The risks in having babies in rural areas – midwifery-led units questioned by consultant.

A letter to the Western Telegraph is reproduced (I gather it was edited down, and was originally stronger) from Miss M R Howells, recently retired Obstetrician and Gynaecologist:

IT WAS only a matter of time before a senior officer of Hywel Dda University Health Board tried to deflect blame for closing Withybush Obstetric Unit and SCBU from itself to Royal Colleges and clinicians ( Bernadine Rees, ‘£300K cost of judicial review’, Western Telegraph, July 30).

Let us be clear, Mrs Rees; the Royal College of Obstetricians and Gynaecologists was not involved. It was ‘quoted’ in the original consultation document, but not invited to participate in the consultation. When convening a Scrutiny Panel, Mark Drakeford was informed that the College would provide two senior fellows to advise if requested. No such request was made. Instead, two clinicians were involved, one a paediatric professor working in London, not rural Wales, and a gynaecologist from Swansea, who has not worked in obstetrics for many years.

Mr Drakeford also ‘quoted’ the College, stating Withybush was “too small to remain open” in a letter to the Patient Participation Group of St Thomas Surgery. The views of Pembrokeshire clinicians, GPs and specialists, familiar with the local problems and overwhelmingly opposing the closures, were ignored, a slap in the face for your own clinicians. No wonder morale is at rock bottom.

We await with dread and trepidation the first adverse event following the closure of the obstetric unit at midnight last Sunday.

Meanwhile, patients, their relatives and friends, face thousands of extra miles of travel, and staff are left with long journeys to provide the best service they can under difficult conditions.

The most up to date facilities in the world are useless if you cannot reach them in time ( “Bosses are totally prepared for the move”, Western Telegraph, July 30). The Health Board alone bears the responsibility for the decision.


Travel time from home to hospital and adverse perinatal outcomes  (British Journal of Obstetrics and Gynaecology BJOG 2010) Women who take 20 minutes or more to get from their home to hospital by car at full term are more likely to suffer from adverse neonatal outcomes suggests new research published today in BJOG.

South Wales Programme midwifeled units paper (Welsh Government)

“Time to clarify maternity services policy” (Mike Broad – 7th February 2014  in Hospital Doctor)

Hywel Dda under pressure as doctor says ‘Glangwili will not cope’ once Withybush has been downgraded..

Midwives and patients warn of ‘devastating’ staff shortages

Furness – the chronology of endemic denial. “Loving the NHS to Death”

In a letter to a colleague Miss Howells says:

“Perhaps worst of all, Powys free standing midwifery led units (FMLUs) are being held up as paragons of maternity virtue, with high numbers of home births, only 4 per cent transfers and no “risk” to mothers and babies. Whatever the cause, Powys’s perinatal mortality (PNM) is the highest in Wales according to the All Wales Perinatal Survey, apart from Cardiff and Vale. Whereas Hywel Dda’s is the in the 4 lowest. The actual Powys transfer rate is 24 per cent (the 4 per cent quoted was the number of the mothers the midwife compiling the stats considered to be “dire emergencies”, but surely any transfer in labour is an emergency, why else would you do it, it’s hardly optimal management.) 24% is more in line with the published literature. As the Powys stats only went electronic in 2011, I am quite concerned how many of the other stats were given this “personalised” treatment. The low PNM in the FMLUs themselves is probably due to all antenatal stillbirths (SBs) being counted as obstetric cases, as Powys only allocate place of birth at onset of labour, so SBs (rightly) immediately become obstetric cases, and also because the pts are transferred to several obstetric units, some in England, Hereford and Shrewbury/Telford, as well as Neville Hall, Bronglais and Merthyr, so that any death on arrival in those units accrues to the obstetric unit, not the FMLU. The PNM ought to be very low in  units which de facto select only low risk women, don’t count the antenatal stillbirths and also have a really low deprivation index, unlike bits of Pembrokeshire.

This is not meant, as it may sound, to rubbish Powys service. They don’t have a DGH, and no doubt do the best they can with the resources they have. What worries me is the drive by HDda to introduce a service for spurious reasons based on their stats, which will initiate a deterioration in our PNM to the levels of Powys, and there doesn’t seem to be anyone out there listening. The WAG seems to think it has the support of the local clinicians, but Pembrokeshire obstetricians and paeds, both in post and retired, are strongly opposed to the moves, so we are not sure where this impression has come from. And this is not just guarding the patch. Contrary to health board opinion, the clinicians in the 3 units have always worked together. If there were a sensible way of merging, we would have done it long ago, and been on a 1 in 8 or 9 rota, like the physicians. It is just too risky.”

Update – Letters in The Telegraph 30th December 2014 from Dr Essex and Mr Spencer:

SIR – The conclusion that doctors are rarely necessary at the delivery of babies will keep me busy for years to come. As a paediatrician who specialises in disabled children, I have produced thousands of reports, forensically analysing events around the delivery of babies who were allegedly damaged at birth.

I have spoken to many parents who feel that they were ignored or were bullied by midwives into not accepting a doctor’s assessment and help. Their babies have been left profoundly and permanently damaged, or even dead, by these perceived attitudes.

Many junior doctors and medical students have told me that they are routinely belittled and bullied by midwives on the labour ward. Some midwives seem to consider it a professional failure to summon a doctor, and often do not call until it is too late.

These attitudes cost the NHS millions of pounds and heartache for parents. The only sanction is the recommendation that the midwife concerned be sent for further training on how to interpret the tracing of the fetal heart rate. This does not address underlying attitudes that are likely to be exacerbated by midwife-led units.

Dr Charles Essex
Leamington Spa, Warwickshire

SIR – A normal delivery is a retrospective diagnosis. Even in the most risk-free and uncomplicated pregnancy and labour, things can go suddenly and catastrophically wrong. Consequently, any one of “all the myriad interventions that doctors relish” (Letters, December 6) may be the only way to rescue the baby or even the mother. Such intervention is not always available in a timely manner at home.

I am not in disagreement with the provision of home delivery, but we have a national shortfall of 3,000 midwives.

It is rare to be sued for carrying out a caesarean section, one of the commoner “myriad interventions”. The reverse is certainly not true.

Peter Spencer FRCS FRCOG
Bury St Edmunds, Suffolk




This entry was posted in A Personal View, Consultants, Midwives, Patient representatives, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

1 thought on “The risks in having babies in rural areas – midwifery-led units questioned by consultant.

  1. Pingback: New guidelines on managing genital herpes in pregnancy | Herpes Survival Kit

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