Midwives to manage uncomplicated childbirth

Role of the consultant obstetrician in the delivery suite

The role of consultant obstetricians is under considerable debate. This has particularly focused on the role of consultants in intrapartum care. The article explores the role of the consultant in delivery suite from the view point of a consultant, a clinical director, a training programme director and a chief executive. These viewpoints determine a range of common themes which mean the duties of consultants over their career lifecycle need to be addressed; the need to expand consultant posts; and the tensions which inevitably occur. The authors believe these need to be addressed because of the need to ensure consultant roles in delivery suite are developed as a key part of seeing quality improvement.

Nurse-midwifery. The beneficial alternative

The number of nurse-midwife-attended births in U.S. hospitals has jumped ten-fold in the last 20 years, rising from just 19,686 in 1975 to 196,977 in 1994. Certified nurse-midwives (CNMs) focus on childbirth as a normal event, emphasizing the educational and psychosocial aspects of care and the judicious use of technological interventions. CNM care appears particularly well suited to help solve two difficult problems in U.S. obstetric care--our country's slow progress in improving the health status of newborns and the excessive use of medical interventions during childbirth. Despite the fact that CNM care has been found to be safe and cost-effective, only a small fraction of those pregnant women who could benefit from CNM care use midwifery services. Lack of consumer awareness is part of the problem, but barriers also exist to accessing CNM services. Sixty-four percent of CNM practices responding to a survey reported practice restrictions, most commonly due to state laws, hospital policies, and inappropriately restrictive physician back-up. One state, Florida, is aggressively promoting the use of CNM care as the standard of practice for healthy pregnant women.

Does midwifery-led intrapartum care require anaesthetic services?

The report of the Expert Maternity Group 'Changing Childbirth' (The Cumberlege Report) advocates a greater role for midwives in the care of the low risk pregnant woman, and has promoted much discussion about the future development of maternity services in the UK. At Leicester Royal Infirmary NHS Trust the 'Home from Home' delivery scheme provides midwifery-led antenatal and intrapartum care of women with uncomplicated pregnancies. We have performed a retrospective review of the requirements for anaesthetic services in this unit. During the 12 month review period 1610 women were admitted to the 'Home from Home' delivery scheme in labour. One hundred and eighty one women subsequently received anaesthetic intervention. Of this group, 137 (77.0%) required an epidural, 17 (9.6%) a spinal, 18 (10.1%) a general anaesthetic, 5 (2.8%) an epidural and a general anaesthetic and 1 (0.6%) an epidural and a spinal. Our results demonstrate that low risk pregnant women in labour being cared for in a midwifery led unit have a considerable need for anaesthesia and analgesia.

Pregnancy care of the low risk woman: the community-hospital interface

Aims to determine the extent to which women suitable for community-based antenatal and intrapartum care will require hospital contact. Reports on an historical cohort study of low risk women who underwent standard shared care and for whom the records for both pregnancy and delivery were complete at The City Hospital and University Hospital, Nottingham. Concludes that the shift to community-based care aims to bring many improvements to the overall care and satisfaction of pregnant women. However, it may not reduce the workload of hospital-based services to a great extent as the majority of women, even if low risk at booking, will require some hospital input at some time during pregnancy or labour.