By Caroline Flint

I can't imagine why women are still complaining about their treatment during childbirth; it must be absolute paradise to have a baby in Britain at the moment. Can there really be any room for improvement at all, here and now, in 1986, surely we've got it right?

You may be asking yourself, has Caroline flipped her lid? Why has this critical old bird suddenly had a great conversion, where are her usual moans and groans? The answer, gentle reader, is that I have been a fly on the wall at a Maternity Services Liaison Committee.

You may remember that the Maternity Services Advisory Committee recommended that these committees should be set up locally, when they produced Maternity Care in Action. These were guides to good practice in maternity care and were issued between 1982 and 1985. Each guide - one for antenatal care, one for intrapartum care, and one for postnatal and neonatal care - had a check list following each chapter, which was put forward as a `plan for action' for each Liaison Committee to follow. As the report pointed out `progress will depend on co-operation amongst everyone concerned'.

I went to the Maternity Services Liaison Committee - an observer, no more, a mute figure on the periphery - and I watched and listened. The chairman was an obstetrician, sitting next to him were the two obstetricians from the unit and next to them was the director of midwifery services. A paediatrician came in late and sat at the same end of the large table.

Before the meeting started the group of `professionals' buzzed amongst themselves, `have you heard, John's got his fellowship'.

'I saw old ... yesterday, I told him what I think about opening up the consultants' car park to the multitude'. The director of midwifery services tried to come in when she could: when a name she knew was mentioned she would say `He was a registrar when I first came here' or `he was a houseman when I was a staff midwife in...'.

At the other end of the table was an assortment of `lay' people; an elderly gentleman who was there representing a community group, a young mother who had her baby with her, which suckled from time to time and made it almost impossible for her to participate fully in the meeting and a representative from the community health council, a very firm and assertive young woman who had obviously read and knew the documents well.

Before the meeting started the group of `professionals' buzzed amongst themselves, `have you heard, John's got his fellowship'.

'I saw old ... yesterday, I told him what I think about opening up the consultants' car park to the multitude'. The director of midwifery services tried to come in when she could: when a name she knew was mentioned she would say `He was a registrar when I first came here' or `he was a houseman when I was a staff midwife in...'.

At the other end of the table was an assortment of `lay' people; an elderly gentleman who was there representing a community group, a young mother who had her baby with her, which suckled from time to time and made it almost impossible for her to participate fully in the meeting and a representative from the community health council, a very firm and assertive young woman who had obviously read and knew the documents well.

The `professionals' were annoyed that their clinical judgement was being questioned. They felt that this was not the time and the place, but of course they avoided intervention unless there were clear medical reasons to the contrary. The young mother suggested that medical reasons for intervention appeared to be growing, she was reassured that this was only to safeguard the lives of babies like hers.

The meeting ground on. Every point on the checklist was being done in this unit and not only was it being done, it was being done well. I had at last found the place which was perfect in every way!

The `we always do that here' syndrome is alive and well in most of our maternity units, it is sister to the `we don't have the room/the money/amenable consultants/supportive management/the staff' syndrome. It's interesting how `high risk' women are becoming. I'm beginning to wonder where all the low risk women have disappeared to, especially at a time when women are on the whole well nourished and are not having huge families, so we have few grand multiparae. Those women who are most at risk - the women producing babies which they do not want - are much depleted in number because of better contraceptive facilities and abortion services. Women at this moment should be less at risk than any other generation in the past.

Frequently when I give a talk on the `Know your midwife scheme' (which aims to provide continuity of care for mothers with four midwives taking on responsibility to care for 250 women a year) someone in the audience tells me, `We already do that here, we've always done it'. I usually suggest that they could be accused of being selfish, if what they are doing is as they describe why don't they write it down? Why don't they share it with their colleagues?

New ideas

The way we all learn, the way ideas are shared is by writing and talking about them. It is no good having good ideas and keeping them to yourself, the women of Britain need to be benefiting from them. We always need new ideas and suggestions, don't we?

Or perhaps you don't because you are lucky enough to work at a unit where everything is perfect, where the staff are able to say `We always do that here'. Do the women in your area think it's perfect too?

September 1986