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No one doubts the importance of good obstetric care; fantastic when it goes as it should, but potentially devastating if it goes wrong. As lawyers acting for babies injured at birth, our focus is typically on whether - rather than why - substandard care has been given. Being busy or out of your depth (two common features in obstetric claims) is no defence. The Royal College of Midwives’ (RCM) recent report highlighting both the huge increase in birth rates as well as the older age at which women are now having children, illustrates that the environment in which midwives and obstetricians are working has rarely been so challenging. Add to this the financial constraints of our times, and you have to ask yourself, are we heading for – or, indeed, are we in – the “perfect storm” for maternity services?
According to the RCM report, a record 688,120 babies were born in England in 2011, the highest level of births since the early 1970s. We are in the middle of a baby boom, with numbers predicted to keep on rising. One of the features of this boom is that the increase in numbers is not evenly spread. The biggest rises since 2001 have occurred in London (up 28%), the South West (up 25%) and the East Midlands (up 24%). The RCM estimate that a further 5,000 midwives are needed to deal with the increase in births. Added to this, figures from the ONS, analysed in the RCM report, reveal that the number of older mothers is increasing with a staggering 76% jump in the number of births to women aged 40-44, while the number of births to women aged 45 and over have tripled. Given the potential for greater complications for older mothers, services are consequently stretched still further.
The squeeze on services is relentless. The Sunday Times (20.01.13) recently reported that more than half of maternity hospitals have had to close their doors on average seven times a year because they were simply too full. The Whittington Hospital has recently announced a cap in the number of births at 4,000 per annum as part of a huge drive to reduce costs. Although the Hospital says no one will be turned away, it is hard to see how this will not be a real risk – especially given the shifting demographics of a city like London. Lewisham Hospital has also been in the news with reports that its maternity unit will be changed to a midwife led section as part of a package of cuts. Is provision really adequate in that area for transfer into consultant led care in an emergency? After all, minutes count in labour if a baby is being compromised.
Time will tell what the impact of these changes in demographics, staffing and finances will be. Additional pressures increase the risk of mistakes being made. It is likely, therefore, that there will be a footprint left in terms of obstetric claims since, whatever the demands on services, the law of negligence remains the same.
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