The increased perinatal mortality rate over weekends is proof that we require a 7‐day maternity service: AGAINST: Shifting resources towards delivery units and away from antenatal care could increase perinatal mortality

Abstract

Palmer et al. (BMJ 2015;351:h5774) demonstrated that perinatal mortality was 5–10% higher at weekends than weekdays and this was widely reported by UK news media. About two‐thirds of perinatal deaths are stillbirths and about 90% of stillbirths follow prelabour death of the baby (Smith and Fretts Lancet 2007;370:1715–25). Hence, most babies stillborn on a Saturday will have died on a weekday. Hence, it is difficult to draw firm conclusions about the quality of out of hours care using analyses of all‐cause perinatal mortality. However, a previous study using nationally collected Scottish data from 1985 to 2004, focused on neonatal deaths attributed to intrapartum anoxia and actually showed stronger associations, with a ~50% increase in the risk of this type of neonatal death at the weekend (Pasupathy et al. BMJ 2010;341:c3498). Does this prove that we require a 7‐day maternity service?