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The British Association of Perinatal Medicine: the First 25 Years (1976

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The British Association of Perinatal Medicine: the First 25 Years (1976 LEADING ARTICLE 181 British Association of Perinatal Medicine there were only 366 consultant paedia- Arch Dis Child: first published as 10.1136/adc.88.3.181 on 1 March 2003. Downloaded from ................................................................................... tricians in the United Kingdom. Besides lacking an interest in the newborn, some paediatricians actively obstructed at- The British Association of Perinatal tempts to establish perinatal paediatrics. Maybe they saw their clinical workload Medicine: the first 25 years being eroded by the development of pae- diatric specialisation and were loath to (1976–2000) lose an interest in the newborn field, even though their commitment for this P M Dunn activity was inadequate. So much for the background in the ................................................................................... early 1970s. Half of all deaths from birth to 15 years were taking place in The founding, achievements, and aspirations of the British maternity hospitals within the first 3 Association of Perinatal Medicine are reviewed days of life.4 For those of us trying on a shoestring to establish and maintain a BACKGROUND as a specialty. Although stating that neonatal intensive care service, it was Although there were pioneers in the newborn care would remain the respon- most frustrating. In 1974 a leader in the 6 1930s and 1940s such as Dr Mary Crosse sibility of general paediatricians, the Lancet, “The price of perinatal neglect”, of Sorrento in Birmingham, newborn authors recommended that a total of 10 drew attention to this. But no immediate care in the United Kingdom was very perinatal paediatricians should be ap- action followed. Knowledge of what we neglected in the first half of the 20th pointed to the various major centres should be doing for newborn infants was century.1 In hospital, newborn babies throughout the country to supervise by now far ahead of what was actually were for the most part looked after by neonatal intensive care. This was to pro- provided. How best to proceed? nursery nurses, midwives, and junior vide for an annual population of new- FOUNDING OF THE BRITISH obstetricians. Two things changed this: born infants in the United Kingdom of ASSOCIATION OF PERINATAL the creation of the NHS in 1948 and the about 700 000, some 10% of which were MEDICINE (BAPM) IN 1976 introduction of the umbilical exchange anticipated to require special or intensive In 1975 June Lloyd, who was then transfusion for Rh haemolytic disease, care. honorary secretary of the British Paedi- which established an entrée for paedia- In 1971 the Government published a atric Association, asked me to find out tricians into maternity hospitals. But report on special care for newborn progress was slow and many errors in 3 for the Department of Health and Social babies. It contained the recommen- Security the number of paediatricians in management were practiced. In the dation that there should be six special nurseries of a teaching maternity hospi- the United Kingdom working mainly in care costs per 1000 births, one of which tal in 1959 where I was neonatal the newborn field. This I did by writing should be for intensive care, with a total registrar, there were no incubators, no to all the major maternity hospitals and of eight nurses per 1000 deliveries per technology, and no rooming in. universities throughout Britain and Ire- year to look after them. However, this Why had newborn care been so land, and enquiring whether there were http://adc.bmj.com/ totally inadequate nursing establish- neglected? Well, there were more babies any paediatricians spending 60% or more ment was not actually available at that than were needed and a fairly wide- of their time in newborn care. Including spread attitude of “survival of the fit- time or indeed for many years to come. eight from the Republic of Ireland, I col- test”. Obstetricians had become gynae- The state of paediatric staffing was no lected 20 names in all. Then it occurred cologists and many had lost their better. When I took up a consultant post to me to bring these 20 paediatricians interest in the newborn. Paediatricians at Southmead Hospital in the late 1960s, together and start a perinatal group. So I were few in number and were mostly there were 6000 births a year and the wrote to them early in 1976 asking them based in children’s hospitals; further- referrals from at least another 6000. The to meet at the BPA in York that April. At on September 25, 2021 by guest. Protected copyright. more few had knowledge of the new- junior paediatric staffing to meet this this point, Roy Meadow, who was then born. case load consisted of half a registrar and secretary to the BPA Academic Board, The 1960s saw the establishment of two housemen. The annual budget for intervened. In York he put up a notice special care baby units in major equipment at that time was £500. But we inviting anyone interested in newborn maternity units. But there was little begged, borrowed, and stole and estab- care to come to the meeting that I had equipment, and paediatric cover was lished an intensive care service in 1970. arranged. After opening the meeting, he poor. The perinatal mortality of 35 per Everyone worked all hours, and in no then left me to chair it. However, my 1000 births at the start of the decade fell time we were rewarded by a falling mor- intention had been to create a pressure only slowly. Progress, however, was being tality. Between 1970 and 1973, the group from among those actually facing made in Scotland, and in England Peter neonatal mortality for non-malformed the problems of providing a neonatal Tizard had created a training ground for infants over 1000 g birth weight fell by intensive care service. As this was now neonatologists at The Hammersmith 74% in the university service.4 However, no longer possible, the meeting closed Hospital.1 However, as there were no although such a fall may have been tak- without making significant progress. consultant posts in neonatal medicine, ing place in a few neonatal units around My next move was to invite those most of his trainees returned to general the country, it was not happening in same 20 neonatal paediatricians to con- paediatrics. In 1968, I think I may have general.4 tribute to a neonatal symposium in Bris- been the first person (certainly south of Apart from the lack of finances gener- tol in November 1976. This they agreed the border) to be appointed to a consult- ally available to the NHS, paediatrics had to do, and after the conference we ant perinatal/neonatal post. received a particularly raw deal, receiv- formed the British Paediatric Perinatal In 1972, Donald Court, chairman of ing possibly a third of the financing to Group (fig 1) and celebrated the event the BPA Academic Board, wrote a book- which child health was entitled as its with a dinner in the cellars of Foster’s let with Tony Jackson entitled Paediatrics share of the medical budget5; and such Rooms. Our declared aim was “to im- in the seventies.2 It contained the first offi- money as was available was badly prove the standard of perinatal care in cial recognition of perinatal paediatrics needed for older children. At the time, the British Isles”. www.archdischild.com 182 LEADING ARTICLE became members of our council, which Arch Dis Child: first published as 10.1136/adc.88.3.181 on 1 March 2003. Downloaded from met each year for a day’s debate before our annual scientific meeting. These annual perinatal symposia, a continua- tion of the Bristol series, went peripa- tetic, visiting in turn most of the major cities throughout the British Isles and Ireland. PROGRESS IN PERINATAL CARE As the pace of work quickened, it was found necessary in 1980 to create an executive committee and the secretary became its chairman. For some time we used to meet in my home in Bristol. In 1982, Peter Tizard who gave our first founders’ lecture, then pointed out that the correct term for a presiding officer was president, not chairman, and so we changed that title. We also changed our name from a perinatal group to British Association of Perinatal Paediatrics and Figure 1 Founding meeting of the British Association of Perinatal Medicine, Bristol, 1976. Left to right: standing: Niall O’Brien, Roger Harris, David Davies, George Russell, Colin registered ourselves as a charity. Walker, David Harvey, Brian Wharton, Forrester Cockburn, Cliff Roberton, John Maclaurin, In 1984, Cliff Roberton took over as Richard Orme, Mark Reid, David Baum, Garth McClure; sitting: Pamela Davies, Osmund president (fig 2). Cliff in turn was Reynolds, Peter Dunn, Margaret Kerr, Brian Speidel (in absentia: Malcolm Chiswick and succeeded in 1987 by Forrester Cock- Harold Gamsu). burn. Then followed Richard Cooke in 1990 and Garth McClure in 1993. Next, My idea had been that there should obstetric view at that time was that all in 1996 Phil Steer became our first also be a twin group, the British Obstet- gynaecologists were perinatologists, and “obstetric” president. From the start we ric Perinatal Group and that together we that it was diversive to suggest that some had welcomed obstetricians to join our would create the British Association of were more perinatal than others. In paediatric group and, in fact, in 1980 Phil Perinatal Medicine with combined meet- addition, the RCOG, unlike the BPA, did had become a valued member of our ings. I approached Richard Beard of St not agree to our new group becoming executive committee. In 1982 the RCOG Mary’s Hospital in London with this affiliated with their College. This was recognised maternal and fetal medicine suggestion and the hope that he would disappointing as it seemed obvious that as a subspecialty of obstetrics and organise the obstetric group.
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