Emergency transport for neonates after home deliveries

EDITOR, — After an elective home delivery of a low risk pregnancy, unexpected neonatal problems ensued and our neonatal flying squad was summoned for immediate help with resuscitation. Such an emergency service to home deliveries has not been planned or funded, and so the midwife was advised to call a standard emergency ambulance.

In view of the increasing trend towards home deliveries, supported by the Royal College of Midwives and the government, we wish to express our concerns over people's expectations of the traditional neonatal flying squad after the discussion at the British Medical Association's annual representative meeting.1 The term “flying squad” is a misnomer for a system established to transfer sick neonates from smaller district general hospitals to neonatal intensive care units. As the district general hospital always provides facilities for initial resuscitation and support, these flying squads have generally not been organised or resourced to provide an instant response assembling the experienced medical and nursing staff required; and an ambulance and crew, particularly out of hours, takes a median of 45 minutes at our unit,2 the team having to be freed from other duties or, at night, attend from home.

In our experience many midwives wrongly believe that a call for help with a home birth will produce an instant response by a neonatal team from the local hospital. Many hospitals will not provide a neonatal flying squad at all, and even those larger units that do are unlikely to provide a 24 hour emergency service. If midwives are unaware of the limited facilities available parents are probably deciding on the place of delivery without the full facts, unaware of the skill required in the event of problems and the inevitable time taken by a neonatal flying squad to arrive to give this support.

If the public wants a full neonatal emergency support service major changes will be needed in the organisation of transport for neonates: a trained team with no other commitments would need to be on permanent standby together with an ambulance and crew, and different equipment would be needed to ensure access to all types of accommodation. The financial and staffing implications of such a service are vast, and community units, as the purchasers, would have to pay for this. Without such a strategy litigation is almost inevitable and will probably cost as much.