Community obstetric care in West Berkshire.

OBJECTIVE

To assess the effects of a revised obstetric booking policy whereby all low risk pregnant women received their antenatal care entirely in the community.

DESIGN

Comparison of the distribution of antenatal clinic attendances, transfers, and perinatal mortality rates for 1987 and 1989, before and after introduction of the revised policy.

SETTING

West Berkshire Health District.

SUBJECTS

All women who delivered with a registrable birth in the district in 1987 (5817 women) and 1989 (5372).

MAIN OUTCOME MEASURES

Attendances at community and consultant antenatal clinics; bookings transferred from community care to consultant care; perinatal mortality rates.

RESULTS

Of 5372 women delivering in West Berkshire in 1989, 3185 (58.3%) were originally booked for general practitioner-midwife care, of whom 1567 (49.2% of general practitioner-midwife bookings) were transferred to consultant care. 1618 women (30.1% of all women delivered) received their entire obstetric care from general practitioners and midwives. Attendance at hospital antenatal clinics was reduced by 16%. In 1989 the perinatal mortality rates (1987 values) for the district were 6.3 (7.6) per 1000 births overall; 8.2 (8.3) per 1000 consultant bookings; 5.0 (4.7) per 1000 for community bookings; and 10.2 (14.4) per 1000 for women transferred to consultant care.

CONCLUSION

Antenatal care of low risk pregnant women may safely be provided by their general practitioner and midwife.