.org/10.1016/j.midw.2012.07.004</span></a><o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span lang="EN-US">I think some areas have improved their organization to support home birth since then, especially through caseload or homebirth teams, but in many areas I don’t see signs of improvement and
 that is reflected in the most recent National Maternity and Perinatal Audit. <o:p>
</o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.5pt;color:black">Christine McCourt<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.5pt;color:black">Professor of Maternal Health &amp; Centre Lead<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.5pt;color:black">Centre for Maternal &amp; Child Health Research<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-family:&quot;Times New Roman&quot;,serif;color:#1F497D"><a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__www.city.ac.uk_health&amp;d=DwMGaQ&amp;c=slrrB7dE8n7gBJbeO0g-IQ&amp;r=-J1OUHafr7BSZ3jmXk6aSw&amp;m=Se2Mk1A7TabNZQrhMkoG6buQDtH0gmovq8sp1YB2fAg&amp;s=cQ6guxBGvbxF1gEPIiyJm479CXUdj659N3G95rl4EM0&amp;e="><span style="color:purple">School of Health Sciences</span></a></span><span style="font-family:&quot;Times New Roman&quot;,serif;color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.5pt;color:black">City, University of London<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.5pt;color:black">1 Myddelton Street<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.5pt;color:black">London EC1R 1UW<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.5pt;color:black;background:#FFFEFE">Tel: 0207 040 5863
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<p class="MsoNormal"><span style="font-size:10.5pt;color:black;background:#FFFEFE">Mob: 0791 235 1476</span><span style="font-size:10.5pt;color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="color:black">Twitter: @ProfMcCourt<o:p></o:p></span></p>
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<p class="MsoNormal"><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__blogs.city.ac.uk_mchresearch_&amp;d=DwMGaQ&amp;c=slrrB7dE8n7gBJbeO0g-IQ&amp;r=-J1OUHafr7BSZ3jmXk6aSw&amp;m=Se2Mk1A7TabNZQrhMkoG6buQDtH0gmovq8sp1YB2fAg&amp;s=qzleaOhhgqNjjqw7zDL_3VoSlSLeN6o_D8qNvZnCw5Q&amp;e=" target="_blank"><span style="text-decoration:none"><img border="0" width="250" height="156" style="width:2.6041in;height:1.625in" id="_x0000_i1031" src="https://blogs.city.ac.uk/mchresearch/files/2015/06/cute-newborn-babycute-newborn-babies-21k444f-624x390.jpg" alt="ps://blogs.city.ac.uk/mchresearch/files/2015/06/cute-newborn-babycute-newborn-babies-21k444f-624x390.j"></span></a><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:16.0pt;font-family:&quot;Segoe UI Semilight&quot;,serif;color:#333333">Centre for Maternal and Child Health Research | City ...</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:&quot;Segoe UI&quot;,serif;color:#666666">The Centre for Maternal and Child Health Research carries out high quality research that aims to improve the health and care of women, children, families and communities.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="color:black"><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__blogs.city.ac.uk_mchresearch_&amp;d=DwMGaQ&amp;c=slrrB7dE8n7gBJbeO0g-IQ&amp;r=-J1OUHafr7BSZ3jmXk6aSw&amp;m=Se2Mk1A7TabNZQrhMkoG6buQDtH0gmovq8sp1YB2fAg&amp;s=qzleaOhhgqNjjqw7zDL_3VoSlSLeN6o_D8qNvZnCw5Q&amp;e=" target="_blank"><span style="font-size:8.5pt;font-family:&quot;Segoe UI&quot;,serif;color:#954F72">Read more...</span></a></span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:11.5pt;font-family:&quot;Comic Sans MS&quot;;color:#1F497D">Want to further your clinical and academic career? To find out more about City, University of London’s MSc Advanced Practice Midwifery programme please click&nbsp;</span><span style="font-size:10.5pt;color:black"><a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__www.city.ac.uk_courses_postgraduate_advanced-2Dpractice-2Din-2Dhealth-2Dand-2Dsocial-2Dcare-2Dmidwifery-23course-2Ddetail-3D0&amp;d=DwMGaQ&amp;c=slrrB7dE8n7gBJbeO0g-IQ&amp;r=-J1OUHafr7BSZ3jmXk6aSw&amp;m=Se2Mk1A7TabNZQrhMkoG6buQDtH0gmovq8sp1YB2fAg&amp;s=dM8gEfzLDJYc-ntWZ2Ir_vZ3II8Cu2gKXFSCDGXjuAk&amp;e="><span style="font-size:11.5pt;font-family:&quot;Comic Sans MS&quot;;color:purple">here</span></a></span><span style="font-size:11.5pt;font-family:&quot;Comic Sans MS&quot;;color:#1F497D">.</span><span style="font-size:10.5pt;color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:12.0pt;color:black">From: </span></b><span style="font-size:12.0pt;color:black">"<a href="mailto:[log in to unmask]">[log in to unmask]</a>" &lt;<a href="mailto:[log in to unmask]">[log in to unmask]</a>&gt; on behalf of Trixie McAree &lt;<a href="mailto:[log in to unmask]">[log in to unmask]</a>&gt;<br>
<b>Reply to: </b>"<a href="mailto:[log in to unmask]">[log in to unmask]</a>" &lt;<a href="mailto:[log in to unmask]">[log in to unmask]</a>&gt;, Trixie McAree &lt;<a href="mailto:[log in to unmask]">[log in to unmask]</a>&gt;<br>
<b>Date: </b>Tuesday, 22 October 2019 at 12:16<br>
<b>To: </b>"<a href="mailto:[log in to unmask]">[log in to unmask]</a>" &lt;<a href="mailto:[log in to unmask]">[log in to unmask]</a>&gt;<br>
<b>Subject: </b>Re: distance to hospital<o:p></o:p></span></p>
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<p class="MsoNormal" style="line-height:12.0pt;background:#FFEB9C"><b><span style="font-size:10.0pt;color:#9C6500">CAUTION:</span></b><span style="font-size:10.0pt;color:black"> This email originated from outside of the organisation. Do not click links or open
 attachments unless you recognise the sender and believe the content to be safe.<o:p></o:p></span></p>
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<p class="MsoNormal">I would be very interested to hear about work done for rural communities, I am frequently asked about are there quantifiable additional risks for them. This is in regard to CoC in England, Cornwall, Devon, Lincolnshire versus working &nbsp;London
 or Birmingham where it takes an hour to travel a mile (not quite) due to traffic.
<o:p></o:p></p>
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<p class="MsoNormal">Are there any definitive facts for me to talk about, or papers to refer to?<o:p></o:p></p>
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<p class="MsoNormal">Thanks<o:p></o:p></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt">Trixie<o:p></o:p></p>
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<p class="MsoNormal"><b>Professor Trixie McAree</b><o:p></o:p></p>
<p class="MsoNormal"><o:p>&nbsp;</o:p></p>
<p class="MsoNormal"><b>Professor of Midwifery and Maternal Health</b><o:p></o:p></p>
<p class="MsoNormal">City South Campus<o:p></o:p></p>
<p class="MsoNormal"><b>Birmingham City University</b><o:p></o:p></p>
<p class="MsoNormal">B15 3TN<o:p></o:p></p>
<p class="MsoNormal"><span style="color:black"><a href="tel:0121%203316085">0121 331</a>6196</span><o:p></o:p></p>
<p class="MsoNormal"><o:p>&nbsp;</o:p></p>
<p class="MsoNormal"><b>Birmingham Womens and Childrens NHS Foundation Trust</b><o:p></o:p></p>
<p class="MsoNormal">Mobil:&nbsp;<a href="tel:07894802961">07894802961</a><o:p></o:p></p>
<p class="MsoNormal">&nbsp;<a href="https://urldefense.proofpoint.com/v2/url?u=Https-3A__orchid.org_0000-2D0001-2D7845-2D2195&amp;d=DwMGaQ&amp;c=slrrB7dE8n7gBJbeO0g-IQ&amp;r=-J1OUHafr7BSZ3jmXk6aSw&amp;m=Se2Mk1A7TabNZQrhMkoG6buQDtH0gmovq8sp1YB2fAg&amp;s=bWXrUWPRS3p0RGlAxHH2pbY7INDA9u6BdhvUMaIIYyQ&amp;e=">Https://orchid.org/0000-0001-7845-2195</a><o:p></o:p></p>
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On 22 Oct 2019, at 09:51, Pauline Dawson &lt;<a href="mailto:[log in to unmask]">[log in to unmask]</a>&gt; wrote:<o:p></o:p></p>
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<p class="MsoNormal">Christine <o:p></o:p></p>
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<p class="MsoNormal">A primary rural maternity unit is a lot less risky than being born in a private car on the side of the road. BBAs rise hugely when these units close and that's not good for anyone except the accountants. And that's only if they are considering
 short term costs.<o:p></o:p></p>
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<p class="MsoNormal">Sorry.. getting away from the original question here. I'm just doing some work for a remote rural community whose unit has recently closed.<o:p></o:p></p>
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<p class="MsoNormal">Pauline<o:p></o:p></p>
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<p class="MsoNormal">On Tue, 22 Oct 2019, 21:43 McCourt, Christine, &lt;<a href="mailto:[log in to unmask]">[log in to unmask]</a>&gt; wrote:<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">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.
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:black">&nbsp;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, &amp; enhanced maternal safety) on the basis that their local unit is small and rural.</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:black">&nbsp;</span><o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:black">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.)</span><o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><b><span style="font-size:12.0pt;color:black">From:
</span></b><span style="font-size:12.0pt;color:black">"<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>" &lt;<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>&gt;
 on behalf of "Sandall, Jane" &lt;<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>&gt;<br>
<b>Reply to: </b>"<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>" &lt;<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>&gt;, "Sandall, Jane" &lt;<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>&gt;<br>
<b>Date: </b>Tuesday, 22 October 2019 at 07:09<br>
<b>To: </b>"<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>" &lt;<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>&gt;<br>
<b>Subject: </b>Re: distance to hospital</span><o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">&nbsp;<o:p></o:p></p>
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<b><span style="font-size:10.0pt;color:#9C6500">CAUTION:</span></b><span style="font-size:10.0pt;color:black"> This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and believe the content
 to be safe.</span><o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">&nbsp;<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">Is there anything in Australian birthplace?&nbsp;
<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;margin-bottom:12.0pt">Jane sandall&nbsp;<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">&nbsp;<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">Please text me for urgent contact 07713743150<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:13.0pt">Sent from my iPhone</span><o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">Professor Jane Sandall<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">King’s College, London<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a><o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">&nbsp;<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;margin-bottom:12.0pt"><o:p>&nbsp;</o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;margin-bottom:12.0pt">On 22 Oct 2019, at 00:33, Pauline Dawson &lt;<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>&gt; wrote:<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">Thanks Christine,
<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">&nbsp;<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">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.<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">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&nbsp;proxy but again very long distances there. These BBA data are around just getting to ANY maternity facility not transfers.<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">&nbsp;<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">I have found a lot of the things you might want to study here in NZ eg transfer&nbsp;time and BBA aren't routinely collected in national datasets.<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">&nbsp;<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">Fascinating conversation - thank you<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">&nbsp;<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">Pauline<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">&nbsp;<o:p></o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto">On Tue, Oct 22, 2019 at 11:59 AM McCourt, Christine &lt;<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>&gt; wrote:<o:p></o:p></p>
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<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">Pauline - to my knowledge no, and it would be a rather challenging thing to research.
<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">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.<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">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. <o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141p1">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.<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">It seems likely that time to be seen on arrival in a well-functioning system would be related to urgency of reason for transfer.&nbsp; 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.<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">The key source with details on transfers from Birthplace is this follow-on analysis paper:<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;<o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span lang="EN-US">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
<a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__eur03.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Fwww.biomedcentral.com-252F1471-2D2393-252F13-252F224-26data-3D01-257C01-257Cjane.sandall-2540KCL.AC.UK-257C9e2d0cef8d0d4f4deedd08d7567f16f6-257C8370cf1416f34c16b83c724071654356-257C0-26sdata-3DrR9-252FMoWN8psoImUr0-252Fz5qmeZaQSx9Rk6rXQNbiv1DnI-253D-26reserved-3D0&amp;d=DwMGaQ&amp;c=slrrB7dE8n7gBJbeO0g-IQ&amp;r=-J1OUHafr7BSZ3jmXk6aSw&amp;m=Se2Mk1A7TabNZQrhMkoG6buQDtH0gmovq8sp1YB2fAg&amp;s=kQHtCKf81S_FDf9N-DJYO1ixeCc6il5vI9YZID0m_M8&amp;e=" target="_blank">
http://www.biomedcentral.com/1471-2393/13/224</a></span><o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">On 21/10/2019, 19:54, "A forum for discussion on midwifery and reproductive health research. on behalf of Pauline Dawson" &lt;<a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>
 on behalf of <a href="mailto:[log in to unmask]" target="_blank">[log in to unmask]</a>&gt; wrote:<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp; CAUTION: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and believe the content to be safe.<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp; <o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp;&nbsp;<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp;&nbsp;This is great data!<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp; <o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp;&nbsp;Further to my email though I don't think anyone has found an optimal time?<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp; Am I wrong??<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp; <o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp;&nbsp;Pauline<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp; <o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp;&nbsp;-----Original Message-----<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp; From: A forum for discussion on midwifery and reproductive health research.<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp; <o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp;&nbsp;########################################################################<o:p></o:p></p>
<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp; <o:p></o:p></p>
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<p class="m-6894932002835547994gmail-m1516652246727221141msoplaintext">&nbsp;&nbsp;&nbsp; <o:p></o:p></p>
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--Apple-Mail-056E08C4-39A4-4680-B4B3-31CEB4C7BD0C--
========================================================================Date:         Tue, 22 Oct 2019 20:55:00 -0700
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              Ronnie Falcao <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         Ronnie Falcao <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: Patricia Burkhardt <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
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In our area (Bay Area, California), some midwives carry
terbutaline to extend the window of safety in cases where
fetal distress is relieved by reduction of uterine activity.

Is that something that was specifically addressed in
New York or anywhere else?

Thanks,
Ronnie Falcao

At 06:02 AM 10/22/2019, Patricia Burkhardt wrote:
>We recently had to address this topic in New York State
> as the Dept of Health was writing regulations for the Midwifery 
>Led birth centers law that passed. A myth that surfaced 
>was how quickly things are done in hospital. As was pointed out
>It’s not just getting to the place but getting the care.  Is there
>any data for in-hospital timing of needed care?  Pat 


Ronnie Falcao, LM, MS - homebirth midwife
Mountain View, California, near San Jose, south of San Francisco, CA, USA
[log in to unmask]
http://www.gentlebirth.org/ronnie/index.html

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========================================================================Date:         Wed, 23 Oct 2019 06:36:55 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
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Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
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Subject:      FW: [ganm] Summary for 10/22/2019
Comments: To: "[log in to unmask] AC. UK"
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In-Reply-To:  <20191022-20191022@19>
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========================================================================Date:         Wed, 23 Oct 2019 08:34:01 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              "Jonge, J. de (Ank)" <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         "Jonge, J. de (Ank)" <[log in to unmask]>
Subject:      Re: distance to hospital
Comments: To: Ronnie Falcao <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
MIME-Version: 1.0
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Message-ID:  <[log in to unmask]>

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YWRtaW4/U1VCRUQxPU1JRFdJRkVSWS1SRVNFQVJDSCZBPTENCg=========================================================================Date:         Wed, 23 Oct 2019 11:09:32 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              "Darra S." <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         "Darra S." <[log in to unmask]>
Subject:      Opportunity in Australia
Content-Type: multipart/related;
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              type="multipart/alternative"
MIME-Version: 1.0
Message-ID:  <[log in to unmask]>

--_011_CWLP265MB1092149476A8C44BA4993840A36B0CWLP265MB1092GBRP_
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--_011_CWLP265MB1092149476A8C44BA4993840A36B0CWLP265MB1092GBRP_--
========================================================================Date:         Wed, 23 Oct 2019 16:11:32 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              Rena Papadopoulos <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         Rena Papadopoulos <[log in to unmask]>
Subject:      FW: Invitation to participate in a survey about Robots and
              Artificial Intelligence PLEASE FORWARD THIS EMAIL TO YOUR NETWORKS
Comments: To: Nina Castro <[log in to unmask]>,
          Edward Carter <[log in to unmask]>, FoNS <[log in to unmask]>,
          Grace Lapwoch <[log in to unmask]>,
          Helen Hingley-Jones <[log in to unmask]>,
          Helen Kehoe <[log in to unmask]>,
          Julie Hodgins <[log in to unmask]>
In-Reply-To:  <[log in to unmask]>
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========================================================================Date:         Thu, 24 Oct 2019 03:34:59 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              Cecily Begley <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         Cecily Begley <[log in to unmask]>
Subject:      THE conference - Two days to the submission deadline: 25 October
              2019
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Message-ID:  <[log in to unmask]>

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========================================================================Date:         Fri, 25 Oct 2019 07:10:03 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              "Sandall, Jane" <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         "Sandall, Jane" <[log in to unmask]>
Subject:      Fwd: [hifa] Fw: Systematic review methods webinar: 12 November
              2019
Content-Type: multipart/alternative;
              boundary="_000_0D42CBE19A144B27943ADE5F90B3798Ekclacuk_"
MIME-Version: 1.0
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========================================================================Date:         Thu, 31 Oct 2019 00:02:26 +0000
Reply-To:     "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>,
              Penny Haora <[log in to unmask]>
Sender:       "A forum for discussion on midwifery and reproductive health
              research." <[log in to unmask]>
From:         Penny Haora <[log in to unmask]>
Subject:      To Australian midwives: re costs of continuity
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Dear Colleagues,

Does anyone plan to respond to the ABC new piece this morning about the increase in birth trauma being experienced by women?  They mentioned overmedicalisation and it was appropriate that they mentioned continuity of midwifery carer, however, of concern/alarm to me was the follow up comment citing "the AMA states [continuity is] expensive"!

My questions/concerns:

  1.  As a long-term member of the ACM I'd like to know if they were approached for comment?  If not, why?  Do they plan to respond?
  2.  Why does the ABC think the AMA is the authority on maternity care economics (and/or continuity)?
  3.  Can anyone respond with authoritative cost evidence?  Comment on the trauma experienced by Aboriginal and Torres Strait Islander women/families in the maternity services in addition to that experienced by other women?
  4.  Even if the statement is correct that continuity is more expensive in the short term, the cost savings need to be referenced/highlighted...

All in all fake news.  Grateful for a well-supported response, I feel like making a complaint to the ABC...

Best wishes,
Penny

Penny Haora
RM MPH PhD
Building on Our Strengths (BOOSt) Study (Mon - Thurs)
Waminda South Coast Women's Health & Welfare Aboriginal Corporation
Molly Wardaguga Research Centre, College of Nursing & Midwifery, Charles Darwin University
T: +61 2 4421 7400
E: [log in to unmask]<mailto:[log in to unmask]>
W: cdu.edu.au<http://cdu.edu.au/>
[CDU logo]
CHARLES DARWIN UNIVERSITY
Nowra NSW, Australia
CRICOS Provider No. 00300K (NT/VIC) I 03286A (NSW) | RTO Provider No. 0373

Latest paper from the team: Kildea, S., Gao, Y., Hickey, S., Kruske, S., Nelson, C., Blackman, R., Tracy, S., Hurst, C., Williamson, D. & Y. Roe (2019) Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: A prospective cohort study, Brisbane, Australia. EClinical Medicine - A Lancet Publication. [Available online<https://aus01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fprotect-au.mimecast.com%2Fs%2F0tc_C91ZkQtnKNWRTorzBZ%3Fdomain%3Daus01.safelinks.protection.outlook.com&data=02%7C01%7Cpenny.haora%40cdu.edu.au%7Cca557165908244e6550c08d746e97270%7C9f2487678e1a42f3836fc092ab95ff70%7C0%7C0%7C637055840808401213&sdata=96S%2B5mpXswDVyQpqCyTSvdC8DX41ovN44VETv9%2FNeAk%3D&reserved=0>]
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<p class="MsoNormal">Dear Colleagues,<o:p></o:p></p>
<p class="MsoNormal"><o:p>&nbsp;</o:p></p>
<p class="MsoNormal">Does anyone plan to respond to the ABC new piece this morning about the increase in birth trauma being experienced by women?&nbsp; They mentioned overmedicalisation and it was appropriate that they mentioned continuity of midwifery carer, however,
 of concern/alarm to me was the follow up comment citing &#8220;the AMA states [continuity is] expensive&#8221;!
<o:p></o:p></p>
<p class="MsoNormal"><o:p>&nbsp;</o:p></p>
<p class="MsoNormal">My questions/concerns:<o:p></o:p></p>
<ol style="margin-top:0cm" start="1" type="1">
<li class="MsoListParagraph" style="margin-left:0cm;mso-list:l0 level1 lfo1">As a long-term member of the ACM I&#8217;d like to know if they were approached for comment?&nbsp; If not, why?&nbsp; Do they plan to respond?<o:p></o:p></li><li class="MsoListParagraph" style="margin-left:0cm;mso-list:l0 level1 lfo1">Why does the ABC think the AMA is the authority on maternity care economics (and/or continuity)?<o:p></o:p></li><li class="MsoListParagraph" style="margin-left:0cm;mso-list:l0 level1 lfo1">Can anyone respond with authoritative cost evidence?&nbsp; Comment on the trauma experienced by Aboriginal and Torres Strait Islander women/families in the maternity services in addition
 to that experienced by other women?<o:p></o:p></li><li class="MsoListParagraph" style="margin-left:0cm;mso-list:l0 level1 lfo1">Even if the statement is correct that continuity is more expensive in the short term, the cost savings need to be referenced/highlighted&#8230;
<o:p></o:p></li></ol>
<p class="MsoNormal"><o:p>&nbsp;</o:p></p>
<p class="MsoNormal">All in all fake news.&nbsp; Grateful for a well-supported response, I feel like making a complaint to the ABC&#8230;<o:p></o:p></p>
<p class="MsoNormal"><o:p>&nbsp;</o:p></p>
<p class="MsoNormal">Best wishes,<o:p></o:p></p>
<p class="MsoNormal">Penny<o:p></o:p></p>
<p class="MsoNormal"><o:p>&nbsp;</o:p></p>
<p class="MsoNormal" style="margin-bottom:12.0pt"><b><span style="font-size:12.0pt;color:#6F6F6F;mso-fareast-language:EN-AU">Penny Haora</span></b><span style="font-size:12.0pt;color:#6F6F6F;mso-fareast-language:EN-AU"><br>
<b>RM MPH PhD</b></span><span style="mso-fareast-language:EN-AU"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#767171;mso-fareast-language:EN-AU">Building on Our Strengths (BOOSt) Study (</span><span style="color:red;mso-fareast-language:EN-AU">Mon - Thurs</span><span style="color:#767171;mso-fareast-language:EN-AU">)</span><span style="mso-fareast-language:EN-AU"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#767171;mso-fareast-language:EN-AU">Waminda South Coast Women's Health &amp; Welfare Aboriginal Corporation</span><span style="mso-fareast-language:EN-AU"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#767171;mso-fareast-language:EN-AU">Molly Wardaguga Research Centre, College of Nursing &amp; Midwifery, Charles Darwin University</span><b><span style="font-size:12.0pt;color:#6F6F6F;mso-fareast-language:EN-AU">&nbsp;</span></b><span style="mso-fareast-language:EN-AU"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#6F6F6F;mso-fareast-language:EN-AU">T: &#43;61 2 4421 7400<br>
E:&nbsp;</span><span style="mso-fareast-language:EN-AU"><a href="mailto:[log in to unmask]"><span style="font-size:12.0pt;color:#6F6F6F">[log in to unmask]</span></a></span><span style="font-size:12.0pt;color:#6F6F6F;mso-fareast-language:EN-AU"><br>
W:&nbsp;</span><span style="mso-fareast-language:EN-AU"><a href="http://cdu.edu.au/"><span style="font-size:12.0pt;color:#6F6F6F">cdu.edu.au</span></a></span><span style="font-size:12.0pt;color:#6F6F6F;mso-fareast-language:EN-AU"><br>
</span><span style="font-size:12.0pt;color:black;mso-fareast-language:EN-AU"><img border="0" width="300" height="100" style="width:3.125in;height:1.0416in" id="_x0000_i1027" src="https://apps.cdu.edu.au/sig-files/CDU-THE.png" alt="CDU logo"></span><span style="font-size:12.0pt;color:#6F6F6F;mso-fareast-language:EN-AU">&nbsp;<br>
CHARLES DARWIN UNIVERSITY<br>
Nowra NSW, Australia<br>
</span><span style="font-size:7.5pt;color:#6F6F6F;mso-fareast-language:EN-AU">CRICOS Provider No. 00300K (NT/VIC) I 03286A (NSW) | RTO Provider No. 0373</span><span style="font-size:12.0pt;color:#6F6F6F;mso-fareast-language:EN-AU"><br>
</span><b><span style="font-family:inherit;color:#767171;mso-fareast-language:EN-AU">&nbsp;</span></b><span style="mso-fareast-language:EN-AU"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;background:white">
<b><span style="color:#767171;mso-fareast-language:EN-AU">Latest paper from the team:</span></b><span style="color:#767171;mso-fareast-language:EN-AU">&nbsp;Kildea, S., Gao, Y., Hickey, S., Kruske, S., Nelson, C., Blackman, R., Tracy, S., Hurst, C., Williamson,
 D. &amp; Y. Roe (2019) Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: A prospective cohort study, Brisbane, Australia.&nbsp;<i><span style="background:white">EClinical Medicine &#8211; A Lancet Publication</span></i><span style="background:white">.
 [</span></span><span style="mso-fareast-language:EN-AU"><a href="https://aus01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fprotect-au.mimecast.com%2Fs%2F0tc_C91ZkQtnKNWRTorzBZ%3Fdomain%3Daus01.safelinks.protection.outlook.com&amp;data=02%7C01%7Cpenny.haora%40cdu.edu.au%7Cca557165908244e6550c08d746e97270%7C9f2487678e1a42f3836fc092ab95ff70%7C0%7C0%7C637055840808401213&amp;sdata=96S%2B5mpXswDVyQpqCyTSvdC8DX41ovN44VETv9%2FNeAk%3D&amp;reserved=0" target="_blank" title="Original URL: https://doi.org/10.1016/j.eclinm.2019.06.001. Click or tap if you trust this link."><span style="color:#767171;background:white">Available
 online</span></a><span style="color:#767171;background:white">]</span><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;background:white">
<span style="color:#767171;mso-fareast-language:EN-AU">&nbsp;&nbsp;<img border="0" width="625" height="142" style="width:6.5138in;height:1.4791in" id="x__x005f_x0000_i1032" src="cid:image001.png@01D58FD9.7CD00360" alt="Molly Wardaguga Centre logo"></span><span style="mso-fareast-language:EN-AU"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;background:white">
<span style="color:#767171;mso-fareast-language:EN-AU">Charles Darwin University acknowledges the traditional custodians across the lands on which we live and work, and we pay our respects to Elders both past and present.</span><span style="mso-fareast-language:EN-AU"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white"><span style="color:#201F1E;mso-fareast-language:EN-AU"><img border="0" width="624" height="498" style="width:6.5in;height:5.1875in" id="x__x005f_x0000_i1031" src="cid:image002.png@01D58FD9.7CD00360" alt="cid:210b34e3-f3c3-4616-ac81-6347993c32e5"></span><span style="mso-fareast-language:EN-AU"><o:p></o:p></span></p>
<p class="MsoNormal"><o:p>&nbsp;</o:p></p>
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