Babies born before arrival (BBA) in Newham, London during 2007-2008:: a retrospective audit and commentary

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The BBA rate is thought to be increasing across England and Wales, although it was difficult to find a national rate for benchmarking purposes.


The purpose of the audit was to evaluate the incidence of babies born outside of the framework of care planned for their birth, which has traditionally been called a BBA (born before arrival [of a qualified attendant]). There was a need to identify any factors which may have contributed to this, with the aim of reducing the BBA rate. A second objective was to assess if there were any adverse outcomes either directly or indirectly related to being BBA.


A busy London maternity unit with an annual birth rate of 5300, in a densely populated area of mixed ethnicity and social grouping.


All women who had planned to give birth in the hospital location but who had then given birth elsewhere. For the purposes of the audit, this was defined as a birth in an unplanned birth environment and unattended by a midwife (BBA).

Design and methodology:

A retrospective audit of maternity records to identify all women who had a BBA between 1 April 2007-31 March 2008.


Forty-four women had given birth outside of the chosen hospital location. There were 5308 viable births that took place over the audit time frame, giving a BBA rate of 0.82%, which equates to approximately four BBAs per month on average. Eighty per cent of the women who had a BBA were born outside the UK, ranging from European countries such as Portugal and Kosovo, to the Asian and American continent. Many required Health Advocacy (HA) support.


There should be a national definition of what constitutes BBA to achieve better comparative data of rates. Maternity units should regularly audit their BBA rate and consider other ways to minimise this increasing trend. It is also important that maternity units with a higher than average BBA rate consider this as part of their midwifery workforce plan.


Although there were common features among the mothers who had a BBA, it is difficult to determine if the incident could have been avoided. While there is no strong evidence from the data to conclude that there were either direct or indirect adverse outcomes as a result of the BBA, the unexpected nature of the event suggests the potential for this. More collaboration between local ambulance services and the maternity services might be one area for further enquiry.


Detailed research using qualitative data would be required to explore women's perspectives of birth and the impact on outcomes of giving birth outside of their planned birth environment.

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