Maternity Services

Abstract

The emphatic conviction that birth in a consultant obstetric unit provided the surest guarantee of a healthy baby has led to the current situation where 98 per cent of women in this country now give birth in NHS hospitals, of which about 4 per cent in 1989 were in GP units and the rest in consultant obstetric units. Assessments of the benefits of this development differ. Perhaps the most radical view is presented by Mrs Marjorie Tew, to whom we have earlier referred, a medical statistician and author of Safer Childbirth? A Critical History of Maternity Care (1990) whose analysis of the statistics relating to the safety of different places of birth provides what she herself describes as ‘revolutionary conclusions’. She says:

First of all there is the obvious evidence that since 1950 mortality rates have gone down a lot. At the same time hospitalisation rates have gone up and everybody fell into the trap of making a causal connection between these two serial time trends. When you carry out the first statistical test to see whether there is likely to be a causal connection, you find that the causal connection, if any, is in the opposite direction. We found that the years when hospitalisation increased most were the years when perinatal mortality declined least. There is a strong negative correlation between these figures.