Expectant women who can't decide between a home delivery and a hospital birth will be helped by a study that has reviewed the practices at seven maternity units in the UK.

The study, carried out by the University of Salford, makes for depressing reading. Researchers found that all the units - which were not identified - were seriously understaffed, and the skill level among the midwives was very mixed. In the short time spent at each unit, the researchers noted many 'near-misses', or accidents that almost happened, that could have proved disastrous for the mother or baby. In short, the units are a danger to mothers until they start receiving more government funding.

Most of the problems stemmed from inadequate staffing levels. The largest units relied on a bank or pool of midwives who were called on when needed. In practice, two midwives would attend a birth - but this could leave the unit seriously exposed if too many women went into labour around the same time.

This actually happened at one unit where six midwives were based. Three women went into labour, so there was nobody on hand to deal with an emergency caesarean to deliver twins. In the end, the woman waited for two hours before two midwives were freed up. The infant survived, but in 'poor condition', the researchers said.

The researchers also witnessed 15 'near-misses' - including one where a woman waited an hour for a caesarean section to deliver twins - although they estimate that there were 153 near misses each three months directly due to staff shortages. Extrapolated across a year, this suggests that the seven units would experience over 600 near misses. Then extrapolate that across all the maternity units in the UK, and you have a national disaster.

Staff did not report any of the near-misses, so the true picture at maternity units across the UK is never revealed; probably just as well as expectant mothers would never step foot in them if they did.

(Source: British Medical Journal, 2003; 327: 584-6).