Maternity services. Volume II, Minutes of evidence.
- Great Britain. Parliament. House of Commons. Health Committee
- Date:
- 1992
Licence: Open Government Licence
Credit: Maternity services. Volume II, Minutes of evidence. Source: Wellcome Collection.
56/320 (page 388)
![13 November 1991] [Chairman Cont] 885. Earlier in response to Mrs Audrey Wise you indicated that the 1960s and 1970s had been the decades of a great deal of sophisticated technological equipment involved in obstetrics and that you had come in for some criticism. Most of that equipment is quite expensive not only to purchase but to use and that perhaps that was not necessary. So are you necessarily making optimal use of available resources? That does not mean necessarily that you are under-resourced. It might mean that you are not using the resources properly. You paid tribute—and I am very grateful to you—to the work of this Committee in concentrating your minds on things that perhaps were not necessary. (Mr Simmons) All I was trying to indicate is that I think we are much more aware of the need to be selective, but let me answer your question, if you are talking about monitoring. If you have to monitor part of your community in the hospital you need a monitor, whether it is half the community or three quarters of the community. The need for the equipment that necessarily has to be available. I am talking about selectivity and I think we are perhaps more aware that there are disadvantages than perhaps we have given sufficient understanding to. That does not in any sense deny the need to have the availability of such equipment. I do not think we have been in any sense guilty of under-utilisation or over-utilisation of resources. I think the reverse is true. I think the achievements we have shown over the last few years are remarkable, despite under- funding. So I am not at all aware of any reason that we may not have used resources appropriately. Chairman: I am sure that my colleagues will be pressing these matters. Mr Clarke 886. Can I ask a few questions on the subject of domino delivery? Everybody seems to be agreed that domino delivery is a good thing, but why then is it not more generally available? What are the arguments against it? Is there still the problem of lack of sufficient midwives? Finally, could present resources be allocated more efficiently to enable the availability of domino deliveries to be increased? (Miss Anderson) If I may I will start the answer to your question. Domino delivery in theory is a highly desirable arrangement. But it is expensive. It is expensive particularly in midwives. The requirements for the number of midwives is increased if one is to run a successful domino scheme. Interestingly enough I have experience of a domino scheme and although theoretically it is a highly desirable thing and one about which I am very enthusiastic about and very supportive of it. But not every mother wants it. Strangely and perhaps understandably, the mother who has children is quite glad of a little longer time in hospital to rest, recover and feel ready to go home to the rest of the family. I would say about domino that perhaps it has not been as successful. I think you asked why it had not been as successful. Perhaps my colleagues can give you other thoughts, but part of the answer may be that it has not been as demanded perhaps as one might expect. I think personally that it is a very good idea indeed, but not so easy to run and not as wished for as one would expect. [Continued Chairman 887. Can I just put a supplementary to Tom Clarke’s question? Can you tell us, Miss Anderson, where shall we find the evidence that domino deliveries are more expensive than hospital births? (Miss Anderson) I do not know the answer to that. 888. So how did you then come out with the statement that it was more expensive? (Miss Anderson) Because I am talking locally. I am talking anecdotally and we find it quite expensive to run. We did not have the midwives to implement it. 889. One further question, again on your response to Mr Clarke, you said that mothers who have given birth should be allowed to lie in for a little bit longer. From the Chair I am delighted to hear that because in most hospitals, even under the normal hospital birth situation, they are not allowed to lie in. They are put out within 24 or 36 hours and if they want to stay in they have to fight to do so. (Miss Anderson) | did not say they should, but many of them want to stay in. I did not say they should. I did not actually commit myself on that. I understood their desire to stay in a little bit longer for a rest, but here again we are talking, I am afraid, in terms of resources because where there is a shortage of beds which there is in many places, the ability to let post natal mothers stay with us for any length of time is greatly diminished. Again I can talk with authority as far as my own scene is concerned. Chairman: If you can let us have any of that anecdotal evidence in writing, we would be most grateful. Alice Mahon 890. Is there consultant resistance to domino delivery? Has the Royal College surveyed its members to ascertain their opinions on domino delivery? (Mr Simmons) No, I do not think there is any resistance to domino delivery. At least it would surprise me to learn that there was from my colleagues. I think you will remember last time we were here Miss Mellows made the same comment as Miss Anderson that in their district it was expensive. : We are talking about anecdotal evidence. We have had the same in East Berkshire. We had a visit from the Community Health Council on the subject of the domino scheme. This was the report from the Berkshire Community Health Council, not by us. There was no chance, although they supported, of having a domino scheme at Heatherwood at the moment as it is expensive to operate and requires twice the amount of community midwives. That was the report that came. That is our experience, but I do not know of any resistance from our discipline. | would support entirely what Miss Anderson says about quite a large number of women who want to stay in not only more than a few hours, but more than 24 hours, and perhaps that is a reflection of the age of first children now. The average of first birth now is round about 30 and the size of the family is now fewer than two and a large number of women are single parents. So in and out quickly and looking after yourself in those circumstances clearly is much more of a problem than it might be where people are going home to a family with other children. I am sure that](https://iiif.wellcomecollection.org/image/b32222907_0056.jp2/full/800%2C/0/default.jpg)
