"Clusters" of anophthalmia in Britain.

guideline from the Royal College of Obstetricians and Gynaecologists that there should be one specialist for 500 deliveries will be tenable only if the trend towards subspecialisation accelerates. A small referral base does not provide enough complications to maintain skills. ' Apart from stipulating a greater role for midwives, the report tries not to be too prescriptive; it recognises that purchasers and providers may agree many different models of care. The result, however, is that much of the report reads like a 100 page mission statement. It also seems to contain some internal contradictions. For instance, it argues that women should have the option of a planned home birth, especially as any increased risk is small (at least in absolute terms) and even those who perceive a risk may make a trade off in order to realise other gains-just as we do when transporting our families by road. Only a parentalist could argue against the report on this point, but the information that the report suggests should inform this choice was biased, although the report argues throughout that couples should be given unbiased information. The report states that any exposition on the risk of an unexpected emergency at home should be balanced by evidence from quoted studies showing higher intervention rates in hospital; the problem is that these studies are confounded by different patterns of midwifery care. The report advocates, however, that, irrespective of where she chooses to deliver, a woman's intrapartum care should be the responsibility of the same midwife. Perhaps this just shows that unbiased information, for which the report makes repeated pleas, exists only in those few areas which can be resolved empirically.