The midwife shortage – mirrors the rest of the health service staff. We must still protect babies and this means leadership which says we cannot provide everything.. and that a utilitarian approach is best.

Babies it seems need an advocate as well as elderly people. There are plenty of Mums who seem to want home deliveries. The total risk in each delivery gets larger as women get older, delay pregnancy and get fatter or poorer. Despite this there is a small group of second pregnancies for whom a home delivery would be relatively less risky than for the rest. Do we put resources into meeting this demand in the constrained times we are going through? Or should we give the baby an in-utero cellphone to ring the minister when in distress? Home births are safe until things go wrong… (Times Letters 8th Dec 2014) We must still protect babies and this means leadership which says we cannot provide everything.. and that a utilitarian approach is pragmatic and allows resources to be distributed better. (Update 17th November More babies born to women 35 or older than under 25 for first time)

Laura Donelly in The Telegraph 10th October reports: Mothers and babies ‘at risk’ as midwife crisis grows.

Lives of mothers-to be and their babies are at risk due to midwife shortage, report by the Royal College of Midwives reveals

Soaring numbers of maternity units are turning women in labour away and refusing home births amid widespread shortages of midwives, new figures suggest.

A report by the Royal College of Midwives (RCM) says a “potentially disastrous” shortfall of staff is putting the lives of mothers-to be and their babies at risk.More than 40 per cent of wards became so busy last year that they closed their doors, forcing women in labour to travel long distances – a rise of one quarter in just one year – their survey of units found.

The average unit closed its doors on five occasions this year, with some closing 23 times, the UK survey of heads of midwifery found.

A year ago NHS guidance called for far more pregnant women to be offered a home birth, suggesting should become the norm for second-time mothers.

But more than one in three maternity services restricted home births this year as midwives were called back to desperately short-staffed units – with a third more restrictions than last year.

The RCM said maternity units are facing “unprecedented challenges” with high birth rates, increasingly complex births – due to rising numbers of older and obese mothers and a serious shortage of midwives.

According to the survey 41.5 per cent of maternity units had to close during the last year because they could not cope with the demand – a rise from 32.8 per cent in 2014.

Thirty per cent of Heads of Midwifery Said that they simply did not have enough midwives.

The college said the shortage of midwives in England is now “critical” with the country still short of 2600 full-time midwives.

Nine in 10 senior midwives said their unit is dealing with more complex cases than the previous year.

Services such as home births are suffering, midwives said.

Midwives shortage?

National probe into maternity care ordered after ‘lethal’ mix of failings found

Almost two thirds said staff who should have been assisting at home births or postnatal care had to be called in to labour suites.

More than one third of Heads of Midwifery (36 per cent) said that this restricted the home birth service, up from just over a quarter (26 per cent) in 2014.

Other services are also being reduced as staffing shortages bite, midwives said.

Eleven per cent reported that they had to reduce services in the last year. This included reductions in specialist midwives, fewer parent classes and less bereavement and breast feeding support.

Cathy Warwick, RCM chief executive said: “Our maternity services are overworked, understaffed, underfunded and struggling to meet the demands being placed on them. This is deeply worrying for the quality of care women are receiving, and the safety of services.”

“Midwives and maternity support workers are too often keeping services afloat by working long hours, often doing unpaid overtime and missing breaks. This is not a situation that leads to safe and high quality care for women and babies.

“All of this shows a system that is creaking at the seams and only able to deliver high quality care through the efforts and dedication of its staff.”

She said safety was at risk because services were operating beyond their capacity.

“The Government is responsible for this and it is they who are letting down women, babies and their families, as well as the staff they purport to value. This is simply not acceptable,” she said.

A spokesperson for NHS England said: “Most mothers report that they get great NHS maternity care. But our major review of maternity services now under way is looking at how best to respond to England’s growing birth rate, and the need for well-staffed and safe services that give mums more say over their care.”

Sarah-Kate Templeton, Health Editor in The Times 11th October reports: Mothers-to-be may get right to home birth

EVERY mother-to-be could be given the right to demand a home birth or caesarean section, under plans to revolutionise NHS maternity care.

In a drive to encourage more women to have their babies away from hospitals, NHS England is considering a voucher scheme that mothers could use to pay for a private home birth if the local NHS failed to provide one.

Women denied a home birth on the NHS could use the vouchers to “commission” their own independent midwife. The scheme is seen as an incentive to force the NHS to make home births more widely available.

The NHS England review is also recommending that more women give birth in the community in units staffed by midwives but not doctors.

According to the review, it would save the NHS hundreds of pounds per birth if women with low-risk pregnancies were able to have their baby outside hospitals without the input of a doctor. Last week, official figures revealed hospitals had run up a £930m deficit in the first three months of this financial year.

The review argues that even if there are risks of giving birth without a doctor on hand, most of these risks can be addressed.

The move, however, will face criticism from doctors and charities who believe natural birth and the “experience” of giving birth is being promoted at the expense of safety of mothers and babies.

The patient representative on the panel review has quit in protest. James Titcombe, whose son, Joshua, died in 2008 after staff failed to treat him for an infection during the Morecambe Bay baby death scandal, resigned last month.

He said: “I feel that there is a real tension between an ideology that I see time and time again as a feature in the tragic stories people come to me with that focuses on woman’s ‘experience’ and protecting ‘normal’ birth, but where risks and safety are played down.

“I have a genuine concern that, in some places, an ethos has developed where there is so much emphasis on ‘experience’ and ‘protecting normality’ that the occasional avoidable loss or serious harm caused to a baby because of failure to properly assess and manage risk, is seen as a sad but inevitable aspect of childbirth.”

Doctors have also written to the national maternity review expressing concerns that groups that highlight risks in childbirth and the need for doctors’ involvement have been excluded from the review.

Felicity Plaat, a consultant in obstetric anaesthetics at Queen Charlotte’s hospital, west London, wrote in a submission to the review that she was concerned anaesthetists specialising in childbirth, obstetricians specialising in caring for illnesses associated with childbirth and the Birth Trauma Association (BTA), which supports mothers who have suffered difficult births, were not represented on the review panel.

Plaat wrote: “I am deeply concerned that those involved with the care of the high-risk patient are not represented. If our future maternity service is designed to avoid the catastrophe that was Morecambe Bay, such groups must be allowed to contribute.”

In his submission, Martin Ward Platt, a consultant paediatrician specialising in newborn babies at Newcastle upon Tyne Hospitals NHS Trust, wrote: “What previous reports all had in common was an unrelenting focus on the adult component of maternity and childbirth, with very little about babies, except as statistics, mostly their mortality and morbidity. The composition of the current working group engenders no confidence that this time round it will be any different.”

Maureen Treadwell, co-founder of the BTA, said: “Most women choose to give birth in an obstetric unit [hospital staffed by doctors] or an alongside midwifery unit [a midwifery unit located alongside a hospital] where there are doctors, emergency facilities, neonatal experts and epidurals nearby. They do not want to risk enduring a harrowing blue light ambulance journey to hospital if things go wrong.

“This is not surprising because what most families want, above all else, is a safe, non-traumatic birth. The safety of community birth is yet to be conclusively proven and certainly for first-time mothers, the risks seem higher.”

The Royal College of Obstetricians and Gynaecologists (RCOG) has said the outcome for babies planned to be delivered at home to first-time mothers is less favourable than for other places of birth, including a higher risk of death or permanent disability. Up to 45% of first-time mothers who deliver at home or in midwifery units have to be taken to obstetric units for medical care.

The RCOG has said that giving birth at home or in midwife-only units is safe for mothers at low risk of complications who are giving birth to their second or a subsequent baby. For those women, the risk to the baby is no higher than if the baby is born in a hospital.

In England, around one in every 50 babies is born at home. Some mothers believe that giving birth at home makes them feel more relaxed and able to cope.

As a woman’s choice of birth is considered by the review team to be of central importance, this is extended to the right to insist on a caesarean section. The panel would advise against a caesarean section if there was no medical reason for having one but may accept that ultimately the mother must decide.

The recommendations would reinforce guidelines from the National Institute for Health and Care Excellence (Nice), which state that, if a woman insists on a caesarean section, after having been counselled about the disadvantages and risks, then she should be granted one.

A spokeswoman for the maternity review, set up by NHS England, said it “has not yet reached any conclusions; however, safety is our first priority and is at the heart of everything we do”.

Sam O’Brien, 39, who does public relations for Independent Midwives UK, a membership organisation for private midwives, gave birth to her son, Eric, at home in 2011 after a traumatic experience giving birth to her daughter Violet in hospital in 2009.

She said: “For some women, hospital just isn’t the right place. I didn’t know anyone, I didn’t have any relationship with the people who were looking after me and I just found the whole experience rushed and frightening.”

O’Brien paid privately for an independent midwife to come to her home: “Because I was at home, in my sitting room, with people I know, and a midwife I had known for eight months, I felt completely happy and relaxed, so birth was very straightforward.”

She added: “It should be open to every woman to be able to make that choice.”

Additional reporting: Benedicte Earl

Maternity overload

More than two-fifths of maternity units have had to close their doors temporarily in the past year because they could not cope with demand.

A survey by the Royal College of Midwives found 41.5% of units shut their doors in the year 2014-15, compared with 32.8% in 2013-14.

One hospital had to close its maternity department to new admissions 33 times up to April 2014 and 23 times up to April 2015.

The midwives union said the service was “creaking at the seams”.

 More babies born to women 35 or older than under 25 for first time 17th Nov 2015 in The Guardian

 

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This entry was posted in A Personal View, Midwives, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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