Centralising midwifery care

Abstract

British Journal of Midwifery • august 2012 • Vol 20, No 8 In a controversial bid to provide higher levels of care for women and babies—especially those with complications, Dr Tony Falconer, president of the Royal College of Obstetricians and Gynaecologists, has proposed that almost a third of NHS maternity units should be closed and replaced with a smaller number of large facilities where consultants are available around the clock. He believes that under the existing maternity care structure, there are too few consultants to guarantee high quality care for everyone. Under the rationalisation programme, a fewer number of units would handle 5000 to 6000 births a year. Having a baby is an extremely personal milestone in a woman’s life and there is a concern that these larger units will lose the human touch and will be more concerned with turning beds around. However, as approximately 94% of births currently take place at hospitals, this may encourage more low-risk women to attend midwifery-led birthing units or to have home-births. But will this have a knock-on effect on the already strained workload of midwives? Additionally, while centralising maternity care may be feasible in larger cities such as London where there are a large number of obstetric units, women from less densely populated areas would have to travel further for their care. The cost implication is not the only thing that should be considered here, what happens to those women who have a precipitous birth and cannot reach a hospital in time? Cathy Warwick, General Secretary of the Royal College of Midwives said: ‘We do need to rationalise because, in future, smaller obstetric units won’t be affordable if they are too small. For units delivering 2500 to 3500 babies a year, their future is a bit gloomy. Units of that size are going to struggle to survive. It’s going to be very hard to justify them, unless there’s a justification based on geography.’ As we are all aware, maternal obesity and the prevalence of older mothers is on the rise. It is well known that these can lead to complications during pregnancy. For example, maternal obesity can increase the risk of caesarean section, postpartum haemorrhage, maternal hypertension and gestational diabetes as well as fetal death (Arrowsmith et al, 2011). There is no doubt that around the clock access to consultants may help improve the outcomes for known high-risk births and surely it is better to go further afield if you will receive higher-quality care. However, this suggestion of centralising services, further from people’s homes, does seem to run contrary to the coalition government’s broader drive to devolve power to local communities, to develop local services, based in community settings, tailored to local needs and demographics (Department of Health, 2010). When weighing up the cost between geography and care, it is vital that everyone works together to ensure care always comes first. BJM