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Some of you may have heard that a pretty major paper was released last week by the RCOG and that I have singularly failed to comment on it.

Am I feeling ok? Has the cutes of my first born dulled my previous sharp inclination to social commentary?

Firstly, yes I am feeling just fine and secondly, he’s not cute. He is a rabid little monster who refused to come inside from his house last night (despite there being a full on downpour) until his dad dragged him in sporting a death pout.

There is actually a very good reason why I haven’t bothered to blog so far about the RCOG paper, and that’s the lesson I was taught as a child that if you have nothing nice to say, you should stay quiet.

Well I tried but the more I read about this story, the more I feel compelled to write something about it. I feel bad being the wet blanket here but I feel like I have to return a dose of reality to things.

With my NCT hat on, this report is amazing news, not just for what it says but for the fact that we as the NCT were heavily involved in contributing. Organisations working together to provide healthcare – that in itself is worthy of the news coverage surely?

I’m also loving the idea that the organisation representing consultants is recommending that more birth be taken outside of the current tertiary setting (that’s consultant led care to you and me) and back into the community where it belongs. It’s a pretty shocking statement to hear from the governing body of God complexes isn’t it?

So what’s your problem woman? What’s with the negativity?

OK well I’ll tell you.

It’s never going to happen.

There I said it. Sorry, I hate naysayers usually but I feel like this euphoria needs a serious dose of reality.

The proposals that are made in the RCOG require what is optimistically called a “cultural change” in the NHS. More precisely it says:

“The impact of developing a woman’s health network will result in more services being delivered in a primary and community-based setting. Women will still have ready access to hospital-based care but this will be when clinical need dictates or the woman chooses to have her care delivered in this setting (if clinically appropriate). Specialist services are likely to be strengthened by pooling the subspecialist consultant resource into fewer localities, allowing for more focused delivery of care.

It is likely that the medical workforce will be required to be more flexible in the settings in which they work to facilitate improvement in care. This will require contractual negotiations across foundation trusts. However, such an excellent model exists within midwifery, with midwives working across different levels of service. This also facilitates continuity of care for the woman.

Such a major change needs a culture change among professionals (particularly primary and secondary care physicians), commissioners and women. A concerted effort will be required to educate all stakeholders.”

Are you out of your ever loving minds?!?!

So just to clarify:

Women (who have spent the last 3 generations being told that if they don’t come to hospital to birth their bodies will implode into a big ball of fail) are going to be suddenly empowered to choose a different model of care. They are going to choose to abandon hospitals in their droves when at the moment most hospitals struggle to get them off their backs in the delivery room.

Midwives who are (according to the report) 5,000 members down on where they need to be now are going to take on a larger slice of maternity care.

And just to top it off, commissioners are going to implement a nationwide strategy removing local variations in service offerings.

Ah ha. I’m sorry was I away the day they dished out the jazz cigarettes?

This is one of those times I really hope I’m wrong because it’s amazing to hear the RCOG looking beyond their egos to what is genuinely in the best interests of women. But my limit experience of the machinations of the NHS leave me feeling pretty hopeless that this paper will ever come to pass. It is certainly not geared up to be able to deliver it now, and to develop that capability and get the people on the front line of delivering the service to implement it on a consistent basis would be like expecting the army to hand in their weapons and resolve all future conflicts through the power of song.

There are your chips, consider them well and truly peed on.    

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