Increasingly complex births combined with a shortage of midwives and continued reduction to staff training has led to a midwifery system that is “creaking at the seams” according to senior midwives.
A UK survey of just under half of all heads of midwifery found that, in 2014 and 2015, 96% and 91% respectively said their unit was dealing with more complex cases than the year before.
This included more overweight or obese women, social problems such as domestic violence, drug and alcohol abuse, child protection concerns and mental health conditions.
“How is it possible to provide high levels of individualised quality care with high cost reductions, cuts to training budgets and more women with complex needs?”
Head of midwifery
One head of midwifery noted that, while the birth rate in England had reduced since 2012, “the increasing complexity absorbs any small gains in terms of activity as more time is needed to care for women with additional health or social needs”.
They added: “This is not reflected in the workforce tools for midwifery establishment.”
The survey, which was carried out by the Royal College of Midwives and forms part of its evidence to the NHS Pay Review body this year, found that at the same time almost a third of respondents were understaffed in their units.
“In both years three-quarters of those surveyed said they had to redeploy staff to cover essential services either very or fairly often”
RCM survey of heads of midwifery
Meanwhile, in both 2014 and 2015 one in five heads of midwifery said they had to reduce training for midwives.
In particular, in 2014, almost half of midwives taking part in an RCM staff survey on pay and conditions said they received no training at all apart from that which was mandatory.
Vacancies for midwives were reported in three quarters of UK units, with more than half being for experienced posts at band 6 to 9 pay grades.
“How is it possible to continue providing high levels of individualised quality care year on year with high cost reductions, cuts to training budgets and more women with complex needs?,” said one director of midwifery who responded to the survey.
“As a head of service I feel powerless to affect change. More staff is not always the answer but staff who have the knowledge and skills to do their job is essential,” they added.
“Midwives and maternity support workers are too often keeping services afloat by working long hours, often doing unpaid overtime and missing breaks”
Another noted that their unit had recruited only three external band 6 midwives in the past 12 months out of more than 30 vacancies.
Similar to the previous RCM survey in 2013, around 40% of maternity units were forced to close temporarily at least once – and on average five times – in the past year as they struggled to cope with demand.
The RCM noted midwifery services such as home births and postnatal care were also affected, with two thirds of respondents reporting on-call community staff had to be drafted in to cover labour and delivery suites.
“This redeployment is also happening far too often,” said the RCM. “In both years three-quarters of those surveyed said they had to redeploy staff to cover essential services either very or fairly often.”
RCM chief executive Cathy Warwick 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,” she said.
She added: “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.”