Routine pregnancies do not need obstetrician care
BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7084.845 (Published 22 March 1997) Cite this as: BMJ 1997;314:845
Specialist participation in routine antenatal care should be reduced, says a report by the Audit Commission. Such a move would be popular with the public and save the NHS £10m ($16m).
The commission's survey of 2376 women, 500 GPs, and visits to 13 NHS trusts highlighted large differences in the way maternity services are provided in England and Wales. For example, the number of antenatal check ups provided varied between seven and 13 and the rates of caesarean section from 11% to 18% of all deliveries.
The report, First Class Delivery: Improving Maternity Services in England and Wales, found that some trusts provide more antenatal check ups than are needed by some women. And in some trusts consultant obstetricians have no routine input in the care of uncomplicated pregnancies, whereas in others they may have four or more routine contacts.
The report quotes a recent randomised trial which confirmed that routine specialist visits for women at low risk of complications are of little or no benefit and that outcomes are similar in hospital and community clinics (BMJ 1996;312:554-9).
It says: “Not only does community care cost significantly less than traditional, obstetrician led shared care, but it is more appropriate and probably more satisfactory for many of these women.” Money saved could then be spent on improving information for all women and providing more support and care to those who have complications in pregnancy.
The report comes halfway though the timetable set by the government to increase women's participation and choice in maternity care, as laid out in the Changing Childbirth report. It found that overall most women were satisfied with the services they receive, but they do not always have enough information or feel involved in decisions.
The commission was concerned that one in four women said that they were left alone during labour. Also, more than a quarter of the women who spent less than 12 hours in a labour ward were cared for by four or more different midwives.
The most critical comments from women concerned postnatal hospital care, with a quarter of those surveyed saying that they were dissatisfied with the length of stay in hospital. The report says that trusts should do more to consult women because those who believed that they were involved in the decision about when to go home were nearly twice as likely to think that their length of stay had been right for them.
The report said that the large variations in the rates of medical interventions were worrying. The commission says that unnecessary interventions should be avoided because of the risks of injury and the potential complications of anaesthesia. In addition, caesarean sections nearly treble the average length of stay in hospital and cost at least £700 more than a normal delivery. It says every 1% increase in the rate of caesarean section costs the NHS over £5m a year. (See p 844)
First Class Delivery: Improving Maternity Services in England and Wales is available from Audit Commission Publications, 0800 502030, price £15.