A&E closure would hit obstetrics

Published: 11 March 2010

‘Maternity services matter,’ argues Professor Cathy Warwick, who calls on Whittington Hospital managers to ensure high-quality
midwifery

MIDWIVES at the Whittington Hospital are clearly under enormous pressure dealing with the rising birthrate and the increasing complexity and diversity of women’s health and social needs.
As a professional organisation and trade union representing midwives, the Royal College of Midwives supports the vision for maternity services set out in Maternity Matters, the government’s blueprint for the future of NHS maternity services in England. Published in April 2007, the deadline for its implementation was the end of 2009.
Central to Maternity Matters are four “national choice guarantees”:
l choice of how to access maternity care;
l choice of type of antenatal care;
l choice of place of birth, including home birth; and
l choice over postnatal care.
The RCM welcomes the national choice guarantees and the pledge to provide all women with the support of a named midwife throughout pregnancy and childbirth.
Unfortunately, despite the best efforts of NHS London and local commissioners, there is still a considerable gap between this vision and the reality of maternity care experienced by many women and families in north London.
Put simply, there are nowhere near enough midwives to provide the levels of choice for maternity care and during childbirth and the continuity of maternity care that women want, as medical intervention rates and caesarean sections continue to escalate.
In 2009, the Whittington’s caesarean section rate was 27 per cent, while the national rate was 24.6 per cent.
The World Health Organisation recommends a maximum of 15 per cent of births should be by caesarean, which is a major surgical procedure. Its instrumental delivery rate for births was 16 per cent, compared with the national rate of 12 per cent.
 The RCM would like to see further progress in terms of investing in more midwives and establishing more midwife-led units and services and smaller midwifery teams.
We know that smaller teams and units provide a great way of establishing close and meaningful relationships with women and their families and lead to better health and social care outcomes.
So increasing resources for midwifery services in the short term leads to long-term benefits in terms of women’s health and the health and development of infants.
What we do know is that under current proposals for the reconfiguration of maternity services some hospitals, or specific services at hospitals, will shut and maternity services are in danger of being consolidated in large “baby factories” undertaking as many as 10,000 births a year.
We are opposed to any such plans which will concentrate maternity care in ever larger and impersonal sites.
We are concerned that the proposal for the Accident & Emergency department at the Whittington to be closed will ultimately lead to the closure of the obstetric unit and the transfer of women to neighbouring maternity services.
The RCM is anxious that such reconfig­urations are likely to have a negative impact on medical intervention rates during labour, impede efforts to support normal childbirth without medical intervention, and make it harder to recruit and retain midwives.
We believe that decisions about maternity services should not be dictated by what is going on with other NHS services.
The decisions must be about what is best for mothers, babies and their families.
Therefore, we call on NHS managers at the Whittington to ensure that women and their families receive accessible, responsive and high-quality midwifery services.
Quite frankly, this is what mothers, babies and their families deserve because local maternity services matter.
• Professor Cathy Warwick is the general secretary of the Royal College of Midwives,
a trade union and professional organisation representing midwives. Visit www.rcm.org.uk