To review the characteristics and features of all ‘born before arrival’ (BBA) births occurring in one year (2006) and to explore trends over the last eight years.Setting:
An English maternity unit with around 5000 births per year serving a large geographical area.Participants:
All women experiencing a BBA birth, defined as either unattended by a health professional, or occurring unintentionally in transit to hospital, attended or unattended.Design and method:
A retrospective detailed review of maternal pregnancy records relating to all BBA births in 2006 and an analysis of trends in the incidence of BBA births over an eight-year period from hospital statistical records (2000-2007) and computerised maternity data (from 2002).Results:
Features of a typical BBA birth were identified relating to characteristics of the women, the pregnancy, labour and birth. An analysis of events occurring around the time of the BBA demonstrated that this was a more common occurrence with planned home births and between the hours of 6-9am. Maternal outcomes of the BBA births were all good. Seventeen per cent of the babies required admission to hospital as a direct consequence of either being born in an inappropriate place, or with no appropriate professional present. The most common reason was hypothermia.Results:
The rate of BBA birth over the eight-year period was 0.48%, equating to around 1 in 200 births, which is in keeping with other studies. There was a slight overall trend of a rising BBA birth rate in the unit studied (annual increase of 11%, p=0.002); however, there was some evidence of midwives recording unplanned but attended home births as BBAs. This did not fulfil the definition criteria and limits generalisability and comparability of these findings with other studies.Conclusions and recommendations:
There is an urgent need for a national definition of a BBA birth and a need to define this in terms of attendance of a health professional and whether or not the place of birth is planned. This would permit valid and reliable comparisons of birth outcome data as BBAs have often been included in home birth figures. Maternity services should ensure adequate provision for BBA births. Only midwives should provide telephone advice in labour, and they should be consulted and talk to the woman directly if another member of staff answers the telephone. It is also recommended that all women should be educated in the need to keep a baby warm immediately after birth.