Editorials

Assessing the consequences of changing childbirth

Pregnancy care in Britain is changing,¹ and the results of these changes need to be monitored. At first sight this seems easy. Obstetricians and midwives have always led the way in clinical audit. The confidential enquiry into maternal deaths was established over 40 years ago,² and perinatal mortality is carefully reviewed locally.³ In research, perinatal medicine stands out from other specialties in its systematic reviews of randomised controlled trials.^{4 5}

Nevertheless, standards of audit and data collection are falling, not rising. In the most recent report on maternal deaths⁶ medical information was missing in 4% of cases, compared with 0.4% in the previous report. The maternity hospital inpatient inquiry has been replaced by a hospital episode system, which is notoriously incomplete, and we now lack reliable figures for such basic concerns as national rates of caesarean section and planned home delivery.⁷ In the 1980s the Office of . . . [Full text of this article]

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This article has been cited by other articles:

• Duff, L. A., Casey, A. (1999). Using informatics to help implement clinical guidelines. Health Informatics Journal 5: 90-97 [Abstract]  
• Higson, N. (1995). Assessing the consequences of changing childbirth. BMJ 310: 1066a-1066 [Full text]  
• Saha, A. (1995). Time is ripe for a "pregnancy based system" of data collection. BMJ 310: 1066b-1066 [Full text]  
• Fawdry, R. (1995). Smart cards are expensive and easily damaged. BMJ 310: 1066c-1067 [Full text]