There was clear evidence that the ratio of hospital births:work-time-equivalent midwife is affected by the intrapartum case-mix related to clinical policies and uptake an epidural analgesia and by the volume of cross-border flow of clients between different units. Both of these factors were variable between different units. In many units the data showed that 40–50% of all cases had entirely normal labour and delivery while in others the figure was less than 25%. This raises issues about the potential for midwife-led care within main hospitals and the difficulty for midwifery managers in influencing clinical practice. Cross-border workload can be very high for some units and questions are raised about the costs of this ‘extra’ workload.