Call the Midwife - while we still have one

Four out of five hospitals are short of midwives, a new investigation has found. Funding cuts mean the situation is "getting worse, not better", according to midwife leaders.

Jessica Ormerod
25 April 2014

Image: NHS Lothian

There is a massive shortfall of midwives across the country, a BBC Radio 4 Woman’s Hour investigation has found.

The report, broadcast yesterday was based on Freedom of Information requests made to hospital Trusts in England. Of the 99 hospitals which responded 80% have vacancies for qualified midwives. The government admit to a shortfall of 2,300 midwives. The Royal College of Midwives puts the figure at 4,800.

Every day news stories report cases of women giving birth without a midwife and over-crowded labour wards. And yet the government writes and rewrites papers and policy that demands more “choice” for women in maternity and higher ratios of midwives to women. Ministers talk endlessly about woman-centred care, about midwife-led birth centres, case-load midwifery.

Dan Poulter, the health minister with responsibility for maternity, insists that the government has improved the situation.

But the House of Commons Public Accounts Committee recently reported:

"There is evidence that many maternity services are running at a loss, or at best breaking even, and that the available funding may be insufficient for trusts to employ enough midwives and consultants to provide high quality, safe care."

A worrying statement when the childbirth rate is rising, the service lacks thousands of midwives.

And midwives are leaving the profession in their droves. A third of midwives leave the profession within 10 years of qualifying. They are being asked to provide much more sophisticated care to a much more complex population while their own numbers are dwindling.

Maternity is unlike any other health service. The users are not patients. They do not need treatment. They need care – sometimes complex care – and they need respect. We know that small maternity units, midwife or obstetric-led give a better and more valued service. We also know that midwives prefer to get to know the women for whom they are caring. They enjoy the intimacy and the act of supporting a woman through a life-changing moment in her life.

The problem we are facing is much more serious even than a shortfall of thousands of midwives. The government seem hell-bent on dismantling the NHS. Fewer and fewer women will have access to good, comprehensive local care.

In 2013 Jeremy Hunt attempted to downgrade Lewisham Hospital's maternity service to leave a stand-alone birth centre with no obstetric-led care – despite the fact that Lewisham sees over 4,000 births per year and houses some of our country's most deprived women, with all the complex healthcare and challenges of that population.

Only 12% of women in Lewisham would have been able to use the midwife-led unit. The vast majority would have been forced to use the already burdened units at neighbouring hospitals, stretching their capacity to over 7,000 births per annum.

Lewisham was a test case for many maternity centres up and down the country. Jeremy Hunt was prevented from closing it by a legal ruling obtained by the campaigners - but the coalition’s agenda is still in motion. The ‘hospital closure clause’, about to return for its final vote in the House of Lords, will remove the law that protected Lewisham's maternity unit from closure and centralisation. No hospital or maternity service in the country will be safe.

Childbirth is intimate, it requires the mother to feel safe in her environment, confident about the support from her midwives. No one wants to be herded into cavernous hospital wards with anonymous carers and a conveyor belt service to give birth in fear or under the surgeon's knife. We need to challenge the assumption that bigger is better, we need to demand named midwives for all women and a service that genuinely caters for all. 

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