By Gabrielle Bourke and Abi Wood
Over the last 10 years, England and Wales have experienced a baby-boom, and the number of midwives simply hasn’t kept up. Almost 80 per cent of NHS trusts don’t meet the recommended ratio of one midwife to 28 births, and despite the on-going baby-boom, 50 trusts and boards employed fewer midwives in 2012 than 2011. The Royal College of Midwives estimates that England is currently short of 5,000 midwives.
The Women’s Institue (WI), the UK’s largest voluntary organisation for women, and NCT, the UK’s largest charity supporting new parents, decided to investigate what the shortage of midwives really means for women who have given birth recently.
Overall, women in England and Wales now enjoy some of the highest quality maternity services in the world and many women receive excellent care. Certainly, the contrast between women’s experiences when NCT was founded in 1956 and today is striking in terms of women’s own involvement in their care: the organisation campaigned for women to have access to information about what happens during childbirth, more choice over where they give birth, to be able to have their partner present and to end the routine use of interventions such as episiotomies and shaving of pubic hair.
Yet of the 2,000 women who will give birth today, many will still be denied the opportunity to make choices or be involved in decisions about their care. Even more find themselves without the support they need during the first few weeks following birth.
Following a resolution approved by the WI at their 2012 annual meeting calling for the employment of more midwives, they decided to carry out a piece of research with NCT to look at the experiences of over 5,000 women who gave birth in the past five years, three quarters of them in 2012.
Despite clear evidence about the importance of a woman’s relationship with her midwife, and NICE guidance to support this, we found that 88 per cent of women had not met the midwives who cared for them during labour and birth before going into labour and a third of women wanted their midwife to give them or their baby more attention.
Offering women a choice over where they give birth is an important element of patient-centred maternity care, and it’s encouraging that over a third of trusts and boards in our sample had recently completed building projects or had plans to expand location options by building new freestanding or co-located maternity units, or funding home birth services.
However, only 23 per cent of women reported a choice of four places to give birth, as recommended by NICE. Less than half of all the women who intended to give birth outside obstetric units actually did so, and one in eight women did not get their choice of birth location because of a lack of staff or beds.
The situation is worse when it comes to postnatal care. While one in five said that they wanted more support during birth, 60 per cent said they wanted more support in the postnatal period. Freedom of information (FOI) requests revealed that many trusts are unable to state how many visits women were actually receiving: some said a certain number of visits was aimed for because of NICE guidance; others said the guidance specified there should not be a set number of visits at all.
It is likely that where only one home visit is offered women will be invited to a local clinic. However, those new mothers who are lacking confidence, feeling unwell, or experiencing difficulties in feeding or caring for the baby, may not be able to get out of the house and find the clinic. Unfortunately, they are the parents who may be most desperately in need of care and support.
Midwives report some of the lowest levels of satisfaction with their job out of all the professionals working in the NHS. The pressure on them is immense. The government must turn the recent surge of interest in midwifery into more student midwives, as well as retaining existing staff and encouraging a return to practice by those who’ve left – and then there must be a rewarding, valued career ahead for them.
To address these problems, the WI and NCT are calling on maternity planners to urgently review staffing levels with a view to fulfilling the recommended level of one midwife to every 28 women in a hospital setting, as well as reviewing staffing levels to boost standards of postnatal care.
We urge clinical commissioning groups (CCGs) in England and health boards in Wales to make maternity care a high priority and to recognise the role of midwives in improving public health and reducing health inequalities. While the current economic climate means funding is scarce, investing in services to support women during birth and the first few weeks of parenthood is one of the most effective forms of health spending.
Gabrielle Bourke is research and campaigns officer at the National Federation of Women’s Institutes.