© 1995 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
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Safety and place of birth in Scotland
Susan K. Cole, Consultant in Public Health Medicine
Alison Macfarlane, Medical Statistician
Scottish Health Services Common Services Agency, Information and Statistics Division Trinity Park House, South Trinity Road, Edinburgh EH5 3SQ
National Perinatal Epidemiology Unit, Radcliffe Infirmary Oxford OX2 6HE
BACKGROUND: The recent publication of policies suggesting women should have choice about where they give birth prompted a comparison of stillbirth and neonatal mortality rates for three types of maternity unit in relation to changes in booking and place of delivery.
METHODS: Scottish Maternity Discharge records and data from stillbirth and neonatal death reports for Scotland were used to analyse stillbirth and neonatal mortality rates according to the level of care, birthweight and cause of death for the years 1986–1990.
RESULTS: For those categories of stillbirths and neonatal deaths which are amenable to prevention by perinatal care, intrapartum stillbirth rates were higher in general practitioner (GP) units than in consultant units, but these accounted for only 11 stillbirths and the difference is compatible with chance variation. Neonatal mortality among babies weighting 2500 g or more was independent of type of hospital. Among babies weighing under 1500 g or 1500–2499 g, neonatal mortality was significantly higher in non-teaching hospitals than in teaching hospitals.
CONCLUSIONS: Although the differences are compatible with chance variation, there is some suggestion that small GP hospitals might have higher rates of intrapartum stillbirths and such rates should be monitored. Provided that there are no barriers to transfer to hospitals with consultant units when appropriate, there is no evidence that these small GP hospitals are unsafe. The high neonatal mortality rates, especially among babies weighing 1500–2499 g in nonteaching consultant units, compared with teaching units, should be investigated further.
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