Specialist leaves Royal College in maternity row

A leading authority on childbirth has resigned as a Fellow of the Royal College of Obstetricians and Gynaecologists, and in a parting shot has accused some members of the college of 'vested interests' which are compromising the care of mothers and babies.

The resignation of Iain Chalmers, who is head of the National Perinatal Epidemiology Unit at the Radcliffe Infirmary, Oxford, has shocked colleagues. His decision is seen as a great loss to the progress of maternity care.

Dr Chalmers is an advocate of greater choice for women about how and where they give birth - he favours home births where appropriate. He is also an outspoken critic of some hi- tech maternity practices which are widely used, but which, he says, are not supported by research.

His views have frequently upset the college; one professor of obstetrics has described Dr Chalmers as the leader of an 'obstetric Baader-Meinhof gang'.

But earlier this year, Dr Chalmers's views received the backing of the Commons Select Committee on Health in its report on maternity services. The report proposed a radical shake-up of services, with an expanded role for midwives.

It criticised obstetricians for 'over- medicalisation' of labour and birth which had degraded the experience for many women.

It also accused doctors of using interventions in labour, such as induction and epidural anaesthesia, which had not been properly investigated.

Dr Chalmers has described the report as a 'landmark in the history of professions of this country'. The committee showed that it wasn't prepared just to accept the 'perceived wisdom' of professionals but wanted detailed research evidence in support.

In a recent speech to midwives, Dr Chalmers made a scathing attack on the 'angry and defensive' reaction of the college to the conclusions of the select committee which appeared to threaten its interests. This reflected a 'failure to recognise that opinions unsupported by strong evidence cannot be expected today to be as influential as they have been in the past in shaping maternity practices', he said.

He accused some obstetricians of 'shroud-waving' to promote policies which are unsupported by research - 'such as the requirement that all women should give birth in hospital'. At the same time, some doctors 'withhold forms of care which careful research has shown to reduce the risks of perinatal mortality', he said.

Dr Chalmers confirmed yesterday his decision to resign but declined to comment further. He said that he had left several maternity and paediatric organisations in preparation for an appointment in the new NHS Research and Development Programme.

But colleagues described his action, after more than 20 years' involvement in maternity and perinatal care, as 'a most unusual event' and 'highly controversial'. One consultant, who asked not to be named, said: 'I imagine that he is doing it because of the profession- centred attitude of the college, rather than a woman-centred response that he favours.'

Another colleague said the college's response to the select committee report had distressed Dr Chalmers. 'It flies in the face of everything he has worked towards. Iain Chalmers has meticulously tried to look at all the evidence . . . and striven to see that women get care based on the evidence. The corporate response of the college appears to disregard that . . . .'