Sunday, July 15, 2012

Centralised maternity care - but who's it for??

The Press AssociationGuardian and Telegraph have reported today on the president of the Royal College of Obstetricians and Gynaecologist's strategy for the future of maternity care. But while the focus has been on Dr. Falconer's idea to centralize care into fewer and larger obstetric units - giving rise to concerns about the distance women might need to travel to hospital, - an even more important issue is being missed.

The government, the RCOG and the RCM are yet to confirm or deny whether women with "low risk" pregnancies will even be allowed to give birth in these centralised hospitals. Or whether they will in fact be "encouraged" (or forced) to give birth in midwife-led birth units.

The PA article reads, "Around 94% of births currently take place at hospitals, but he said the number could be reduced through the expansion of home births and midwife-led birthing units based at or near hospitals. This would also lessen the need for so many obstetric units."

And the RCM's new president has sugeested that it's time midwifery led care became "the default path for healthy women".

No thank you. Even if I'd never chosen a cesarean birth, I would still have wanted to be in a hopsital with emergency obstetric and other specialist care immediately available (i.e. without transfer).
This was my comment on each article: "What readers need to be made aware
of is what is NOT being said in this article, and that is the likelihood that these plans may ONLY allow 'high risk' women into the newly centralised hospitals - with all other women with 'low risk' pregnancies being 'enouraged' (or forced - this is yet to be confirmed...) into giving birth at midwife-led birth centres.

This is not simply an issue of physical distance from hospital maternity care for pregnant women in general - this is about whether ALL women will still have the right to choose to give birth in one of these large hospitals. For example, the RCM's new president, Lesley Page, has said, "midwifery led care is safe and is associated with a lower intervention rate and is more cost effective than care by a team of doctors and midwives gives an impetus to developing more midwifery led care including out of hospital care. Perhaps it is time for this to be the default path for healthy women."

Home birth and midwifery-led care have been available and supported in this country for years - yet women continue to vote with their fee, and the vast majority choose to give birth in hospitals with obstetricians and surgical facilities immediately available.

What the government, the RCOG and the RCM need to publicly confirm is whether these restructuring plans mean that some women will have to travel further to give birth - or whether it is only women with 'high risk' pregnancies that will be invited into these hospitals in the first place?"


Mrs. W. said...

This is a concerning trend that might lead to a rather odd (but entirely concievable) result that high risk mothers in obstetrician lead units will have better outcomes than low risk women (see the Netherlands as an example). Also what does this mean in terms of the availability of pain relief - specifically access to epidurals?

Anonymous said...

Its the power of pressure that concerns me. Regardless of whether women are formally denied access to large CLU, they are going to do so with this policy. There simply won't be the facilities available and the net result will be pressure placed on women - whether it is formal or informal is completely irrelevant - it will happen and it will place some groups of women into disadvantaged groups compared to others.

Unless you know how to navigate the system or be prepared to be forceful in your wishes, a lot of women will be effectively railroaded into making a decision they would prefer not to, and are uncomfortable with.

The recent study into place of birth, is a very enlightening read when it comes to choice of birth location. Proximity of services and the desire to be in hospital were highlighted as being very important to some women.

In combination with statements coming out from the RCM, I'm extremely nervous in the rising power being given to midwives, who seem to have an agenda about natural birth over and above treating women as individuals with very different needs.

All in all, I do feel its about removing choice and power from the people who should have it most - pregnant women.