It is 86 years since the foundation of the Royal College of Obstetricians and Gynaecologists (RCOG). Here, current President Dr David Richmond describes how, despite its many achievements over the years in shaping women’s healthcare, the specialty still faces some difficult challenges ahead. By Pat Hagan.
The role of the RCOG
So much of medicine is about trying to avoid loss of life, that the chance to help bring new life into the world is something all healthcare professionals cherish.
That’s how it is with obstetrics and gynaecology, where the overriding objective of all involved is to ensure the safety and survival of a mother and her newborn child. This was one of the driving forces behind Dr David Richmond’s decision to pursue it as a clinical specialty when he was starting out as a hospital doctor back in the late seventies.
Several decades later, it led to him becoming elected President of the RCOG, a role which has given him the chance to steer women’s healthcare in new directions. “I think this organisation’s greatest achievement has been becoming a Royal College in its own right,” says Dr Richmond.
“In 1929, a group of obstetricians and gynaecologists decided they weren’t getting a satisfactory deal through the Royal College of Physicians and Royal College of Surgeons. Women’s health was probably falling between the gaps and there was a specific opportunity to focus particularly on that aspect of healthcare.
“The RCOG’s royal charter talks about the remit to enhance and promote the standards of women’s healthcare. And that remit extends way beyond Britain’s shores – the College has a global influence, particularly when it comes to raising the bar in standards and education.”
A global remit
Over the last 15 to 20 years, the RCOG has been spearheading education and training packages designed to standardise the quality of new doctors across large parts of the world. Today, the RCOG exam is sat by over 5,000 hopefuls, not just in the UK but in 22 different countries.
“It has become a global passport in obstetrics and gynaecology,” says Dr Richmond.
But testing new recruits is one thing. A bigger challenge is to uphold the standards of care amongst all qualified obstetricians and gynaecologists. This is where RCOG guidelines come into play.
Dr Richmond says: “At any one time, there will probably be 60 to 70 guidelines available. They can be plucked from the shelf whether you are in Kathmandu, Kuala Lumpur, Beijing or London. They are universally acclaimed and respected and are completely patient focussed.”
Reducing maternal and infant deaths
Universal improvements in care take time, however. And there are still some frightening statistics around the world on the numbers of women losing their lives during childbirth. Dr Richmond says: “It’s roughly 800 women a day globally – or the equivalent of two jumbo jets crashing every single day of the year.”
As far back as 1952, the College led the way on tackling maternal mortality. Dr Richmond says a report led by MMBRACE-UK is highly regarded around the world as a means of reducing future risks. But he adds: “if you are in deepest, darkest Africa or other parts of the world where you haven’t got access to anaesthetists or surgeons or even blood, you haven’t a chance.’
Maternal deaths are not the only issue. The RCOG has recently initiated a project called ‘Each Baby Counts’, which is a national quality improvement programme which aims to reduce by 50% the number of stillbirths, early neonatal deaths and brain injuries occurring in the UK as a result of incidents during term labour by 2020.
A crucial part of the project involves bringing together the lessons learned from local investigations in order to improve the quality of care in labour at a national level.
“Around £500m to £600m a year is spent on obstetric litigation,” he says, “of which 85 per cent will be cerebral palsy.” If we could reduce that by just ten per cent, then much of the savings could go on more midwives, more doctors and better equipment.
“It’s only been running a few months but already we’ve seen phenomenal enthusiasm from midwives and doctors around the country. “We hope that all maternity providers will continue to show their support for this project and engage in reporting and learning from these tragic incidents, so that in time we can make it as safe for a baby to be born as it is for a mother to deliver.”
The challenges to improving care
Driving up care standards is laudable but largely futile without adequate staffing. Dr Richmond says around 3,000 more midwives are needed in the UK to properly staff NHS units. And limits on use of overseas doctors means finding locums is harder than ever.
As well as top-down management, this clinical specialty faces other challenges more to do with the changing nature of motherhood. Obesity is emerging as a major factor because it means consultants must now deal with a whole range of health issues, such as diabetes and high blood pressure and the consequences for the baby and delivery process.
“Obesity is a serious public health problem and it is our role as healthcare professionals to inform and encourage women to adopt healthier lifestyles, and this approach should be taken throughout a woman’s life. We must focus on early intervention, rather than just preventing disease,” says Dr Richmond.
Among obese women, newborn deaths are higher, Caesarean sections are more difficult, anaesthetics are harder to manage, sepsis is more likely and there is an increased risk of clots.
Rising maternal age is the other major current issue, as professional women postpone motherhood. “By your early forties, the physical function of having a baby is not as good as in your twenties and so we have to take account of that,” Dr Richmond says.
The challenges may change as the years pass. But the role of the RCOG is clear, he says. “I would like to see this College as the voice of women for women, promoting their rights across the spectrum and promoting outcomes to improve the health of women in this country.”