Specialist shortage puts women at risk in childbirth

The proportion of UK medical graduates choosing obstetrics has halved in a decade and the specialty is increasingly reliant on doctors trained overseas.

The extent of the shortage is revealed in figures from the Royal College of Obstetricians and Gynaecologists showing that in November 2004, 171 doctors gained membership of the college by passing the admission exam - of whom just 12 were UK graduates.

Professor Allan Templeton, president of the college, told The Independent: "The future of obstetrics and gynaecology and the future of women's health care in this country depends on a reversal and focused response to this stark reality."

Surgical intervention in labour is increasing, with more than a third of women experiencing some form of operative delivery and the Caesarean rate has risen since 1985 from 10 per cent to 22 per cent. But there are too few consultants to deliver the necessary care and provide round-the-clock cover on the labour wards despite evidence their presence improves safety.

The annual Confidential Inquiry into Stillbirths and Deaths in Infancy found more than 77 per cent of deaths during labour had sub-standard care, and more than half might have had a different outcome with better management.

Professor Templeton said more than half of all obstetricians currently in post in the UK had qualified overseas. UK-trained doctors were turning away from obstetrics because of its unsociable hours, a perceived lack of a career path and fear of litigation.

"We can get the trainees but they are mainly from the Indian sub-continent," he said. "Many are extremely good - they go the extra mile. But why are we training doctors here if it isn't to get them into our specialty? Our target is to get UK graduates back into the specialty. It is not helpful to the developing world to be taking their doctors. But we are going to be dependent on the Indian sub-continent for at least 10 years - even if we solve the problem tomorrow."

The college has set a target to have 24-hour, seven-days-a-week consultant presence in all hospitals with more than 4,000 deliveries a year by 2011. But that will require an expansion of between one-third and one-half in the current workforce of 1,500 over the next five years.

Professor Templeton said: "The key thing is to get consultants back in the labour wards. All the evidence points to the presence of the consultant improving patient satisfaction, morbidity and outcomes."

The Healthcare Commission, the Government's NHS watchdog, warned in its annual report last July that poor standards in maternity units could be causing long-term health problems for mothers and babies. It blamed "weak managerial or clinical leadership" and said some maternity services were "not as good or as safe as they could be". The commission ordered all health trusts to review their maternity care.