Statistical Bulletin

NHS Maternity Statistics, England: 2003-04 This bulletin summarises information from the Hospital Episode Statistics system relating to NHS maternities in the year 2003-04 and includes some comparisons with similar data from earlier years. KEY FACTS Between 2002-03 and 2003-04:

the caesarean rate increased slightly from 22.0% to 22.7%

In 2003-04:

over 20% of deliveries were induced

23% of deliveries were by caesarean section; more than half of these were emergency caesareans

about 12% were instrumental deliveries

an estimated 46% of deliveries were ‘normal

deliveries’ defined as those without surgical intervention, use of instruments, induction, epidural or general anaesthetic

women with spontaneous deliveries spent on

average 1 day in hospital after delivery, women with instrumental deliveries 1 or 2 days and women with caesarean deliveries 3 or 4 days

During delivery about 1/3 of women had an

epidural, general or spinal anaesthetic

12% of women had an episiotomy

Contents Page Introduction 2 Analysis and Commentary deliveries 3 complications 9 hospital data 11 Definitions 13 Editorial notes 13 Index to tables 14 Reference tables 15 Bulletin 2005/10 Published March 2005 Free of charge ISBN 1 84182 955 2 © Crown Copyright 2005

These National Statistics were prepared by the Government Statistical Service

1. INTRODUCTION 1.1 This is the sixth Statistical Bulletin presenting information derived from the Maternity Hospital Episode Statistics (HES) and covers data for 2003-04. The first Bulletin covered the first six years of Maternity HES, 1989-90 to 1994-95 and the second and third bulletins covered years 1995-96 to 1997-98 and 1998-99 to 2000-01 respectively. The bulletin is now published annually. Most maternity details are reported on a special extension (the “maternity tail”) to the general core HES record. Submission of the tail data has continued to pose problems for several NHS Trusts; coverage of hospital deliveries rose from 70% in 2001-02 to 72% in 2002-03 but has not increased further in 2003-04. Coverage of home deliveries has fallen slightly from 15% to 14%. See Tables 25 and 26. 1.2 As in the previous Bulletins, the HES data are estimates based on the valid records received. Most of the data are presented as percentages, calculated from those records where the variable(s) under consideration were reported but excluding those where the classification “not known” was used. A further restriction was used for analyses of method of onset of labour and method of delivery in combination.

For such analyses, those records were used only where both variables were known, or where method of delivery was known but method of onset was not. 1.3 In order to give some idea of the numbers of deliveries with particular features, several England level tables for 2003-04 contain estimates in which the percentages (that are based on records with data) are grossed up to the known total number of deliveries registered in the year. There were 576,000 deliveries reported to the Office for National Statistics (ONS) through the Birth Registration system as occurring in NHS hospitals in England in 2003-04. 1.4 Caesarean rates are calculated from the maternity tail item method of delivery; however, the core HES record does include details of operative procedures undertaken, and an alternative caesarean rate may be calculated using this variable. Caesarean rates on both bases are shown in Table 33. Those from the core record have the advantage in that they are available for almost all hospitals rather than just those completing the maternity tail. As may be expected, where both rates are available, they do not always match. However, analysis of the operative procedures allows a useful check on the validity of the

tail data. The overall England caesarean rate using the core data is slightly higher than that derived from the tail; this is probably because there are a small number of records that either have no procedure reported, or report procedure as not known. These are more usually spontaneous deliveries. 1.5 A small amount of data “cleaning” was undertaken prior to analysis as several hospitals inadvertently recorded spontaneous deliveries as “delivery method not known”. All the records for the relevant hospitals showing delivery method “not known" have been treated as having spontaneous method of delivery, even though a very small number may have been genuinely unknown and may not have been spontaneous. Also, several hospitals submitted duplicate data. In almost all cases, the duplicate records had no tail information. Regional and national totals of valid HES records exclude these duplicates, but they remain included in Table 32 for each relevant hospital. In 2003-04 about 16% of records with delivery onset reported as (elective) caesarean had delivery method as emergency caesarean. This has led to slight inconsistencies between Tables 1 and 3. In general, the delivery method better

matches the procedure information in the core record, and should be used in preference. 1.6 Where possible, charts and tables include data from before the Maternity HES system was introduced. These are taken from the following publications: Hospital In-patient Enquiry maternity (HIPE) tables, ONS series MB4 Nos 8 (covering 1973-1976), 19 (1977-1981) and 28 (1982-1985) Macfarlane A. and Mugford M. Birth Counts: Statistics of pregnancy and childbirth. Second Volume. Tables (Second Edition) (2000) (for caesarean rates prior to 1979 extracted from earlier hospital in-patient enquiry reports) 1.7 Although Maternity HES was intended to cover all deliveries, very little data has been available about those that occur at home and even less about those that occur in private hospitals. The Independent Midwives Association (IMA), which provides private midwifery care for both home and NHS hospital deliveries, has recently developed a database that holds similar information to that held in HES. Summary information about 337 deliveries attended by Independent Midwives in 2003-04 (representing 83% of all

deliveries attended by Independent Midwives) is in Annex B. 1.8 The general HES system also includes information about miscarriages and ectopic pregnancies where these result in a hospital stay. Some information about these is presented in section 3 below and in Annex C. 2. ANALYSIS AND COMMENTARY 2.1 Overview 2.1.1 About 593,600 deliveries took place in England in 2003-04 an increase of 5% over 2002-03. The vast majority of deliveries take place in NHS hospitals though about 2% are home deliveries and 0.5% occur in private hospitals. 2.1.2 Over half of the NHS hospital deliveries are spontaneous, both in onset and actual delivery, but a substantial proportion of women undergo some kind of intervention. In 2003-04 about 11% of women had an elective caesarean section and 20% were induced (whether surgically or using drugs or both). In total about 23% of women had a caesarean section and 10% required an instrumental delivery. During delivery, about 1/3 of women had an epidural, general or spinal anaesthetic; and 12% of

women had an episiotomy. Women whose delivery is without such intervention may be defined as having had a “normal delivery” – this occurred in about 46% of all NHS deliveries in England in 2003-04. 2.1.3 Other reported factors may also have affected the course of the delivery. About 6% of women were reported as having a uterine scar (usually from a previous caesarean section); hypertension was a complicating factor in 6% of deliveries; obstructed labour occurred in 3% of deliveries and in 11% labour was recorded as “long”. 2.1.4 A typical hospital delivery episode starts on the day of delivery, with the woman (and baby) discharged the following day. However, where interventions occur, these have a marked effect, particularly on postnatal stay – women with instrumental deliveries typically stay in hospital for one or two days after delivery and women delivered by caesarean section typically stay for three or four days. 2.2 Method of onset of labour (Tables 1 and 2) 2.2.1 Although the majority of women start labour spontaneously, in 2003-04 about 11% had an elective

(planned) caesarean section and 20% had labour induced. The proportion of women having an elective caesarean has been increasing slowly, from about 5% in 1989; the proportion induced remained around 17-18% from 1989 to 1993 but has been rising slowly since. Induction may be by oxytocic drugs or by surgical methods such as artificial rupture of membranes (known as ARM) or a combination of both these methods. Since 1991 drugs have been used in 80% - 85% of inductions and surgical methods in 40% - 45%. 2.3 Method of delivery (Tables 3 and 4) 2.3.1 The proportion of all hospital deliveries that occurred spontaneously in 2003-04 was about 65%, having fallen steadily from 78% in 1989. 2.3.2 Caesarean delivery rates have continued to climb. From a level of under 3% in the 1950s, the proportion of deliveries that were by caesarean section rose to 9% by 1980, and to 12% by 1990-91. During the 1990s the rate has increased more rapidly, reaching 22% by 2001-02 and rising slightly to 23% in 2003-04. (Figure 1) 2.3.3 Instrumental deliveries account for most of the remaining

cases. Throughout the 1990s, the proportion of instrumental deliveries has remained around 10%. Within this, there has been a marked shift in the type of instrumental delivery (Figure 2). In 1989, forceps were used in 83% of instrumental deliveries and ventouse (vacuum extraction) in only 17%; by 2002-03, 68% of instrumental deliveries were by ventouse. 2.4 Method of onset and method of delivery (Table 5) 2.4.1 The relationship

between method of onset of labour and method of delivery in 2003-04 is summarised in Table A below. Where onset was spontaneous, three-quarters of deliveries were spontaneous; a further 11% were instrumental and 11% were by emergency caesarean section. A similar pattern was observed for deliveries induced surgically without the use of drugs, but with slightly fewer spontaneous deliveries and more by caesarean section. Where delivery was induced by drugs, whether or not surgical induction was also

Figure 1 Caesarean rate, England, 1955 to 2003

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25

1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

total

elective

percentage

25

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15

10

5

percentage

Figure 2 Instrumental delivery rate, England, 1990 to 2003

0

2

4

6

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12

1990 1992 1994 1996 1998 2000 2002

total instrumental deliveries

ventouse

percentage

12

10

8

6

4

2

percentage

attempted, only two thirds of women were delivered spontaneously, with about 14% having instrumental deliveries and 19% emergency caesareans. 2.4.2 Overall, about 54% of women had a spontaneous labour and delivery, without induction, the use of instruments or caesarean section. The proportion of these women who did not have an episiotomy during delivery or anaesthetic is considered in section 2.11.5. 2.5 Duration of antenatal stay (Tables 6 and 7) 2.5.1 In 2003-04, about 60% of deliveries took place on the same day as admission to hospital and about 30% took place on the next day. These proportions have remained very much the same since 1989-90. Only 3% of deliveries in 2003-04 took place after a stay of 4 or more days; in 1989-90 the proportion was about 5%. 2.6 Duration of postnatal stay (Tables 9 and 10)

2.6.1 In 2003-04, about 15% of women left hospital on the same day as delivery took place, about 35% left the next day, 20% two days later and 15% three days later. These figures continue the long term trend towards shorter postnatal stay. In 1989-90, nearly 40% of women remained in hospital for 4 or more days after delivery; by 2003-04, the proportion was only 16%. 2.7 Method of onset, method of delivery and duration of stay (Tables 8 and 11) 2.7.1 Women whose delivery in 2003-04 was spontaneous in onset and proceeded without induction, instrumental assistance or caesarean section generally had their delivery on the day they were admitted (73%) or on the day after (24%). By the end of the day after delivery, 68% had left hospital and a further 19% left two days after delivery. Where either onset or delivery were not spontaneous, both antenatal

and postnatal stays were longer. 2.7.2 Patterns of postnatal stay suggest a strong relationship with method of delivery. About 58% of women who gave birth spontaneously after induction left hospital by the day after delivery and a further 24% left two days after; these figures are not very different from those for women with spontaneous delivery and onset. Women with an instrumental delivery typically spent 1 or 2 days in hospital after delivery, regardless of whether onset was spontaneous or induced. Women delivered by caesarean section typically spent 3 or 4 days in hospital after delivery, regardless of whether the caesarean was elective or performed in an emergency after spontaneous onset or after induction. 2.7.3 The duration of antenatal stay is not clearly related to either method of onset or method of delivery. This may be because the course of the delivery can be determined by the duration of labour, which forms part of the antenatal stay. Most women who had an elective caesarean in 2003-04 were operated on the day they were admitted (65%) or the following day (24%). Where spontaneous onset was followed by instrumental delivery or emergency caesarean,

Table A Method of onset of labour by method of delivery, 2003-04

England percentages

method of onset method of delivery estimated total number of

spontaneous instrumental caesarean deliveries (=100%)

spontaneous 78 11 11 398,300induction (surgical) 72 12 16 61,900induction (surgical & drug) 63 14 22 60,300induction (drugs) 65 14 21 21,600caesarean 1 1 98 33,900

total 67 10 22 575,900

delivery generally occurred on the day of admission (55%) or the next. Spontaneous delivery following induction occurred on the day of admission in 31% of cases but was more typically on the next day (45%). The longest antenatal stays were in cases where induction was followed by an instrumental delivery or by an emergency caesarean: about 17% of such deliveries took place on the day of admission, but more typically delivery occurred the following day (47%) or the day after that (23%). 2.8 Person conducting delivery (Tables 12 and 13) 2.8.1 In 2003-04, about 33% of deliveries were conducted by hospital doctors and 66% by midwives. The overall balance between the professions has changed steadily since 1989-90 when about 24% of deliveries were conducted by doctors and 76% by midwives. This shift reflects the changing pattern of delivery method. Virtually all spontaneous deliveries are conducted by midwives; doctors conduct caesareans and all but about 10% of instrumental deliveries. 2.9 Place of delivery (Tables 14, 15 and 16) 2.9.1 Almost all hospital deliveries take place in what

are designated consultant wards or combined consultant/Midwife/GP wards. In 2003-04 2% of deliveries were reported as being on GP wards and 5% on midwife wards. 2.9.2 Although the vast majority of hospital deliveries are intended to take place in that setting, about 0.2% of hospital deliveries in 2003-04 were reported as originally intended to take place at a domestic address. This suggests that about 1,400 women who intended to have a home delivery ended up giving birth in hospital. In 66% of these cases, the reason for changing location was reported as being clinical; nearly half the decisions to change were reported as being made during labour. 2.10 Episiotomy (Tables 17 and 18) 2.10.1 Episiotomies were reported in about 12% of deliveries in 2003-04, continuing the gradual downward trend apparent since the early 1990s when the level was over 20%. The fall is not entirely attributable to the increasing rate of caesarean sections. The proportion of instrumental deliveries with episiotomy has remained stable at about 75-80% for forceps and 60% for ventouse, though there may be some under-reporting in these cases. For

spontaneous deliveries, the proportion with episiotomy reported has fallen from 21% in 1989-90 to 8% in 2003-04. Not unexpectedly, as in earlier years, episiotomies were hardly ever reported with elective caesareans in 2003-04 and only rarely with emergency caesareans. 2.11 Anaesthetics before delivery (Tables 19 and 20) 2.11.1 In 2003-04, about 21% of women had an epidural before or during delivery, 2% had a general anaesthetic and 12% a spinal anaesthetic. The use of anaesthetics varies according to the type of delivery and for some types has changed over time. 2.11.2 Where both onset and delivery were spontaneous, about 11% of women had an epidural, only slightly more than the 9% reported in 1989-90. Where onset was spontaneous followed by instrumental delivery 42% had an epidural, slightly less than previous years. Where onset was induced but delivery spontaneous, 23% had an epidural in 2003-04. For inductions followed by an instrumental delivery about 54% had an epidural. In all these four groups, there has been negligible use of general anaesthetic. The use of spinal anaesthetic, though still relatively rare, has

shown signs of increasing in cases with instrumental delivery. 2.11.3 The principal changes in anaesthetic use have occurred where women have caesarean sections. In 1989-90, over 50% of women having an elective caesarean had a general anaesthetic; by 2003-04 the proportion had fallen to 6%. In 1989-90, over 30% had an epidural but that proportion has now also fallen substantially to 7%. The proportion with a spinal anaesthetic has risen from 11% to 67% and a further 9% of women in 2003-04 (1% in 1989-90) had both epidural and spinal anaesthetic. 2.11.4 Women undergoing emergency caesarean section, whether with onset spontaneous or induced, have a different pattern again. In 1989-90, over half had a general anaesthetic but by 2003-04 this had fallen to about 9%; the use of epidural alone has risen from about 25% to about 32%; and of spinal from less than 5% to over 31%. Use of more than one type of anaesthetic whether sequentially or in combination, is more common with emergency caesareans. In 1989-90 about 10% of cases involved both general and epidural anaesthetics. This fell to 2% by 2003-04. The use of both epidural and spinal anaesthetics has risen

from hardly any to about 5%. 2.12 Normal Delivery (Table 34) 2.12.1 An estimated 46% of hospital deliveries were ‘normal deliveries’; this is equivalent to a rate of 48% of all NHS deliveries when home deliveries are included. In this context a normal delivery is one without induction, without the use of instruments, not by caesarean section and without general, spinal or epidural anaesthetic before or during delivery. Excluded are any other procedures not relating to an unassisted delivery except repair of laceration. See para 2.20.8 also below. 2.13 Gestation (Table 21) 2.13.1 In 2003-04, about 88% of deliveries occurred between 37 and 41 weeks of gestation. About 5% occurred after a longer gestation (ie were post-term). The remaining 7% of deliveries were pre-term ie occurred before 36 completed weeks of gestation. The majority of pre-term deliveries occurred after at least 32 weeks of gestation, but 0.9% of all deliveries were reported as occurring between 28 and 31 weeks and 0.5% before 28 weeks of gestation. This

pattern has remained stable since 1994-95 when the data were first extracted. 2.13.2 The pattern for multiple deliveries was somewhat different. About half of twin deliveries were pre-term. Although most of these occurred after at least 32 weeks of gestation, 7% of all twin deliveries were reported as occurring between 28 and 31 weeks and 3% before 28 weeks of gestation. Triplet and higher order deliveries were even less likely to reach full term. Of the estimated 130 deliveries, nearly 58% were pre-term; about 1 in 6 occurred before 32 weeks of gestation. 2.13.3 The pattern differed also according to the method of onset of labour. 34% of elective caesarean deliveries were carried out at 38 weeks of gestation and over half the remainder (37% of all elective caesareans) at 37 or 39 weeks of gestation. Deliveries with spontaneous onset occurred most often at 40 weeks of gestation (33%), at 39 weeks of gestation (23%) or at 41 weeks of gestation (18%). About half of deliveries where labour had been induced took place at 40 or 41 weeks of gestation, with 12% at 42 weeks or later (Table B).

2.14 Birthweight (Tables 22 and 23) 2.14.1 The majority of singleton deliveries in 2003-04 were of babies weighing between 2410 and 4220 grams (about 5½ to 10 lbs). Under 2% of singleton babies weighed 4500g or more, but about 5% were low (but not very low) birthweight (between 1500 and 2499 grams) and a further 1% were very low birthweight (under 1500 grams). 2.14.2 The estimated overall stillbirth rate among singleton babies in 2003-04 was about 5 per 1000 live and still births. The rate varied markedly with birthweight, from 225 per 1000 for babies weighing under 1000 grams to about 1 per 1000 for babies

weighing 3000 grams or more. 2.14.3 Birthweight is clearly related to gestation, though for any given gestational age there is a wide spread of birthweights. The median birthweight for singleton and twin babies born at 26 weeks in 2003-04 was about 850 grams (ie half the babies born at this gestational age weighed

more than 850 grams and half weighed less). From 29 to 34 weeks gestation the median birthweight of singleton babies was around 200 grams higher for every week but the median birthweight for twin babies averaged only 150 grams higher for every week. (Figure 3). 2.15 Day of week of delivery (Table 24) 2.15.1 If deliveries occurred randomly, then 1 in 7 (14.3%) would be expected to take place on each day of the week. In 2003-04, however, more deliveries occurred on a Friday (16.2%) or a Thursday (14.9%) than on any other day. Fewer than average deliveries occurred on a Sunday (13.1%) or on a Monday (13.8%) or Tuesday (13.7%). These and all other figures in this section have been adjusted to allow for the fact that 2003-04 included 53 Tuesdays and Wednesdays and 52 of each of the other days.

Table B Deliveries by length of gestation and method of onset of labour, 2003-04

England percentages

length of method of onset of labourgestation (weeks)

caesarean spontaneous induced

Total 100 100 100

under 32 4 2 132 to 36 10 5 537 10 5 738 34 11 1339 27 23 1340 8 33 1841 5 18 3142 and over 2 3 12

Figure 3 Median birthweight by gestation for singletons, twins & triplets, England 2003-04

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2500

3000

3500

4000

20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44andoverlength of gestation in weeks

gram

s

singletons twin triplet and higher

2.15.2 As in previous years, there were marked differences in the pattern, according to the method of onset of labour. Where onset was spontaneous, there was very little variation between days, with Monday and Tuesday slightly above average and Saturday and Sunday slightly below. This broadly level pattern was observed even where there was some subsequent intervention in the form of an instrumental delivery or an emergency caesarean section. 2.15.3 Where labour was induced, deliveries were more likely on Tuesday to Friday and somewhat less likely on Monday and, in particular, on Sunday. Again, the pattern was similar regardless of whether the actual delivery was spontaneous, instru-mental or by caesarean section. Deliveries by elective caesarean section rarely occurred at the weekend and were most likely to take place on Monday to Friday. Only 6% of all elective caesareans took place on a Saturday or a Sunday. 2.16 Complications during the delivery episode (Tables 27 and 28) 2.16.1 Hypertensive disorders and oedema during pregnancy were recorded in about 6% of

deliveries in 2003-04. Abnormality of the pelvic organs was recorded in about 7% of deliveries; most of these cases were uterine scars resulting from a previous caesarean section. 2.16.2 The principal recorded complications of labour and delivery were perineal laceration (recorded in 38% of deliveries), fetal stress (20%), prolonged 2nd stage of labour (8%) and postpartum haemorrhage (7%). 2.16.3 The existence of complications such as those mentioned above may affect decisions about onset of labour or method of delivery. Table C shows that in about half of the cases where pre-eclampsia or hypertension was recorded, labour was induced; such cases accounted for about 1 in 6 of all induced deliveries. Labour was also induced in over three-quarters (79%)of cases of prolonged

pregnancy, and these accounted for about 46% of all inductions. 2.16.4 In 51% of the cases where malpresentation of the fetus was reported, the woman had a planned caesarean section; an emergency caesarean was carried out in a further 25% of cases. Malpresentation of the fetus accounted for about a quarter of planned caesarean sections and about 10% of emergency caesareans. 2.16.5 Over 70% of women whose records indicated that they had a scar from a previous caesarean section had a planned caesarean; a further 19% had an emergency caesarean, with only 9% reported as having a non-caesarean delivery. Women with a reported scar from a previous caesarean accounted for about 43% of planned caesarean sections and about 10% of emergency caesareans. 2.16.6 Just under two-thirds of women with

Table C Deliveries with selected complications by methodof onset of labour and by delivery, 2003-04

percentages

estimated to tal

method of onset method of delivery number o f

cases (=100%)

spont- induced caes- spont- instru- caes-aneous arean aneous mental arean

pre-eclampsia 23 52 25 38 12 50 10,000hypertension 35 50 15 51 14 35 32,600malpresentation of fetus 37 12 51 18 6 76 26,400uterine scar from previous surgery 23 5 72 7 2 91 36,000prolonged pregnancy 19 79 2 66 15 20 43,300prolonged labour 1st stage 67 32 1 22 12 66 16,400prolonged labour 2nd stage 74 25 0 20 64 16 43,600

prolonged first stage of labour had an emergency caesarean, accounting for about 15% of all emergency caesareans. A prolonged second stage of labour most commonly led to an instrumental delivery (about 2/3 cases) and these accounted for around 45% of instrumental deliveries. 2.17 Complications in non-delivery obstetric episodes (Table 29) Data were not available in 2002-03 while further investigations were undertaken into the incorrect definition of non delivery maternity episodes in HES in previous years. This has now been corrected and data are shown for 2003-04. The error resulted in some conditions being undercounted in previous years specifically those for diagnoses of haemorrhage, excessive vomiting in pregnancy and general maternity care. This was because such episodes were

not flagged locally as maternity care episodes. 2.18 Ethnic Group 2.18.1 Information about ethnic group of mother has been collected in HES since 1995 but coverage remains incomplete. However, comparison of HES deliveries in 2000-01 with 2001 census data on women with children aged under 1 suggests that the ethnic group distribution of HES deliveries is broadly accurate as long as cases with ethnic group not stated are grouped with those where ethnic group was stated to be white.

2.18.2 In 2003-04 ethnic group was recorded in about 75% of delivery records and was recorded as “not stated” in a further 20% of cases. For this analysis, the ethnic categories have been grouped as follows: White (including “not stated”); Black [aggregate of Black African, Black Caribbean and Black Other]; Asian [Indian, Pakistani, Bangladeshi]; and Chinese & Other [Chinese and Other (including mixed ethnic origin)]. 2.18.3 There were differences in 2003-04 between ethnic groups in methods of onset of labour and in methods of delivery. About 21% of White women were induced compared with around 17% of Black and Asian women. Fewer Asian and Chinese women had elective caesareans (8%) compared with about 11% for Black women or White women and 8% of Asian women. When onset was spontaneous more Black women had emergency

Table D Ethnic group by method of onset of delivery and method of delivery. England, 2003-04

percentages

ethnic group

method of onset method of delivery ChineseAsian Black & other White

TOTAL 100 100 100 100

spontaneous spontaneous 60 57 59 54instrumental 7 4 8 8caesarean 7 10 8 7

induced spontaneous 12 11 10 14instrumental 2 1 2 3caesarean 4 5 4 4

caesarean caesarean 8 11 9 10

Table E Birthweight by ethnic group, England, 2003-04

percentages

Asian Black White

Total 100.0 100.0 100.0

under 2500g 11.1 9.5 6.92500-2999g 29.0 20.9 15.73000-3499g 38.9 38.0 35.43500-3999g 17.1 24.2 30.0over 4000g 3.9 7.4 12.1

caesareans (14% of those with spontaneous onset) compared with around 11% for other groups. (Table D) 2.18.4 There were marked differences in birthweight between ethnic groups. Analysis of singleton births showed that low birthweight babies comprised about 11% of Asian women’s babies, compared with 10% of Black and 7% of White women’s babies. Differences at higher birthweights were even more marked. Only 21% of Asian women’s babies weighed more than 3500g compared with nearly 42% of White women’s babies and 32% of Black women’s babies. (Table E & Figure 4) 2.19 Conditions affecting newborn babies (Tables 30 and 31) 2.19.1 Details of conditions affecting newborn babies are recorded in HES birth episodes (ie hospital

episodes that commence at birth and are not initiated on transfer from another episode or on separate admission to hospital, regardless of the age of the baby). 2.19.2 The most common conditions reported in 2003-04 were respiratory disorders: intrauterine hypoxia in 5% of births (an estimated 27,000 babies), birth asphyxia in 1% (6,000) and respiratory distress in 2% (14,000). Neonatal jaundice was reported in 5% of births. Conditions under the heading of birth trauma were relatively rare. Birth injury to scalp was the most common of these, reported in 1% of cases (about 5,800 babies). Not unexpectedly, the incidence of scalp injury appears to be related to method of delivery. There were very few such cases where delivery was spontaneous, or where the baby was delivered by caesarean section; but scalp injury was reported in about

5% of instrumental deliveries. 2.20 Hospital data (Tables 32 to 34) 2.20.1 This section examines in more detail the information about method of onset of labour and method of delivery for each NHS Trust providing maternity services in England. Most trusts have one principal hospital site with delivery facilities. In general all deliveries recorded by these trusts are shown under the name of that hospital. Where information is available about individual smaller units with delivery facilities, these are shown separately, although only a very few trusts currently provide information that enables different sites to be distinguished. 2.20.2 For the 151 hospitals where method of onset data were available in 2003-04 the majority reported induction of labour being used in between 14% and 31% of deliveries. The majority range for caesarean onset (ie of elective caesareans) was from about 5% to 16%. 21 units reported induction or elective caesarean in less than 5% of cases, or in none at all. These were all small units providing only community-based delivery services.

Figure 4 Birthweight by ethnic group, England, 2003-04

0% 20% 40% 60% 80% 100%

White

Black

Asian

under 2500g 2500g - 2999g 3000g - 3499g 3500g and over

2.20.3 Of the 185 separately identified hospitals or trusts, 181 had usable core record data for calculating the total caesarean rate (see section 1.4 above). With the exception of a few small community-based units with zero or very low caesarean rates, the majority of hospitals had rates in 2003-04 in the range 18%-29%; four units reported a caesarean rate of above 30% in 2003-04. 2.20.4 Information about instrumental deliveries was available for 145 units. The proportion of instrumental deliveries that were reported as using the vacuum/ ventouse method ranged from about 17% to 91%. 2.20.5 On average, about 10% of women with spontaneous deliveries had an episiotomy. In individual units, the proportion varied between about 1% and 22%. 2.20.6 Nationwide, 59% women delivered by caesarean section left hospital within 3 days of delivery. But there was considerable variation between units: most reported between 25% and 85% leaving within 3 days, though a few units reported rates outside this range. 2.20.7 There was also wide variation in the reported use of different kinds of

anaesthetic for women delivered by caesarean section. This information was available for 124 units. Reported use of general anaesthetic for caesarean section deliveries varied from under 5% to over 30% with over half of units in the range 6%-16%. Reported use of spinal anaesthetic varied from under 6% to over 83% with over half in the range 53%-69%. Reported use of epidurals varied from under 5% to over 40%, with over half in the range 12%-29%. Other anaesthetics (a category that includes pethidine and gas/air) were rarely reported, with over half of the units recording 0%-2%, though some reported over 20%. Extreme values in the table are likely to be the result of miscoding. 2.20.8 Information about normal delivery is reported for 138 units, the majority of rates falling between 34% and 75%. Smaller midwife-led units delivering between 90 and

300 women per year had higher percentages of between 75% and 100% and in 2 units delivering around 600 women per year each the percentage of normal deliveries was around 90%. Data was excluded for 8 trusts due to miscoding in delivery method, delivery onset method or anaesthetic used. 3. MISCARRIAGES AND ECTOPIC PREGNANCIES 3.1 The statistics discussed in this section relate to miscarriages and ectopic pregnancies that resulted in a woman staying in hospital. It is thought that most women with ectopic pregnancies are admitted to hospital, so these statistics present a fairly accurate picture of the incidence of ectopic pregnancy. For women who have miscarriages, the proportion admitted to

Figure 5 Miscarriages and Ectopic Pregnancies that resulted in an NHS hospital stay; rates per 100 deliveries by age,

England, 2003-04

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10

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under20

20-24 25-29 30-34 35-39 40 andover

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iver

ies

miscarriages

ectopicpregnancies

hospital has not been accurately established. Estimates of miscarriages as a proportion of all pregnancies vary between about 1 in 5 and 1 in 6; using these estimates and the hospital data from HES suggests that between a quarter and a third of miscarriages result in a stay in hospital. 3.2 In each year in the period 1990-91 to 2003-04 there have been about 45,000 miscarriages and 9,000 ectopic pregnancies resulting in a stay in hospital. The figures show a broadly steady relationship with the number of deliveries. The ratio of miscarriages resulting in a hospital stay to deliveries (miscarriage rate) has been about 7:100 throughout the period and the corresponding ectopic pregnancy rate has been about 1.6:100. Both rates show variation by age.

Miscarriage rates in 2003-04 were lowest (6:100) for women aged between 20 and 34, slightly higher (9:100) for women aged under 20 and substantially higher (19:100) for women aged 40 and over. Ectopic pregnancy rates appeared to increase steadily with age and for women aged 40 and over the rate (2:100) was about double that for women aged under 20 (1:100). (Figures 5 and 6 and Annex C) 4. DEFINITIONS 4.1 A list of the data items collected in the HES maternity tail, together with their classifications, is in Annex A. 4.2 For most analyses by method of delivery, the methods (see Annex A for the full list) have been aggregated into three groups: spontaneous includes deliveries recorded as

spontaneous vertex, spontaneous other and breech instrumental includes deliveries recorded as low forceps, other forceps, ventouse and breech extraction caesarean includes deliveries recorded as elective caesarean and emergency caesarean cases with method of delivery other or not known are excluded. 4.3 The hospitals identified in Tables 32 to 34 are those in existence during 2003-04. The hospitals are listed within the 28 Strategic Health Authorities (SHAs) that were established in 2004; the SHAs are shown grouped within Regions that approximate to the Government Offices for the Regions (GOR) areas. Where regional figures are shown in Tables 2 to 26, these are aggregated to the GOR areas. 5. EDITORIAL NOTES 5.1 Data are subject to rounding and totals may not agree with the sum of the component figures shown. 5.2 The following symbols are used in the tables: . . = not available

Figure 6 Miscarriages and Ectopic pregnancies that resulted in an NHS hospital stay; rates per 100 deliveries, England, 1990 - 2004

02468

1012

1990-91

1992-93

1994-95

1996-97

1998-99

2000-01

2002-03

rate

s pe

r 100

del

iver

ies

miscarriagesectopic pregnancies

5.3 Enquiries about the data or requests for further information should be addressed to: Lesz Lancucki Statistics Division 3G Department of Health Room 438B Skipton House 80 London Road London SE1 6LH tel: 020 7972 5533 fax: 020 7972 3889 e-mail: lesz.lancucki@doh.gsi.gov.uk 5.4 Extracts from this publication may be reproduced provided a reference to the source is given. 5.5 Further copies of this bulletin can be obtained from: Department of Health PO Box 777 London SE1 6XH tel: 08701 555 455 fax: 01623 724 524 e-mail doh@prolog.uk.com 5.6 This bulletin, with those covering earlier years’ data, can also be found on the Department of Health website: www.dh.gov.uk/ healthcarestatistics March 2005

INDEX TO TABLES

Table Descriptionnumber

Table 1 NHS hospital deliveries: method of onset of labour, 2003-04

Table 2 NHS hospital deliveries: method of onset of labour by region, 2003-04

Table 3 NHS hospital deliveries: method of delivery, 1980 to 2003-04

Table 4 NHS hospital deliveries: method of delivery by region, 2003-04

Table 5 NHS hospital deliveries: method of delivery by method of onset of labour, 2003-04

Table 6 NHS hospital deliveries: duration of antenatal stay, 1989-1990 to 2003-04

Table 7 NHS hospital deliveries: duration of antenatal stay by region, 2003-04

Table 8 NHS hospital deliveries: duration of antenatal stay by method of onset of labour and method of delivery, 2003-04

Table 9 NHS hospital deliveries: duration of postnatal stay, 1975 to 2003-04

Table 10 NHS hospital deliveries: duration of postnatal stay by region, 2003-04

Table 11 NHS hospital deliveries: duration of postnatal stay by method of onset of labour and method of delivery, 2003-04

Table 12 NHS hospital deliveries: person conducting delivery, 1989-90 to 2003-04

Table 13 NHS hospital deliveries: person conducting delivery by region, 2003-04

Table 14 NHS hospital deliveries: place of delivery, 1989-90 to 2003-04

Table 15 NHS hospital deliveries: place of delivery by region, 2003-04

Table 16 NHS hospital delivieries: reason for change of delivery location by intended and actual location, 2003-04

Table 17 NHS hospital deliveries: deliveries with episiotomy by method of delivery, 1975 to 2003-04

Table 18 NHS hospital deliveries: deliveries with episiotomy by method of delivery and region, 2003-04

Table 19 NHS hospital deliveries: anaesthetics used before or during delivery by method of onset of labour and method of delivery, 2003-04

Table 20 NHS hospital deliveries: anaesthetics used before or during delivery by method of onset of labour and method of delivery, 2003-04

Table 21 NHS hospital deliveries: total, singleton, twin and higher order multiple deliveries by gestation, 2003-04

Table 22 NHS hospital deliveries: singleton and multiple deliveries by birthweight, 2003-04

Table 23 NHS hospital deliveries: median birthweight of singleton, twin & triplet deliveries by gestation, 2003-04

Table 24 NHS hospital deliveries by day of week, by method of onset of labour and method of delivery, 2003-04

Table 25 Coverage of Maternity HES by place of delivery, 1989-90 to 2003-04

Table 26 NHS hospital deliveries: coverage of Maternity HES by region, 2003-04

Table 27 NHS hospital deliveries: deliveries with antenatal, delivery or postnatal complications, 2003-04

Table 28 NHS hospital deliveries: deliveries with selected complications by method of onset of labour and method of delivery, 2003-04

Table 29 Non-delivery obstetric NHS hospital episodes by condition, 2003-04

Table 30 NHS hospital births: births with complications, 2003-04

Table 31 NHS hospital births: births with selected complications by method of onset of labour and method of delivery, 2003-04

Table 32 Registered deliveries, total HES records, usable HES records and onset method, by hospital, 2003-04

Table 33 Method of delivery, by hospital, 2003-04

Table 34 Selected statistics by hospital, 2003-04

Table 1 NHS hospital deliveries: method of onset of labour, 1980 to 2003-04

England percentages

Total Method of onset of labournumber ofdeliveries(=100%) Spontaneous Caesarean Induction

section

Total Surgical Oxytocic Surgicalinduction drugs and drugs

1980 601,500 75.4 4.0 20.6 . . . . . .

1985 605,100 77.6 4.9 17.5 . . . . . .

1989-90 633,500 76.7 5.0 18.3 4.3 8.1 5.91990-91 652,100 76.9 5.3 17.7 3.6 8.4 5.71991-92 643,800 76.7 5.6 17.6 3.0 9.7 5.0

1992-93 624,600 77.5 5.7 16.8 2.9 9.4 4.41993-94 620,200 76.0 6.2 17.7 2.8 10.3 4.71994-95 604,300 73.7 6.8 19.5 2.9 11.7 4.9

1995-96 592,600 72.6 7.2 20.2 3.1 12.3 4.81996-97 594,500 71.6 7.7 20.7 3.2 12.5 5.01997-98 585,000 70.3 8.4 21.3 3.3 12.9 5.1

1998-99 577,500 69.4 8.9 21.7 3.3 13.0 5.41999-00 565,300 68.5 9.6 21.8 3.5 12.6 5.72000-01 549,600 68.7 9.8 21.5 3.6 12.2 5.8

2001-02 541,700 68.1 10.4 21.5 3.1 12.0 6.42002-03 548,000 69.0 10.5 20.5 3.6 11.5 5.42003-04 575,900 69.2 10.6 20.2 3.6 10.8 5.8

Source: HIPE, HES

Table 2 NHS hospital deliveries: method of onset of labour by region, 2003-04

percentages

Total Spontaneous Caesarean Inductionsection

Total Surgical Oxytocic SurgicalGovernment Office Region induction drugs and drugs

England 100 69.2 10.6 20.2 3.6 10.8 5.8

North East 100 71.5 7.2 21.1 5.3 8.6 7.3North West 100 65.7 11.8 22.6 2.8 11.2 8.7Yorkshire & Humber 100 70.7 9.1 20.1 4.1 9.8 6.2

East Midlands 100 70.2 8.6 21.3 2.9 10.6 7.8West Midlands 100 66.6 10.8 22.6 5.3 11.1 6.2East 100 68.4 12.5 19.1 5.9 9.3 3.9

London 100 72.4 10.8 16.9 2.0 10.6 4.2South East 100 69.6 10.5 19.9 3.3 11.6 5.0South West 100 67.2 12.2 20.6 3.3 13.9 3.4

Source: HES

Table 3 NHS hospital deliveries: method of delivery, 1980 to 2003-04

England percentages

Total Method of deliverynumber of

deliveries Spontaneous Forceps Ventouse Breech Breech Caesarean Other(=100%) extraction

Vertex Other Low Other Total Elective Emergency

1980 601,500 75.5 1.0 6.2 5.1 0.7 1.2 1.3 9.0 4.0 5.0 0.1

1982 574,600 75.8 1.1 5.7 4.6 0.6 1.0 1.0 10.1 4.6 5.5 0.01983 578,400 75.3 2.1 5.6 4.2 0.6 0.9 1.0 10.1 4.6 5.5 0.11984 586,100 75.8 2.0 5.5 4.2 0.6 0.9 0.9 10.1 4.6 5.5 0.11985 605,100 75.4 2.5 5.3 3.8 0.7 0.9 0.9 10.4 4.9 5.5 0.1

1989-90 633,500 76.7 1.4 3.9 3.9 1.6 0.8 0.3 11.3 4.9 6.3 0.21990-91 652,100 75.6 1.1 4.0 3.5 2.1 0.8 0.3 12.4 5.3 7.1 0.11991-92 643,800 75.1 1.2 3.9 3.0 2.7 0.8 0.2 12.9 5.5 7.4 0.2

1992-93 624,600 74.4 1.1 3.6 3.0 3.1 0.7 0.2 13.8 5.6 8.1 0.21993-94 620,200 72.5 1.3 3.5 3.0 3.7 0.7 0.2 15.0 6.1 8.9 0.21994-95 604,300 71.5 1.3 3.3 2.5 4.8 0.7 0.2 15.5 6.5 9.0 0.2

1995-96 592,600 70.8 1.5 2.8 2.3 5.4 0.7 0.2 16.3 6.9 9.5 0.11996-97 594,500 70.6 1.1 2.4 2.1 5.9 0.7 0.1 17.0 7.3 9.7 0.31997-98 585,000 69.2 1.0 2.2 1.7 6.5 0.5 0.1 18.2 7.9 10.4 0.5

1998-99 577,500 67.7 1.2 2.0 1.7 7.1 0.5 0.1 19.1 8.0 11.1 0.61999-00 565,300 66.3 1.1 2.0 1.8 7.4 0.4 0.1 20.6 8.6 12.0 0.42000-01 549,600 65.1 1.5 2.1 1.7 7.2 0.5 0.1 21.5 8.8 12.7 0.4

2001-02 541,700 65.6 0.9 2.0 1.5 7.2 0.3 0.1 22.0 9.3 12.7 0.32002-03 548,000 65.9 1.0 1.9 1.5 7.1 0.3 0.1 22.0 9.3 12.7 0.22003-04 575,900 65.5 1.0 1.7 1.6 7.0 0.3 0.1 22.7 9.6 13.1 0.2

Source: HIPE, HES

Table 4 NHS hospital deliveries: method of delivery by region, 2003-04 percentages

Total Spontaneous Forceps Ventouse Breech Breech Caesarean Otherextraction

Government Office Region Vertex Other Low Other Total Elective Emergency

England 100 65.5 1.0 1.7 1.6 7.0 0.3 0.1 22.7 9.6 13.1 0.2

North East 100 66.8 1.3 2.3 1.7 7.4 0.3 0.1 20.0 7.5 12.5 0.2North West 100 67.0 1.6 1.9 1.3 6.3 0.3 0.1 21.5 9.4 12.1 0.1Yorkshire & Humber 100 66.0 2.3 1.5 2.0 6.3 0.2 0.1 21.4 8.7 12.7 0.1

East Midlands 100 65.6 1.0 2.6 1.8 7.1 0.2 0.2 21.2 8.6 12.6 0.1West Midlands 100 68.3 0.6 1.4 1.4 5.4 0.4 0.1 22.2 9.7 12.5 0.1East 100 63.1 0.7 1.1 2.2 7.5 0.3 0.0 25.0 10.3 14.7 0.0

London 100 63.9 0.5 1.5 1.1 7.9 0.3 0.1 24.6 10.0 14.5 0.2South East 100 64.9 0.7 1.6 2.1 7.5 0.3 0.0 22.2 9.9 12.3 0.6South West 100 65.0 0.5 1.9 1.7 7.9 0.3 0.1 22.5 10.2 12.3 0.1

Source: HES

Table 5 NHS hospital deliveries: method of delivery by method of onset of labour, 2003-04

England estimated number (thousands)

Method of onset Method of deliveryof labour

Total Spontaneous Forceps Ventouse Breech Breech Caesarean Otherextraction

Vertex Other Low Other Total Elective Emergency

Total 575.9 380.6 5.4 9.6 9.3 40.4 1.7 0.4 127.4 54.4 72.9 1.1

Spontaneous 398.3 304.8 4.4 7.0 6.6 29.7 1.5 0.3 43.1 2.2 40.9 0.7Caesarean 61.9 0.7 0.0 0.0 0.0 0.3 0.0 0.0 60.6 50.9 9.7 0.1Induction: surgical 21.6 15.2 0.3 0.3 0.5 1.6 0.0 0.0 3.5 0.1 3.4 0.0

drugs 60.3 39.2 0.0 1.0 1.4 5.8 0.1 0.0 12.5 0.3 12.3 0.1surgical & drugs 33.9 20.6 0.7 1.1 0.8 3.0 0.0 0.0 7.6 0.9 6.7 0.0

Source: HES

Table 6 NHS hospital deliveries: duration of antenatal stay, 1989-90 to 2003-04

England percentages

Total Days from start of episode to deliverynumber ofdeliveries(=100%) same 1 2 3 4 or more

day

total 4 5 6 7 ormore

1989-90 633,500 56 32 5 2 5 1 1 1 31990-91 652,100 55 32 5 2 5 1 1 1 31991-92 643,800 55 33 5 2 5 1 1 0 3

1992-93 624,600 56 33 6 2 4 1 1 0 21993-94 620,200 55 33 6 2 4 1 1 0 21994-95 604,300 55 33 6 2 4 1 1 0 2

1995-96 592,600 56 33 6 2 3 1 1 0 11996-97 594,500 56 33 6 2 3 1 1 0 21997-98 585,000 56 33 6 2 3 1 1 0 1

1998-99 577,500 56 33 6 2 3 1 1 0 11999-00 565,300 56 33 6 2 3 1 1 0 12000-01 549,600 57 32 6 2 3 1 1 0 1

2001-02 541,700 57 32 6 2 3 1 0 0 12002-03 548,000 59 31 6 2 3 1 0 0 12003-04 575,900 60 30 6 2 3 1 0 0 1

2003-04 estimated numbers 342,900 174,800 32,000 11,300 14,900 5,000 2,500 1,600 5,900

Table 7 NHS hospital deliveries: duration of antenatal stay by region, 2003-04 percentages

Days from start of episode to delivery

Total same 1 2 3 4 or more day

total 4 5 6 7 or Government Office Region more

England 100 60 30 6 2 3 1 0 0 1

North East 100 59 32 5 1 2 1 0 0 1North West 100 57 32 6 2 3 1 0 0 1Yorkshire & Humber 100 58 32 6 2 3 1 0 0 1

East Midlands 100 60 30 5 2 3 1 0 0 1West Midlands 100 60 30 6 2 2 1 0 0 1East 100 60 30 5 2 3 1 0 0 1

London 100 60 29 6 2 3 1 1 0 1South East 100 61 31 5 2 2 1 0 0 1South West 100 65 27 5 2 2 1 0 0 1

Table 8 NHS hospital deliveries: duration of antenatal stay by method of onset of labour and method of delivery, 2003-04

percentages

Method of Method Days from start of episode to deliveryonset of oflabour delivery

same 1 2 3 4 or moreday

total 4 5 6 7 or more

Spontaneous Spontaneous 73 24 2 1 1 0 0 0 0Instrumental 55 40 4 1 1 0 0 0 0

Caesarean 55 36 5 2 2 1 0 0 1

Induced Spontaneous 31 45 14 5 4 2 1 1 1Instrumental 17 47 23 7 6 3 1 1 1

Caesarean 19 41 23 9 9 4 2 1 2

Caesarean Caesarean 65 24 4 2 5 1 1 1 2

Source: HES

Source: HES

Source: HES

Table 9 NHS hospital deliveries: duration of postnatal stay, 1975 to 2003-04England percentages

Total Days from delivery to end of episodenumber ofdeliveries(=100%) 0 to 3 4 to 6 7 or

more

total same day 1 2 3 total 4 5 6

1975 540,300 32 . . . . . . . . 26 . . . . . . 42

1980 601,500 39 . . . . . . . . 34 . . . . . . 28

1985 605,100 49 . . . . . . . . 36 . . . . . . 15

1989-90 633,500 62 4 17 23 17 30 14 10 7 8

1992-93 624,600 71 8 24 23 16 25 11 9 5 51993-94 620,200 73 9 26 23 15 23 11 8 4 41994-95 604,300 75 10 27 22 15 22 11 8 3 4

1995-96 592,600 76 11 29 22 14 21 11 7 3 41996-97 594,500 78 12 30 22 14 20 11 7 2 41997-98 585,000 79 13 31 21 13 19 11 6 2 3

1998-99 577,500 79 13 32 20 13 18 10 5 2 31999-00 565,300 80 13 33 20 14 17 10 5 2 32000-01 549,600 81 13 33 20 14 16 10 5 2 3

2001-02 541,700 81 13 33 20 15 15 9 4 2 32002-03 548,000 84 14 35 20 14 14 8 4 2 32003-04 85 15 35 20 15 13 8 3 2 3

2003-04 est numbers 575,900 486,700 85,400 198,900 116,000 86,400 73,100 44,100 19,200 9,800 16,100

Table 10 NHS hospital deliveries: duration of postnatal stay by region, 2003-04percentages

Total Days from delivery to end of episode

0 to 3 4 to 6 7 or more

Government Office Region total same day 1 2 3 total 4 5 6

England 100 85 15 35 20 15 13 8 3 2 3

North East 100 87 15 33 24 15 11 7 3 1 2North West 100 79 11 31 21 16 18 10 5 2 3Yorkshire & Humber 100 85 13 34 22 16 12 7 3 2 3

East Midlands 100 84 17 34 19 14 13 8 3 2 3West Midlands 100 86 14 37 21 15 12 7 3 1 2East 100 87 19 34 19 14 10 6 3 1 3

London 100 85 13 38 19 15 12 7 3 2 3South East 100 85 18 33 20 15 12 7 3 2 3South West 100 85 18 35 20 13 11 7 3 2 4

Table 11 NHS hospital deliveries: duration of postnatal stay by method of onset of labour and method of delivery, 2003-04percentages

Method of Method Days from delivery to end of episodeonset of oflabour delivery

0 to 3 4 to 6 7 or more

total same day 1 2 3 total 4 5 6

Spontaneous Spontaneous 94 22 46 19 7 5 3 1 1 2Instrumental 86 8 37 29 12 10 5 3 2 4

Caesarean 57 2 2 15 38 36 23 9 4 7

Induced Spontaneous 91 14 44 24 9 7 4 2 1 2Instrumental 83 6 31 30 16 13 7 4 3 5

Caesarean 54 1 1 14 37 39 24 10 4 8

Caesarean Caesarean 60 1 2 19 39 32 20 8 4 8

Source: HIPE, HES

Source: HES

Source: HES

Table 12 NHS hospital deliveries: person conducting delivery, 1989-90 to 2003-04

England

Total Person conducting deliverynumber ofdeliveries(=100%) Hospital GP Midwife Other

Doctor

1989-90 633,500 23.7 0.3 75.6 0.5

1990-91 652,100 24.5 0.2 74.8 0.4

1991-92 643,800 25.1 0.2 74.3 0.5

1992-93 624,600 25.3 0.2 74.0 0.5

1993-94 620,200 26.1 0.2 73.3 0.4

1994-95 604,300 27.2 0.1 72.3 0.4

1995-96 592,600 28.1 0.1 71.1 0.6

1996-97 594,500 28.4 0.2 70.8 0.7

1997-98 585,000 30.0 0.2 69.4 0.5

1998-99 577,500 31.1 0.1 68.1 0.7

1999-00 565,300 32.5 0.0 66.9 0.6

2000-01 549,600 33.3 0.0 66.2 0.5

2001-02 541,700 33.8 0.0 65.4 0.7

2002-03 548,000 33.3 0.0 66.1 0.6

2003-04 33.5 0.0 66.1 0.4

2003-04 estimated numbers 575,900 192,800 200 380,500 2,400

Table 13 NHS hospital deliveries: person conducting delivery by region, 2003-04

Total Person conducting delivery

Hospital GP Midwife OtherGovernment Office Region Doctor

England 100 33 0 66 0

North East 100 31 0 69 0

North West 100 31 0 69 0

Yorkshire & Humber 100 32 0 67 0

East Midlands 100 36 0 64 1

West Midlands 100 33 0 67 0

East 100 33 0 67 0

London 100 35 0 64 0

South East 100 35 0 64 1

South West 100 36 0 63 1

percentages

Source: HES

percentages

Source: HES

Table 14 NHS hospital deliveries: place of delivery, 1989-90 to 2002-03

England percentages

Total Place of deliverynumber ofdeliveries(=100%) Consultant GP ward Consultant / Midwife ward /

Midwife /ward GP ward Other ward

1989-90 633,500 64 5 30 11990-91 652,100 62 3 35 01991-92 643,800 63 3 33 0

1992-93 624,600 60 3 37 01993-94 620,200 58 3 38 01994-95 604,300 58 3 39 0

1995-96 592,600 61 3 36 01996-97 594,500 67 2 29 11997-98 585,000 65 2 31 1

1998-99 577,500 59 2 38 11999-00 565,300 57 1 40 22000-01 549,600 58 2 38 2

2001-02 541,700 55 1 40 32002-03 548,000 59 1 37 3

2003-04 575,900 58 2 35 5

Source: HES

Table 15 NHS hospital deliveries: place of delivery by region, 2003-04

percentages

Consultant GP ward Consultant / Midwife ward /Government Office Region ward Midwife / Other ward

GP ward

England 58 2 35 5

North East 38 2 60 0North West 88 1 10 0Yorkshire & Humber 66 1 32 2

East Midlands 47 0 51 2West Midlands 62 6 30 2East 54 1 39 6

London 56 0 32 12South East 54 3 41 2South West 23 0 59 18

Source: HES

Table 16 NHS deliveries: reason for change of delivery location by intended and actual location, 2003-04

England percentages

Reason for change Intended location : Hospital Home

Actual location : Home Hospital

Change of address 1 4

Prior to labour: clinical 13 31other 21 13

During labour: clinical 8 35other 14 13

Unintentional 42 3

Estimated number with changed location (=100%) 4000 1400

Source: HES

Table 17 NHS hospital deliveries: deliveries with episiotomy by method of delivery, 1975 to 2003-04

England percentage of deliveries with mention of episiotomy

All Method of deliverydeliveries

Spontaneous Forceps Ventouse Breech Breech Caesareanextraction

Vertex Other Low Other Elective Emergency

1975 51 . . . . . . . . . . . . . . . . . .

1980 52 . . . . . . . . . . . . . . . . . .

1985 37 . . . . . . . . . . . . . . . . . .

1989-90 23 21 20 69 73 60 55 59 0 11990-91 24 21 20 77 79 68 60 60 0 11991-92 23 20 25 77 82 68 58 60 0 0

1992-93 21 17 19 78 81 69 54 59 0 01993-94 19 15 21 74 78 63 51 47 0 11994-95 19 15 17 77 82 65 52 52 0 0

1995-96 18 13 19 78 82 65 50 48 0 11996-97 17 13 19 77 83 64 49 49 0 11997-98 15 11 19 76 79 61 44 39 0 0

1998-99 15 10 16 78 82 60 43 37 0 11999-00 15 10 17 79 77 60 40 39 0 12000-01 14 10 14 77 74 59 37 31 0 1

2001-02 13 9 16 77 76 58 29 23 0 02002-03 13 9 14 78 76 58 26 26 0 0

2003-04 12 8 14 81 75 58 25 22 0 0

2003-04 estimated numbers 69,600 29,700 800 7,800 7,000 23,500 400 100 - 200

Source: HIPE, HES

Table 18 NHS hospital deliveries: deliveries with episiotomy by method of delivery and region, 2003-04

percentage of deliveries with mention of episiotomy

All Method of deliverydeliveries

Spontaneous Forceps Ventouse Breech Breech Caesareanextraction

Government Office Region Vertex Other Low Other Elective Emergency

England 12 8 14 81 75 58 25 22 0 0

North East 11 6 8 73 68 57 35 21 0 0North West 12 7 10 85 76 66 24 17 0 0Yorkshire & Humber 14 10 5 88 81 64 28 23 0 0

East Midlands 12 7 16 88 58 55 28 28 0 0West Midlands 12 9 21 79 83 67 24 21 0 0East 12 7 16 77 73 58 29 13 0 0

London 12 9 36 75 69 55 15 22 0 0South East 12 8 14 84 83 54 30 11 0 0South West 11 7 17 77 81 46 24 42 0 0

Source: HES

Table 19 NHS hospital deliveries: anaesthetics used before or during delivery by method of onset of labour and method of delivery, 2003-04

England percentages

Method of Method Total Type(s) of anaesthetic/analgesic used before or during deliveryonset of of number oflabour delivery cases

( thousands) General Epidural Spinal General General Epidural Other/none( = 100% ) anaesthetic anaesthetic & epidural & spinal & spinal

Total all deliveries 575.9 2 19 12 0 0 2 65

Spontaneous Spontaneous 305.9 0 11 1 0 0 0 87Instrumental 45.3 0 42 5 0 0 2 51Caesarean 43.2 10 29 33 2 1 5 18

Induced Spontaneous 77.6 0 23 1 0 0 1 75Instrumental 17.2 0 54 3 0 0 2 40Caesarean 24.0 8 38 28 3 1 5 18

Caesarean Caesarean 62.9 6 7 67 0 1 9 10

Source: HES

Table 20 NHS hospital deliveries: anaesthetics used before/during delivery by method of onset of labour & method of delivery, 1989-90 to 2003-04

England percentages

Type(s) of anaesthetic/analgesic used Type(s) of anaesthetic/analgesic usedbefore or during delivery before or during delivery

Gen- Epi- Spi- Gen + Gen + Epi + Gen- Epi- Spi- Gen + Gen + Epi +eral dural nal epi- spi- spi- eral dural nal epi- spi- spi-

dural nal nal dural nal nal____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____

All deliveries Elective caesarean deliveries

1989-90 7 16 1 1 0 0 1989-90 53 31 11 1 0 11992-93 6 17 3 1 0 1 1992-93 38 21 33 1 0 21995-96 5 20 6 1 0 1 1995-96 24 13 49 0 1 4

1998-99 3 21 8 0 0 1 1998-99 14 10 59 0 1 71999-00 3 22 9 0 0 2 1999-00 12 11 60 0 1 72000-01 3 22 10 0 0 2 2000-01 10 10 60 0 1 8

2001-02 3 21 10 0 0 2 2001-02 9 9 64 0 1 72002-03 2 19 11 0 0 2 2002-03 8 8 64 0 1 82003-04 2 19 12 0 0 2 2003-04 6 7 67 0 1 9

Onset and delivery spontaneous Onset induced, delivery spontaneous

1989-90 0 9 0 0 0 0 1989-90 0 20 0 0 0 01992-93 0 10 0 0 0 0 1992-93 0 21 0 0 0 01995-96 0 12 0 0 0 0 1995-96 0 23 0 0 0 0

1998-99 0 13 0 0 0 0 1998-99 0 23 0 0 0 11999-00 0 14 0 0 0 0 1999-00 0 25 0 0 0 12000-01 0 13 0 0 0 1 2000-01 0 24 0 0 0 1

2001-02 0 13 0 0 0 1 2001-02 0 24 0 0 0 12002-03 0 12 1 0 0 0 2002-03 0 23 1 0 0 12003-04 0 11 1 0 0 0 2003-04 0 23 1 0 0 1

Onset spontaneous, with instrumental delivery Onset induced, with instrumental delivery

1989-90 2 44 1 0 0 1 1989-90 1 57 1 0 0 11992-93 1 47 2 0 0 1 1992-93 1 61 1 1 0 11995-96 0 49 2 0 0 1 1995-96 0 61 1 0 0 1

1998-99 0 50 3 0 0 1 1998-99 0 60 2 0 0 11999-00 0 49 3 0 0 1 1999-00 0 60 2 0 0 22000-01 0 48 3 0 0 2 2000-01 0 60 2 0 0 2

2001-02 0 48 4 0 0 3 2001-02 0 58 2 0 0 32002-03 0 44 4 0 0 2 2002-03 0 56 2 0 0 22003-04 0 42 5 0 0 2 2003-04 0 54 3 0 0 2

Onset spontaneous, with caesarean delivery Onset induced, with caesarean delivery

1989-90 59 22 3 9 0 1 1989-90 54 26 2 13 0 01992-93 44 27 10 8 0 1 1992-93 40 32 8 11 0 11995-96 29 31 19 5 1 3 1995-96 26 37 16 6 1 2

1998-99 19 33 24 3 1 4 1998-99 15 41 19 4 0 41999-00 16 34 26 3 1 5 1999-00 13 43 20 4 1 42000-01 14 33 28 3 1 5 2000-01 12 42 20 4 0 6

2001-02 13 31 28 3 1 6 2001-02 11 41 21 3 1 62002-03 11 30 31 3 1 6 2002-03 9 39 25 3 1 62003-04 10 29 33 2 1 5 2003-04 8 38 28 3 1 5

Source: HES

Table 21 NHS hospital deliveries: total, singleton, twin and higher order multiple deliveries by gestation, 2003-04

England

Gestation Total deliveries Singleton deliveries Twin deliveries Triplet and higher(weeks) order deliveries

estimated % estimated % estimated % estimated %number number number number

Total 575,900 100 567,200 100 8,600 100 130 100

under 20 100 0 0 0 0 0 0 0

20-23 500 0 440 0 60 1 0 1

20 100 0.0 50 0.0 10 0.121 100 0.0 100 0.0 10 0.122 100 0.0 110 0.0 10 0.223 200 0.0 180 0.0 40 0.4

24-27 2,800 0 2,500 0 300 3 0 3

24 600 0.1 500 0.1 60 0.725 600 0.1 500 0.1 70 0.826 800 0.1 700 0.1 110 1.327 800 0.1 700 0.1 60 0.7

28-31 5,000 1 4,400 1 600 7 10 1628 1,000 0.2 900 0.1 110 1.2 0 1.329 1,100 0.2 1,000 0.2 130 1.5 0 3.830 1,400 0.2 1,200 0.2 150 1.8 0 2.531 1,600 0.3 1,300 0.2 220 2.6 10 8.9

32-36 34,400 6 31,100 5 3,200 37 50 38

32 2,300 0.4 2,000 0.4 280 3.2 0 2.533 3,300 0.6 2,900 0.5 370 4.3 10 5.134 5,200 0.9 4,600 0.8 610 7.1 20 12.735 8,200 1.4 7,400 1.3 770 8.9 10 11.436 15,400 2.7 14,200 2.5 1,200 13.6 10 6.3

37-41 506,300 88 501,900 88 4,400 51 40 4237 33,800 5.9 31,900 5.6 1,900 22.1 0 3.838 81,400 14.1 79,600 14.0 1,800 20.8 10 8.939 122,800 21.3 122,400 21.6 500 5.6 10 8.940 156,600 27.2 156,500 27.6 200 2.3 10 11.441 111,700 19.4 111,600 19.7 40 0.5 10 8.9

42 or over 26,800 5 26,800 5 30 0 0 0

42 22,700 3.9 22,700 4.0 30 0.343 2,300 0.4 2,300 0.4 0 0.044 1,000 0.2 1,000 0.2 0 0.045 430 0.1 430 0.1 0 0.046 190 0.0 190 0.0 0 0.047 100 0.0 100 0.0 0 0.0

48 or over 120 0 120 0 0 0

Source: HES

Table 22 NHS hospital deliveries: singleton and multiple deliveries by birthweight, 2003-04

England

Birthweight Singleton deliveries Multiple deliveries(grams)

total liveborn stillborn weight of firstbaby in the

deliveryestimated estimated % estimated % stillborn

number number number per 1000 (estimated numbers)deliveries

Total 567,200 564,100 100 3,100 100 5 8,700

under 1000 4,300 3,400 1 1,000 32 225 400 1000-1499 4,000 3,600 1 350 12 92 500

1500-1999 6,900 6,600 1 300 10 44 1,200 2000-2499 23,800 23,400 4 350 11 15 2,500

2500-2999 96,600 96,200 17 400 12 4 2,900 3000-3499 205,700 205,300 36 400 13 2 1,000

3500-3999 163,200 163,000 29 200 6 1 190 4000-4499 53,400 53,300 9 100 3 1 30

4500-4999 8,500 8,500 1 30 1 3 5000+ 900 900 0 10 0 9

Source: HES

Table 23 NHS hospital deliveries: median birthweight of singleton, twin and triplet deliveries by gestation, 2003-04

England

Gestation Singleton deliveries Twin deliveries Triplet deliveries

median birthweight range median birthweight median birthweightbirthweight (5th to 95th percentiles) of first baby of first baby

all gestations

under 20 290 . . . .20 320 . . . .21 420 . . . .22 460 370 - 580 470 .23 550 380 - 750 580 .

24 670 475 - 980 670 .25 760 485 - 1,100 720 .26 870 530 - 1,226 840 .27 980 590 - 1,330 1,050 .

28 1,110 710 - 1,490 1,110 .29 1,280 740 - 1,700 1,300 .30 1,460 880 - 2,625 1,420 .31 1,630 1,000 - 2,810 1,580 1,340

32 1,820 1,170 - 2,860 1,710 1,620 33 2,030 1,380 - 2,990 1,930 1,980 34 2,250 1,580 - 3,140 2,090 2,080 35 2,520 1,810 - 3,410 2,260 2,030 36 2,720 1,980 - 3,560 2,430 2,370

37 2,950 2,210 - 3,780 2,610 2,440 38 3,170 2,450 - 3,980 2,770 3,150 39 3,320 2,620 - 4,100 2,880 3,180 40 3,460 2,760 - 4,240 3,090 .41 3,600 2,890 - 4,380 3,190 .

42 3,640 2,920 - 4,440 . .43 3,480 2,680 - 4,300 . .

44 or over 3,490 2,630 - 4,320 . .

Source: HES

Table 24 NHS deliveries by day of week and by method of onset of labour and method of delivery, 2003-04

England percentages

Method of Method Day of week on which delivery takes placeonset of oflabour delivery

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Total all hospital deliveries 13.1 13.8 13.7 14.4 14.9 16.2 14.0

Spontaneous Total 14.0 14.6 14.6 14.4 14.3 14.2 13.8Spontaneous 14.0 14.6 14.5 14.5 14.3 14.2 13.9Instrumental 14.4 14.5 15.0 14.4 14.1 13.9 13.7Caesarean 13.3 15.0 14.7 14.4 14.8 14.5 13.3

Induced Total 11.1 11.9 14.8 15.4 15.9 16.4 14.4Spontaneous 10.7 12.1 14.8 15.4 16.1 16.8 14.1Instrumental 12.0 11.4 15.0 15.1 15.6 15.9 15.0Caesarean 12.0 11.9 14.8 15.3 15.6 15.5 15.0

Caesarean Caesarean 2.6 19.0 18.4 19.9 17.5 19.3 3.3

Intended home deliveries

Actual home 14.2 14.7 15.4 13.9 15.6 13.3 12.8

Actual hospital 12.9 14.1 15.3 13.8 16.5 15.0 12.5

Source: HES

Table 25 Coverage of Maternity HES by place of delivery, 1989-90 to 2003-04

Englandpercentages

NHS hospital deliveries Home deliveries

deliveries HES records HES records with deliveries (=100%) HES records (%) HES records with (=100%) (%) maternity data (%)(1) maternity data (%) (1)

1989-90 633,500 79 57 6,600 20 201990-91 652,100 86 53 7,100 23 231991-92 643,800 90 68 7,700 20 20

1992-93 624,600 95 78 8,900 26 251993-94 620,200 95 70 10,400 29 281994-95 604,300 93 67 11,300 28 27

1995-96 592,600 95 72 12,000 29 291996-97 594,500 94 67 13,000 24 241997-98 585,000 93 60 13,500 11 11

1998-99 577,500 95 61 13,000 15 151999-00 565,300 96 64 12,500 17 172000-01 549,600 95 66 11,600 12 12

2001-02 541,700 97 70 11,700 14 132002-03 548,000 99 72 12,100 15 132003-04 575,900 99 72 12,900 14 14

Source: HES, ONS(1) Records with method of delivery present in the tail

Table 26 NHS hospital deliveries: coverage of Maternity HES by region, 2003-04

deliveries HES records HES records with maternity data (1)

number number percentage number percentageof maternities of maternities

England 575,896 572,178 99 415,214 72

North East 28,310 27,069 96 24,447 86

North West 78,358 77,446 99 64,776 83

Yorkshire & Humber 59,535 59,270 100 33,480 56

East Midlands 40,643 40,704 100 31,365 77

West Midlands 64,129 64,795 101 48,988 76

East 57,018 57,301 100 51,673 91

London 110,990 111,512 100 81,377 73

South East 86,839 86,075 99 58,445 67

South West 50,074 48,006 96 20,663 41

Source HES(1) Records with method of delivery present in the tail

Table 27 NHS hospital deliveries: deliveries with antenatal, delivery or postnatal complications, 2003-04

England percentage of deliveries with mention of complication / indication for care

ICD 10 Condition 2003-04condition 2003-04 estimated numbercode of cases

Oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperiumO10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium 0.3 1,500 O11 Pre-existing hypertensive disorder with superimposed proteinuria 0.0 100 O12 Gestational (pregnancy-induced) oedema and proteinuria without hypertension 0.3 1,900 O13 Gestational (pregnancy-induced) hypertension without significant proteinuria 1.9 11,000 O14 Gestational (pregnancy-induced) hypertension with significant proteinuria (pre-eclampsia) 2.6 10,000 O15 Eclampsia 0.1 500 O16 Unspecified maternal hypertension 1.6 9,500

Other maternal disorders predominantly related to pregnancy.O20 Haemorrhage in early pregnancy 0.2 900 O21 Excessive vomiting in pregnancy 0.1 500 O22 Venous complications in pregnancy 0.2 1,000 O23 Infections of genitourinary tract in pregnancy 1.0 5,700 O24 Diabetes mellitus in pregnancy 1.6 9,200

O25 Malnutrition in pregnancy 0.0 0 O26 Maternal care for other conditions predominantly related to pregnancy 1.8 10,100 O28 Abnormal findings on antenatal screening of mother 0.2 1,400 O29 Complications of anaesthesia during pregnancy 0.0 0

Maternal care related to the fetus and amniotic cavity and possible delivery problemsO30 Multiple gestation 0.8 4,800 O31 Complications specific to multiple gestation 0.0 200 O32 Maternal care for known or suspected malpresentation of fetus 4.6 26,400 O33 Maternal care for known or suspected disproportion 0.2 1,200 O34 Maternal care for known or suspected abnormality of pelvic organs 7.4 42,400

O342 Uterine scar from prevoius surgery (including previous caesarean section) 6.3 36,000

O35 Maternal care for known or suspected fetal abnormality and damage 0.3 1,800 O36 Maternal care for known or suspected fetal problems 5.6 32,100 O40 Polyhydramnios 0.4 2,300 O41 Other disorders of amniotic fluid and membranes 1.6 9,100 O42 Premature rupture of membranes 7.4 42,500

O43 Placental disorders 1.4 8,100 O44 Placenta praevia 0.6 3,400 O45 Premature separation of placenta (abruptio placentae) 0.4 2,000 O46 Antepartum haemorrhage not elsewhere classified. 0.0 200 O47 False labour 0.3 1,600 O48 Prolonged pregnancy 7.5 43,300

Complications of labour and deliveryO60 Preterm delivery 5.3 30,300 O61 Failed induction of labour 1.1 6,100 O62 Abnormalities of forces of labour 2.3 13,300 O63 Long labour 11.5 65,900

O630 prolonged first stage 2.9 16,400 O631 prolonged second stage 7.6 43,600 O632 delayed delivery of second twin, triplet etc 0.0 100

O64 Obstructed labour due to malposition and malpresentation of fetus 1.1 6,300 O65 Obstructed labour due to maternal pelvic abnormality 0.3 1,600 O66 Other obstructed labour 1.8 10,300 O67 Labour and delivery complicated by interpartum haemorrhage, not elsewhere classified 0.6 3,600 O68 Labour and delivery complicated by fetal stress (distress) 19.8 113,700 O69 Labour and delivery complicated by umbilical cord complications 2.6 14,900

O70 Perineal laceration during delivery 37.6 216,400 O71 Other obstetric trauma 1.3 7,300 O72 Postpartum haemorrhage 7.2 41,300 O73 Retained placenta and membranes, without haemorrhage 1.0 6,000 O74 Complications of anaesthesia during labour and delivery 0.1 800 O75 Other complications of labour and delivery, not elsewhere classified 4.9 28,100

Complications predominantly related to the puerperiumO85 Puerperal sepsis 0.0 100 O86 Other puerperal infections 0.8 4,300 O87 Venous complications in the puerperium 0.2 1,300 O88 Obstetric embolism 0.0 100

O89 Complications of anaesthesia during the puerperium 0.0 300 O90 Complications of the puerperium, not elsewhere classified 0.4 2,100 O91 Infections of breast associated with childbirth 0.0 100 O92 Other disorders of breast and lactation associated with childbirth 0.3 1,600

Other obstetric conditions complicating pregnancy, childbirth and the puerperiumO98 Maternal infectious and parasitic diseases 0.7 4,000 O99 Other maternal diseases 7.8 45,000

Source: HES

Table 28 NHS hospital deliveries: deliveries with selected complications by method of onset of labour and method of delivery, 2003-04

England percentage of deliveries with mention of complication / indication for care

ICD 10 Selected conditions Method of onset of labour : Spontaneous Induced Caesareancode

Method of delivery : Spont- Instru- Caes- Spont- Instru- Caes- Caes-aneous mental arean aneous mental arean arean

O10-O16 ex O12 Hypertension 2 4 5 12 15 17 8O14 Pre-eclampsia 0 1 2 3 5 7 4

O32 Malpresentation of fetus 1 2 12 2 2 6 22O342 Uterine scar from previous surgery (inc. previous caesarean section) 1 2 13 0 1 5 43O35,O36,O43 Fetal and placental problems 4 5 7 14 10 13 12O40,O41,O42 Disorders of amniotic fluid and membranes; premature rupture 8 10 12 15 15 16 5O48 Prolonged pregnancy 2 2 3 29 31 28 2

O60 Preterm delivery 4 3 9 3 2 4 8O630 Long labour, prolonged first stage 1 3 13 1 2 17 0O631 Long labour, prolonged second stage 2 45 11 2 41 10 0O639 Long labour, unspecified 0 1 3 0 1 4 0O64,O65,O66 Obstructed labour 1 10 18 1 10 13 2O69 Labour and delivery complicated by umbilical cord complications 3 3 3 3 3 3 1O70 Perineal laceration during delivery 51 30 1 49 29 1 0O72 Postpartum haemorrhage 4 10 14 5 13 16 12

Source: HES

Table 29 Non-delivery obstetric NHS hospital episodes by condition, 2003-04

England estimated number of episdodes with mention of complication / indication for care (thousands)

ICD 10 Conditioncondition 2003-04code

Oedema, proteinuria & hypertensive disorders in pregnancy, childbirth and the puerperiumO10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium 1,000O11 Pre-existing hypertensive disorder with superimposed proteinuria 200O12 Gestational (pregnancy-induced) oedema and proteinuria without hypertension 3,300O13 Gestational (pregnancy-induced) hypertension without significant proteinuria 12,000O14 Gestational (pregnancy-induced) hypertension with significant proteinuria (pre-eclampsia) 5,100O15 Eclampsia 100O16 Unspecified maternal hypertension 19,600

Other maternal disorders predominantly related to pregnancy.O20 Haemorrhage in early pregnancy 39,000O21 Excessive vomiting in pregnancy 22,900O22 Venous complications in pregnancy 900O23 Infections of genitourinary tract in pregnancy 13,200O24 Diabetes mellitus in pregnancy 4,500

O25 Malnutrition in pregnancy 0O26 Maternal care for other conditions predominantly related to pregnancy 116,100O28 Abnormal findings on antenatal screening of mother 2,700O29 Complications of anaesthesia during pregnancy 0

Maternal care related to the fetus and amniotic cavity and possible delivery problemsO30 Multiple gestation 3,100O31 Complications specific to multiple gestation 400O32 Maternal care for known or suspected malpresentation of fetus 6,100O33 Maternal care for known or suspected disproportion 100O34 Maternal care for known or suspected abnormality of pelvic organs 4,700

O342 Uterine scar from prevoius surgery (including previous caesarean section) 2,100

O35 Maternal care for known or suspected fetal abnormality and damage 3,400O36 Maternal care for known or suspected fetal problems 77,400O40 Polyhydramnios 1,200O41 Other disorders of amniotic fluid and membranes 4,200O42 Premature rupture of membranes 16,000

O43 Placental disorders 300O44 Placenta praevia 2,000O45 Premature separation of placenta (abruptio placentae) 100O46 Antepartum haemorrhage not elsewhere classified. 26,200O47 False labour 61,700O48 Prolonged pregnancy 4,900

Complications of labour and delivery

O60 Preterm delivery 700O61 Failed induction of labour 400O62 Abnormalities of forces of labour 1,300O63 Long labour 2,400

O630 prolonged first stage 800O631 prolonged second stage 1,500O632 delayed delivery of second twin, triplet etc 0

O64 Obstructed labour due to malposition and malpresentation of fetus 400O65 Obstructed labour due to maternal pelvic abnormality 0O66 Other obstructed labour 100O67 Labour and delivery complicated by interpartum haemorrhage, not elsewhere classified 0O68 Labour and delivery complicated by fetal stress (distress) 2,400O69 Labour and delivery complicated by umbilical cord complications 100

O70 Perineal laceration during delivery 1,600O71 Other obstetric trauma 200O72 Postpartum haemorrhage 4,900O73 Retained placenta and membranes, without haemorrhage 600O74 Complicatiobns of anaesthesia during labour and delivery 100O75 Other complications of labour and delivery, not elsewhere classified 1,000

Complications predominantly related to the puerperiumO85 Puerperal sepsis 600O86 Other puerperal infections 2,200O87 Venous complications in the puerperium 400O88 Obstetric embolism 200

O89 Complications of anaesthesia during the puerperium 300O90 Complications of the puerperium, not elsewhere classified 4,100O91 Infections of breast associated with childbirth 600O92 Other disorders of breast and lactation associated with childbirth 200

Other obstetric conditions complicating pregnancy, childbirth and the puerperiumO98 Maternal infectious and parasitic diseases 800O99 Other maternal diseases 40,700

Table 30 NHS hospital births: births with complications, 2003-04

England percentage of births with mention of complication

2003-04ICD 10 Condition estimatedcode 2003-04 number

of cases

Fetus and newborn affected by maternal factors and by complications of pregnancy, labour & delivery

P00 Fetus and newborn affected by maternal conditions that may be unrelated to present pregnancy 0.6 3,300P01 Fetus and new born affected by maternal complications of pregnancy 1.0 5,500P02 Fetus and newborn affected by complications of placenta, cord and membranes 0.6 3,700P03 Fetus and newborn affected by other complications of labour and delivery 1.8 10,200P04 Fetus and newborn affected by noxious influences transmitted via placenta or breast milk 0.1 700

Disorders related to length of gestation and fetal growth

P05 Slow fetal growth and malnutrition 1.5 8,400P07 Disorders related to short gestation and low birth weight, not elsewhere classified 6.7 38,500P08 Disorders related to long gestation and high birth weight 1.3 7,300

Birth traumaP10 Intracranial laceration and haemorrhage due to birth injury 0.0 0P11 Other birth injuries to central nervous system 0.0 200P12 Birth injury to scalp 1.0 5,800P13 Birth injury to skeleton 0.1 400P14 Birth injury to peripheral nervous system 0.0 300P15 Other birth injuries 0.8 4,700

Respiratory and cardiovascular disorders specific to the perinatal periodP20 Intrauterine hypoxia 4.7 27,200P21 Birth asphyxia 1.0 5,500P22 Respiratory distress of newborn 2.4 14,100P23 Congenital pneumonia 0.1 400P24 Neonatal aspiration syndromes 0.3 1,500

P25 Interstitial emphysema and related conditions originating in the perinatal period 0.1 700P26 Pulmonary haemorrhage originating in the perinatal period 0.0 200P27 Chronic respiratory disease originating in the perinatal period 0.1 600P28 Other respiratory conditions originating in the perinatal period 1.5 8,900P29 Cardiovascular disorders originating in the perinatal period 0.7 4,000

Infections specific to the perinatal periodP35 Congenital viral diseases 0.0 100P36 Bacterial sepsis of newborn 0.6 3,500P37 Other congenital infectious and parasitic diseases 0.1 300P38 Omphalitis of newborn with or without mild haemorrhage 0.1 800P39 Other infections specific to the perinatal period 0.7 4,100

Haemorrhagic and haematological disorders of fetus and new born

P50 Fetal blood loss 0.0 100P51 Umbilical haemorrhage of newborn 0.0 0P52 Intracranial non-traumatic haemorrhage of fetus and newborn 0.1 700P53 Haemorrhagic disease of fetus and newborn 0.0 0P54 Other neonatal haemorrhages 0.2 1,200

P55 Haemolytic disease of fetus and newborn 0.2 1,100P56 Hydrops fetalis due to haemolytic disease 0.0 0P57 Kernicterus 0.0 0P58 Neonatal jaundice due to other excessive haemolyysis 0.0 100P59 Neonatal jaundice from other and unspecified causes 5.1 29,300P60 Disseminated intravascular coagulation of fetus and newborn 0.0 100P61 Other perinatal haematological disorders 0.5 2,700

Transitory endocrine and metabolic disorders specific to fetus and newbornP70 Transitory disorders of carbohydrate metabolism specific to fetus and newborn 1.5 8,900P71 Transitory neonatal disorders of calcium and magnesium metabolism 0.1 300P72 Other transitory neonatal endocrine disorders 0.0 100P74 Other transitory neonatal eletrolute and metabolic disturbances 0.4 2,000

Digestive system disorders of fetus and newbornP75 Meconium ileus 0.0 0P76 Other intestinal obstruction of newborn 0.0 200P77 Necrotizing enterocolitis of fetus and newborn 0.1 300P78 Other perinatal digestive system disorders 0.1 500

Conditions involving the integument and temperature regulation of fetus and newborn

P80 Hypothermia of newborn 0.5 2,700P81 Other disturbances of temperature regulation of newborn 0.2 1,300P83 Other condiitons of inegument specific to fetus and newborn 1.2 6,800

Other disorders originating in the perinatal period

P90 Convulsions of newborn 0.1 600P91 Other disturbances of cerbral status of newborn 0.1 500P92 Feeding problems of newborn 1.6 9,000P93 Reactions and intoxications due to drugs administered to fetus and newborn 0.0 0P94 Disorders of muscle tone of newborn 0.3 1,700P96 Other conditions orginating in the perinatal period 0.5 2,800

Source: HES

Table 31 NHS hospital births: births with selected complications by method of onset of labour and method of delivery, 2003-04

England

Condition Method of onset of labour Spontaneous Induced Caesarean

ICD 10 Method of delivery Spont- Instru- Caes- Spont- Instru- Caes- Caes-code aneous mental arean aneous mental arean arean

P12 Birth injury to scalp 1 5 1 1 6 1 0P15 Other birth injuries 1 2 1 1 2 1 0P20 Intrauterine hypoxia 3 11 10 4 10 12 1P21 Birth asphyxia 1 1 2 1 1 1 1P22 Respiratory distress of newborn 1 2 5 1 2 3 6P29 Cardiovascular disorders originating in the perinatal period 1 1 1 1 1 1 1

P36 Bacterial sepsis of newborn 0 1 1 0 1 1 1P59 Neonatal jaundice from other and unspecified causes 3 6 9 4 8 8 9

P70 Transitory disorders of carbohydrate metabolism specific to fetus & newborn 1 1 2 2 2 3 4P92 Feeding problems of newborn 1 2 3 1 2 2 3

Source: HES

Table 32 Registered deliveries, total HES records and usable HES records, and onset method by hospital, 2003-04

Deliveries HES Records with method Method of onset of labour (%)registered records of delivery present

(1) usable sponta- caes- inductionnumber percentage records neous arean

Hospital of deliveries number total surgical surgical drugregistered (=100%) and drug

England 575,896 572,178 415,214 72 453,461 69 11 20 4 6 11

NORTH EASTCounty Durham & Tees Valley

RXPDA Bishop Auckland and Darlington Hospitals 2789 2931 2920 105 2675 70 8 17 4 2 0RXP00 Dryburn Hospital 2214 1587 747 34 743 67 8 25 2 13 10RTR45 Friarage Hospital, Northallerton 1238 1221 1145 92 1146 59 5 35 13 9 13RVW Hartlepool & North Tees Hospitals 3574 3580 3572 100 3461 73 7 20 2 6 12RTR00 South Cleveland Hospital 3528 3497 2124 60 2455 89 0 11 6 3 2

Northumberland, Tyne & WearRTF01 Ashington Hospital 1973 1962 1908 97 1886 71 10 19 6 10 3RTF04 Hexham General Hospital 320 320 305 95 306 79 15 6 0 0 6RTF02 North Tyneside General Hospital 1691 1706 1692 100 1663 68 8 23 3 2 19RR7 Queen Elizabeth Hospital, Gateshead 1648 1688 1638 99 1639 71 8 21 5 6 10RTD Royal Victoria Infirmary, Newcastle 4809 4766 4737 99 4633 70 8 21 4 9 9RE9 South Shields Maternity Hospital 1497 1513 1428 95 1402 63 9 28 3 14 11RLN Sunderland Royal Hospital 3029 2298 2231 74 2254 71 7 22 1 13 9

NORTH WESTCheshire & Merseyside

RBL Arrowe Park Hospital, Birkenhead 3251 3366 3212 99 3214 61 16 24 0 0 24RJR Countess of Chester Hospital 2928 3129 2963 101 2872 69 10 21 0 21 0REM Fazakerley Hospital 1955 2034 1947 100 1952 61 14 25 5 11 10RBT Leighton Hospital, Crewe 2570 2608 1893 74 1872 72 8 19 2 7 10REP Liverpool Women's Hospital 6456 6437 6341 98 6360 59 12 29 0 29 0RJN Macclesfield DGH 1732 1736 1736 100 1736 66 14 20 0 20 0RVY Ormskirk & Southport Hospitals 2237 2290 2174 97 2177 62 11 27 2 5 21RWW Warrington Hospital 3138 3071 0 0 0 .. .. .. .. .. ..RBN Whiston Hospital 2559 2573 0 0 2573 64 11 25 4 8 12

Cumbria and LancashireRXR Burnley General Hospital 2284 2307 2296 101 2300 67 11 22 3 9 10RXN01 Chorley and District Hospital 249 215 213 86 214 100 0 0 0 0 0RTX Morecambe Bay Hospitals 3274 3178 3046 93 3050 61 12 26 3 7 17RNL North Cumbria Acute Hospitals 2946 2948 1759 60 2915 70 10 21 1 3 17RMB Queens Park Hospital, Blackburn 3622 3506 3465 96 3489 68 10 23 6 5 12RXN02 Sharoe Green Hospital, Fulwood 3717 3474 3466 93 3470 69 12 20 1 5 14RXL Victoria Hospital, Blackpool 2799 3142 2781 99 2799 63 14 23 2 6 14

Greater ManchesterRRF Billinge Hospital, Wigan 2829 2821 2812 99 2818 64 12 24 2 10 12RM3 Hope Hospital, Salford 2448 1746 1601 65 1611 62 13 25 3 10 12RW6 Pennine Acute Hospitals 9284 9347 7849 85 7865 66 12 22 5 5 12RMC Royal Bolton Hospital 4148 4067 3974 96 3977 68 10 22 1 6 16RW3 St Mary's Hospital, Manchester 4412 4368 4188 95 4289 71 12 17 10 0 7RWJ Stepping Hill Hospital, Stockport 3015 3209 3175 105 3187 70 12 18 2 1 15RMP Tameside General Hospital 2391 2389 0 0 0 .. .. .. .. .. ..RM4 Trafford General Hospital 1436 1311 1259 88 1272 70 12 18 7 0 11RM2 Wythenshawe Hospital 2678 2683 2626 98 2625 66 12 22 3 13 6

YORKSHIRE & HUMBERNorth & East Yorkshire and Northern Lincolnshire

RWA Castle Hill and Hull Maternity Hospitals 4916 4881 0 0 0 .. .. .. .. .. ..RJL Grimsby Maternity and Scunthorpe Hospitals 3939 3939 0 0 527 65 13 22 22 0 0RCD Harrogate District Hospital 1580 1591 366 23 1515 66 10 23 1 1 21RCC Scarborough Hospital 1680 6359 0 0 0 .. .. .. .. .. ..RCB York District Hospital 2860 2865 2716 95 0 .. .. .. .. .. ..

South YorkshireRFF Barnsley DGH 2289 2295 0 0 1646 65 10 24 2 14 8RP5BA Bassetlaw DGH 1261 1264 0 0 1241 72 8 20 5 4 11RP5DR Doncaster Royal Infirmary 3327 3353 0 0 3271 70 7 23 3 15 6RHQ Northern General Hospital, Sheffield 6180 6163 6158 100 5559 74 7 18 4 11 3RCX Queen Elizabeth Hospital, Kings Lynn 2019 2011 1881 93 1881 65 16 18 4 1 13RFR Rotherham DGH 2516 2529 2463 98 2428 72 7 21 3 3 15

West YorkshireRCF Airedale General Hospital 2273 2256 2203 97 2205 62 15 23 5 3 15RAE Bradford Royal Infirmary 5324 5312 5095 96 4949 64 7 29 9 8 12RXF10 Dewsbury District Hospital 3056 3013 3007 98 2846 74 5 21 1 3 17RWY02 Halifax General Hospital 2545 2521 0 0 2393 78 9 13 5 5 3RWY01 Huddersfield Royal Infirmary 2573 2852 0 0 2678 74 10 16 3 4 9RR8 Leeds Teaching Hospitals 8193 7863 6569 80 6352 70 13 17 3 6 9RXF03 Pontefract Maternity Hospital 3004 3056 3022 101 2883 80 5 15 3 2 11

Table 32 Registered deliveries, total HES records and usable HES records, and onset method by hospital, 2003-04

Deliveries HES Records with method Method of onset of labour (%)registered records of delivery present

(1) usable sponta- caes- inductionnumber percentage records neous arean

Hospital of deliveries number total surgical surgical drugregistered (=100%) and drug

England 575,896 572,178 415,214 72 453,461 69 11 20 4 6 11

EAST MIDLANDSLeicestershire, Northamptonshire & Rutland

RNQ Kettering General Hospital 3483 3594 3257 94 3237 69 10 21 4 6 11RWEAA Leicester Royal Infirmary 5264 5334 3886 74 3921 71 10 19 1 12 6RWEAK Leicestershire General Hospital 3813 3834 2815 74 2815 74 10 17 1 9 6RNS Northampton General Hospital 3804 3834 3830 101 3704 70 12 19 3 7 95EH St Mary's Hospital, Melton Mowbray 231 38 0 0 0 .. .. .. .. .. ..

TrentRFS Chesterfield & N. Derbyshire Royal Hospital 2909 2918 2614 90 2582 68 7 25 7 5 14RTG Derby City General Hospital 4399 4432 4426 101 4427 79 3 18 1 11 6RK5 King's Mill Hospital, Sutton in Ashfield 2455 2622 2353 96 2355 66 8 26 3 16 6RCS Nottingham City Hospital 5592 5588 0 0 5444 71 8 21 3 5 13RFK Nottingham University Hospital 3756 3770 3476 93 3447 68 11 21 3 8 11RWD United Lincolnshire Hospitals 4937 5007 4708 95 4344 64 9 27 4 3 20

WEST MIDLANDS Shropshire & Staffordshire

RXWMB Bridgnorth Hospital 70 94 89 127 91 100 0 0 0 0 0RXWML Ludlow Hospital 93 109 105 113 108 100 0 0 0 0 0RJE North Staffordshire Hospital, Stoke on Trent 5001 5113 0 0 0 .. .. .. .. .. ..RJF Queen's Hospital, Burton upon Trent 2947 2974 2940 100 2940 63 11 26 5 4 17RXWMR Robert Jones & Agnes Hunt Hospital, Oswest 50 76 69 138 72 97 0 3 1 0 1RXWMS Royal Shrewsbury Hospital 4064 4196 3786 93 3793 63 5 31 6 10 16RJD Staffordshire General Hospital 2142 2167 2131 99 2129 62 11 27 10 6 105DQ Victoria Hospital, Lichfield 363 358 271 75 346 100 0 0 0 0 0RXWMT Wrekin Unit, Princess Royal Hospital, Telford 460 637 624 136 627 100 0 0 0 0 0

Birmingham & the Black CountryRLU Birmingham Women's Hospital 6424 6397 6321 98 6299 70 12 18 1 3 14RXK02 City Hospital, Birmingham 3355 3410 3381 101 3390 51 8 42 35 6 1RJH Good Hope Hospital, Sutton Coldfield 3037 3052 3033 100 2951 66 11 22 3 9 11RBK Manor Hospital, Walsall 3587 3608 3597 100 3607 67 11 23 1 4 18RL4 New Cross Hospital, Wolverhampton 3489 3894 0 0 2565 61 16 24 3 5 15RXK01 Sandwell General Hospital 2518 2524 2478 98 2484 66 17 18 2 2 14RR1 Solihull Maternity Hospital 6637 6591 5994 90 6098 76 6 18 6 12 0RNA Wordsley Hospital 3668 3784 3619 99 3619 64 14 22 4 6 12

West Midlands SouthRLQ Hereford County Hospital 1715 1580 1499 87 1523 67 12 21 2 4 15RLT Nuneaton Maternity Hospital 2546 2582 2520 99 2519 66 11 23 1 1 20RKB Walsgrave Hospital, Coventry 4065 4074 3992 98 4037 65 15 20 2 10 9RJC Warwick Hospital 2534 2550 2539 100 2504 69 10 20 3 7 11RWP Worcestershire Acute Hospitals 5364 5430 0 0 0 .. .. .. .. .. ..

EAST Norfolk, Suffolk & Cambridgeshire

5JT Hartismere Hospital, Suffolk 27 7 0 0 0 .. .. .. .. .. ..RQQ Hinchingbrooke Hospital 2179 2115 166 8 166 67 6 27 5 0 21RGQ Ipswich Hospital 3308 3302 2989 90 2994 71 13 16 3 2 11RGP James Paget Hospital, Gorleston 2069 2075 2074 100 2008 68 10 23 4 9 9RM1 Norfolk and Norwich Hospital 4830 4938 4848 100 4848 63 13 23 6 1 16RGN Peterborough District Hospital 3415 3434 3249 95 3251 69 10 21 2 6 13RGT Rosie Maternity Hospital 4750 4981 4875 103 4852 62 16 22 21 0 0RGR West Suffolk Hospital 2346 2389 2344 100 2217 67 12 21 3 4 13

Bedfordshire & HertfordshireRC1 Bedford Hospital 2736 2646 2635 96 2635 69 9 23 0 23 0RWR Hemel Hempstead Hospital 422 7 0 0 0 .. .. .. .. .. ..RC9 Luton and Dunstable Hospital 4296 4518 4175 97 3720 76 9 15 5 5 5RWH Queen Elizabeth II and Lister Hospitals 5086 4790 3294 65 3292 66 12 21 2 4 16RWG Watford Hospital 4829 8270 5268 109 5277 68 15 17 12 3 2

EssexRDD Basildon Hospital 3936 4062 3507 89 3537 75 11 3 9 2 0RDE Colchester Maternity Hospital 3209 3101 2890 90 2881 65 11 24 2 2 20RQ8LK Courtauld Hospital, Braintree 121 124 120 99 120 99 0 1 1 0 0RQW Princess Alexandra Hospital, Harlow 2721 2750 2724 100 2654 75 9 17 2 3 11RAJ Southend Hospital 3303 3425 3247 98 2884 72 17 10 6 2 2RQ8LH St John's Hospital, Chelmsford 3255 3157 3066 94 3077 61 18 21 1 1 20RQ8LJ St Peters Hospital, Maldon 180 202 202 112 202 100 0 0 0 0 0

LONDONNorth Central London

RVL01 Barnet General Hospital 3138 3169 0 0 3039 72 12 16 0 3 12RVLC7 Chase Farm Hospital, Enfield 2834 2915 2825 100 2769 74 9 17 2 3 12RAP North Middlesex Hospital 3088 3124 1725 56 1705 87 8 5 1 1 3RAL Royal Free Hospital, Hampstead 2622 2695 2436 93 2333 74 18 8 3 2 3RRV University College Hospital, London 3094 3307 3087 100 2995 70 11 19 2 3 14RKE Whittington Hospital 3285 3402 3320 101 3246 73 8 18 4 2 11

North East LondonRF400 Harold Wood Hospital 4081 4090 3982 98 3864 68 9 23 4 5 14RQX Homerton Hospital 4500 4561 4527 101 4528 78 8 13 1 6 6RF401 King George Hospital, Newbury Park 4417 4451 4411 100 4367 71 8 20 2 5 14RNH Newham Hospital 4367 4385 4302 99 4302 76 8 16 1 7 8RNJ Royal London Hospital 3903 3963 3925 101 3926 75 7 18 1 11 7RGC Whipps Cross Hospital 4171 4335 4256 102 4140 73 10 17 0 0 16

Table 32 Registered deliveries, total HES records and usable HES records, and onset method by hospital, 2003-04

Deliveries HES Records with method Method of onset of labour (%)registered records of delivery present

(1) usable sponta- caes- inductionnumber percentage records neous arean

Hospital of deliveries number total surgical surgical drugregistered (=100%) and drug

England 575,896 572,178 415,214 72 453,461 69 11 20 4 6 11

North West LondonRV8 Central Middlesex & Northwick Park Hospitals 4743 4810 0 0 0 .. .. .. .. .. ..RQM Chelsea and Westminster Hospital 4608 4901 3802 83 3385 80 0 20 0 20 0RC3 Ealing Hospital 2609 2621 0 0 0 .. .. .. .. .. ..RAS Hillingdon Hospital 3252 3137 2188 67 2115 85 10 5 2 2 1RQN Queen Charlotte's and Chelsea Hospital 5243 5072 4996 95 5002 63 17 20 3 1 16RJ5 St Mary's Hospital, Paddington 4156 4182 0 0 3953 69 16 16 1 4 10RFW West Middlesex Hospital 2999 3063 3031 101 3063 76 9 15 1 3 11

South East LondonRJ1 Guy's Hospital 5717 5852 5559 97 5519 71 10 19 4 0 16RJZ King's College Hospital 4132 4120 0 0 0 .. .. .. .. .. ..RJ2 Lewisham Hospital 3239 2694 0 0 0 .. .. .. .. .. ..RG3 Princess Royal University Hospital, Orpington 3017 3002 0 0 0 .. .. .. .. .. ..RG2 Queen Elizabeth Hospital, Greenwich 3357 3367 3323 99 3312 69 12 18 1 7 11RGZ Queen Marys Hospital, Sidcup 3039 3021 3003 99 3003 64 17 20 0 0 20

South West LondonRVR Epsom & St Helier Hospitals 4463 4471 3714 83 3720 73 11 16 3 5 8RAX Kingston Hospital 4791 4700 4685 98 4695 65 14 21 5 7 9RJ6 Mayday Hospital, Croydon 4253 4361 4359 102 4338 73 12 15 2 2 11RJ7 St George's Hospital, Tooting 3872 3961 3921 101 3945 73 14 13 4 0 9

SOUTH EASTHampshire & Isle of Wight

RN5 North Hampshire Hospital, Basingstoke 2343 2386 1706 73 1793 70 10 19 3 6 10RHM Princess Anne Hospital, Southampton 4702 5094 0 0 4281 76 6 18 2 5 10RN1 Royal Hampshire County Hospital, Wincheste 2681 2903 2342 87 2546 73 12 14 5 0 9RR2 St Mary's Hospital, Isle of Wight 1086 1108 1036 95 1039 68 14 18 18 0 0RHU St Mary's Hospital, Portsmouth 5304 5418 4995 94 5004 68 12 20 6 5 9

Kent & MedwayRN7 Darent Valley Hospital 2541 2544 2539 100 2539 61 11 27 0 3 24RVV East Kent Hospitals 6161 6099 0 0 0 .. .. .. .. .. ..RWF02 Maidstone Hospital 2301 2197 0 0 0 .. .. .. .. .. ..RPA Medway Maritime Hospital 4207 4155 2100 50 2059 65 7 4 11 10 0RWF01 Pembury Hospital 2273 2248 2219 98 2220 68 14 18 3 4 12

Surrey & SussexRXC00 Conquest Hospital, St Leonards on Sea 1506 1463 1462 97 1462 64 11 25 0 0 25RTP East Surrey Hospital, Redhill 3975 3867 0 0 2932 75 8 17 0 5 12RXC02 Eastbourne DGH 2118 2127 2080 98 2083 62 13 25 3 2 19RDU Frimley Park Hospital 3868 3853 3614 93 3618 69 12 19 2 3 14RXH Royal Sussex County Hospital, Brighton 5224 4389 294 6 317 71 10 19 4 2 12RA2 Royal Surrey County Hospital, Guildford 3301 3373 2368 72 2371 62 15 22 5 3 15RTK St Peter's Hospital, Chertsey 3395 3151 3150 93 3151 61 15 24 1 3 20RPR St Richards Hospital, Chichester 1918 1940 1708 89 1841 77 13 10 4 3 3RPL Worthing Hospital 2346 2329 2304 98 2318 71 11 19 2 5 12

Thames ValleyRD7 Heatherwood and Wexham Park Hospitals 4409 4487 4451 101 4263 68 13 19 10 6 3RTH05 Horton Maternity Hospital 1514 1537 1530 101 1529 64 12 24 2 4 18RTH00 John Radcliffe Hospital, Oxford 6013 6915 6197 103 6197 63 11 26 2 10 13RD8 Milton Keynes General Hospital 3297 3294 2997 91 3227 81 9 10 3 5 2RHW Royal Berkshire Hospital, Reading 4861 4952 4284 88 4101 85 0 15 0 0 15RNT Stoke Mandeville Hospital 2632 2711 2208 84 2206 68 12 20 1 15 5RH2 Wycombe General Hospital 2863 2867 2861 100 2849 69 9 22 6 8 8

SOUTH WEST Avon, Gloucestershire & Wiltshire

RTE Gloucester Maternity & St Paul's Hospitals 5561 5612 5567 100 5575 66 12 22 3 3 15RN3 Great Western Hospital, Swindon 3279 3220 0 0 0 .. .. .. .. .. ..RNZ Salisbury District Hospital 2018 1917 0 0 1803 74 9 16 3 4 9RVJ Southmead Hospital 4800 4205 4157 87 4167 65 13 22 3 3 17RA7 St Michael's Hospital, Bristol 4660 4665 4617 99 4563 67 14 19 3 0 165KY Stroud Maternity Hospital 268 269 266 99 266 100 0 0 0 0 05DH West Wiltshire PCT 4900 4562 0 0 0 .. .. .. .. .. ..RA3 Weston General Hospital 320 310 304 95 304 100 0 0 0 0 0

Somerset & DorsetRBD Dorset County Hospital 1735 1747 321 19 320 67 13 20 2 8 11RBA Musgrove Park Hospital, Taunton 2845 2797 0 0 0 .. .. .. .. .. ..RD3 Poole Hospital 3640 3653 0 0 2984 56 17 27 5 9 12RDZ Royal Bournemouth Hospital 514 512 0 0 494 97 0 3 1 1 2RA4 Yeovil District Hospital 1268 1266 886 70 1261 67 13 20 2 5 14

South West PeninsulaRK9 Derriford Hospital, Plymouth 4081 3041 0 0 0 .. .. .. .. .. ..5FT Honiton Hospital 172 172 171 99 171 100 0 0 0 0 0RBZ North Devon District Hospital, Barnstaple 1346 1346 0 0 90 80 9 11 4 0 75KT Penrice Hospital, St Austell 257 256 0 0 0 .. .. .. .. .. ..REF Royal Cornwall Hospital, Truro 3371 3372 1435 43 1445 69 8 22 5 0 18RH8 Royal Devon and Exeter Hospital 2831 2842 2813 99 2815 64 13 22 4 5 135FM St Mary's, Helston, Cornwall 18 12 0 0 0 .. .. .. .. .. ..5FV Tiverton and Okehampton Hospitals 177 183 126 71 126 100 0 0 0 0 0RA9 Torbay Hospital 2013 2047 0 0 0 .. .. .. .. .. ..

Table 33 Method of delivery by hospital, 2003-04

Hospital Method of Delivery (%) Total caesarean Ventouse as a

Usable Spont- Breech Caes- delivery percentage of allrecords aneous Instrumental arean (procedure instrumental

Total For- Vent- coded deliveriesceps ouse - see para 1.4) %

ENGLAND 515,214 67 0 10 3 7 23 23 68

NORTH EASTCounty Durham & Tees Valley

RXPDA Bishop Auckland and Darlington Hospitals 2920 68 1 10 3 8 21 21 72RXP00 Dryburn Hospital 747 68 0 12 2 10 20 19 84RTR45 Friarage Hospital, Northallerton 1145 75 0 10 4 6 15 14 59RVW Hartlepool & North Tees Hospitals 3572 72 0 9 2 7 18 19 79RTR00 South Cleveland Hospital 2124 79 0 2 2 0 19 19 ..

Northumberland, Tyne & WearRTF01 Ashington Hospital 1908 61 0 15 5 9 25 25 63RTF04 Hexham General Hospital 305 76 1 4 3 1 18 19 ..RTF02 North Tyneside General Hospital 1692 72 0 7 3 3 21 21 50RR7 Queen Elizabeth Hospital, Gateshead 1638 65 0 13 4 9 22 22 68RTD Royal Victoria Infirmary, Newcastle 4737 60 1 18 7 11 22 22 61RE9 South Shields Maternity Hospital 1428 69 0 11 2 9 18 19 84RLN Sunderland Royal Hospital 2231 70 1 13 6 7 17 17 55

NORTH WESTCheshire & Merseyside

RBL Arrowe Park Hospital, Birkenhead 3212 66 1 13 6 8 20 21 54RJR Countess of Chester Hospital 2963 66 1 11 4 7 23 23 63REM Fazakerley Hospital 1947 69 0 6 2 5 24 23 75RBT Leighton Hospital, Crewe 1893 73 1 8 3 5 19 19 59REP Liverpool Women's Hospital 6341 68 1 9 5 4 23 25 43RJN Macclesfield DGH 1736 65 0 11 2 8 24 24 78RVY Ormskirk & Southport Hospitals 2174 65 0 11 3 8 23 23 74RWW Warrington Hospital 0 .. .. .. .. .. .. 27 ..RBN Whiston Hospital 0 .. .. .. .. .. .. 22 ..

Cumbria and LancashireRXR Burnley General Hospital 2296 71 0 7 1 6 22 20 83RXN01 Chorley and District Hospital 213 100 0 0 0 0 0 0 ..RTX Morecambe Bay Hospitals 3046 71 0 8 2 6 21 21 74RNL North Cumbria Acute Hospitals 1759 73 0 7 2 5 19 20 74RMB Queens Park Hospital, Blackburn 3465 73 1 7 1 6 20 22 79RXN02 Sharoe Green Hospital, Fulwood 3466 71 0 8 3 5 20 20 62RXL Victoria Hospital, Blackpool 2781 68 0 9 4 6 21 22 ..

Greater ManchesterRRF Billinge Hospital, Wigan 2812 65 1 12 3 9 22 23 73RM3 Hope Hospital, Salford 1601 66 0 10 5 5 23 23 48RW6 Pennine Acute Hospitals 7849 70 0 8 2 6 21 21 70RMC Royal Bolton Hospital 3974 69 0 11 4 8 20 20 68RW3 St Mary's Hospital, Manchester 4188 72 1 9 3 6 19 19 69RWJ Stepping Hill Hospital, Stockport 3175 64 0 12 4 8 24 24 68RMP Tameside General Hospital 0 .. .. .. .. .. .. 16 ..RM4 Trafford General Hospital 1259 70 0 7 2 6 23 23 76RM2 Wythenshawe Hospital 2626 59 0 15 5 10 26 27 66

YORKSHIRE & HUMBERNorth & East Yorkshire and Northern Lincolnshire

RWA Castle Hill and Hull Maternity Hospitals 0 .. .. .. .. .. .. 22 ..RJL Grimsby Maternity and Scunthorpe Hospitals 0 .. .. .. .. .. .. 18 ..RCD Harrogate District Hospital 366 57 0 13 5 8 29 26 65RCC Scarborough Hospital 0 .. .. .. .. .. .. 18 ..RCB York District Hospital 2716 65 0 10 4 7 24 26 66

South YorkshireRFF Barnsley DGH 0 .. .. .. .. .. .. 20 ..RP5BA Bassetlaw DGH 0 .. .. .. .. .. .. 22 ..RP5DR Doncaster Royal Infirmary 0 .. .. .. .. .. .. 18 ..RHQ Northern General Hospital, Sheffield 6158 68 1 9 0 8 23 23 90RCX Queen Elizabeth Hospital, Kings Lynn 1881 68 0 8 2 6 23 24 70RFR Rotherham DGH 2463 67 0 13 2 10 21 22 81

West YorkshireRCF Airedale General Hospital 2203 65 0 8 4 5 26 28 54RAE Bradford Royal Infirmary 5095 71 0 9 4 5 20 20 58RXF10 Dewsbury District Hospital 3007 72 1 9 4 5 18 18 54RWY02 Halifax General Hospital 0 .. .. .. .. .. .. 22 ..RWY01 Huddersfield Royal Infirmary 0 .. .. .. .. .. .. 21 ..RR8 Leeds Teaching Hospitals 6569 66 0 12 7 5 21 22 41RXF03 Pontefract Maternity Hospital 3022 75 0 8 2 5 17 19 70

Table 33 Method of delivery by hospital, 2003-04

Hospital Method of Delivery (%) Total caesarean Ventouse as a

Usable Spont- Breech Caes- delivery percentage of allrecords aneous Instrumental arean (procedure instrumental

Total For- Vent- coded deliveriesceps ouse - see para 1.4) %

ENGLAND 515,214 67 0 10 3 7 23 23 68

EAST MIDLANDSLeicestershire, Northamptonshire & Rutland

RNQ Kettering General Hospital 3257 71 0 7 2 5 21 22 68RWEAA Leicester Royal Infirmary 3886 67 1 11 5 6 22 22 57RWEAK Leicestershire General Hospital 2815 68 0 13 7 6 19 19 49RNS Northampton General Hospital 3830 62 0 12 3 9 26 26 765EH St Mary's Hospital, Melton Mowbray 0 .. .. .. .. .. .. 0 ..

TrentRFS Chesterfield & N. Derbyshire Royal Hospital 2614 73 0 8 2 6 19 19 76RTG Derby City General Hospital 4426 63 0 14 5 9 22 23 64RK5 King's Mill Hospital, Sutton in Ashfield 2353 69 1 13 6 7 17 18 55RCS Nottingham City Hospital 0 .. .. .. .. .. .. 18 ..RFK Nottingham University Hospital 3476 63 1 15 7 8 21 23 54RWD United Lincolnshire Hospitals 4708 68 0 10 5 6 21 22 55

WEST MIDLANDS Shropshire & Staffordshire

RXWMB Bridgnorth Hospital 89 89 2 7 1 6 2 0 83RXWML Ludlow Hospital 105 97 0 3 0 3 0 0 ..RJE North Staffordshire Hospital, Stoke on Trent 0 .. .. .. .. .. .. 23 ..RJF Queen's Hospital, Burton upon Trent 2940 63 1 13 3 10 24 24 78RXWMR Robert Jones & Agnes Hunt Hospital, Oswestry 69 90 0 9 3 6 1 0 67RXWMS Royal Shrewsbury Hospital 3786 77 1 8 3 5 14 15 61RJD Staffordshire General Hospital 2131 70 0 9 2 6 20 20 735DQ Victoria Hospital, Lichfield 271 100 0 0 0 0 0 0 ..RXWMT Wrekin Unit, Princess Royal Hospital, Telford 624 95 0 2 1 1 2 0 50

Birmingham & the Black CountryRLU Birmingham Women's Hospital 6321 64 1 12 4 7 24 24 62RXK02 City Hospital, Birmingham 3381 69 1 6 3 3 23 23 47RJH Good Hope Hospital, Sutton Coldfield 3033 65 0 9 3 6 25 26 64RBK Manor Hospital, Walsall 3597 68 1 10 3 7 22 22 69RL4 New Cross Hospital, Wolverhampton 0 .. .. .. .. .. .. 28 ..RXK01 Sandwell General Hospital 2478 68 0 7 2 5 25 25 68RR1 Solihull Maternity Hospital 5994 72 0 6 2 3 22 23 58RNA Wordsley Hospital 3619 70 0 6 3 4 23 24 55

West Midlands SouthRLQ Hereford County Hospital 1499 69 0 8 2 6 22 24 74RLT Nuneaton Maternity Hospital 2520 70 0 7 2 5 23 23 70RKB Walsgrave Hospital, Coventry 3992 67 0 7 2 4 26 26 63RJC Warwick Hospital 2539 63 0 11 3 8 25 25 74RWP Worcestershire Acute Hospitals 0 .. .. .. .. .. .. 28 ..

EAST Norfolk, Suffolk & Cambridgeshire

5JT Hartismere Hospital, Suffolk 0 .. .. .. .. .. .. 0 ..RQQ Hinchingbrooke Hospital 166 61 1 13 5 7 25 24 55RGQ Ipswich Hospital 2989 69 0 8 3 5 22 22 59RGP James Paget Hospital, Gorleston 2074 68 0 12 1 10 20 20 87RM1 Norfolk and Norwich Hospital 4848 63 0 12 3 10 24 24 78RGN Peterborough District Hospital 3249 67 0 10 5 6 22 23 56RGT Rosie Maternity Hospital 4875 57 1 15 5 10 27 27 64RGR West Suffolk Hospital 2344 61 0 8 2 6 31 31 76

Bedfordshire & HertfordshireRC1 Bedford Hospital 2635 63 0 14 6 9 22 22 60RWR Hemel Hempstead Hospital 0 .. .. .. .. .. .. .. ..RC9 Luton and Dunstable Hospital 4175 64 1 11 3 8 25 25 76RWH Queen Elizabeth II and Lister Hospitals 3294 65 0 11 3 9 23 23 77RWG Watford Hospital 5268 64 0 10 3 8 26 26 75

EssexRDD Basildon Hospital 3507 68 0 11 4 7 20 22 64RDE Colchester Maternity Hospital 2890 64 0 11 2 9 25 25 81RQ8LK Courtauld Hospital, Braintree 120 98 0 1 0 1 1 1 ..RQW Princess Alexandra Hospital, Harlow 2724 63 1 9 2 7 27 28 80RAJ Southend Hospital 3247 64 0 7 6 2 29 28 25RQ8LH St John's Hospital, Chelmsford 3066 60 0 7 2 6 33 33 79RQ8LJ St Peters Hospital, Maldon 202 97 0 0 0 0 3 1 ..

LONDONNorth Central London

RVL01 Barnet General Hospital 0 .. .. .. .. .. .. 25 ..RVLC7 Chase Farm Hospital, Enfield 2825 68 0 7 1 6 24 24 79RAP North Middlesex Hospital 1725 72 0 9 2 7 18 18 79RAL Royal Free Hospital, Hampstead 2436 64 0 8 2 7 27 28 77RRV University College Hospital, London 3087 61 1 11 2 9 27 28 78RKE Whittington Hospital 3320 60 0 15 4 11 25 26 75

North East LondonRF400 Harold Wood Hospital 3982 66 0 14 4 10 20 20 74RQX Homerton Hospital 4527 66 0 9 4 5 25 23 58RF401 King George Hospital, Newbury Park 4411 73 1 7 3 4 19 20 60RNH Newham Hospital 4302 72 0 6 1 4 22 22 73RNJ Royal London Hospital 3925 68 0 9 3 6 22 22 68RGC Whipps Cross Hospital 4256 65 0 5 2 3 29 29 56

Table 33 Method of delivery by hospital, 2003-04

Hospital Method of Delivery (%) Total caesarean Ventouse as a

Usable Spont- Breech Caes- delivery percentage of allrecords aneous Instrumental arean (procedure instrumental

Total For- Vent- coded deliveriesceps ouse - see para 1.4) %

ENGLAND 515,214 67 0 10 3 7 23 23 68

North West LondonRV8 Central Middlesex & Northwick Park Hospitals 0 .. .. .. .. .. .. 29 ..RQM Chelsea and Westminster Hospital 3802 57 0 13 2 11 30 31 86RC3 Ealing Hospital 0 .. .. .. .. .. .. 27 ..RAS Hillingdon Hospital 2188 64 0 10 3 8 25 24 74RQN Queen Charlotte's and Chelsea Hospital 4996 57 0 12 3 9 30 30 76RJ5 St Mary's Hospital, Paddington 0 .. .. .. .. .. .. 29 ..RFW West Middlesex Hospital 3031 67 1 11 2 9 20 21 78

South East LondonRJ1 Guy's Hospital 5559 60 0 13 4 9 25 25 70RJZ King's College Hospital 0 .. .. .. .. .. .. 29 ..RJ2 Lewisham Hospital 0 .. .. .. .. .. .. 31 ..RG3 Princess Royal University Hospital, Orpington 0 .. .. .. .. .. .. 30 ..RG2 Queen Elizabeth Hospital, Greenwich 3323 67 0 9 2 7 24 24 81RGZ Queen Marys Hospital, Sidcup 3003 59 0 11 3 8 30 30 76

South West LondonRVR Epsom & St Helier Hospitals 3714 60 0 15 4 11 25 25 76RAX Kingston Hospital 4685 62 0 12 2 10 26 26 82RJ6 Mayday Hospital, Croydon 4359 67 1 9 1 7 23 23 85RJ7 St George's Hospital, Tooting 3921 64 0 13 3 11 23 22 80

SOUTH EASTHampshire & Isle of Wight

RN5 North Hampshire Hospital, Basingstoke 1706 71 1 11 4 7 18 19 66RHM Princess Anne Hospital, Southampton 0 .. .. .. .. .. .. 22 ..RN1 Royal Hampshire County Hospital, Winchester 2342 62 0 0 0 0 24 25 17RR2 St Mary's Hospital, Isle of Wight 1036 69 0 8 2 6 23 23 71RHU St Mary's Hospital, Portsmouth 4995 67 0 10 3 7 23 23 68

Kent & MedwayRN7 Darent Valley Hospital 2539 65 0 10 5 4 25 26 47RVV East Kent Hospitals 0 .. .. .. .. .. .. 23 ..RWF02 Maidstone Hospital 0 .. .. .. .. .. .. 25 ..RPA Medway Maritime Hospital 2100 61 0 13 5 8 25 25 62RWF01 Pembury Hospital 2219 60 0 15 4 11 25 28 76

Surrey & SussexRXC00 Conquest Hospital, St Leonards on Sea 1462 65 0 10 4 6 25 26 59RTP East Surrey Hospital, Redhill 0 .. .. .. .. .. .. 26 ..RXC02 Eastbourne DGH 2080 71 0 8 2 6 21 22 73RDU Frimley Park Hospital 3614 68 0 8 3 5 22 23 66RXH Royal Sussex County Hospital, Brighton 294 67 0 11 3 7 23 27 71RA2 Royal Surrey County Hospital, Guildford 2368 56 0 18 5 12 26 23 69RTK St Peter's Hospital, Chertsey 3150 58 0 16 3 13 26 26 81RPR St Richards Hospital, Chichester 1708 63 0 10 5 6 26 26 53RPL Worthing Hospital 2304 68 0 8 2 6 24 24 74

Thames ValleyRD7 Heatherwood and Wexham Park Hospitals 4451 62 0 10 5 6 27 27 56RTH05 Horton Maternity Hospital 1530 64 0 12 5 7 24 24 58RTH00 John Radcliffe Hospital, Oxford 6197 67 0 13 6 8 20 19 58RD8 Milton Keynes General Hospital 2997 67 0 11 3 8 22 22 73RHW Royal Berkshire Hospital, Reading 4284 76 0 16 2 13 8 27 84RNT Stoke Mandeville Hospital 2208 65 0 12 4 8 23 22 66RH2 Wycombe General Hospital 2861 65 0 12 5 7 22 23 55

SOUTH WEST Avon, Gloucestershire & Wiltshire

RTE Gloucester Maternity & St Paul's Hospitals 5567 64 0 11 3 8 24 24 69RN3 Great Western Hospital, Swindon 0 .. .. .. .. .. .. 24 ..RNZ Salisbury District Hospital 0 .. .. .. .. .. .. 23 ..RVJ Southmead Hospital 4157 63 1 13 5 8 24 24 64RA7 St Michael's Hospital, Bristol 4617 62 0 13 4 9 24 24 665KY Stroud Maternity Hospital 266 100 0 0 0 0 0 0 ..5DH West Wiltshire PCT 0 .. .. .. .. .. .. 20 ..RA3 Weston General Hospital 304 100 0 0 0 0 0 0 ..

Somerset & DorsetRBD Dorset County Hospital 321 60 1 9 2 7 28 24 72RBA Musgrove Park Hospital, Taunton 0 .. .. .. .. .. .. 24 ..RD3 Poole Hospital 0 .. .. .. .. .. .. 29 ..RDZ Royal Bournemouth Hospital 0 .. .. .. .. .. .. 1 ..RA4 Yeovil District Hospital 886 67 0 9 3 6 23 22 70

South West PeninsulaRK9 Derriford Hospital, Plymouth 0 .. .. .. .. .. .. 19 ..5FT Honiton Hospital 171 100 0 0 0 0 0 0 ..RBZ North Devon District Hospital, Barnstaple 0 .. .. .. .. .. .. 22 ..5KT Penrice Hospital, St Austell 0 .. .. .. .. .. .. 0 ..REF Royal Cornwall Hospital, Truro 1435 71 1 13 3 10 16 18 77RH8 Royal Devon and Exeter Hospital 2813 65 0 11 2 9 24 24 775FM St Mary's, Helston, Cornwall 0 .. .. .. .. .. .. 0 ..5FV Tiverton and Okehampton Hospitals 126 100 0 0 0 0 0 0 ..RA9 Torbay Hospital 0 .. .. .. .. .. .. 23 ..

Table 34 NHS hospital deliveries; selected statistics by hospital 2003-04

Hospital Spontaneous Caesarean deliveries Caesarean deliveries with Normal deliveries with a postnatal anaesthetic (%) : delivery

with episiotomy stay of 0-3 days Gen- Spin- Epi- Other % (%) (%) eral al dural (1) (see para 2.11.5)

ENGLAND 8 59 10 55 19 15 46

NORTH EASTCounty Durham & Tees Valley

RXPDA Bishop Auckland and Darlington Hospitals 6 68 11 51 10 27 48RXP00 Dryburn Hospital 6 63 3 27 24 45 47RTR45 Friarage Hospital, Northallerton .. 60 .. .. .. .. 48RVW Hartlepool & North Tees Hospitals 8 78 .. .. .. .. 57RTR00 South Cleveland Hospital .. 81 .. .. .. .. 57

Northumberland, Tyne & WearRTF01 Ashington Hospital 10 65 2 21 19 58 45RTF04 Hexham General Hospital 4 39 2 6 4 89 73RTF02 North Tyneside General Hospital 8 53 3 22 11 63 52RR7 Queen Elizabeth Hospital, Gateshead 9 66 11 61 17 12 47RTD Royal Victoria Infirmary, Newcastle 7 64 .. .. .. .. 48RE9 South Shields Maternity Hospital 6 46 8 76 5 11 49RLN Sunderland Royal Hospital 7 86 0 0 0 100 43

NORTH WESTCheshire & Merseyside

RBL Arrowe Park Hospital, Birkenhead 11 25 16 67 14 3 43RJR Countess of Chester Hospital 6 43 11 81 6 2 50REM Fazakerley Hospital .. .. .. .. .. .. ..RBT Leighton Hospital, Crewe .. 6 35 55 9 0 ..REP Liverpool Women's Hospital 13 43 17 54 4 24 46RJN Macclesfield DGH 8 47 12 83 5 0 46RVY Ormskirk & Southport Hospitals 6 39 13 69 12 7 44RWW Warrington Hospital .. .. .. .. .. .. ..RBN Whiston Hospital .. .. .. .. .. .. ..

Cumbria and LancashireRXR Burnley General Hospital 22 .. 14 70 15 0 52RXN01 Chorley and District Hospital 5 .. .. .. .. .. 100RTX Morecambe Bay Hospitals 6 35 10 66 15 9 46RNL North Cumbria Acute Hospitals 6 64 10 87 1 2 60RMB Queens Park Hospital, Blackburn .. .. .. .. .. .. ..RXN02 Sharoe Green Hospital, Fulwood 6 45 11 71 18 0 46RXL Victoria Hospital, Blackpool 4 54 15 72 12 1 42

Greater ManchesterRRF Billinge Hospital, Wigan 11 69 16 69 14 0 44RM3 Hope Hospital, Salford 7 45 14 64 22 1 39RW6 Pennine Acute Hospitals 6 53 17 70 12 1 50RMC Royal Bolton Hospital 7 30 22 60 14 4 48RW3 St Mary's Hospital, Manchester 4 21 8 62 23 7 47RWJ Stepping Hill Hospital, Stockport 6 31 0 0 0 100 53RMP Tameside General Hospital .. .. .. .. .. .. ..RM4 Trafford General Hospital 8 25 15 67 17 1 47RM2 Wythenshawe Hospital 12 51 15 66 19 0 34

YORKSHIRE & HUMBER

North & East Yorkshire and Northern Lincolnshire .. .. .. .. .. .. ..RWA Castle Hill and Hull Maternity Hospitals .. .. .. .. .. .. ..RJL Grimsby Maternity and Scunthorpe Hospitals .. .. .. .. .. .. ..RCD Harrogate District Hospital 11 .. .. .. .. .. ..RCC Scarborough Hospital .. .. .. .. .. .. ..RCB York District Hospital 8 59 3 94 3 0 ..

South YorkshireRFF Barnsley DGH .. .. .. .. .. .. ..RP5BA Bassetlaw DGH .. .. .. .. .. .. ..RP5DR Doncaster Royal Infirmary .. .. .. .. .. .. ..RHQ Northern General Hospital, Sheffield 12 41 13 63 19 4 47RCX Queen Elizabeth Hospital, Kings Lynn 4 64 13 77 10 0 49RFR Rotherham DGH 7 63 24 56 19 1 47

West YorkshireRCF Airedale General Hospital 8 63 6 86 2 6 41RAE Bradford Royal Infirmary 12 62 15 67 17 0 48RXF10 Dewsbury District Hospital 7 68 6 33 61 0 47RWY02 Halifax General Hospital .. .. .. .. .. .. ..RWY01 Huddersfield Royal Infirmary .. .. .. .. .. .. ..RR8 Leeds Teaching Hospitals 10 59 3 68 27 2 37RXF03 Pontefract Maternity Hospital 7 69 5 48 26 21 54

Table 34 NHS hospital deliveries; selected statistics by hospital 2003-04

Hospital Spontaneous Caesarean deliveries Caesarean deliveries with Normal deliveries with a postnatal anaesthetic (%) : delivery

with episiotomy stay of 0-3 days Gen- Spin- Epi- Other % (%) (%) eral al dural (1) (see para 2.11.5)

ENGLAND 8 59 10 55 19 15 46EAST MIDLANDS

Leicestershire, Northamptonshire & Rutland .. .. .. .. .. .. ..RNQ Kettering General Hospital 10 68 12 76 11 1 51RWEAA Leicester Royal Infirmary 8 53 1 1 0 99 52RWEAK Leicestershire General Hospital 12 40 0 0 0 100 54RNS Northampton General Hospital 10 66 11 53 4 32 525EH St Mary's Hospital, Melton Mowbray

TrentRFS Chesterfield & N. Derbyshire Royal Hospital 6 73 11 69 18 2 49RTG Derby City General Hospital 9 39 13 69 17 1 51RK5 King's Mill Hospital, Sutton in Ashfield 6 48 12 67 21 0 40RCS Nottingham City Hospital .. .. .. .. .. .. ..RFK Nottingham University Hospital 4 37 11 66 17 6 45RWD United Lincolnshire Hospitals 3 50 11 65 24 0 45

WEST MIDLANDS Shropshire & Staffordshire

RXWMB Bridgnorth Hospital 1 36 .. .. .. .. 84RXWML Ludlow Hospital 5 .. .. .. .. .. 90RJE North Staffordshire Hospital, Stoke on Trent .. 42 .. .. .. .. ..RJF Queen's Hospital, Burton upon Trent 10 57 0 0 0 100 46

RXWMR Robert Jones & Agnes Hunt Hospital, Oswestry 8 75RXWMS Royal Shrewsbury Hospital 10 63 15 17 67 1 47RJD Staffordshire General Hospital 11 58 31 59 10 0 465DQ Victoria Hospital, Lichfield 5 .. .. .. .. .. 97RXWMT Wrekin Unit, Princess Royal Hospital, Telford 3 .. .. .. .. .. 90

Birmingham & the Black CountryRLU Birmingham Women's Hospital 5 54 17 67 15 1 46RXK02 City Hospital, Birmingham 8 66 32 57 10 0 34RJH Good Hope Hospital, Sutton Coldfield 12 68 14 63 21 2 44RBK Manor Hospital, Walsall 6 49 15 66 19 1 44RL4 New Cross Hospital, WolverhamptonRXK01 Sandwell General Hospital 6 88 .. .. .. .. 54RR1 Solihull Maternity Hospital 9 71 17 67 12 4 56RNA Wordsley Hospital 6 .. 9 68 13 10 47

West Midlands SouthRLQ Hereford County Hospital 11 67 13 72 15 1 48RLT Nuneaton Maternity Hospital 18 41 15 74 11 1 48RKB Walsgrave Hospital, Coventry 12 33 13 67 19 1 44RJC Warwick Hospital 10 69 11 64 25 1 44RWP Worcestershire Acute Hospitals .. .. .. .. .. .. ..

EAST Norfolk, Suffolk & Cambridgeshire

5JT Hartismere Hospital, SuffolkRQQ Hinchingbrooke Hospital 12 71 18 53 30 0 49RGQ Ipswich Hospital 5 61 9 75 16 0 52RGP James Paget Hospital, Gorleston 6 66 7 65 23 5 43

RM1 Norfolk and Norwich Hospital 6 71 12 53 29 7 41RGN Peterborough District Hospital 9 78 12 59 28 1 46RGT Rosie Maternity Hospital 10 66 8 65 19 8 37RGR West Suffolk Hospital 6 76 10 66 11 13 45

Bedfordshire & HertfordshireRC1 Bedford Hospital 13 67 2 6 24 68 39RWR Hemel Hempstead Hospital .. .. .. .. .. .. ..RC9 Luton and Dunstable Hospital 6 54 2 12 0 86 53RWH Queen Elizabeth II and Lister Hospitals 6 58 5 42 7 46 50RWG Watford Hospital 7 86 5 79 15 2 44

EssexRDD Basildon Hospital 8 70 15 53 24 8 54RDE Colchester Maternity Hospital 8 57 7 50 25 18 42RQ8LK Courtauld Hospital, Braintree 8 .. 0 0 100 0 96RQW Princess Alexandra Hospital, Harlow 9 70 8 37 17 38 51RAJ Southend Hospital 4 77 11 59 17 13 49RQ8LH St John's Hospital, Chelmsford 12 85 9 75 15 1 40RQ8LJ St Peters Hospital, Maldon 11 .. 17 83 0 0 95

LONDONNorth Central London

RVL01 Barnet General HospitalRVLC7 Chase Farm Hospital, Enfield 5 80 6 40 12 42 37RAP North Middlesex Hospital 9 47 80 16 4 0 64RAL Royal Free Hospital, Hampstead 11 61 2 39 42 16 40RRV University College Hospital, London 6 61 4 15 30 52 45RKE Whittington Hospital 8 67 5 29 23 43 45

North East LondonRF400 Harold Wood Hospital 12 85 .. .. .. .. 51RQX Homerton Hospital 8 68 15 56 27 2 26RF401 King George Hospital, Newbury Park 16 50 12 49 33 6 50RNH Newham Hospital 12 67 10 71 17 3 56RNJ Royal London Hospital 9 59 10 58 31 2 50RGC Whipps Cross Hospital 15 45 2 17 13 68 52

Table 34 NHS hospital deliveries; selected statistics by hospital 2003-04

Hospital Spontaneous Caesarean deliveries Caesarean deliveries with Normal deliveries with a postnatal anaesthetic (%) : delivery

with episiotomy stay of 0-3 days Gen- Spin- Epi- Other % (%) (%) eral al dural (1) (see para 2.11.5)

ENGLAND 8 59 10 55 19 15 46North West London

RV8 Central Middlesex & Northwick Park Hospitals .. .. .. .. .. .. ..RQM Chelsea and Westminster Hospital 6 65 0 10 32 58 39RC3 Ealing Hospital .. 40 .. .. .. .. ..RAS Hillingdon Hospital 11 68 .. .. .. .. ..RQN Queen Charlotte's and Chelsea Hospital 10 72 4 12 84 0 31RJ5 St Mary's Hospital, Paddington .. .. .. .. .. .. ..RFW West Middlesex Hospital 5 47 7 40 41 12 47

South East LondonRJ1 Guy's Hospital 3 64 3 38 59 0 44RJZ King's College Hospital .. .. .. .. .. .. ..RJ2 Lewisham Hospital .. .. .. .. .. .. ..RG3 Princess Royal University Hospital, Orpington .. .. .. .. .. .. ..RG2 Queen Elizabeth Hospital, Greenwich 4 53 10 61 29 0 47RGZ Queen Marys Hospital, Sidcup 11 67 .. .. .. .. 45

South West LondonRVR Epsom & St Helier Hospitals 9 46 12 62 26 0 38RAX Kingston Hospital 11 64 3 59 24 14 40RJ6 Mayday Hospital, Croydon 11 51 7 64 29 1 53RJ7 St George's Hospital, Tooting 0 60 10 61 26 3 46

SOUTH EASTHampshire & Isle of Wight

RN5 North Hampshire Hospital, Basingstoke 9 76 8 62 19 12 54RHM Princess Anne Hospital, Southampton .. .. .. .. .. .. ..RN1 Royal Hampshire County Hospital, Winchester 6 63 7 64 27 2 47RR2 St Mary's Hospital, Isle of Wight 7 25 8 76 14 2 50RHU St Mary's Hospital, Portsmouth 5 76 11 68 11 10 51

Kent & MedwayRN7 Darent Valley Hospital 11 78 2 12 0 85 47RVV East Kent Hospitals .. .. .. .. .. .. ..RWF02 Maidstone Hospital .. .. .. .. .. .. ..RPA Medway Maritime Hospital .. 61 1 21 34 44 40RWF01 Pembury Hospital 9 46 10 67 22 0 21

Surrey & SussexRXC00 Conquest Hospital, St Leonards on Sea 6 77 8 73 15 4 43RTP East Surrey Hospital, Redhill .. .. .. .. .. .. ..RXC02 Eastbourne DGH 6 70 7 76 17 0 44RDU Frimley Park Hospital 7 66 8 67 22 3 48RXH Royal Sussex County Hospital, Brighton 10 52 7 69 24 0 47RA2 Royal Surrey County Hospital, Guildford 6 58 0 0 0 100 43RTK St Peter's Hospital, Chertsey 9 61 6 73 21 0 36RPR St Richards Hospital, Chichester 5 61 11 74 13 2 47RPL Worthing Hospital 4 61 14 63 23 1 50

Thames ValleyRD7 Heatherwood and Wexham Park Hospitals 4 71 7 69 12 12 45RTH05 Horton Maternity Hospital 9 55 13 66 21 0 41RTH00 John Radcliffe Hospital, Oxford 5 46 7 64 29 0 40RD8 Milton Keynes General Hospital 6 71 15 62 9 14 57RHW Royal Berkshire Hospital, Reading 15 71 8 62 26 4 56RNT Stoke Mandeville Hospital 9 32 9 64 26 0 ..RH2 Wycombe General Hospital 12 66 .. .. .. .. 41

SOUTH WEST Avon, Gloucestershire & Wiltshire

RTE Gloucester Maternity & St Paul's Hospitals 9 61 12 67 21 1 44RN3 Great Western Hospital, Swindon .. .. .. .. .. .. ..RNZ Salisbury District Hospital .. .. .. .. .. .. ..RVJ Southmead Hospital 9 66 7 66 27 0 37RA7 St Michael's Hospital, Bristol 8 67 4 60 20 16 475KY Stroud Maternity Hospital 2 .. .. .. .. .. 1005DH West Wiltshire PCT .. .. .. .. .. .. ..RA3 Weston General Hospital 1 .. .. .. .. .. 99

Somerset & DorsetRBD Dorset County Hospital 6 .. 16 46 5 32 14RBA Musgrove Park Hospital, Taunton .. .. .. .. .. .. ..RD3 Poole Hospital .. .. .. .. .. .. ..RDZ Royal Bournemouth Hospital .. .. .. .. .. .. ..RA4 Yeovil District Hospital .. .. 18 63 16 3 71

South West PeninsulaRK9 Derriford Hospital, Plymouth .. .. .. .. .. .. ..5FT Honiton Hospital 2 .. .. .. .. .. 98RBZ North Devon District Hospital, Barnstaple .. 67 0 89 0 11 ..5KT Penrice Hospital, St Austell .. .. .. .. .. .. ..REF Royal Cornwall Hospital, Truro 9 65 9 54 22 16 46RH8 Royal Devon and Exeter Hospital 4 58 14 59 27 1 405FM St Mary's, Helston, Cornwall .. .. .. .. .. .. ..5FV Tiverton and Okehampton Hospitals 3 .. .. .. .. .. 98RA9 Torbay Hospital .. .. .. .. .. .. ..

Annex A Data items in HES maternity tail 2003-04 The data fields below are repeated as many times as there are babies in the delivery (up to 6); all fields also include a category “not known” First antenatal assessment date day/month/year Total previous pregnancies • no previous pregnancies resulting in a

registrable birth • one • two etc, up to • nineteen Delivery place type (actual) • at a domestic address • in NHS hospital – delivery facilities

associated with consultant ward • in NHS hospital – GMP ward • in NHS hospital – midwife ward • in NHS hospital – joint consultant /

GMP / midwife ward • in private hospital • in other hospital or institution • in NHS hospital – ward or unit

without delivery facilities • other ie none of the above Delivery place (intended) categories as for delivery place (actual) Delivery place change reason • decision made during pregnancy

because of change of address • decision made during pregnancy for

clinical reasons • decision made during pregnancy for

other reasons • decision made during labour for

clinical reasons • decision made during labour for other

reasons • occurred unintentionally during labour

(not present in 2002-03 HES data) • other

Gestation length 10 – 49 in weeks Labour/delivery onset method • spontaneous; the onset of regular

contractions whether or not preceded by spontaneous rupture of the membranes

• any caesarean section carried out before the onset of labour; or a planned elective caesarean section carried out immediately following the onset of labour, when the decision was made before labour

• surgical induction; by amniotomy • medical induction; including the

administration of agents either orally, intravenously or intravaginally with the intention of initiating labour

• combination of surgical induction and medical induction

Delivery method • spontaneous vertex (normal vaginal

delivery, occipitoanterior) • spontaneous other cephalic (cephalic

vaginal delivery with abnormal presentation of head at delivery, without instruments, with or without manipulation)

• low forceps, not breech (eg forceps, low application, without manipulation; includes forceps delivery not otherwise specified)

• other forceps, not breech (eg forceps with manipulation; includes high forceps and mid forceps)

• ventouse, vacuum extraction • breech (spontaneous delivery assisted

or unspecified; includes partial breech extraction)

• breech extraction (not otherwise specified; includes total breech

extraction and version with breech extraction)

• elective caesarean section (caesarean section before, or at onset of, labour)

• emergency caesarean section • other than those specified above (eg

application of weight to leg in breech delivery; includes destructive operation to facilitate delivery and other surgical or instrumental delivery)

Status of person conducting delivery • hospital doctor • general practitioner • midwife • other than above Anaesthetic given during labour/delivery • general anaesthetic; the administration

by a doctor of an agent intended to produce unconsciousness

• epidural or caudal anaesthetic; the injection of a local anaesthetic agent into the epidural space

• spinal anaesthetic; the injection of a local anaesthetic agent into the subarachnoid space

• general anaesthetic and epidural or caudal anaesthetic

• general anaesthetic and spinal anaesthetic

• epidural or caudal and spinal anaesthetic

• other than above • not applicable ie no analgesic or

anaesthetic administered Number of babies • one • two • three • four • five • six or more

Sex (baby) • male • female • not specified Birth order • first or only birth in the sequence (ie

singleton) • second • third • fourth • fifth • sixth Live or still birth • live • stillbirth, ante-partum • stillbirth, intra-partum • stillbirth, indeterminate Birth weight 0001 – 6999 grams Resuscitation method positive pressure nil, drugs nil positive pressure nil, drugs administered positive pressure by mask, drugs nil positive pressure by mask, drugs administered positive pressure by endotracheal tube, drugs nil positive pressure by endotracheal tube, drugs administered not applicable (eg stillborn, where no method of resuscitation was attempted) Birth date (baby) day/month/year Birth date (mother) day/month/year

Annex B NHS Deliveries attended by Independent Midwives, England, 2003-04 Total number of deliveries 407 Total number of deliveries with data 337 number percentage woman’s age under 20 2 1 20-29 43 13 30-39 261 77 40-49 31 9 parity 0 131 39 1 132 39 2 60 18 3+ 14 4 gestation (weeks) under 37 17 5 37 15 4 38 32 9 39 71 21 40 104 31 41 74 22 42 and over 24 7 place of delivery home 230 68 (about 2% of all home deliveries) NHS birth centre 5 1 NHS GP unit 2 1 NHS consultant unit 100 30 method of onset spontaneous 317 94 induced 9 3 caesarean 11 3 method of delivery spontaneous 277 82 ventouse 8 2 forceps 6 2 caesarean 46 14 episiotomy yes 13 4 no 324 96 See also commentary paragraph 1.7 Further information may be obtained from IMA at www.independentmidwives.org.uk

Annex C Miscarriage and Ectopic pregnancies Table C1 Miscarriages and ectopic pregnancies that resulted in an NHS hospital stay, England, 1990-91 to 2003-04. Miscarriage Ectopic Pregnancy

number rate per 100

deliveries number rate per 100

deliveries 1990-91 43,900 6.7 8,900 1.4 1991-92 45,700 7.1 9,600 1.5 1992-93 47,200 7.6 9,800 1.6 1993-94 48,100 7.8 9,500 1.5 1994-95 45,000 7.4 9,800 1.6 1995-96 42,100 7.1 9,400 1.6 1996-97 43,300 7.3 9,600 1.6 1997-98 41,800 7.2 9,300 1.6 1998-99 41,400 7.2 9,100 1.6 1999-00 39,600 7.0 8,900 1.6 2000-01 39,600 7.2 9,100 1.7 2001-02 41,400 7.6 8,800 1.6 2002-03 43,600 8.0 8,800 1.6 2003-04 43,400 7.5 9,000 1.6

Table C2 Miscarriages and ectopic pregnancies that resulted in an NHS hospital stay by age, England, 2003-04.

Miscarriage Ectopic Pregnancy

number rate per 100

deliveries numberrate per 100

deliveries

under 20

3,900 9.3

400 1.0

20-24

6,800 6.2

1,500 1.3

25-29

8,200 5.6

2,200 1.5

30-34

10,000 5.7

2,600 1.5

35-39

7,800 8.6

1,800 2.0

40 and over

3,400 19.4

400 2.4

Source: HES. Footnote: Figures have not been adjusted for shortfalls in data (i.e. the data are ungrossed).