Centralization of Obstetric Units: (Austerity) Challenges to Maternity Care

By Marita Vyrgioti

Last week, the President of the Royal College of Obstetricians and Gynaecologists, Dr David Richmond, made quite a controversial proposal, one that would create a “public and political furore”, in his own words[1]. The British National Health System (NHS) has been dealing with a serious shortage of middle-grade obstetricians and therefore has suffered a general drop in the quality of maternity services offered, due to exhausting shifts and antisocial-hours of work, and to doctors’ burnout. In his recent interview in Guardian, Dr Richmond suggested a merger of the current 147 obstetric units into 118; a reduction of 20%. He supported his view saying that the concentration of obstetric experts in central units can result in high-quality maternity care and 24/7 consultancy, which would be impossible otherwise. The centralization of obstetric units will be combined with the boosting of midwife-led units, suitable for women who have a low-risk pregnancy.

There is nothing new in the claims of an ailing national health system. According to a survey conducted by the Japan Medical Association in 2008, UK obstetricians and gynaecologists are indeed hyper-productive, delivering the highest number of births among their fellow professionals across 15 countries: 468.1 births per doctor, a figure almost double than that in Canada, the second in terms of numbers of births[2]. The same report reveals that the UK maternity system is highly dependent on the support of 31,186 full-time midwives to 1,600 obstetricians and gynaecologists. A similar shortage is highlighted in a 2011 OECD report on the health workforce, which shows that between 2000 and 2009, there were 22.1 gynaecologists/ obstetricians per 100,000 females; with an OECD average of 26.8[3].

Five years and a Tory government later, these figures indicate that perhaps some of NHS’s weaknesses are structural: there is a long-term shortage of obstetricians and a significant reliance on midwives for childbirth. However, a question seems to emerge; ‘Do arguments about merging and centralizing obstetric units actually deal with the current problem or merely attempt to institutionalise it’?

Published almost four years ago, MaMSIE’s special issue on ‘Austerity Parenting’ seems particularly pertinent to these emerging questions. In the editorial note, the guest editors Tracey Jensen and Imogen Tyler argue that changes in the welfare system affect first and foremost mothers; rendering them one of the most vulnerable and precarious social groups. They also trace the so-called ‘interpellations of impossibility’ that inform parenthood in austerity regimes: ‘to be at once held more responsible than ever before for the future successes (and failures) of your children and yet at the same time to be increasingly vulnerable (through the retreat of state support, public services and welfare benefits) to the conditionalities and precarities of late capitalism’[4]. In a sense, Jensen and Tyler claim that policies or measures advanced to deal with austerity, make parents more precarious through a twofold process: less welfare support and more personal, individual responsibility. In other words, such policies render parenthood a strictly personal matter. So, does the same happen with childbirth as well?

Having said this, how can we—academics and researchers working on the maternal, mothers or future-mothers—evaluate the Dr Richmond’s proposals, through the lens of ‘Austerity Parenthood’? For instance, closing down 29 maternity units appears as a promise to pregnant women and future parents in general: to purge a malfunctioning, wasteful and inefficient system. However, at the same time, this narrative conceals the multiple implications mothers will have to deal with: traveling further to give birth, squeezing themselves into fewer maternity units, or resorting to private clinics, just to name a few. Moreover, what seems to be at stake in establishing segregation between an ‘expert-led centralized clinic’ and a ‘local midwife- unit’?

Perhaps, Dr Richmond was right in one thing: these proposals should, indeed, create a ‘public and political debate’ (and not a furore) on the current inadequacies of NHS’ Maternity Services and open-up a dialogue on the possible ways to deal with them, beyond, austerity solutions.

[1] Denis Campbell, ‘Doctor’s chief calls for string of maternity unit closures’, The Guardian, 21 January 2016, http://www.theguardian.com/society/2016/jan/21/dozens-of-maternity-units-should-be-closed-down-says-doctors-chief

[2] Narumi Eguchi, ‘Do We Have Enough Obstetricians?–A survey by the Japan Medical Association in 15 countries’, JMAJ, 52:3 (2009), 150-157.

[3] OECD, Gynaecologists and obstetricians per 100,000 females, 2009 and change between 2000 and 2009, Health at a Glance (2011), http://goo.gl/d8bLB9.

[4] Tracey Jensen, Imogen Tyler, ‘Austerity Parenting: new economies of parent-citizenship’, Studies in the Maternal, 4:2 (2012), http://doi.org/10.16995/sim.34

Marita Vyrgioti is a Ph.D student in the Department of Psychosocial Studies and an Anniversary Scholarship Holder from the School of Social Sciences, History and Philosophy, at Birkbeck University, London. She currently works under the supervision of Professor Stephen Frosh, on a thesis titled: ‘Devouring: a Psychosocial Critique of Sovereignty’. Before joining MaMSIE as an intern, she worked as an Editorial Assistant at Common Ground Publishing and as a Researcher in Educational Programs at the European Public Law Organization (EPLO).

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