The current challenges facing the midwifery profession in England and Scotland have been laid bare by a new investigation by the Royal College of Midwives.
Poor midwife retainment, increasing complexities of care, and the impact of Brexit on the workforce are among the issues highlighted by the college today in its new State of Maternity Services Report, which covers both England and Scotland.
“We should be aiming for our maternity care to not just be among the best in the world, but to be the best”
The college found that while birth rates are falling in both countries, demand for midwives was still increasing due to a rise in older and overweight women accessing maternity services and requiring more complex care.
The RCM’s latest estimate is that England’s NHS is short of 3,500 full-time midwives.
The report found that while 2,132 midwives graduated from English universities in 2016-17, the NHS midwifery workforce increased by just 67 to 21,601 in May 2018 compared to the previous year. This equates to one new midwife entering the NHS for every 30 who newly qualify.
The RCM chief executive Gill Walton said the disparity arose from increasing numbers of midwives leaving the profession.
“The problem is that so many existing midwives are leaving the service”
She said: “It is of deep concern that we’re only seeing an increase of about one NHS midwife for every 30 or so newly-qualified midwives graduating from our universities.
“It’s not that new midwives aren’t getting jobs, they are,” she said. ”The problem is that so many existing midwives are leaving the service that the two things almost cancel each other out.”
The government has previously committed to training an extra 3,000 midwives in England over four years.
While welcoming the move, Ms Walton said if the trend identified in the report continued, this could result in just 100 extra midwives on the NHS frontline.
In addition, the RCM report raised fears about the impact of Brexit on the country’s midwife shortage.
It found that, in the year to March, just 33 midwives who trained elsewhere in the European Union registered in the UK to work as midwives, a drop from 272 two years previously, before the 2016 referendum.
Over the same period, the number of EU midwives leaving the register jumped from 160 to 234, RCM noted.
Ms Walton said: “We have around 1,700 EU-trained midwives registered to work here in the UK, and they will be caring for tens of thousands of women every year.
“Their numbers are already falling quite dramatically however, and my fear is that if Brexit goes ahead, especially without a deal, then their numbers could quite simply collapse,” she said.
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She added: “More needs to be done right now to guarantee their right to stay and work in the UK post-Brexit, even if there is no deal, then more will leave and that will make our shortage even worse.”
Meanwhile, the RCM found the profile of pregnant women has changed significantly in both countries.
In England, 55% of births last year were to women in their 30s or older – the highest since records began in 1938.
While in Scotland, births to women in their early 40s increased by more than two-thirds between 2000 and 2017.
More than half of women accessing maternity services in both countries are now obese or overweight.
The RCM said older and overweight women typically required additional care and support throughout pregnancy.
The number of midwifery vacancies in Scotland quadrupled from 32 in September 2013, to 127 in March 2018, with particular problems in the north, the report found.
It also highlighted continuing concerns about the ageing of the country’s midwifery workforce, with the number of retirements tripling in the four years to 2016-17.
Despite these challenges, the RCM found there were many positive developments in Scotland’s maternity services, including rising student numbers and the continuation of bursaries.
Mary Ross-Davie, RCM director for Scotland, said: “What is important is that our government continues to invest in maternity services to ensure they can cope with current and future demand.
“The NHS, the Scottish government, the RCM and others need to keep working together to identify the challenges and tackle them,” she said.
“We should be aiming for our maternity care to not just be among the best in the world, but to be the best,” she added.