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What we have lost

A rare home delivery makes the Jobbing Doctor nostalgic for the days when GPs did obstetrics.

All my troubles seemed so far away
Now I need a place to hide away
Oh, I believe in yesterday.

These lyrics, from the most covered song of all time, are not exactly TS Eliot, but they do express a certain nostalgia.

Jobbing Doctors are not averse to a little bit of nostalgia themselves, and I was able to experience this when I attended a home delivery yesterday. One midwife throughout pregnancy and labour, and one GP to be there if needed (which, frankly, I wasn't).

I sat on the patient's bed with her husband and daughters in attendance, and marvelled at the beauty of the whole situation. Mother was serene in her own environment, and no clinical feel to the whole process at all. She was relaxed, and the labour (although fitful) went well.

I was then able to examine their daughter, and demonstrate my nappy changing skills, which used to be legendary in the days of Terry-towelling nappies and safety pins. I could change a nappy one-handed, and fold it in at least three ways (triangular-style, kite-style and french-style for aficionados of such things). Yesterday, I was using the usual disposable nappy. But everything else was very much as it always used to be.

I cast my mind back to when I was a young GP and we had a busy obstetric practice, I attended up to three small GP maternity units, and home deliveries, and felt a very special bond with all the mothers and children (many of whom are now parents themselves). I even did some deliveries myself (usually lift-out forceps deliveries with my favourite - the Neville-Barnes forceps). I was their doctor, not just the doctor.

That was a most enjoyable, if exhausting, time, and was a golden era for me personally in my career. I remember it with much warmth.

But all good things come to an end, and - inevitably - it was the meddling of politicians and lawmakers who saw the end of GP obstetrics with the Cumberlege report, which saw a problem where none existed, and effectively froze general practitioners out of obstetric practice. It was made quite clear that there was no place for GPs in the management of maternity care, and the authorities set to with glee to close all the GP maternity units that they could.

They cited a wide variety of reasons, including ‘concerns for the safety of mother and child' and ‘cost efficiency'. The real reasons were more to do with politics.

The only type of maternity care that I am now involved in is the occasional home delivery like this, and the whole experience has reminded me of what our patients have lost, now having to put up with a series of different midwives, and different doctors of all grades, and a historically high level of intervention and Caesarean Sections.

The whole experience indicates that people in Government never have, and never will, understand general practice, and every time they try and make changes they invoke the law of unintended consequences - not thinking through issues, or understanding the end point of changing a dynamic situation.

So now I am sitting at the end of my patient's bed, having a cup of coffee with the family and being in an incredibly privileged position of sharing a magic moment with lovely people, and being part of their joy: and it was so easy, as I didn't actually have to do a thing!

So, wistfully, I remember a wonderful aspect of my job that I regard as being stolen from me by Philistines.

Jobbing Doctor