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Monday, 16 July 2012

Obstetric Care - is bigger better?

Of all the Medical Negligence cases that I have done over the years the most distressing are those that relate to child birth and neonatal care. This should be a time a celebration and in the vast majority of cases it is. There are however those rare cases where something goes wrong. I have seen cases where babies suffer tragic brain injuries due to lack of oxygen and suffer life long disabilities. These cases are few and far between but when they happen the consequences are devastating.

If there is any area of medicine which should be given a top priority it is this.

There are proposals from one expert that there should be a small number of ‘centres of excellence’ with a strong concentration of consultants to ensure the best possible care.

The idea is to reduce the number of obstetric departments and concentrate the funding in larger centres that are able to offer high quality care. It sounds good. Who would object to improving care?

But there is also a downside. Fewer centres inevitably mean closure of units and the loss of local facilities. It does not seem that long ago that the community midwife visited mothers on her bike and was there when the baby was delivered at home. So will the loss of local facilities mean a less personal service? This is the concern of Mary Newburn from the National Childbirth Trust –

"We are concerned that very large hospital units can seem like baby factories to parents: impersonal and preoccupied with pushing mothers and babies through the system, that people are processed like components in a factory, and that some don't get personalised care."

This is a finely balanced argument. I can see the concerns of mothers who feel that they will lose a locally available service. Some may have to travel long distances. On the other hand I have seen the terrible consequences of things going wrong which suggests that anything that improves standards is a good thing.

I have to say that my concern is that this will all be about saving money. Closing units is associated with cuts. And if the welfare of the newborn is placed at risk for economic reasons then the proposals should be vigorously opposed. The final decision should be with local health providers to decide the best means of providing care in their area.

Such decisions should not be left to politicians.

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