In the new system, women will be able to choose who looks after them - midwife, GP or hospital doctor - and it will mean more home births with midwives playing the lead role more frequently. The proposals are to be implemented over the next five years.
But hospital specialists fear the safety of women and their babies is being put at risk by the plans being promoted by Virginia Bottomley, the Secretary of State for Health, and Baroness Cumberlege, the Under-Secretary of State. The plans are intended to put women in charge of their pregnancies and childbirth.
The report, Changing Childbirth, heralds a battle between the Department of Health and the Royal College of Obstetricians and Gynaecologists. It rarely mentions obstetricians and recommends that women should carry their notes as 'proof that the woman is in charge'. In some cases, where there are no complications, a woman might never consult a doctor.
Lady Cumberlege, chairwoman of the working party, said yesterday that she was determined that the report would be implemented. A foreword from Mrs Bottomley says that 'pregnancy is not an illness' and that women should be at the centre of decisions about their care. She says the report is in line with the philosophy of the reformed National Health Service.
The Royal College of Midwives welcomed the report, but warned against 'warfare' among health professionals. 'The views of mothers must come first,' it said.
Mr Joseph Jordan, a Birmingham obstetrician and gynaecologist and spokesman for the college, said it had 'grave concerns' about the safety of women and babies if the report was fully implemented. The college said: 'Our unhappiness with the report stems from the fact that it appears to be suggesting major alterations in current practice without objective review of the available evidence.'
But Lady Cumberlege said each proposal had already been successfully implemented in a unit or community somewhere in the country.
In nine months of visits and inquiry, the working party had found much good practice, she said. 'But we also uncovered the mediocre and the poor; we found rigid, inflexible, unthinking and wasteful duplication of services, a total disregard for the emotional and psychological feelings of women and their partners.' She said that women telling them 'all I wanted was a familiar face' was a theme that had haunted the working party.
The report is in line with the findings of the House of Commons Select Committee on Health report in March 1992 which criticised the 'over-medicalisation' of childbirth. It said that mothers' experience of pregnancy and birth had been degraded by arguments about safety which were based more on prejudice than evidence.
Key proposals are that the woman should have, in almost all cases, the same professional providing care throughout her pregnancy and that she should be given full information about all the choices available to her.
The Royal College is submitting a detailed report to the Department of Health. Yesterday, it listed points from the report which it said were 'inadequately justified'. The obstetricians say that midwives are not trained to screen for abnormal heart murmurs or chest conditions.
They said that a survey had shown that three-quarters of women initially referred for delivery in 'low-risk' midwives' units had needed some form of medical intervention.
Changing Childbirth; HMSO; pounds 18.50.
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