‘BBA’ births. An analysis of one year’s ‘born before arrival’ births (n=29) and trends in BBA birth 2000-07 in a large English maternity unit
Ford J; Pett G
MIDIRS Midwifery Digest, Mar 2008, Volume 18, Number 1

The aim of this study was to analyse the births classified as ‘Born Before Arrival’ [BBA] covering a period of one year(2006) at an English Maternity unit with a delivery rate of around 5000 and analyse trends over an eight year period.

It was a well conducted study considering the complexities involved in the descriptive nature of the data collected. It is pertinent in identifying possible risk factors so that remedial measures can be initiated to minimise these deliveries.

The authors found a rising trend in the number of BBA deliveries, rising from 0.22% in 2002 and peaking to a rate of 0.70% in 2005 .The average rate over the entire 7 year [ 2000-2007 ] was 0.48%; which was consistent with rates quoted from other studies.

Detailed analysis of the 29 BBA deliveries recorded in 2006 was carried out. They found that 86% of these women were multiparous. Maternal age, fetal birth weights and maternal ethnicity did not appear to play a role. They also found that BBA births were more common between 19.00 hours and 09.00 hours[79%] suggesting according to the authors” difficulty in getting to the hospital, a reluctance to attend in these hours or, for planned home births, possible difficulty in the midwife attending in these hours”.

Another interesting observation was an apparent peak in BBAs during between 06.00 hours and 09.00 hours, which was attributed to possible early morning traffic congestion and the need to arrange child care.

Sixty-five percent of the women had spoken to a midwife within one hour prior to the delivery “suggesting that they either had a rapid labour, that the midwife misjudged the progress of the labour, or that the women had left it too late to attend the hospital or to ensure the arrival of the community midwife for a home birth”.

In terms of outcomes, maternal complications were few, with only 7% requiring admission [2/29 ]and both for complicated perineal tears. Almost 20% of babies required admission to the hospital with the most common complication being hypothermia.

In conclusion I agree with the authors’ views that BBA procedures should be reviewed regularly and emphasis should be placed on the importance of keeping the baby warm immediately after birth, specially with skin to skin contact. Problems with finding a standardised definition for BBA deliveries were also highlighted and hopefully the concerned colleges will offer a nationally accepted definition which will go a long way in achieving reliable comparison and help with the planning of maternity services.