Women's experience of transfer from community-based to consultant care in late pregnancy or labour.

Background: Women booked for home or GP unit delivery, under the care of their community midwife and GP, are frequently transferred to consultant care. Even obstetrically low risk women may develop complications which necessitate hospitalbased intervention. Transfer has been perceived as undesirable and booking policies have been developed to avoid it, but few studies have focused on transfer from either a medical or a maternal view point. Objectives: To describe the community-based obstetric service, focusing on transfer, and to compare it with shared care; to investigate women's experience of transfer. DesBn: (1) A prospective comparative survey with non-equivalent controls, using ante- and postnatal postal questionnaires; the data were analysed using SPSS. (2) Long interviews 3 to 8 weeks postnatally, which were taped, transcribed and analysed according to grounded theory. Setting and subjects: All 122 women booked for GP unit or home birth in a northern English city in the second half of 1991; 141 controls were drawn from low risk women booking for shared care. The response rates were 82% and 62% respectively. Twelve transferred women were interviewed. Main outcome measures: obstetric intervention and outcome; maternal characteristics, preferences and satisfaction; continuity of care; length of stay; transfer rate and indications. Results: Community-booked women have similar obstetric outcomes to shared care women, but less intervention, better continuity and shorter length of stay. They have higher expectations but are more satisfied with their care. Overall transfer rates (46% in primiparous and 23% in multiparous women) resemble those in other units. Transferred women are especially vulnerable to disappointment, but continuity of care and sensitive debriefing ameliorate it. Conclusio:n Transfer does not detract from the overall advantageso f communitybased maternity care, but for the women it affects, special attention is needed.