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Half of women report 'red flag' care delays 'due to midwife shortages', finds survey

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One in two women receiving maternity care in England and Wales have experienced so-called “red flag” events that indicate low staffing levels, a new report has warned, which described the finding as “shocking”.

According to a survey of 2,500 women over the past three years, half reported experiencing at least one event that guidelines from the National Institute for Health and Care Excellence state should prompt senior midwives to review staffing.

“Staffing was the third most common issue women identified when we asked them to comment about the quality of their care overall”

NCT and NFWI report on maternity care

Such events include a delay of 30 minutes or more in receiving pain relief while in labour – reported by 31% of women in the survey – and a lack of one-to-one continuous care during established labour, which was experienced by 17% of respondents.

The survey findings, included in a joint report from the National Childbirth Trust and the National Federation of Women’s Institutes, also revealed 28% of women who required medication, either during or following birth, experienced a delay in getting their prescription or receiving it.

In addition, 15% of women said their immediate post-birth care, such as washing or suturing, was delayed, according to the report published today.

“Staffing was the third most common issue women identified when we asked them to comment about the quality of their care overall,” said the report titled Support Overdue: Women’s experiences of maternity services.

“Nearly all of the comments indicate that they believe maternity services were understaffed or that their midwife was over-worked and very busy…[the womens’] comments suggest that understaffing is a common thread that runs throughout the entire care pathway,” it added.

“This report highlights in stark detail how much pressure our midwives and maternity services are under”

Louise Silverton

The report called for a number of actions to be taken to end midwife shortages, including for the 2015 NICE guidelines to be implemented so that trusts reviewed their midwifery staffing establishment at board level at least every six months.

Employers should ensure maternity services have procedures to monitor midwifery “red flag events” and respond to them, it said.

It also called for the development of a tool to help determine adequate midwifery staffing establishments within new service models that aim to provide continuity of care.

Meanwhile, it warned that the controversial plans to remove student bursaries for midwives in England would exacerbate staffing shortages and called on the government to scrap its proposals.

Similarly, the government “must clarify how it will ensure that the UK’s decision to leave the European Union does not result in further pressures on midwifery staffing and midwifery support workers”, which it noted was estimated to have reached 3,500 staff in England.

“Serious and sustained investment in maternity care is needed to counter the huge increase in births over the last decade or more”

Louise Silverton

In Wales, the government must ensure there are enough midwives trained to deal with those retiring, it said.

Commenting on the report, Louise Silverton, director for midwifery at the Royal College of Midwives, said it was “hugely worrying” that half of the women in the survey had experienced a red flag event.

“There is much to celebrate about our maternity services, not least the dedication and commitment of the staff. However, this report highlights in stark detail how much pressure our midwives and maternity services are under,” she said.

“This ongoing shortage of midwives and underfunding of services is not delivering the service that women and their families need, and it is storing up health problems for the future that could be prevented,” she added.

Ms Silverton noted that the report showed inadequate postnatal care was an ongoing issue, as was lack of choice about place of birth.

Royal College of Midwives

Quarter of stillbirth investigations ‘not good enough’

Louise Silverton

In addition, she highlighted that maternity services did not feature strongly enough in local NHS plans for future services, known as sustainability and transformation plans (STPs).

“Serious and sustained investment in maternity care is needed to counter the huge increase in births over the last decade or more, the increasing demands on the service and the historical lack of funding,” she said.

RCM director for Wales Helen Rogers said Welsh ministers must take action now to avoid a chronic midwife shortage similar to in England.

“Student midwife numbers have remained static since 2014. This is despite the fact that this year health boards have employed all newly qualified midwives needing jobs and there are still vacancies,” she said.

She also noted the ongoing struggle to provide continuity of care in Wales, which she said was “extremely disappointing”.

“There is a wealth of clinical evidence regarding the benefits continuity of carer which we know improves women’s satisfaction with their maternity care as well as ensuring better outcomes for both mother and baby,” she said.

Professor Mary Ann Lumsden, senior Vice president of the Royal College of Obstetricians and Gynaecologists, added: “Stretched and understaffed services affect the quality and safety of care provided to both mothers and babies and this report highlights the extreme pressures faced by our maternity services.”

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