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Leading doctor adds voice to concerns over lack of midwives

The question of whether understaffing on Britain’s maternity wards is leading to high rates of baby deaths is a legitimate one, the country’s leading obstetrician has said.

Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, has voiced concern over the numbers of babies who are dying or being left with brain damage during birth or shortly after.

Figures from 2009, the latest available, show that 144 babies died during labour that year, with 134 dying within a week of birth, despite having no major congenital abnormality. A further 1,200 were left with brain damage or other serious health problems.

The concerns follow accusations from the Royal College of Midwives that hospital managers were “burying their heads in the sand” over midwife shortages. Figures revealed last week by BBC Radio 4’s Woman’s Hour programme suggested a quarter of NHS trusts had not assessed their workforce needs for at least four years.

In an interview with The Guardian newspaper, Dr Richmond said it was “a legitimate question to ask” whether pressures on resources and insufficient staff were a contributory factor.

He said: “We need to look at the possibility that understaffing, labour wards that are under pressure and busy, and stretched facilities may be a factor in some of these poor outcomes.

Dr David Richmond

Dr David Richmond

Labour wards have too few midwives and about 800 fewer consultants than needed to provide 24-hour care in the 62 units that handle more than 5,000 births a year in which complications arise in pregnancy, the newspaper said.

Dr Richmond said a baby boom of 22% in the last 10 years left maternity units “squeezed” because midwife and doctor numbers have not risen at the same rate.

But restrictions on NHS budgets meant the likelihood of consultant numbers rising from 2,200 to the ideal of 3,000 is unrealistic, he added.

Dr Richmond conceded that medical errors were occasionally to blame for the high rates, saying there were instances where staff made “small, relatively innocuous mistakes (which), when combined, lead to a disaster. There are no easy fixes.

“The challenge is to be willing to share these experience, learn from each other and invest in safety,” he told the newspaper.

Dr Richmond also condemned the rate of stillbirth, at almost 4,000 a year or 10 a day, as “appalling” and largely preventable. Data from the Office for National Statistics show there were 4.9 stillbirths for every 1,000 live births in England and Wales in 2012.

He also called for action to reduce the 1,200-a-year “near misses”, in which babies are left with serious health issues from complications during birth.

“We need more midwives so that women can have continuity of care in pregnancy and one-to-one care in labour”

Charlotte Bevan

Stillbirth and neonatal deaths charity Sands said the shortage of midwives in the NHS was a factor in the UK’s relatively high baby death rates.

Charlotte Bevan, Sands’ senior research and prevention adviser, told The Guardian: “In many cases these are tragedies that happen at term, when the baby is ready to start new life outside the womb, and they should never happen.

“We need more midwives so that women can have continuity of care in pregnancy and one-to-one care in labour.”

Staffing issues during weekends also needed addressing, she said.

Health minister Dr Dan Poulter, who is also an obstetrician, said death rates during and around childbirth are

Dan Poulter

Dan Poulter

declining, and that the NHS in England has more than 1,500 more midwives than in 2010 and a record 6,000 more in training.

He said: “The numbers of stillbirths and infant mortalities are at the lowest levels since 1993, but there is still more to do. The NHS is a safe place to give birth, with women reporting high levels of trust and confidence in staff.”

Readers' comments (2)

  • It's not surprising that the government are failing to recruit midwifes when they get such a lot of bad mouthing and putting down. Also the wages they get are an insult to what they do. I think the government should perhaps put a limit on children per family as there is such a strain on our NHS?

    Unsuitable or offensive?

  • Anon 1:00pm
    I don't think the government will even think of putting a limit on children per family. That is because the amount of elderly people is growing fast, so the workforce need growing as well for balance.
    Focus need to be placed on improving services all the time. Wise decisions to be made. Get the people at the top out, if they are not making improvements to the services, we simply have no time to waste.

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