Table Of ContentPREGNANCY CARE FOR THE 1980s
PREGNANCY CARE FOR
THE 1980s
Based on a Conference Held at the
Royal Society of Medicine
Edited by
LUKE ZANDER
Senior Lecturer, Department of General Practice
St Thomas's Hospital Medical School
London
and
GEOFFREY CHAMBERLAIN
Professor of Obstetrics and Gynaecology
St George's Hospital Medical School
London
Published jointly by
The Royal Society of Medicine
and
The Macmillan Press Ltd
© The Royal Society of Medicine 1984
Softcover reprint of the hardcover 1s t edition 1984
All rights reserved. No part of this publication may be reproduced or
transmitted, in any form or by any means, without permission.
First published jointly in 1984 by
THE ROYAL SOCIETY OF MEDICINE
1 Wimpole St, London, WI
and
The Scientific and Medical Division
THE MACMILLAN PRESS LTD
London and Basingstoke
Companies and representatives throughout the world
ISBN 978-0-333-33346-4 ISBN 978-1-349-17389-1 (eBook)
DOI 10.1007/978-1-349-17389-1
The Contributors
Professor Eva ALBERMAN Mrs Beryl KINGSTON
Dept of Clinical Epidemiology, The School Education Service
London Hospital Medical College Mrs Sheila KITZINGER
Mrs Helen BENDER Social Anthropologist, Oxford
Principal Child Psychotherapist, The Dr Michael KLEIN
London Hospital (Whitechapel) Dept of Family Medicine, McGill
Dr Michael J. V. BULL University, Canada; Visiting Re
General Practitioner, Oxford search Fellow, Dept of Obstetrics,
Dr lain CHALMERS Oxford
National Perinatal Epidemiology Professor G J KLOOSTERMAN
Unit, Oxford Professor and Chairman, Dept of
Professor Geoffrey CHAMBERLAIN Obstetrics and Gynaecology, Univer
Dept of Obstetrics and Gynaecology, sity of Amsterdam
St George's Hospital Medical School Mr Tom LEWIS,
Miss Valerie CHAPMAN President, RSM Section of Obstetrics
Senior Lecturer in Health Visiting, and Gynaecology
Polytechnic of the South Bank Dr J. Aidan MACFARLANE
Professor John DAVIS Community Paediatrician, Oxford
Dept of Paediatrics, Cambridge shire Health Authority
University Dr Sally MACINTYRE
Professor Sir John DEWHURST MRC Medical Sociology Unit, Aber
Institute of Obstetrics, London deen
Dr Sue DOWLING Dr Ian H. MCKEE
Dept of Community Health, Univer General Practitioner, Edinburgh
sity of Bristol Mrs Kate NEWSON
Dr Murray W. ENKIN Senior Midwifery Tutor, St Mary's
Dept of Obstetrics and Gynaecology, Hospital, London
McMaster University, Hamilton, Dr Ann OAKLEY
Ontario, Canada National Perinatal Epidemiology
Dr Marion H. HALL Unit, Oxford
Consultant Obstetrician and Gynaecol Dr Michel ODENT
ogist, Aberdeen Teaching Hospitals Obstetrician, Pithiviers, Loiret, France
Miss Dora HENSCHEL Dr Mia Kellmer PRINGLE (deceased)
Principal of Midwifery Education, Formerly Director, National Children's
King's College Hospital, London Bureau
Dr Edmund N. HEY Mrs Gwenyth RANKIN
Dept of Child Health, University of National Childbirth Trust, London
Newcastle upon Tyne Dr Martin RICHARDS
Ms Lea JAMIESON Medical Psychology Unit, Cambridge
West Hertfordshire School of Mid Dr Gordon W. TAYLOR
wifery, Watford General Practitioner, Reading
vi The Contributors
Professor R. W. TAYLOR Ms Juliet WILMOTT
Dept of Obstetrics, St Thomas's Community Midwife, Islington Health
Hospital, London District
Mrs Marjorie TEW, Dr Luke ZANDER
Statistician, Dept of Surgery, Medical Dept of General Practice, St Thomas's
School, The University of Nottingham Hospital, London
Contents
The Contributors v
Foreword Sir John Stallworthy xi
Preface xiii
SECTION I ANTENATAL CARE 1
1 ARE OUR ACCEPTED PRACTICES BASED ON
VALID ASSUMPTIONS? 3
Dr Marion H. Hall
2 CONSUMER REACTION TO PRESENT-DAY
ANTENATAL SERVICES 9
Dr Sally Macintyre
3 THE PROVISION OF COMMUNITY ANTE-
NATAL SERVICES 18
Dr Sue Dowling
4 COMMUNITY-BASED SPECIALIST OBSTET-
RIC SERVICES 28
Professor R. W. Taylor
5 COMMUNITY ANTENATAL CARE: THE
SIGHTHILL COMMUNITY ANTENATAL
SCHEME 32
Dr Ian H. McKee
DISCUSSION 41
SECTION II PARENT AND CHILD INTERACTION 49
6 THE MYTH OF BONDING 51
Dr Martin Richards
7 FACTS, BELIEFS AND MISCONCEPTIONS
ABOUT THE BONDING PROCESS 59
Dr J. Aidan MacFarlane
8 A PSYCHOTHERAPIST'S ROLE IN A SPECIAL
CARE BABY UNIT 63
Mrs Helen Bender
9 FAMILY-CENTRED OBSTETRICS 71
Dr Murray W. Enkin
vii
viii Contents
10 HOW TO HELP WOMEN IN LABOUR 77
Dr Michel Odent
DISCUSSION 81
SECTION III INTRANATAL CARE-WITHIN THE HOME 91
11 STATISTICAL COMPARISON OF HOME AND
HOSPITAL CONFINEMENTS 93
Professor Eva Alberman
12 UNDERSTANDING INTRANATAL CARE
THROUGH MORTALITY STATISTICS 105
Mrs Marjorie Tew
13 THE DUTCH EXPERIENCE OF DOMICILIARY
CONFINEMENTS 115
Professor G. J. Kloosterman
14 THE SIGNIFICANCE OF THE HOME
DELIVERY ISSUE 126
Dr Luke Zander
15 THE COMMUNITY MIDWIFE AND DOMI-
CILIARY CONFINEMENTS 133
Ms Juliet Wilmott
DISCUSSION 138
SECTION IV INTRANATAL CARE-WITHIN THE
HOSPITAL 151
16 MODERN OBSTETRICS AND PATIENT CARE 153
Professor Geoffrey Chamberlain
17 THE ROLE OF THE GENERAL PRACTITIONER
IN HOSPITAL OBSTETRICS 165
Dr Michael J. V. Bull
18 WHAT ARE WE EXPECTING OF OUR MID-
WIVES? 176
Miss Dora Henschel
19 A COMPARISON OF GENERAL PRAC
TITIONER AND SPECIALIST DELIVERY SER-
VICES 180
Dr M. Klein, I. Lloyd, C. Redman, M. Bull and A. C.
Turnbull
20 EXPERIENCES OF OBSTETRIC PRACTICES IN
DIFFERING COUNTRIES 196
Mrs Sheila Kitzinger
DISCUSSION 205
Contents ix
SECTION V PREPARATION FOR PARENTHOOD 213
21 A MEDICAL VIEW 215
Dr Edmund N. Hey
22 A MIDWIFE'S PERSPECTIVE 223
Ms Lea Jamieson
23 THE ROLE OF THE HEALTH VISITOR 226
Miss Valerie Chapman
24 THE PLACE OF THE NON-PROFESSIONAL
EDUCATOR 231
Mrs Gwenyth Rankin
25 SCHOOL AGE IS THE TIME TO START 237
Mrs Beryl Kingston
DISCUSSION 241
SECTION VI THE NEED FOR TODAY'S PLANNERS
TO CONSIDER TOMORROW'S
DEVELOPMENTS 249
26 WHICH WAY FORWARD FOR OBSTETRICS? 251
Professor Sir John Dewhurst
27 WHAT ARE WE TRAINING OUR GENERAL
PRACTITIONERS FOR? 254
Dr Gordon W. Taylor
28 WHAT SORT OF MIDWIFERY SERVICE DO WE
WANT? ~8
Mrs Kate Newson
29 THE CONSUMER'S ROLE: ADVERSARY OR
PARTNER? 263
Dr Ann Oakley
DISCUSSION 271
Index 279
Foreword
by
Sir John Stallworthy
One hundred and eighty years ago some doctors in London became concerned
about the growing tendency to form multiple new medical and surgical
societies within the city. This fragmentation was the more surprising at a time
when scientific knowledge was relatively limited. Among those who reacted
adversely to these divisive developments were men of vision who believed that
medicine should be based on scientific principles, aided by access to, and use
of, excellent libraries and good communications. The practical outcome of
their concern was the amalgamation of a number of these groups into a new
composite Medical and Chirugical Society with the nucleus of a splendid
library. The Royal Society of Medicine developed from this metropolitan
institution with national, and later international, membership and
commitments.
The escalation of scientific progress with its many contributions to medicine
and surgery revived interest in fragmentation into specialties and sub
specialties with the creation of new colleges, faculties and other institutions.
These have brought benefits to many aspects of patient care, but they have
also increased those same dangers which worried our predecessors nearly two
centuries ago. This medical revolution, for such it certainly is, has taken place
while rapidly increasing knowledge, and the application of technological
advances to medical and surgical practice have made acceptance of team
concepts essential in the development and maintenance of high standards.
As a response to this changing scene, The Royal Society of Medicine has
encouraged the creation of multidisciplinary forums designed to explore in
depth subjects of importance to the profession and to society as a whole.
It is fitting that this publication should be edited by two such enthusiastic
pioneers of the forum concept as Dr Luke Zander and Professor Geoffrey
Chamberlain. The establishment of a forum entitled Maternity Care and the
Newborn which followed directly from the pregnancy care conference owed
much to their imaginative and careful planning, and marks a development for
which many concerned with the provision of maternity care will, I believe,
have cause to be grateful. Readers of this book will similarly be grateful to
