There will always be a risk at child birth, but any health trust has a duty to reduce those risks to a minimum. This is the firm conclusion of the Lay Report on Obstetric and Midwifery Services which its authors, Angela Fearfield, Diana Stamper and Sandra Guise have shared with Egremont Today.
The report considers two alternative options for obstetric and midwifery services in North Cumbria, one maintaining obstetric units at the Cumberland Infirmary and the West Cumberland Hospital, where any woman in labour could expect the support of a consultant, and the other providing an obstetric unit only at the Cumberland Infirmary, while a unit at Whitehaven would be midwife led. The report's authors are very concerned that many West Cumbrian mothers would have to give birth in Carlisle rather than in their local community, if potential complications were recognised beforehand, and that some would need to be transported to Carlisle while in labour if an unexpected emergency arose.
At present all expectant mothers in Egremont live only 10 minutes away from the hospital at which they can give birth. If they needed to go to Carlisle the journey would take an hour along the A595, with no dual carriageway along the route. In an emergency, the delay could be critical, and there is a considerable risk that the number of mothers who give birth before reaching the unit, at present just 0.5% in our area, could increase alarmingly. The report is painstaking in its detail. It points out that only 3% of births in England take place in units served by midwives only and that of these 99.8% take place in units that are within 35 minutes’ travel time of an obstetric unit served by consultants. The volume of of transfers from the Whitehaven Midwife Led Unit would almost equal the total number of transfers from all Scottish remote MLUs.
There would be a formidable cost for West Cumbrian mothers who might have to give birth in Carlisle in order to avoid the risk of a hazardous emergency journey. They would be denied a real choice to give birth near their own community and would face separation from their families at the most sensitive of times, and the expense of transport arrangements and child care. West Cumbria has a higher percentage of households without a car than any other part of the county. The Inverse Care Law would apply viciously: medical care least available where it is most needed.
The real problem, of course, is not that there is a conspiracy to deprive West Cumbria of its natural rights but that it is literally the most remote region in England. 41% of families in Cumbria live more than 7 miles from the nearest hospital compared with only 1.7% in Lancashire, for exactly the same reason that you need to wait for a bus for at least 20 minutes in Egremont compared with 2 minutes in Manchester. The risks of living in remote areas like ours are different from the risks of living in inner cities. The managers of any health trust have a complicated task not in eliminating risks, for that is impossible, but in balancing them. We know of no other acute hospital in England that serves a population the size of West Cumbria, which is barely 130,000. An obstetric unit served by consultants with experience of a relatively limited number of critical situations is exposed to risks which have to be balanced against the risks of travelling and travel time outlined in the report.

On this subject the Royal College of Obstetricians and Gynæcologists gives precisely relevant guidance: "Measures to reduce risk are more likely to be successful if there is involvement of those most likely to be harmed by the risk; that is, the users of the service". The fact that every birth is a potential emergency gives weight to the argument that expectant mothers should not be more than 30 minutes' travelling time from emergency treatment.