Sir, - As a former consultant obstetrician in this country from 1966 to 1997 and also a former chairman of the Institute of Obstetricians and Gynaecologists, I wish to make a personal comment on Marie O'Connor's article of August 13th.
Firstly, I would accept that the approach of some obstetricians in the past was too paternalistic, with too little regard taken of the views of the pregnant woman. However, I am convinced that the opinions expressed by Ms O'Connor represent the views of a vocal minority rather than the silent majority.
Although I was not personally a disciple of the regimentation of the formalised, active management of labour, certain points must be made:
1. When I commenced consultant practice the perinatal mortality rate was around 40 per 1,000, whereas by the 1990s this figure had fallen to 10 or fewer. What this meant was that for every 1,000 mothers, there were 30 who took home a live baby in the 1990s who in the 1960s would have been grieving the loss of their baby. I do not pretend that this is due to the active management of labour, but more medical involvement and intervention are certainly major contributory factors.
While the vast majority of pregnancies will have a happy ending, even without any medical involvement, for the mother who loses her baby the loss rate is 100 per cent.
2. Ms O'Connor seems to favour "leaving matters to nature". Quite apart from the question of perinatal mortality, does she want to go back to the days when a teacher of mine was able to write a paper on "The outcome of labours lasting over 96 hours"?
3. Ms O'Connor attacks the high incidence of induction of labour, which she implies is being imposed on unwilling mothers. However, during my career I spent more time dissuading mothers from requesting medically unnecessary inductions than persuading unwilling mothers to agree to the procedure.
4. The thesis that modern management of labour is driven by the need for financial savings is manifestly incorrect. The amount of expensive equipment needed, together with the vastly increased costs to the Health Service of the present high rates of Caesarean section, far outweigh any savings which might be achieved by more rapid turnover in the labour wards.
I accept that mothers' views should be more fully considered, but let us not "throw out the baby with the bath water" by ignoring the safety advantages which were achieved in the second half of the 20th century and the expertise of those advising our mothers-to-be. - Yours, etc.,
Dr Conor Carr, Ballinasloe, Co Galway.