YOUR report on deaths during childbirth is a timely reminder that young women still die before their time as a consequence of pregnancy ("Revealed: Deaths during childbirth are on the rise", The Herald, January 4).
Major changes are being implemented to the way in which deaths associated with pregnancy are being investigated in Scotland. There is a grave danger that the changes will result in poorer quality of information, poorer interrogation of data and therefore failure to recognise patterns of preventable harm from these rare but devastating events.
Since 1952 every maternal death in Scotland (and the UK) has been investigated by a "Confidential Inquiry" process which identifies patterns of substandard care, and makes recommendations for improvement, published every three years as the Saving Mothers' Lives Report.
This inquiry process has led the way in making childbirth safer in Scotland today than it has ever been. It is held up by the rest of the world as an exemplar of clinical audit, laying the foundation for much of what we now take for granted as evidence-based medicine and safe healthcare.
As Dr Cath Calderwood says in the article, there is no question that changes are needed in order that the inquiry process is quicker and more effective at leading improvement in the way women experience care for pregnancy. However, the changes being implemented risk Scotland accepting an untested inquiry process as part of a recently-introduced unproven UK system. The providers of this untested system have a three-year contract and are currently struggling to recover a two-year gap in English maternal death data resulting from the breakdown of the previous contractual arrangement.
The same situation of risk also exists for all Scottish data relating to stillbirths and deaths in the first year of life, because of insistence in joining with the untested UK data collection system.
The very least we owe to young mothers who die, their babies and to the families of Scotland, is a solemn commitment to thoroughly investigate what has happened and to learn from it. Scotland is different from England in many respects, not least in our diverging healthcare systems. The lessons learned from these tragic events may also be different. How will the future citizens of Scotland view these decisions which cede to England control over information determining the wellbeing of generations to come?
Dr Hilary MacPherson,
Consultant obstetrician and gynaecologist, Forth Valley Royal Hospital, Larbert.
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