Dr Tony Falconer, RCOG President, writes…
In my interview with the Observer published over the weekend, I spoke about the need to reorganise our maternity services to improve the safety and care of women and their babies.
Centralised units with 24hour senior consultant cover, for high-risk pregnancies, will ensure that a high level of care is provided. Pregnancies are increasingly complicated and there are many reasons for this. Rising levels of obesity amongst the population certainly has an impact along with increasing numbers of first-time older mothers.
Certain women need to give birth in a hospital setting and require consultant care. However, not all women need this. The NPEU Birthplace study published last year was an important piece of work and looked at 65,000 low-risk births. It compared where women planned to give birth and looked at safety, cost and provision of maternity care in England.
Overall it found that childbirth is generally very safe which is reassuring, however, it showed that first-time mothers wishing to deliver at home have an increased risk of poor outcomes for their babies. The study also showed that first-time mothers have higher transfer rates from freestanding and adjoining maternity units, therefore, raising questions about the best place for this group of women to give birth.
It is clear to us that for low-risk mothers having their second or third child, there was no increased risk if they chose to give birth at home, so an expansion of midwifery-led care would improve women’s choices and ease pressure on hospital units.
Likewise, based on the findings of this same study, the RCOG favours birth in co-located midwifery-led units rather than stand-alone units since this means women have better access to consultant care in the event of an unexpected emergency.
Going back to my interview with the Observer, I made the case that small maternity units may need to close, especially in large urban areas where there are several units within reach of one another. However, talk that these centralised units will become ‘baby factories’ is unhelpful to discussions. In order for our maternity services to work better, there is the need to concentrate services where they are needed most, with increased consultant presence at these units. Clearly, for isolated or remote units, different solutions will need to be found.
As laid out in our High Quality Women’s Health Care report, major reorganisation will improve care as the current configuration cannot be sustained. It doesn’t mean closing units for the sake of saving money nor is it meant to be an inconvenience to women. We must focus on safety and offering high quality care.