Maternity unit admissions policy and the use of simulations.

A VERY noticeable feature of the development of the obstetric services in the United Kingdom during the past 20 years has been the emphasis on the importance of hospital confinements in reducing the incidence of maternal deaths and perinatal infant deaths. The extent to which the need for a hospital confinement is urged varies between the rather subdued statements of the triennial Reports on the Confidential Enquiries into Maternal Deaths (1963, 1966, 1969), which stress the need for proper selection of cases for a domiciliary confinement, the Report of the Maternity Services Committee (1959), and those who appear to take the view that all births should be in hospital (Peel, 1968; Morison, 1969; Baird, 1969; Yellowlees, 1969). Although many believe that a domiciliary maternity service still has a part to play, there has been throughout the country an increase, which shows no signs of coming to an end, in the proportion of confinements in hospital (Figure). In part, this has been the product of an increase in available maternity beds and a reduction in the statutory minimum period of the puerperium, but a much more important factor has been the increase of early dis-