Born Before Arrival ‐ Uncovering the Hazards

EDITORIAL COMMENT : We accepted this paper for publication because it examines the socioeconomic problems of mothers who deliver before arrival in hospital. The findings are important and though they may apply to communities other than Hong Kong, they are unlikely to apply to women who are admitted to metropolitan hospitals in Australia. There is remarkably little literature on birth before arrival in hospital (BBA) when one considers how many mothers‐to‐be, and their husbands, show much anxiety about the possibility of delivery before reaching hospital (A). There are different definitions used for birth before arrival that are relevant to an understanding of this paper. Weir's paper from Melbourne considered only booked patients, and the incidence of BBA's in his study was only 0.14% (1 in 695 confinements) ‐ these labours were usually precipitate (71%) and 51% occurred in the woman's first or second pregnancy; 65% were avoidable had the woman attempted to reach the hospital at the onset of labour (A). In this series from Hong Kong there were 78 (40%) unbooked patients and the main causes of the BBA's were ‘social deprivation and young maternal age’, although table 2 shows that fast labour accounted for 78 cases. The situation remains quite different in Australia: during the triennium 1987–1989 there were 15,216 women who delivered at the Mercy Hospital for Women, Melbourne, including 36 BBA's of booked patients (0.2%); none resulted in perinatal deaths although 23 of the 36 mothers had first or second degree lacerations of the perineum. During these 3 years there was only 1 nonbooked patient admitted after delivery, who had delivered anywhere else but in another hospital. The Discussion in this paper will interest readers, as the authors explain how the superior health‐care facilities available in Hong Kong should be directed to cater for those women destined to deliver their babies in an inappropriate setting. Summary In a retrospective case controlled study the demographic background and outcome of 193 mothers whose babies were born before arrival at hospital was compared to that of a control group who delivered within the maternity units of 2 teaching hospitals in Hong Kong. Mothers who delivered before arrival at hospital were significantly more likely to be single, to have received no antenatal care, to have an unplanned pregnancy, low family income and to come from a socially disadvantaged group such as Vietnamese refugees and illegal immigrants from China. Lacerations to the genital tract, postnatal anaemia and blood transfusions were more common in the study group. Results of cervical cytology and rubella status were available in significantly fewer of these mothers. They were more likely to be ambivalent about contraception and less likely to attend the postnatal clinic. The perinatal mortality and morbidity was significantly increased.