By Dr Daghni Rajasingam, Consultant Obstetrician and Member of the RCOG Board of Trustees
Today marks 70 years since the National Health Service (NHS) was launched in 1948. This anniversary provides a wonderful opportunity to celebrate the many life-enhancing achievements of the NHS. Due to pioneering advances in science, medicine and technology, and the extraordinary efforts of NHS staff, the health of the nation – particularly women – has significantly improved over the past seven decades.
In this time, the needs of women have changed dramatically and so too has the care that they require. The Royal College of Obstetricians and Gynaecologists (RCOG) is marking this important anniversary by celebrating medical innovations within the obstetrics and gynaecology speciality that have advanced the health of women in the UK and beyond.
The first NHS baby – Aneira Thomas – was born a minute past the hour on 5 July 1948 at Amman Valley Hospital in Carmarthenshire. The team of nurses encouraged Aneira’s mother to hold on until just after midnight. The inspiration for Aneira’s name came from the founding father of the NHS - Aneurin Bevan.
Prior to the establishment of the NHS in 1948, the majority of women gave birth at home and often with no medical assistance. Seventy years on, and women have more support and choice about where and how they give birth. They also have greater control over when they become pregnant due to advances in contraception.
Giving birth in the UK is now safer than ever. Since 1948, there have been significant reductions in maternal and infant mortality. Clinical practice become more evidence-based and multi-professional working has developed to ensure the care of mother and baby can be supported by a range of specialists. When the NHS was launched, infant mortality rate was 34 deaths per 1,000 births*. Seventy years on, that rate has dropped dramatically to 3.8 per 1,000 births*.
To mark the NHS’s landmark birthday, the RCOG carried out a survey of its members to ask what they thought was the most important medical innovation in obstetrics and gynaecology (O&G) over the last 70 years.
Almost 30% of respondents** said obstetric ultrasound scanning was the most important medical innovation. This was followed by contraception (20%), IVF and fertility treatment (15%) and cervical screening (11%). Other innovations on the list included laparoscopy, the mirena coil, epidural anaesthesia, HPV vaccine and fetal surgery.
By the 1970s, ultrasound scanning had been taken up widely in hospitals across Britain. In 1972, the first accurate detection of fetal cardiac action was reported. In the early days, clinicians could only detect the baby’s head. Now women are able to see 3D, real-time colour images of their baby. This vast improvement in image quality led to the new field of fetal medicine that has paved the way for diagnosis and treatment in pregnancy.
Ultrasound scanning has also revolutionised other areas of women’s health, including the detection of gynaecological cancers. Although used in every speciality, ultrasound is arguably most intrinsic to obstetrics and gynaecology, and will continue to be used as a tool to improve women’s health in the next 70 years.
Contraception is also another vital part of women’s healthcare, particularly sexual and reproductive care. The range of contraception methods empower women to take control of their fertility, prevent transmission of sexually transmitted infections and improve sexual health at every age and stage of life.
Infertility affects one in seven couples and can have a devastating effect on people’s lives – it can lead to distress, depression, and the breakdown of relationships. The Nobel Prize in Physiology or Medicine in 2010 was awarded to Sir Robert Edwards for the development of pioneering IVF treatment which has helped millions of people across the world to become parents. In the UK alone, more than a quarter of a million babies have been born as a result of IVF treatment. Louise Brown was the first baby to be born as a result of IVF in 1978 in Oldham General Hospital, Manchester.
Cervical cancer was a major cause of death among women in the UK, but over the last 20 years the incidence of cervical cancer in England has almost halved following the introduction of the cervical cancer screening programme. And with the HPV vaccination programme, incidence of cervical cancer is expected to be reduced even further.
As we now look to the future of the NHS, the RCOG remains committed to improving the quality of, and access, to care for women. Greater focus must be placed on early detection and preventative care, while ensuring shared decision-making and that women are always at the centre of their own care.
Pioneering advances in precision medicine, artificial intelligence and genomes research will also transform healthcare, including within obstetrics and gynaecology, for women in the UK. The RCOG looks forward to seeing these developments and remains deeply committed to improving care of women across in the UK and across the world.
* ONS report: Child Mortality in England and Wales 2016
** The survey involved 63 members