2. Ultrasound Best practice antenatal care for a woman who has no complications of pregnancy, involves referral for two screening-based ultrasounds a first trimester ultrasound optimally performed at around 12 weeks for dating, identification of twin pregnancy, early anatomy assessment and screening for chromosomal anomaly an anatomy ultrasound optimally performed at 19+ weeks for detailed assessment of fetal anatomy. In 2013/14, the NMMG reviewed primary maternity ultrasound claims data held by the Ministry of Health and found that the average total number of ultrasounds for women who had a live birth or stillbirth was 3.4.

3. Costing the cascade: estimating the cost of increased ob stetric intervention in childbirth using population data Author: Tracy, Sally K ; Tracy, Mark B Is Part Of: BJOG: An International Journal of Obstetrics and Gynaecology, 2003, Vol.110(8), pp.717-724 r Reviewed Journal]Tracy, Sally K Tracy, Mark B Findings: The relative cost of birth increased by up to 50% for low risk primiparous women and up to 36% for low risk multiparous women as labour interventions accumulated. An epidural was associated with a sharp increase in cost of up to 32% for some primiparous low risk women, and up to 36% for some multiparous low risk women. Private obstetric care increased the overall relative cost by 9% for primiparous low risk women and 4% for multiparous low risk women. Conclusions The initiation of a cascade of obstetric interventions during labour for low risk women is costly to the health system. Private obstetric care adds further to the cost of care for low risk women.

4. The Birthplace national prospective cohort study: perinatal and maternal outcomes by planned place of birth. Birthplace in England research programme. Final report part 4. NIHR Service Delivery and Organisation programme; 2011. Hollowell J, et al. Findings: Giving birth in midwifery lead units appear to be safe for babies and offer benefits to both the mother (fewer interventions) and baby (more frequent initiation of breastfeeding). The substantially lower incidence of major interventions, including intrapartum caesarean section, in non obstetric settings has potential future benefits to both the woman and the NHS. There is a need to address the higher frequency of major interventions and the relatively low proportion of “normal births‟ in “low risk‟ births in Obstetric Units.