Only around half of babies born in England’s hospitals last year were delivered by midwives, show the latest maternity figures.
The statistics, published last week by NHS Digital, show there were 648,107 births in NHS hospitals during 2015-16.
“It may be that some women are not getting enough support from midwives”
Of those, just 53% were conducted by midwives. This is down from 53.5% the previous year and a continuation of a steady decline in midwife-led births in hospital over the past 25 years.
The data shows in 1989-90 midwives conducted 75.6% of deliveries in NHS hospitals, but this proportion has dropped steadily pretty much every single year up until now.
The Royal College of Midwives said the main reason was the increasing complexity of births over the years and the “rising tide” of Caesarean sections.
The statistics show the proportion of spontaneous births dropped to 60% in 2015-16, while the number of Caesareans increased from 24.1% to 27.1% in the past 10 years, show the statistics published in NHS Digital’s report – Hospital Maternity Activity, 2015-16.
RCM director of midwifery Louise Silverton told Nursing Times that the figures showed a cycle of increased intervention in births was continuing, in part due to the “normalisation of Caesarean” as a way of giving birth.
There was also the issue of “defensive practice” where hospitals opted to intervene earlier to avoid being sued should something go wrong, alongside an overall drive to reduce still births and growth problems in the womb, she said.
“I don’t think it is a shortage issue but it makes shortages worse”
While there are ongoing shortages of midwives – with the RCM estimating that England needed at least 3,500 more – she doubted it was one of the main factors behind the reduction in the percentage of midwifery births in hospital.
“I don’t think it is a shortage issue but it makes shortages worse, because postnatally you have women who are post-operative as opposed to women who are up and about, and need different kinds of support,” she said.
“However, it may be that some women are not getting enough support from midwives and are getting to a point where can’t go any further with labour sooner,” said Ms Silverton.
She flagged variations in Caesarean rates, with some areas doing more work to encourage women to consider vaginal birth for a second child having had a Caesarean first time round, while some had “a big focus on first vaginal birth”, which vastly increased the chances of spontaneous birth next time.
She suggested the environment in which women gave birth could be key, with evidence women cared for by midwives in midwifery-led settings had fewer interventions, compared to those cared for by midwives on labour wards.
Meanwhile, continuity of care – something the national Maternity Transformation Programme is intended to improve – was also important. Women who experience continuity of care are more likely to have normal births even with risk factors, noted Ms Silverton.
The figures show the number of deliveries among women aged over 40 rose from 20,530 in 2005-06 to 24,942 in 2015-16, an increase of 21.5%.
While there are more likely to be complications when older mothers give birth, Ms Silverton said the picture had changed.
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In the past, older mothers may have had several children already and were tired and in poor health, she highlighted. But births to older women these days tended to be planned, while mothers were generally fit and healthy and “could afford” to have a new baby.
She said one of the most encouraging figures was a drop in the number of births to women aged under 20. This has almost halved over the last 10 years, from 43,572 in 2005-06 to 22,032 in 2015-16.
Ms Sliverton said it was testament to the work of public health nurses as well as midwives, but feared cuts in council funding could lead to the rate of teenage pregnancies, teen abortion and young women giving birth going up again.
“The increased reduction in the birth rate to young women is a huge mark of success for school nurses, health visitors and midwives who run teenage pregnancy services,” she said. “It is brilliant but there are still big variations.”
She warned that funding public health cuts could mean local authorities focus on statutory responsibilities to children aged 0-5 while 6-19 “might get missed out”.
“The worry is those rates will creep up particularly in areas with low education attainment and multiple deprivation,” she said.