The recent revelation that in 2010 over 1000 women paid for a private midwife to care for them throughout their pregnancy and birth prompts an array of questions about the current state of NHS maternity services within the UK. It has been well publicised that there is a vast shortage of midwives at present and that maternity services are buckling under the pressures of providing for a rising birth rate with limited numbers of midwives. A recent BBC Panorama documentary detailed the devastating consequences these issues have had on women and their families; namely the preventable deaths of women and babies either shortly after birth or in pregnancy. The programme featured a particular couple who painfully retold their devastating experience of losing their first baby at a London hospital; the couple made it explicitly clear that the night their baby died was a night when the maternity ward was dangerously understaffed, to the point where there was not a midwife available to them throughout labour. An independent body investigating the death of their child concluded that it could have been prevented had there been adequate and safe staffing levels on the maternity ward. This is a tragic and completely unacceptable occurrence.
With the birth rate in the UK currently standing at a 40 year high, having already risen by 2.4% since 2009, it seems obvious to suggest that increasing numbers of midwives are required in order to support the rising numbers of pregnant women. Cathy Warwick, the General Secretary of the Royal College of Midwives (RCM) has acknowledged that around 4700 more midwives are needed in order to allow maternity services to meet the vast demands being placed upon them. This is a shocking figure and goes some way to highlight the circumstances and working conditions that midwives are working amongst. Cathy Warwick also recognises that the situation majorly contributes towards midwives feeling deeply dissatisfied, unfulfilled, and increasingly disillusioned about their careers.
Prior to the 2010 general election, David Cameron pledged to increase the numbers of practicing midwives by 3000. This promise is yet to be fulfilled and the Government confirmed in January this year that there is currently no intention to raise the number of midwives. This is an almighty disservice to maternity care and a worryingly signal that harder times are still to come.
Adding to this, in January, a spokesperson for the Department of Health stated that there were a ‘record’ number of midwifery students currently in training across the UK. In itself, this is excellent news and signifies the sustained interest and uptake of midwifery as a career choice. In reality, this record figure only matters when there is confirmation that the current students will be able to secure a job at the end of their training and make the transition from student to qualified healthcare professional. In order for midwifery positions to be available, there needs to be continual investment in maternity services by the government, thus making jobs available. It is not nearly enough to cover up a shortage of midwives with maternity support workers or health visitors; whilst these two professions have very real and valuable roles, it is midwives that are so desperately sought after.
Midwifery is a continually underrated and undervalued profession, covering an area that remains a mystery to most until personally experienced either as a pregnant woman or an expectant father. For this reason, many overlook the positive impact midwives have upon a women’s health and wellbeing as well as the overall health of families. Midwives are often positioned at the heart of women’s care throughout pregnancy as the lead healthcare professional. They are ideally placed to liaise with other maternity care providers, instigating any necessary or appropriate referrals as well as remaining a ‘professional friend’ to the woman throughout, supporting and encouraging her during the transition from woman to mother and the extensive lifestyle changes this brings. During the 40 weeks of pregnancy, a midwife has the privilege of caring for the woman throughout this time as she experiences many changes physically, emotionally and socially. Although for most a joyous experience, pregnancy brings with it many questions and worries, some trivial and some much more far-reaching and long term. These may revolve around key social concerns such as domestic violence and abuse, sexual and mental health, drug and alcohol misuse and adoption and fostering. With midwives being the main care providers for pregnant women (as opposed to doctors and other professionals) it is impossible to not acknowledge the awareness midwives must possess of wider social concerns and how this relates to the pregnant woman and her family.
It would be irresponsible for me to imply or claim that midwives are heroes, capable of changing the world, and there are undoubtedly some situations that cannot be improved by midwifery care alone and require input from other professionals with specific expertise in certain areas; for example, drug rehabilitation workers and smoking cessation advisors. However, it remains the role of the midwife to engage with all women with regards to their general health and wellbeing, explaining the importance of good health in pregnancy for both the woman and the unborn baby, as well as implications poor health may have later in life and after pregnancy. Health promotion initiatives can also extend to the woman’s immediate family, such as smoking cessation and healthy dietary changes, and these are examples of the midwife’s vast contribution to bettering outcomes for not just the pregnant woman, but the family unit too.
Pregnancy presents a unique situation for health professionals in that there are two lives being cared for at the same time. For a woman, carrying an unborn baby within her body is a fulfilling and special experience; providers of maternity services must realise that for some women, pregnancy may be the only time in their life that they have actively sought health advice or care and that this is an opportunity to provide valuable support and education, potentially improving overall awareness of health issues and contributing towards greater social outcomes. Midwives are able to participate hugely in this opportunity and are the main professionals involved with many public health initiatives such as breastfeeding, healthy diet promotion and folic acid supplementation in early pregnancy as a means of preventing brain and spinal defects in the developing baby. Breastfeeding in particular has vast health benefits for both mother and baby including a greatly reduced risk of obesity, diabetes and eczema for the baby and reduced risks of breast and ovarian cancer for the mother in later life.
Well organised maternity services that function efficiently and effectively are essential in order to enable midwives to carry out their role and reach their full potential as healthcare professionals. As aforementioned, the current shortage of midwives in the UK is impacting hugely upon the safety of maternity care and the extent to which midwives can look after women successfully. This is an ongoing issue that restricts women’s access to midwives and places great constraints on maternity services as a whole. With regards to the increasing number of women seeking and paying for a private midwife, it is a sad day for NHS midwifery when women are seeking care elsewhere and are willing to pay high rates for it if it means that they are provided with the service they want. This is a dangerous and downward spiral. Independent midwives currently charge between £2000 and £4500 for their services throughout pregnancy, birth and the postnatal period. Clearly, this is not attainable by all women and it is unacceptable that those who cannot afford the standard of care they deserve and should be provided with free of charge are having to experience the substandard circumstances currently being seen on maternity wards up and down the UK. Women should be able to access and receive gold-standard maternity care that makes them feel valued and takes into account their individual beliefs and wishes for pregnancy, regardless of social class or income.
At its best, midwifery care is empowering, inspiring and exceptionally fulfilling for both the woman and her midwife; being able to develop a continuous, trusting relationship with a midwife throughout pregnancy is both reassuring and motivating for a pregnant woman. It enables her to receive vital information about her health and the health of her unborn baby, encourages her to make informed choices and decisions about her wishes for pregnancy, labour and birth, empowers her to trust in her body’s natural and powerful ability to nurture a developing life and bring it into the world, improving her self esteem and sense of self worth and often prompts her to think more broadly about her personal health and how her choices can affect her long term wellbeing.
Midwives are highly skilled healthcare professionals who, through caring for pregnant women, have unprecedented access to a range of prominent social issues affecting the general public as well as the ability to enhance the health and other outcomes of women and their families. The Government need to honour the ongoing work of midwives by ensuring sustainable investment in maternity services; creating jobs that are available for current students upon qualification, ensuring vacancy rates are filled and recruiting the midwives that services are so desperately crying out for. This will work to support a workforce that has become increasingly tired and overstretched and will soon become a liability if something drastic isn’t done. By failing to do so, not only are maternity services being put at huge risk, but so are the lives of women and babies and the health and happiness of families across the country.