Hansard

The genesis of the concern that prompted my motion was probably the loss of maternity services at Inverurie hospital 20 years ago, in the teeth of local opposition. However, the trigger was a recent review of maternity services that was undertaken by central Aberdeenshire local health care co-operative in my constituency. That review came to the conclusion that one of the two maternity units at Insch and Huntly should close and that maternity services should be centralised on the Jubilee hospital site in Huntly.

For those who are not familiar with the area, Insch and Huntly are market towns that are 12 miles apart. Each has a fairly evenly populated farming hinterland. Aberdeen maternity hospital is the main maternity hospital in the region and it is 28 miles from Insch. Although the nearest major facility for Huntly is Dr Gray's hospital in Elgin—which is 27 miles away—for historical reasons, Huntly would normally look to Aberdeen rather than to Elgin. The review was prompted by the steady decline in recent years of the number of mothers who choose to give birth in the local units. Another relevant factor is the demographic projection of a decline in the number of women of child-bearing age in the area over the next 15 years.

Obviously, midwives need a certain number of deliveries to maintain their skill levels. Existing local protocols for dealing with maternity emergencies rely heavily on the availability of GP support. It was suggested in the review report that in the area where Grampian doctors—G docs—provide out-of-hours cover, a GP who was responding to an emergency might not have obstetric experience. That might be looked at more closely as a justifiable reason for closing the unit because G docs is a co-operative out-of-hours service that is largely manned by local GPs.

Whatever the reason for proposing rationalisation of services on one site, my concern with the process is that it has started in the wrong place. Much more could and should have been done to investigate why the decline is happening. The decline should not merely have been accepted passively as a fact and reacted to.

The midwives in the units gathered some statistics that were published as part of the report. I find those statistics interesting. Over two six-month periods—one in 1999 and one in 2000—women were asked at the start of their prenatal care where they would prefer to be delivered. It was then noted where they had been delivered. In 1999, 26 out of 41 women in Huntly said initially that they would prefer to have their babies in Huntly and 15 said that they would prefer to have them in Aberdeen maternity hospital. In the event, the numbers were reversed. The place of delivery was Aberdeen maternity hospital for 26 of the women and only 12 were delivered in Huntly.

Initial preferences in Insch were more evenly split—18 for Insch and 19 for Aberdeen. However, again, there was a significant shift over the course of pregnancy and there were only eight actual deliveries in Insch, but 27 in Aberdeen. For those whose mental arithmetic is good, I should point out that the numbers do not tally exactly because some people moved house in the middle of the process.

In 2000, 26 women in Huntly said that their preferred place of delivery was Huntly and nine said that they would prefer to deliver in Aberdeen. In the event, 11 delivered in Huntly and 29 in Aberdeen. Twenty-four women in Insch said that their preferred place of delivery was Insch and 12 said that they would prefer to deliver in Aberdeen. The figures for the actual place of delivery were 13 in Insch and 20 in Aberdeen. Some of the women who would have preferred local deliveries were delivered in Aberdeen because of complications or possible complications. That is absolutely as it should be, but I would like to know more about why there is such a big shift away from local delivery during the course of a pregnancy. I find it hard to believe that it is all for genuine medical reasons.

Another interesting factor is that the National Childbirth Trust mounted an awareness-raising campaign in Insch, to ensure that local women knew that they could choose to have their babies in the local hospital. That had a measurable impact. Whereas, over the period monitored, there were 12 Huntly deliveries in 1999 dropping to 11 in 2000, in Insch there were eight deliveries in 1999 rising to 13 in 2000. Those statistics cover a limited period, but raise questions that are wider than events in Insch and Huntly. They reflect national trends and those questions need to be answered.

According to an article in The Times earlier this month, pregnancy and childbirth were taken over by doctors in the 1970s, when the Peel report recommended hospital deliveries and took away the traditional autonomy of midwives. As a result, mothers lost the right to have one familiar midwife to see them through pregnancy, childbirth and antenatal care—ironically, that is something that every Victorian mother expected as a matter of course.

It is true that more women died in childbirth when babies were routinely delivered at home, but that was before antibiotics, improved housing and nutrition, contraception, and NHS expert care for the small percentage of problem pregnancies that really require a doctor's help. Today, in the Netherlands, 40 per cent of women have their babies at home with the help of midwives. The Netherlands has one of the lowest perinatal mortality rates in the world. America's maternity system is led by obstetricians, but its perinatal mortality rate is higher than Cuba's.

Medical intervention can be crucial for some mothers and babies. No one would deny that or try to obstruct such intervention in any way. However, some of the statistics suggest that we have got the emphasis wrong. The World Health Organisation says that the rate for Caesarean sections should be no higher than 10 per cent to 15 per cent of births. The British percentage is 19 per cent overall—which is bad enough—but, in some areas it is as high as 30 per cent.

According to the Royal College of Midwives, staff shortages in the NHS are a factor. If two thirds of women are left alone during labour because there are not enough staff for continuous care, the anxiety and stress that that can cause contribute to those ever-rising rates of Caesareans and the other avoidable interventions that are more dangerous than natural birth. A midwife who was quoted in the article in The Times stated:

"There are millions of women with scars from Caesareans or from forceps deliveries … who have been taken in by one of the biggest lies in the past 100 years."

I do not know whether I would be quite as forceful as that, but I do think that we have the balance wrong and that it is time to hand back to midwives authority for the vast majority of births. They are ready and waiting. There are 90,000 registered midwives, but only 32,000 are practising in the health service. Many have gone into private practice where they are able to offer the sort of care that they want to give.

We have been over-medicalised for so long that shifting the balance back will need a concerted effort by all those who are involved. Doctors must let go. We have to encourage the midwives to take over; they have the skills and they know where medical intervention is necessary. Women must be given the information and the confidence that they need to make informed choices. The Scottish Executive should be running the sort of awareness-raising campaigns that a voluntary organisation ran so successfully in Insch. The whole thrust of modern health service provision is to bring it as near to the patient's home as is medically and practically sensible. I look forward to pregnant women being seen as patients only in the few instances in which that is necessary, and to their being able to choose to have their babies safely and happily in their own local midwife-led facility.

The closure of maternity services at Insch is still just a proposal that technically, even at this late stage, need not and might not happen. At the very least, we must ensure that conditions are right—that could possibly be as simple as ensuring that attitudes are right—for Huntly to flourish and for Insch, if it does not close, and even Inverurie, eventually to be brought back to midwife-led use.