October 02, 2002

The UK birth websites

If you are expecting a baby in the UK, choosing an appropriate birthplace has never been easier. The Dr Foster website (an initiative linked with Boots Chemists) has a listing of all the maternity units in the country and details about the services they offer together with their birth outcome statistics. Another website, set up by a group of childbirth educators and a statistician, has similar information. For those without internet access, The Times newspaper has published extracts - in July 2001 the whole Sunday Supplement was devoted to birth, using the Dr Foster statistics as a starting point for a series of articles about that childbirth that were extensive and useful. This year they followed up again unduly with a series of supplements in the Sunday edition over 5 weeks. These updated the information given the previous year and contained additional notes for parents on a whole range of issues associated with pregnancy, birth, breastfeeding and early parenting. A book has also been published that contains the same data as the web site.

The only potential problem for expectant parents in using these figures to choose a birth place is the difficulty in being able to access services outside the area in which you live. In the UK, health services are provided by a series of Trusts or Primary Care Groups, which handle the budget for the area nd decide which services will be provided. Their geographical area of responsibility can be quite small and larger cities will be divided up into a number of Trust areas.

In Britain, people are not able to shop around for health care as they can in other developed countries. Each person must “sign on” with a local GP, who is paid per patient to provide medical care when needed (the patient pays nothing directly to the doctor). Each GP is allowed to carry a specified caseload and this determines, to a large extent, the salary that will be earned. If your preferred GP has no vacancies on their list, you must approach another until you find one willing to take you on. If you find you don’t like the doctor, it can be very difficult to change, because you must first find another willing to accept you as a client before you can move on and “shopping around” is frowned upon.

Like all systems, it has pros and cons. For example, there is no tendency for doctors to over service their patients in order to make more money, but there is also no incentive for doctors to see you as they won’t get paid for each visit you make. People can’t visit several GPs to get extra prescriptions, for example, and costs of providing health care can be determined in advance, to a large extent. However, if your GP is against home birth, you will not get much support and you may find it daunting to find another GP who is supportive and willing to have you sign on to their list.

In a similar way, it can be hard to make use of the birth outcome statistics offered by these internet guides. If, for example, your local Trust does not have a Birth Centre (and very few do), but the one next door does, you may have difficulty in accessing it, because this will require special funding arrangements between Trusts, a procedure that is available, but discouraged. This “postcode lottery” has been often discussed in the press here and can have major implications for those who require specialised services that are only available in some centres in the entire country.

The availability of these guides to maternity care is wonderful, but it seems to me, of limited value unless women are actively encouraged to seek out the care they want. A free enterprise system would encourage this, but socialised medicine is not well set up to support the idea. Those who have money an can afford private care will be able to choose a private hospital anywhere and therefore can exercise their right to choice, but those reliant on the National Health System may have very few options.

Another example of the double standards that are so prevalent in maternity care: there are a range of choices in maternity care in this country , but make sure you choose the local hospital, whether it meets your needs or not! If you have money, however...... (the rich win again!)

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