Consultant care 'is no better than midwifery': Opposition to home births unsuitable for the Nineties, obstetrician says

THREE out of four women do not need to see an obstetrician at any time during their pregnancies and can be adequately cared for from conception to delivery of their babies by midwives and GPs, a leading consultant said yesterday.

Malcolm Pearce, a consultant obstetrician and gynaecologist at St George's Hospital, London, said there were too many doctors who were reluctant to give up their power base in maternity units. Hospitals need to employ only half the present number of consultants, and problem pregnancies should be cared for by a new breed of specialists in foetal medicine, rather than obstetricians, he said.

Speaking at a meeting in London yesterday to highlight the difficulties women face in getting a home birth, Mr Pearce said many consultants were 'entrenched' in the idea of hospital births and medical intervention. His efforts to set up a maternity unit run entirely by midwives near St George's had been blocked by senior colleagues.

'It is all to do with loss of power; being a consultant is about the numbers of beds and numbers of patients. There is no evidence that consultant care is better than midwifery care and it is a damn sight more expensive,' Mr Pearce said.

Offering women more choice about how they gave birth also made good 'business' sense in the NHS internal market, he added, with those hospitals supporting home and midwife deliveries attracting more women than those which did not.

Earlier this year, the Government announced a radical overhaul of maternity services, giving women greater freedom to choose where and how they had their babies. More home births and a central role for midwives will be introduced over the next five years.

The review followed a report by the cross-party Commons Select Committee on Health criticising the 'over- medicalisation' of birth which made it a degrading experience for most women.

Sheila Kitzinger, a pioneer of the home birth movement, said that the proposed changes were welcome, but women faced many obstacles and ignorance among doctors. She said many women who ask about a home birth are told: 'Well, I wouldn't allow my wife to have a home birth. . .'

Donald Gibb, a consultant obstetrician and director of womens' services at King's College Hospital, London, said there was still a strong perception among many members of the Royal College of Obstetricians and Gynaecologists that women who wanted home births and midwives who supported them were 'mad, bad or marginal'. He said: 'The Royal College position of being implacably opposed to home birth is unsuitable for the 1990s . . . There are high and low risk women and, having been informed of that, they should be free to choose.'

There was no conflict in wanting the best of both worlds, the benefits of high- tech medicine and procedures such as amniocentesis and scanning, and low-tech birth in the home, he added.