Transfer of women during the peri-natal period

Transfer of women during the peri-natal period

I. ‘Mind you, there’s no anaesthetist on the road’: women’s experiences of labouring en route (Dietsch, 2010)

The aim of this article was to learn from women in rural New South Wales (NSW) Australia, their experiences of labouring en route to birth in a centralised maternity unit.  It was part of a larger project that explored women’s experiences when they birthed away from their rural communities. Participants were recruited from communities all over rural NSW where a maternity unit had closed. This article draws on data collected during in-depth interviews with 12 participants and one partner who shared their experiences of labouring en route to a centralised maternity service. Two themes were identified. These relate to the way the risk of dangerous road travel is ignored in obstetric risk discourse, and the deprivations experienced when women labour en route.  Many participants questioned why they needed to risk unsafe road travel when their preference was to labour and birth in their local communities with a midwife.

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II. Aeromedical transfer of women at risk of preterm delivery in remote and rural Western Australia: Why are there no births in flight? (Akl et al., 2012)

For more than three decades, women at imminent risk of preterm birth (PTB) in Western Australia have been transferred by small aircraft over long distances to the single tertiary level perinatal centre in Perth, with no known case of birth during the flight. The aim of this paper was to review recent experience to understand how aircraft travel may delay PTB by conducting a retrospective observational study of 500 consecutive Royal Flying Doctor Service (RFDS) transfers of women at risk of preterm labour to the tertiary referral centre, from September 2007 to December 31, 2009. The study identified that the clinical factors associated with a shorter time from landing to subsequent delivery included cervical dilatation >4 cm, ruptured membranes, gestational age > 32 weeks and nulliparity. The aircraft reaching an ambient altitude > 14,000 feet, or cabin altitude above zero (sea level), was associated with a delay in time from landing to delivery for women who were not in spontaneous preterm labour. The findings confirm that women at risk of preterm labour do not deliver during aeromedical transfer and this was associated with transfer the ambient and cabin altitude of the aircraft.

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III. Patterns of transfer in labour and birth in rural New Zealand (Patterson, Foureur and Skinner, 2011)

The objective of this study was to explore the number of and reason for transfers during labour and birth for well women, close to full term, from primary rural maternity facilities to specialist care in rural New Zealand. The participants were the 4678 women who began labour in a rural facility during this time period. The data revealed that 16.6% of women who commenced labour in a rural unit were transferred in labour or within 6 hours of birth; 3% of babies born in rural units were transferred after birth and up to 7 days post-birth. The primary reason for maternal transfer was slow progress in labour (49.67%). Of the 123 babies transferred, this was most often due to respiratory problems (43%). Key features of the rural context (times and distances to be travelled, geological and climatic characteristics, types of transport systems and availability of local assistance) influenced the timeliness of the decision to transfer.

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