A Frightening Future for Maternity Services

In December the government announced that they were going to go back on the promise made in July that maternity services would be commissioned by a national board and that they were going to hand over commissioning to GPs. When the White Paper came out there was a great deal of praise from every relevant body, including the Royal College of Midwives (RCM) and Royal College of Obstetricians and Gynaecologists (RCOG). It was widely recognised that maternity services need to be commissioned nationally in order to ensure the best care in every area and in order to work efficiently with neonatal services. While other commissioning was going to GPs, it was acknowledged that GPs have very little experience or knowledge of maternity health and are primarily focussed on treating ill people, whereas pregnancy is not an illness.

However, GPs complained, they stamped their feet and said the idea was "stupid". It has been suggested that this is basically about money. GPs know they don't have the expertise but are afraid of losing out on some funding if they don't get to control the purse strings.

The government bowed to this pressure and have now handed over commissioning to the GP consortia.

Since the decision was announced, Cathy Warwick, general secretary of RCM has been very vocal in the press about the bleak future of maternity services. Midwife shortages, lack of choice for women and their families and GP interference are of grave concern and she has been trying hard to get the message out there.

This article in the Guardian on Saturday sums it up well. Basically, lives are at risk. The government is falling short on its commitment to maternity services. I love Cathy Warwick and I am so glad she is speaking out, but there were a few things about this article that concerned me.

The title image was one of them (see top of page). A newborn baby being held by a woman in scrubs, presumably a midwife, in an operating theatre. Hardly an image of normal birth. Perhaps the point was to negatively depict the current situation? Dangerously high caesarian section rates, complete medicalisation of birth that can only get worse with GPs at the helm. However, I doubt many readers would interpret it as such, my suspicion is that this image will only perpetuate the idea that this is what birth is and has to be, bright lights, clinical, operative, the mother not even depicted - not important.

But this image was only an afterthought for me.

The article makes reference to the number of currently enrolled student midwives, a figure that the government is throwing about in order to defend itself against allegations of not honouring promises to increase the number of midwives. I've seen it a lot lately in response to Cathy Warwick. What I have yet to see is any journalist drawing attention to the low retention rates, midwives are leaving the NHS in droves because of poor working conditions and then there is the little matter of the recent government decision to lift the tuition fee cap to £9000 per year. How many student midwives will withdraw from courses now that they can no longer afford the fees? How many prospective midwifery students, both school leavers and older people looking to retrain, are now rethinking their plans? This figure really can't be relied upon as an indicator of how many midwives we can expect to see working within the NHS in the coming years.

The main thing about the article that sent chills up my spine was the final quote from Steve Field, the former chair of the Royal College of GPs (RCGP). The article states

Professor Steve Field, former chairman of the Royal College of General Practitioners, said the new maternity networks which will be set up in England as part of the government's contentious NHS reforms should improve the quality of care. "Maternity care is not as good as it should be," he said. "But GPs, working with obstetricians and patients themselves, should be able to design better patient-centred services."

Two things about this frighten me. The first is his referring to pregnant women as "patients", which demonstrates his general attitude towards pregnancy, i.e. that it is an illness to be cured, rather than a natural biological condition and that most pregnant women are not ill. Secondly and even more alarmingly, the lack of midwives from the consultation process. At best their exclusion here is an unconscious omission based on Field's lack of understanding of the important role of a miwdwife in pregnancy and birth. This is the very reason people fear GP commissioning. They simply don't understand maternity care provision. How can they go forward from this place of no comprehension? How can they do it without consulting with midwives? This is the best case scenario. The worst is that he is aware of what midwives do and RCGP is actively planning to marginalise midwives from maternity service provision.

There are GPs practising in the UK today who are demonstrating absolutely appalling lack of knowledge on normal birth and of midwifery led care. Make no mistake, these people are NOT the people we want deciding how the money gets distributed. For a recent discussion between maternity service users on GPs see here.