STAND BY for a rethink of the British way of birth. A Government
report out today offers women a total new deal on childbirth. After 20
years of the forced march to the maternity wing, women are being
encouraged to do an about-turn.
In what is called a manifesto for choice, Britain's maternity services
are being subjected to a complete overhaul. If a woman wants to have her
baby at home, so be it. If she shuns doctors but prefers a midwife, that
is her right. If she wants to hold her own case-notes, well, of course.
If she opts for a small local hospital, so much the better.
The winds of change have been charted in this column from time to time
over the past 18 months, but the end result is none the less
breathtaking. Campaigners in the cause of ''a female profession
attending females'' have had most of their dreams fulfilled. It is a
shining example of government by women, for women.
Two in particular have made it happen. One is the Labour MP Audrey
Wise. The other is Health Secretary Virginia Bottomley. Politically they
are poles apart. But they came into effective alliance when Mrs Wise
instigated an inquiry by the Commons Health Committee that assembled
evidence which convinced Mrs Bottomley that a policy U-turn was needed.
Today's report (the companion to a similar one from the Scottish
Office last month) therefore starts from the concept of ''woman-centred
care''. This contrasts with the ''medical-centred care'' which has
dominated NHS maternity services. That pattern of clinical care is now
seen as more appropriate to ill-health than to the normal pregnancies
which most women experience.
Now in a change of fashion, the midwife model of low-tech maternity
care is set to prevail over the medical model of high-tech care. This
amounts to taking away the lead role from the obstetricians and at the
same time diminishing their siren warnings about the safety of mother
and child. While heeding the cry for safety, today's report says it is
often an excuse for unnecessary interventions by doctors. Comparing
safety, it finds no evidence that having babies other than in hospital
is less safe for women with uncomplicated pregnancies.
So in future the premium will be on maternity services that are
''kinder, more welcoming and supportive to women''. Out go unwarranted
inductions, epidurals, and foetal monitoring. In comes ''reassurance and
a comforting touch'' to make labour a fulfilling experience. This softer
approach favours the midwife and the new regime aims to restore her
professional status.
Instead of being a chaperone to the doctor the midwife will become the
lead professional chosen in her own right by at least 30% of women to
manage their care plan. The new emphasis will be on continuity of care
by a named midwife before, during, and after the birth.
More midwives will run their own maternity units (as in the pioneering
midwife unit in Glasgow). They will routinely admit women in labour to
maternity beds. Family doctors who refuse women home births will be
expected to hand over to a midwife. In hospital, midwives will outrank
junior doctors.
The drive to de-medicalise pregnancy may also halve the number of
ante-natal checks, some of which are unnecessary. Instead of 12 to 14
they should come down to between nine and six. But new sessions might
include solo groups for pregnant teenagers without partners, classes for
first-time parents, refresher courses for others, and even updates for
grandparents.
The changes chime in with the more user-friendly NHS. The Government
now admits that most women are given little choice about the place of
birth. Hospital delivery has become virtually universal, at 98%. But a
MORI survey shows that nearly three-quarters of women who gave birth in
hospital would have liked an alternative choice, with 22% of these
opting for home birth and 44% for a midwife-led domino delivery.
Today, an insignificant 1% of all births are at home. Women
campaigners think it should be at least 33%. The report sets no target.
It suggests that home confinement may have come to symbolise choice
because it is more personalised and leaves control in the hands of the
woman. And although the risks are ''extremely small'' the report
recognises that there will have to be better emergency back-up and
flying squads for the two babies in a thousand that will need
resuscitation in hospital.
And when precisely will all these great expectations come about? In
Scotland, health boards are being asked to review their services within
the next two years to make them more responsive to women and their
families. England is adopting a five-year timetable.
Despite its manifesto for midwives, the Government is anxious not to
stir up professional rivalries. The Scottish Office wants a seamless
transition. Midwives and GPs should work together while obstetricians
concentrate mainly on complicated pregnancies. Every woman would have
the option of being seen by a consultant obstetrician at least once
during pregnancy.
Finally, this context allows me to correct a mistake. On July 9 I
wrote that the president of the Royal College of General Practitioners
had resigned when a patient's complaint against him was upheld. In fact,
it was not the president who resigned but the chairman, Dr Colin Waine.
He decided it was the honourable thing to do. My only contact with Dr
Waine was when I observed him at work as a dedicated conciliator between
the professions in the cause of better maternity care.
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