Letter: Home births: high risk cases put off GPs

Sir: Your article on general practioners and childbirth ('I had my baby, but I lost my GP', 18 October) raised a number of interesting points, not least the punitive removal of patients from GPs' lists.

It is, however, a mistake to ascribe this reluctance to undertake intrapartum obstetric care to all GPs. In the rural areas surrounding Bath, for example, a majority of women are offered confinement under care of their own midwife, with the support of the general practioner in case of difficulties. In my own practice, approaching 70 per cent of all deliveries take place at home or in the tiny cottage hospital at Frome.

It is not merely the fear of litigation, or even the insultingly low remuneration, which makes us reluctant, however, to offer this service to women with major difficulties such as breech presentation or high blood pressure. My recurring nightmare is being faced with an emergency situation but being unable to take appropriate action (such as a caesarian section) in order to save a mother or child. Worse still is to know that the outcome is a child who will be severely mentally and physically handicapped for life.

Unlike obstetricians and midwives, we cannot hand over such a disaster to a NHS trust's lawyers and put it firmly behind us. The very nature of our job means care to all members of the family from cradle to grave.

Marjorie Tew's evidence on home births being safer than hospital reflects experience of normal so-called 'low risk' confinements, and GPs have a responsibility to support these. However, mothers have a responsibility to their unborn children in higher risk circumstances to listen when discussing their choice of place of birth.

Yours sincerely, BILL IRISH Mendip Country Practice Coleford, Somerset 18 October