This is a summary of chapter 11, the Organisation of NHS maternity care, by Professor Jim Thornton. He is a Professor at the Academic Division of Obstetrics & Gynaecology and Child Health, City Hospital, Nottingham.
He descibes three organisational features which distinguish NHS maternity care from that of most other West European countries.
1. Britain has the most centralised system. Not only do we have a low rate of home births, typical of most other countries, but we also have the lowest proportion of small delivery units <1000,>5,000 deliveries.
2. Doctors, and in particular senior doctors, are relatively uninvolved in labour and delivery. It is difficult to overemphasise the importance of close consultant involvement in labour. Although maternal and perinatal deaths are now both uncommon, the day of delivery remains the most dangerous in most individuals’ entire lifespan. Yet normal deliveries are left largely to midwives and senior doctors leave complicated deliveries, forceps and caesareans, to doctors in training.
3. Probably as a consequence, Britain is unique in having the majority of normal births conducted by midwives. However, midwives are expanding their role outside labour and the required number of midwifes has not kept pace with these new developments leading to a possible overall shortage of midwifes.
4. The potential medico-legal claims arising from alleged negligent care in labour causing brain damage, now dwarf all other medical claims from any other NHS specialty. The chapter reviews evidence of the NHS having the highest rate of sub-optimal care in Europe and suggests ways to improve the service.
To dicuss further about some of his more chilling insights, then please e mail me direct or post a comment.