Changing Childbirth.


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a.  the Cumbernauld report was of particular significance False
  The following were recommended:  
b. every woman should have an identified lead professional, either a Consultant Obstetrician or General Practitioner False
c. there should be increased scope for home delivery if the woman wished it and there were no contra-indications True
d. "flying squad" services should be available from all specialist maternity units to facilitate an increase in the provision of home delivery.      False
e. midwives should be allowed access to hospital beds True
f. service consumers should be involved in planning services True
g. post natal stay in hospital should normally be 24 hours for multiparous patients and 48 hours for nulliparous False
h. rationalisation of antenatal care with reduction in planned visits for low risk women True
  In assessing implementation:  
i.  assessment should be made within three years False
j. at least 30% of women should be entitled to be responsible for their own antenatal notes False
k. all women should have a "named" midwife as lead professional False
l. at least 50% of women should be delivered by a midwife they know False
m. at least 30% of women delivered in a maternity unit should be under the management of their midwife False
n. all ambulances should have a paramedic trained to support a midwife in an emergency. False


The report was by Baroness Cumberledge, hence the "Cumberledge" report.

It was the result of a backlash against the "medicalisation" of midwifery, which has gone on since the 1970s.

About that time electronic fetal monitoring and other "scientific" advances occurred.

These encouraged bright young obstetricians to take an increasing interest in labour.

We then had more intervention with induction of labour, epidural anaesthesia, higher section rates etc.

The essence of "Cumberledge" is to give greater choice about antenatal care and place of delivery and encourage a return to midwifery.

Midwives are to have greater formal responsibility for patients as lead professional in suitable cases.

Obstetricians will concentrate on the high risk and abnormal.

It encourages choice, not only in the place of delivery, but the professional taking the lead in planning and supervising the care.

It also aims to make care more personal, in particular recommending that the majority.

Ideally all, women should know the midwife who cares for them in labour.

It specifies that each woman should have a lead professional: midwife, obstetrician or general practitioner.

In addition, regardless of who the lead professional is, she should have a "named" midwife, who will often also be the lead professional.

Much was made of access to services for all groups, better information provision about services etc.

Flexibility was also advocated e.g. with regard to post natal care.

Similarly, it was seen that many low risk women had needless routine checks.

Reducing these could lead to a higher standard of care in clinics, with more time to spend on the individual woman.

Antenatal care in the community rather than hospital clinics was encouraged.

Guidelines, e.g. by the RCOG, were published and updated in 2003.

Flying squads have largely vanished as it is often quicker to get the woman to hospital in the first available ambulance in the event of emergency.

With the prospect of more home deliveries, it was recommended that all front line ambulances should have a paramedic trained to support the midwife in an emergency.

The report was published in 1993.

Purchasers and Providers were told to review local practices and draw up plans in 1994-5 and establish targets in 1995-6.

Assessment of implementation was recommended after 5 years, i.e. 2000- 2001.

By that time, all women should have a "named" midwife and be entitled to carry their notes.

Of women delivered in hospital, at least 30% should be admitted under the responsibility of a midwife and 75% should know the midwife who cares for them during delivery.

There were many good ideas in this report, but, like so many others, implementation has been patchy.

There has been rationalisation of the number of antenatal visits and a shift from hospital to community.

Most, if not all, patients use "hand-held" notes. I.e. the patient has the notes. 

Why "hand-held" I do not know. "Foot-held" would seem inconvenient at best!

The lead professional concept is not much heard any more.

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