Women's preference for place of birth

Knowledge of and preference for the DOMINO delivery option

OBJECTIVE

To examine women's knowledge of and preference for the DOMINO (Domiciliary In and Out) delivery option in order to explain why uptake is lower than might be expected.

DESIGN

Descriptive study using a self completion postal questionnaire.

SETTING

Mid Staffordshire Health Authority (now part of South Staffordshire Health Authority).

SUBJECTS

A systematic random sample of 1568 women aged 16-44 drawn from the Staffordshire Family Health Services Authority register of patients registered with a general practitioner. All women were included, regardless of childbirth experience.

MAIN OUTCOME MEASURES

Preference and knowledge levels for this delivery option.

MAIN FINDINGS

The response rate was 74%. Thirty-nine per cent had heard of the DOMINO option prior to receiving the questionnaire. Sixteen per cent expressed a preference for this option (95% CI 11.1-21.9). Some women who expressed a preference were excluded owing to high risk factors, giving an adjusted preference of 11% (95% CI 5.2-16.4). Preference was not related to either age, pregnancy experience or previous knowledge.

CONCLUSIONS

More women expressed a preference for the option than would be expected from examination of national and local uptake figures. Lack of knowledge appears to be an important factor in explaining the low uptake. Purchasers, therefore, need to set contracts reflecting more realistic preferences and ensure that women have information on all options available to them, so that at the beginning of pregnancy women are enabled to make a shared decision on the choice of delivery. Both purchasers and providers need to monitor uptake and levels of knowledge.

Outcome in low risk pregnancies

AIMS

To determine the obstetric and neonatal outcomes of a cohort of very low risk pregnancies in hospital, that would be suitable for home delivery.

METHODS

A retrospective analysis was undertaken of computerised records covering five years from July 1988 to August 1993 of 32424 pregnant women who delivered at the North Staffordshire Maternity Hospital, Stoke on Trent, during that period.

RESULTS

Of 32424 deliveries, only 1314 (4%) fulfilled our criteria for being low risk. Sixty seven (5.1%) of the low risk group had an operative delivery, with Caesarean section accounting for 32 (2.4%) cases, 16 (23.9%) babies were resuscitated and three were intubated. A normal vaginal delivery occurred in 1245 women, but a paediatrician attended 122 births (9.22%), assisted ventilation was provided in 65 cases (5.2%), and five babies were intubated (0.4%). Fourteen babies in total were admitted to the neonatal unit and one died.

CONCLUSIONS

These results suggest that at least 5% of women suitable for delivery at home will require transfer in labour. Midwives attending home births must be skilled in bag and mask resuscitation as only rarely will an urgent intubation be required. The British Paediatric Association Working Party report on neonatal resuscitation suggests a need for resuscitation in only 0.2% of low risk deliveries: but these findings suggest that the need is greater.