Garry cites less rewarding antenatal care in the developed world as one of the several reasons for obstetricians to give up obstetrics. To his list, I would add another frustrating fact that two key players, the one who is giving birth and the one who ‘carries the can’ when things go wrong, are sidelined and have the least to say in the delivery of maternity services.
Although most pregnancies and deliveries are physiological and normal and, as such, the women involved do not need to see an obstetrician, this is also a time of extreme vulnerability for a pregnant woman, irrespective of her social status, and the reassurance of seeing an obstetrician during pregnancy and the knowledge that he/she will always be there should the need arise must not be underestimated. This does not undermine the pivotal role played by the midwife, but both sets of professionals have an important part to play in this biggest event in a woman's life.
Some women prefer a shared care or obstetrician-led care-only model and, indeed, outside the UK seeing an obstetrician is the norm. The gender of the obstetrician is immaterial to these women but, regrettably, a woman's choice to see an obstetrician and an obstetrician's support is seen as men justifying their dominance.
Successive innovations,[3, 4] although necessary, have eroded the role of an obstetrician in antenatal and intrapartum care. Obstetricians are seen as an anathema to a physiological process and, in some organisations, a metaphorical fortress of midwifery-only care is built and an obstetrician is called in only when complications or, indeed, serious complications arise.
There are two key issues here. First, a woman's right to choose is recognised but, in a proportion of cases in which a woman chooses obstetrician-led care, considerable efforts are made to dissuade her. The second issue is the legal issue, such that the obstetrician is the person who receives a letter of complaint or claim and has to answer the same.
I believe that we have lost the doctor–patient relationship and rapport, and, as a result, some women are losing out on their right to choose and obstetricians are losing out on their rewarding and fulfilling role, which is the reason why they chose the specialty in the first place.
Midwives and obstetricians are two wheels of the maternity services and we must move towards more integrated and truly woman-centred care, rather than drawing battle lines. We must reclaim and restore patient and professional satisfaction and bring back obstetricians into normal pregnancy and delivery, which, incidentally, is essential for their training in order to recognise and deal with the abnormal.