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The birth of perinatal medicine in the United Kingdom
1Perinatal Medicine and Child Health, University of Bristol, Southmead Hospital, Bristol BS10 5NB, UK. p.m.dunn@bristol.ac.uk
Insights
Medical care for newborns faced setbacks but saw renewed interest with pediatrics and the NHS. The establishment of perinatal services and specialized units improved care for the fetus and newborn infant.
Area of Science:
- Medical history
- Perinatal medicine
- Obstetrics and Gynecology
Background:
- Maternal and infant care progressed slowly from the 16th-19th centuries, declining in the early 20th century due to a focus on gynecological surgery.
- Renewed interest in fetal and newborn care emerged post-1928 with pediatrics development and the 1948 National Health Service formation.
Observation:
- Special Care Baby Units (SCBUs) were established in the 1960s, coinciding with the introduction of obstetric technology and a shift to hospital births.
- Neonatal intensive care developed in the 1970s, but resource limitations hindered progress, prompting critical reports and a call for improved perinatal services.
Findings:
- Government recognition in 1982 extended NHS patient status to all newborns from birth.
- The Royal College of Obstetricians and Gynaecologists (RCOG) recognized the need for a maternal and fetal medicine subspecialty.
- A dedicated perinatal pressure group evolved into a multidisciplinary association, solidifying perinatal medicine as a distinct discipline by 1983.
Implications:
- The historical trajectory highlights the critical role of policy, specialized units, and multidisciplinary collaboration in advancing perinatal care.
- The establishment of perinatal medicine as a subspecialty signifies a commitment to improving outcomes for mothers and newborns.
- This evolution underscores the importance of addressing resource limitations to ensure effective healthcare delivery for the most vulnerable patients.
Abstract:
Slow but steady progress in the medical care of mothers and their infants during the 16th-19th centuries received a setback early in the 20th century following a shift of focus from the baby towards gynaecological surgery. The development of paediatrics after 1928 and the formation of a national health service in 1948 led to a renewed interest in the fetus and newborn infant. Special care baby units (SBCUs) were created in the 1960s. At this time, too, obstetric technology arrived in the delivery room and domiciliary birth largely gave way to hospital delivery. Neonatal intensive care arrived in the 1970s. However, a severe lack of resources retarded progress. Many medical reports in the 1970s drew attention to the deplorable situation. In 1980 a House of Commons working party called for the establishment of a sound perinatal service. In 1982 the Government recognized all newborn infants as NHS patients from the moment of birth rather than after their registration. That year too the Royal College of Obstetricians and Gynaecologists (RCOG) acknowledged the need for a subspecialty in maternal and fetal medicine. Meanwhile, a paediatric perinatal pressure group, arising in 1976, became a multidisciplinary association of perinatal medicine in 1981. By 1983 the new discipline of perinatal medicine had become firmly established.
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