Support midwives to support women and families.


The combination of skilled and personally sensitive care that is required of midwives is difficult when they are under the pressure we see in National Health Service maternity services. This pressure comes from a combination of staffing problems and extreme complexity. We are in the middle of a baby boom with England, Wales, Northern Ireland and Scotland all with a higher birth rate. The birth rate has increased by 22% in England, Wales 17%, Northern Ireland 15%, and Scotland 12%. There are not enough midwifery posts in many places. Moreover care is highly complex. In addition to the generally complicated care and systems there is a 25% caesarean section rate. This in itself adds to the complexity of midwifery work.

A move to supersize units will not help this pressure.

This pressure on midwives and others affects all but is particularly important to students and newly qualified midwives. Newly qualified midwives have told me just how keenly they feel this pressure when their skills are newly acquired.

What can we do? One fundamental change would be to make better use of midwives and extend midwifery led care. The RCM proposes that midwifery led care units and home birth services should be expanded because this will reduce the intervention rate. This in itself will ease the burden on resources, and also provide greater satisfaction for midwives and higher quality care for women and families.

There has been considerable work in sustaining implementing and evaluating midwifery led services (see for example the recently published results of the Birth Place study) indicating that midwifery led care is safe and is associated with a lower intervention rate, and is cost effective.

Throughout the UK I hear of midwifery led services that seem to have capacity to do more, some are wasted because the midwives may be taken away to help on a central delivery suite or are used as overflow beds. These services need to be used to capacity if they are to be cost effective. But it will be important that staffing of these services, as well as staffing of consultant led services, is right. Midwives should have a choice of where to practice, but wherever they practice they should be supported to give of their best. How would you support midwives to support women and their families?