Not wanted in North London

When the Central Middlesex Consultant-led maternity unit closed, and its deliveries moved to Northwick Park in 2004, Brent Birth Centre was created on the Central Middlesex Hospital site. It had everything going for it – beautiful buildings, all the best facilities for natural childbirth, and support from obstetricians, midwives and women’s groups. Almost everyone asked said that if they could, they’d want to deliver in such a unit. The plan was to deliver at least a thousand women a year. Click here for the publicity at the time.

The timing was auspicious. London’s birth rate was rising, and most maternity hospitals were crowded and understaffed. Edgware Birth Centre was the only other NHS free-standing midwife-led unit (MLU) in the whole of London, Tooting Independent Birth Centre was many miles away in South London, and the local hospital, Northwick Park, was unpopular.  It had had a run of maternal deaths, was about to have ten more, and had just undergone the first of two devastating investigations into the poor standard of maternity care. Click here for details. Surely women would queue up to deliver in the shiny new Brent Centre.

But they didn’t. Less than 300 women a year chose to deliver there, and it was soon clear that it was not viable. After public consultation (click here) it closed in 2008, and a co-located MLU was created alongside the Northwick Park consultant-led unit (CLU).

What happened?

We can’t blame the NHS. The Tooting private unit, run by the charismatic Caroline Flint, also closed a few years ago due to lack of demand.

Not so many people really want to deliver in a free-standing MLU, at least in urban areas. It’s a case of what people say, and what they do giving different answers. People say MacDonalds provides terrible food, but its profits keep going up. People say they want more government spending on the NHS, education, and police, but vote for lower taxes. They say they want to stop smoking, but keep on puffing. Actions speak louder than words.

Reasons are not hard to find. It’s difficult for a mother to predict whether she will want or need an epidural, instrumental delivery or Caesarean section, and MLUs provide none of these. Women who need them, have to get back in an ambulance and travel to the nearest CLU. About one in five women in a free-standing MLU end up being transferred in labour.  There’s nothing unsafe about this, the NHS has a fabulous ambulance service and blue lights can get through any traffic jam. Overall, delivery in a free-standing MLU is just as safe as delivery in a consultant unit. But women don’t want to miss out on an epidural if it turns out more painful than expected, or to be that one in five. Nor is it just mothers who say one thing and do another. Midwives’ enthusiasm may cool somewhat during a long night with a slow labour, an anxious woman, and a testy partner.

Things are different in rural areas. If the consultant unit is 50 miles away, and there is a tradition of delivering in the local midwife unit, such units can work well. But they seem to be a minority interest in London.  Edgware Birth Centre battles on, also delivering about 300 women a year, and the new Barkantine Birth Centre in the East End has survived its first few years – 429 women delivered there in 2009.  But that’s it for the whole of London.  I wouldn’t bet on the success of too many new ones.

Jim Thornton