Crisis in Obstetrics: experts say more units should be closed

Crisis in Obstetrics: experts say more units should be closed

… and three-tier network created

The commission tasked with mapping a way out of Portugal’s obstetric crisis is due to propose the closure of yet more maternity units.

“As we do not have enough obstetricians and gynecologists in the SNS (State health system), and as we cannot invent them, the only way to resolve the problem is to concentrate resources”, leader of the commission, head of obstetrics within the Lisbon North hospital centre and leader of the commission Diogo Ayres de Campos has told reporters.

Thus, the ‘conclusions’ of three months of work are expected to be a kind of Hobson’s Choice; a ‘cut your coat according to the cloth available’ solution which will still leave a number of expectant mothers (those living in rural areas) with very difficult decisions to make.

The plan is a three-tier network, with ‘specialised units’ to deal with the most complicated issues only found in large cities.

As tabloid Correio da Manhã explains, this is what happens already with illnesses like cancer. But pregnancy is not an illness: it is a stage that tends to come in the lives of every female citizen (and not all of them live near large cities…)

As to the accompanying crisis (of rising maternal mortality), CM has not given any clues – but on the basis that obstetric units were closed in 2006 in a bid to reduce infant mortality, it will probably be argued that this ‘concentrated services’ plan will do the same for maternal mortality.

The commission’s recommendations are due to be formally presented on September 14 (the day before health minister Marta Temido is finally expected to stand down after resigning in the wake of another obstetric drama).

CM’s story today comes over yet another weekend where obstetric units up and down the country are ‘closed’: most of them until Monday.

In 2006, the government of José Sócrates chose to close maternity units with less than 1,500 births per year.

Says CM, if this was the yardstick for closures today, 18 maternity units would close straight away: including those in Évora, Santarém, Vila Nova de Gaia, Caldas da Rainha, Barreiro, Setúbal and Castelo Branco.

It is not surprising therefore that Portuguese media has been highlighting a growing trend in ‘home births’ by resident couples – an option that, if everything goes well, removes the strain of haring across the countryside in what are usually critical moments that would be better spent in comfort, and the hands of experts.

Another interesting aspects of CM’s report is that it lists the nation’s maternity units, showing how many births they performed in the first six months of this year, and how many of these were Cesarean sections. There is not one hospital in the country performing within World Health Organisation guidelines, which set 15% as a healthy percentage for C-section births. Portugal’s ‘best’ percentage between January and June was 25% (Castelo Branco); its worst 47% (Trás-os-Montes e Alto Douro).

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