A local maternity care system in South West England under review.

Since the Cranbrook Report in 1959 there has been a steady increase in the proportion of institutional confinements in England and Wales and a steady decrease in perinatal mortality. This association should not be regarded as evidence of cause and effect nor as justification for continuing the Cranbrook policies for the provision of maternity care throughout the 1970s. Due weight must be given to other factors, including improvements in the general health and education of the population and advances in standards of medical care affecting all parts of the maternity services. The present study examines current performance of a local maternity care system and analyzes some 3700 confinements which took place in a Health Care District (formerly a Hospital Management Committee area) in South West England during 1970. The local resources consisted of a consultant obstetric unit, a Special Care Baby Unit, five general practitioner units and the associated medical and nursing staff, and two Local Authority domiciliary midwife services. An expectant mother may call upon a variety of resources in pregnancy, during delivery, and in the puerperium. The concept is developed of the "stream" of care received by the mother and the case histories are analyzed in these terms. The deliveries are classified in terms of nonintervention and intervention at delivery. Perinatal mortality is not in itself an adequate measure of the overall performance of a local maternity care system so other performance indices are used. These are based upon the extent to which the resources available diverge between booking and actual usage. Results obtained indicate that existing policies may be less than optimal and alternatives ought to be considered.