The disasters at several maternity hospitals across the country are evident to all. The situation at East Kent is in the BBC News today 23rd Jan but it is symptomatic of a general decline. There are insufficient O&G consultants, there are insufficient midwives, and there is so much litigation that the future debt burden is becoming greater than a complete year’s budget. Nothing significant has been done to increase the number of full time midwives or GPs or consultant obstetricians in training in the last three governments. Yes, choice is under threat in England, but we in Wales have already lost it. The out of date NICE advice from 2014 needs to be replaced. All pregnancies have to be regarded as risky today, even if a small minority are women under 35 with second pregnancies and no previous complications. The numbers of these are too small. The NHS guide: Your pregnancy and baby guide: where to give birth is also out of date. What they should be saying is “where to avoid”! Doctors are often “out of their depth” and “without proper cover” and no wonder they get stress. The least experienced doctors are at the coal face when this should be a place for the experienced brain to triage and sort appropriately, avoid delays and unnecessary mistakes, and avoid over treatment. Working in A&E needs “tough love”… A&E consultants are a rare breed of dedicated people, but there are not enough of them: just like GPs. The difference is that GPs are not contracted to cover emergencies, and they can down tools. The buck stops at A&E departments, and the closures across the country are as a result of too few staff across the board. The shortage was known 10 years ago, covered in the Guardian 6 years ago, and yet nothing has been done.
GPs used to share the care of pregnant women, leading to long term relationships and trust. The GPs are now working flat out and bureaucratically, for long hours, and often without examining patients. The Nuffield Trust reports on the falling number of full time equivalent GPs across the UK, but agrees that the number of GPs has stayed the same!
A year ago in the Guardian Dennis Campbell reported: Concerns over birthing options as NHS shuts midwife-led centres – Trusts say midwives needed in hospitals, as critics argue women’s right to choose under threat
in 2014 NICE announced that Midwife-led units (are) safest for straightforward births – More women should be encouraged to give birth at midwife-led units rather than traditional labour wards, says NICE.