In January last year, when David Cameron may just have known he was going to be a dad again, the future prime minister penned a brief opinion piece arguing that every mother should be able to give birth in a relaxed local setting instead of what he dismissed as "one of Labour's baby factories". He promised to increase the number of midwives by 3,000 and he proposed putting them in charge of a network of birthing centres bringing together all maternity services. The script might have been written by the Royal College of Obstetricians. Yesterday they produced a report arguing for all of the above. The report also makes a persuasive case for a new approach to women's health. But however sympathetic Mr Cameron sounded in January 2010, it is not likely to influence government health policy anytime soon.
For a start, the government took a tiny decline in last year's birth statistics as an excuse for putting off recruiting more midwives. Unfortunately, this year's figures show the number of births resuming its upward trajectory. According to the Royal College of Midwives, the service is already 25% below what's needed. There are lots of midwives in training, just no jobs for them to go to. These figures are an important backdrop to the cosy headlines calling for more home births. Home births and births in maternity-led units involve low-risk mothers – and fewer midwives.
The royal college wants to provide a high and uniform quality of health care for every woman in Britain. That means big changes in the way it is organised. The report paints a devastating picture of uneven standards, where survival rates from cervical and ovarian cancer can be three times higher in some areas than others. The use of emergency caesarians is equally varied. Most depressingly, the rate of perinatal mortality is improving too slowly to catch up with the best in Europe: 6.8 deaths per 1,000 births here, against only 4.7 in Spain or 3.2 in Austria, suggests there is plenty of scope to do it better.
And even if the improvements envisaged by the report could be delivered within the diminishing NHS budget, at its core is a large stick of political dynamite. In an era of more older mothers, with more underlying health problems, and significantly more multiple births, there is a strong case for concentrating scarce resources in centres of excellence where consultant care is always available. A centre of excellence sounds much nicer than a baby factory. But it still spells closure for many much-loved maternity units, and it means local political battles in which arguments in favour of the de-medicalisation of birth will look suspiciously like a justification for NHS cuts.
