Thursday, July 14, 2011

Shaken, Not Stirred: RCOG's proposed maternity shake-up hard to swallow

It's been reported right across the media today (e.g. BBC news online) that the Royal College of Obstetricians and Gynaecologists wants to shake-up UK maternity wards.

But as far as I can tell, the proposed new model mirrors the maternity care system in The Netherlands rather too much for my taste - where the perinatal mortality rate is NOT something I think we should aspire to.

The problem is this (as outlined in my letter to the BMJ, which was published earlier this year): who is capable of identifying - without the benefit of hindsight - low risk pregnant women?

The Good News

Today, I took a look at RCOG's Expert Advisory Group Report, "High Quality Women’s Health Care: A proposal for change", and I also asked the press office a few questions about the report, and it seems that there MAY WELL BE an element of choice involved here.

For example, in response to my question about where women with maternal request cesareans fit into this model, RCOG said:

"The RCOG supports clinically appropriate choice. If a woman is going to have a caesarean section, then under our proposals, she will be cared for in an obstetric unit. Likewise, if she requests for pain relief, then she should have her delivery in a hospital."

And in its press release, Chair of the Expert Advisory Group, Dame Joan Higgins, says:
Women will still have ready access to hospital-based care but this will be when clinical need dictates or the woman chooses to have her care delivered in this setting.

How Many Women Will Choose Midwife-Led Units? 

This is one of the key questions here in my opinion - how on earth will this shake-up be managed?

Women will be labeled low and high risk, but they'll also have autonomy (we hope - in practice) to choose the current hospital birth model in preference to a midwifery-led unit.

I've asked the question of RCOG, and now await the answer, but has anyone calculated just how many women will CHOOSE to go down the midwife-only route?

And how many women will still prefer to give birth in traditional hospital environment (with all its faults), with immediate access (ideally) to consultant care and 24-hour emergency services?

Top Down versus Bottom Up

(an accidental birth metaphor I'm afraid)

I get the feeling that this proposal has been designed with finding a solution to the 'birth rate increase / midwifery shortage' situation that the UK's hospitals are facing - instead of deciding first what would be BEST for and WANTED by mothers.

So let's listen to women, and make sure that ANY changes we make in our maternity services are for the benefit of positive physical and psychological outcomes for our mothers and babies - and not for any other reason.

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