Intended for healthcare professionals

Rapid response to:

This Week In The Bmj

Giving birth: home can be better than hospital

BMJ 2005; 330 doi: (Published 16 June 2005) Cite this as: BMJ 2005;330:0-a

Rapid Response:

Scientific support for previously recognised phenomenon

This study, coming from North America (of all places), highlights
what was accepted by us many years ago. Copying the "modern" practices of
the metropolitan countries has been a failing of most underdeveloped and
developing countries. Not the least has been the hospital delivery for
women with low risk pregnancies. It became fashionable for women, even of
moderate means, to have a delivery in private hospitals by "their
gynaecologist", and their babies to be seen at birth and thereafter by
"their paediatrician". This in spite of the fact that over 96% of
pregnancies are said to be normal.
There was a time when the District Health Visitor/Midwife saw the mothers
throughout their pregnancy, and proceeded to deliver them at home. The
District Medical Officer (DMO) reviewed each mother on admission, at 3
months and near term. The local midwife ("Middie"), usually with a great
deal of practical experience, successfully conducted most of the
deliveries, the DHV visiting soon after. As a young District Medical
Officer, I was at first appalled at the practice, until my brother, a
consultant with WHO, convinced me that I should, instead, take advantage
of the services of these women (already well-accepted in their
communities) by helping them to upgrade their skills.
The first oil boom did not help. Government Health planners preferred to
build more hospitals (poorly staffed, poorly equipped and poorly
maintanied, than to train more district midwives. With this came a
proliferation of Ob & G "specialists" who performed ALL private
hospital deliveries, and Paediatric "specialists" who would oversee the
infant from birth, including the administration of protective vaccines!
There is only an impression, but from patient records it would appear that
there are significantly more Caesarean deliveries now than ever before, a
claim denied but not disproven.

Competing interests:
None declared

Competing interests: No competing interests

20 June 2005
Bernard C Boyd
Family Physician
Trinidad, West Indies