Letter: Short of midwives

Sir: My first thought on reading your headline "Crisis in obstetrics looming, says NHS" (7 May) was that at last the shortage of midwives was about to be addressed by Mr Taylor, NHS director of personnel. I was wrong, as Mr Taylor believes that the threat to the safety of women in childbirth comes from a shortage of obstetricians.

Only about 15 per cent of births actually need the services of an obstetrician, and the majority of women can be extremely well cared for by midwives, based in the community or hospital, without medical intervention.

Since market forces were applied to the NHS, trusts have made "economies" by engaging newly qualified midwives on lower salary scales, in place of the senior midwives who have been offered early retirement, which has often been gladly accepted because of overwork and stress. The inexperienced midwives then call in the medical staff, many of whom are themselves inexperienced. This may, in part, account for the rapid rise in caesarean section and other obstetric interventions, with the inevitable rise in litigation costs.

That there is a problem I do not doubt, but it will not be solved by a massive injection of obstetric consultants. The solution lies in implementation of the government report Changing Childbirth (1993) and the Winterton Report (1992) which outlined a blueprint for excellent community-based, midwife-led maternity care. There are thousands of experienced midwives who would gladly return to practice, given the opportunity.

Of course this solution has short-term resource implications, but in the long term the result would be a greatly enhanced maternity service and a healthier nation.

ISHBEL KARGAR SRN SCM

The Association of Radical Midwives

Ormskirk, Lancashire