"Obstetric care isn't the same at 3am as it is at 3pm, and it should be. This is a matter of huge concern," Falconer told the Guardian in his first interview since becoming president of the Royal College of Obstetricians and Gynaecologists.

"Care overnight isn't as robust as it is at it is at 9am or 2pm. It's not as good. At 2am, you do not have the same experience."

Problems can arise because trainee obstetricians and other key staff, such as anaesthetists, who do almost all the night duty are much less experienced than those in the day.

Junior obstetric doctors can lack the technical skills to use forceps or vacuum to ease a baby's birth, he said.

Disproportionate numbers of payouts by the NHS to settle cases of alleged medical negligence in childbirth involve babies born overnight, said Falconer, a consultant gynaecologist.

Such settlements often reach £6m.

The NHS should use most or all of the money spent settling such cases – around £300m a year – to hire 500 to 1,000 senior doctors, who would improve quality and safety of care by working round-the-clock in all big maternity hospitals, rather than just being available by phone to advise junior colleagues, he added ...

Guardian  31 Dec 2010    NHS 'Reforms'

Survival or development? The infant policymaker

Babies haven’t changed much for millennia.

Give or take a few enzymes this perfectly designed little bundle of desires and interests has not needed to evolve.

He’ll be fine provided there are some people there to care for him.

If not, evolution has taken care of that too.

You live in a cruel world and treat him roughly: he will develop into a compulsively self-reliant and ruthless individual with little concern for others.

Mean societies produce mean people ...

Family & Parenting Institute 

Deprived Children    Has the Coalition abandoned Children?

Where now for UK parenting?

Midwives' leader warns against 'baby factories'

The drive to centralise maternity services could create unfriendly mega-centres unable to give individual, personal care, says the Royal College of Midwives' general secretary, Cathy Warwick ...

mothmoth
6 May 2010 11:49AM

Lovely photo, the kind of nurse whose confidence is infectious.

Next task: to protect the individual relationships people forge with their midwife, and shelter new parents from invasive medicine of every kind.

The big problem with giving birth in a major teaching hospital is that trainee doctors want to learn on real bodies, so they hurry in with the surgical interventions.

This is terrifying to be on the receiving end of, and it's well-nigh impossible to argue with professional whitecoats while in labour; a well-trained midwife acts as a powerful advocate because she is in communication with her patient .

As clumsiness in the delivery room results for some women in PTSD and scarring that lasts a lifetime, this accounts for a proportion of those who say they were not satisfied with their hospital care.

Best practice should take into account the very natural and intimate atmosphere necessary for childbirth to go well.

If high-tech facilities are required, this is even more crucial to further the bonding parents and babies need afterwards.

Guardian 04 May 2010

NHS cuts putting vulnerable babies at risk

Bliss, a special care baby charity, said staff cuts in a third of England's 172 neonatal units were "significantly affecting the care of premature and sick babies".

Minimum standards set by the Department of Health require 70% of nurses and midwives in neonatal units to be qualified in specialist care, Bliss said, but more than half had failed to meet this target. Last year, the charity said 1,150 extra nurses would be needed to reach minimum standards, but a recent freedom of information request by the charity found 140 posts had been cut.

In addition, it said that while 450 nurses needed to receive extra training to meet the department's standards, one in 10 units said they were struggling to release staff for training because of budget cuts ...

Gdn  17 Oct 2011    A 'modern and compassionate party'    Cutting the Deficit

Midwives warn further cuts will put women's safety at risk

More than a third of midwifery heads surveyed said they would have to reduce the number of staff in the next 12 months – even though 60% say they do not have enough midwives to staff the unit even now.

Most senior midwives (79%) said they had job vacancies and that two-thirds of the posts had been empty for more than three months.

The rising birthrate means midwives are stretched and numbers need to increase, they say.

In July, the Office for National Statistics reported that the number of births had risen by 2.4% compared with the previous year – a continuation of the decade's steady rise ...

Gdn  28 Sept 2011    Coalition Log    NHS 'Reforms'

Midwife shortage 'dangerously high'

Midwife shortage 'dangerously high'

The RCM report said 4,700 more midwives were needed across England to keep up with added pressures, such as growing numbers of obese and older pregnant women.

Its figures showed the north-east and north-west had a shortfall of less than 10%, while the east Midlands and east of England needed 41% more midwives, it was reported ...

While the north-east needed 91 extra midwives, the south-east required 1,015 more.

A medium-sized maternity unit delivering 3,000 babies a year would need around 91 midwives, according to the RCM ...

Gdn  15 Sept 2011    NHS 'Reforms'    

The hospital is dead, long live the hospital

Revealed: secret government plans to win back women

Maternity units struggle as birth rate soars

Across the UK, maternity units were forced to close to new admissions 1,055 times last year, nearly always because of understaffing or lack of beds, a series of Freedom of Information requests have found.

At least 927 women were turned away.

In some London trusts, one in five midwifery posts lies vacant.

The Royal College of Midwives says at least 4,700 extra midwives are needed in England and Wales.

An as yet unpublished independent inquiry examining an increase in maternal deaths in the capital looked at 42 deaths of women over an 18-month period from January 2009 and found that substandard treatment was a major factor in 17 cases ...

Ind  25 July 2011    Coalition Log    NHS 'Reforms'    

Cameron 'breaks election midwife pledge'

Babies' lives put at risk by understaffed neonatal units

NHS maternity units falling short

Too few midwives, too many risks

Drinks firm Diageo funds pregnancy health initiative

Drinks retailer Diageo is to pay for 10,000 midwives in England and Wales to be trained to offer advice on the dangers of alcohol during pregnancy.

The Department of Health hopes the training initiative will in turn help more than one million expectant mothers over three years.

It is part of government moves to bring the private sector into public health ...

Public Health Minister Anne Milton said: "Midwives are one of the most trusted sources of information and advice for pregnant women. This pledge is a great example of how business can work with NHS staff to provide women with valuable information.

"This will help over a million women over the next three years to make an informed decision about drinking during their pregnancy. It will potentially improve their health and also give their baby the best start in life."

BBC NEWS  12 June 2011    Coalition Log

Cameron 'breaks election midwife pledge'

Minimum alcohol price fiasco

NHS chief admits UK is short of 4,500 midwives

Diageo hits out at UK tax regime

Diageo warns it could leave UK over tax

Diageo branded socially irresponsible for UK tax avoidance

The G8 Gleneagles Summit: Diageo Plc

British maternity wards in crisis

Latest Report

"David Cameron pledged" - a fitting epitaph.

The safety of maternity care in Britain's hospitals is under the gravest threat from an over-stretched, underresourced service which is putting mothers and babies in danger, experts have warned.

Fourteen NHS trusts have significantly raised baby death rates which are up to twice the national average. Shortages of staff, a rising birth rate, lack of training, inadequate equipment and poor leadership are leaving women in childbirth exposed to unacceptable risks ...

David Cameron pledged 3,000 extra midwives before the election but the Government has failed to honour the pledge. The Royal College of Midwives says 4,500 extra midwives are needed to deliver a safe, high-quality service.

The dangers were highlighted by the death in January of a healthy 27-year-old mother and her daughter following an emergency Caesarean at Queen's Hospital, Romford, Essex.

Sareena Ali suffered a ruptured womb which triggered a heart attack after being left for two hours without being checked ...

Independent  04 Mar 2011

Anger over plan to close small maternity units

Cameron drops plan to hire 3,000 extra midwives

Midwives urged by health service to let volunteers help with chores

The King's Fund wants the NHS to improve maternity care by, among other things, midwives undertaking some jobs currently done by doctors, such as examining newborn babies; nurses attending elective caesarean section operations instead of midwives; midwives supervising the labour and birth of many women now looked after by a doctor; and maternity support workers taking on extra roles.

The report wants hospitals to copy the experience of a few maternity units that are already working in different ways.

For example, the Homerton hospital in east London uses 40 "active labour volunteers", each working up to 18 hours a week.

"They provide support in labour by massaging women, encouraging and supporting them, and staying with them if a midwife has to leave the room to do other things," said head of midwifery Joan Douglas. Volunteers receive only travel expenses and lunch vouchers.

At East Surrey hospital in Redhill, "task-shifting" has increased the amount of time midwives spend with mothers-to-be from 32% to 50%.

A round-the-clock ward clerk has been hired to welcome expectant mothers and help them fill in their paperwork, allowing the midwives to concentrate on one-to-one care of women in labour.

Hospital managers had found that midwives were spending 32% of their time dealing with patients but 34% on clerical duties ...

sol2sol
6 March 2011 4:52AM

Dear Thinktank

I'm a bit blokey so midwifery doesn't appeal.

However I'm a dab hand with power tools so any amputations or cranial drilling and I'm all yours.

Piecesofeight
6 March 2011 8:43AM

No, no, no. We are already on the road to becoming a third world country with plans to replace formerly public services with volunteers in every other sector. There are not enough midwives therefore train some more.

Otherwise this is the thin end of the wedge to families being asked to bring in food for their relatives in hospital, no doubt a schools think tank will next suggest that unpaid reading helpers be asked to sit in classes, and that we could all help tidy our local streets by organising a rota to sweep our own street.

There is nothing wrong with voluntary assistance as an addition to a publicly funded essential service but not as a replacement for the lack of properly funded staff, which the above is.

This is a deplorable suggestion and I hope it is thrown back where it belongs and midwives training increased and soon. An honourable and highly respected profession.

Observer  06 Mar 2011

Cameron 'breaks election midwife pledge'

The Prime Minister made the promise to provide funding for 3,000 extra midwives before the election ...

Cathy Warwick, general secretary of the RCM, said the service is at "cracking point" but the government had reneged on its promise to create more midwifery posts ...

... an RCM survey found maternity units are facing cuts despite dealing with a high birth rate and more complex deliveries.

About 30 per cent of 83 of the most senior midwives said their units had seen a fall in their budget in the past year while 33 per cent had been asked to cut staff.

Two-thirds of those questioned said they did not have enough staff to cope with demand, despite a high birth rate ...

Telegraph  17 Nov 2010

Babies' lives are being put at risk as a result of a chronic lack of nurses in overcrowded neonatal units, a report claims today. The annual review by baby care charity Bliss claims that services are being stretched to the limit, with a shortage of some 1,150 nurses across England.

The government is warned that unless action is taken, vulnerable newborns will continue to be denied the care they need.

Bliss's sixth annual Baby Report suggests that specialist units looking after 70,000 babies every year are chronically understaffed. Only a third have enough nurses in place to meet the Department of Health's own minimum standards, it claims.

And more than half of these shortages are found in the most specialised centres – intensive care units.

A 2009 government report recommended that neonatal units should have no more than 80% of their cots filled. This would allow for occasional peaks in activity and would give babies and their parents the level of care needed.

But research found that four in every five specialist centres were operating at a higher occupancy level than set out in the guidelines, with at least 100% of cots full for at least a month during 2009.

In addition, three-quarters of units had to close to new admissions at one point last year.

Guardian  02 Nov 2010        

New mothers let down by postnatal care

Many new mothers are being let down by the care they receive after having a baby, a survey suggests.

In a survey of 1,260 first-time mothers by the National Childbirth Trust (NCT), under half said they got the advice and support needed after giving birth.

The parenting charity said the survey showed a "shocking" level of postnatal care and warned the NHS had to improve.

The Royal College of Midwives said more money should be invested in maternity services.

BBC NEWS  03 Oct 2010    

Midwives have no time to care for new mums

Postnatal care: New mums' views

Dads do the baby ward night shift

Midwives accuse ministers of hypocrisy over training cuts

Hewitt promises more choice for expectant mothers by end of 2009

Single mothers have a poor experience of NHS maternity care

Lone mothers say they are less likely to get the pain relief they want, be treated with dignity and respect, trust medical staff or have the right to choose where they give birth, according to a study in the Journal of the Royal Society of Medicine.

They are also more likely to be left alone during labour by midwives and doctors when they are feeling worried.

Single new mothers were much more negative about key aspects of the quality of care they experienced before, during and after the birth, compared with those who had a husband or partner.

They were also less likely to be given information they wanted during labour and birth, be offered a choice of food while in hospital or see a midwife as often as they wanted once they got home with their baby.

The findings are drawn from previously unpublished detailed responses about 26,325 new mothers' experiences which were collated in 2007 by the Healthcare Commission (HCC), the then NHS watchdog in England, as part of what became a highly critical report into maternity services ...

One in eight of the 26,325 mothers were single ...

Guardian  08 May 2010        

JRSM

Premature baby charity Bliss found just 20% of UK hospitals had enough staff to meet recommended care guidelines.

The study of 194 neonatal units showed that more than 50% had been forced to close to new admissions during a five-month period because of shortages.

The charity said it was shocking that such problems were persisting. The government insists care is safe.

Each year, more than 80,000 babies - 10% of the total born - need specialist care in a neonatal unit - usually because they are underweight or premature. ...

To meet the recommended guidelines the charity said it believed an extra 1,700 neonatal nurses were needed in addition to the 6,500 already employed.

More doctors were also needed, it added.

But it warned there had been a lack of progress made in neonatal care over the years.

This is the fourth report the charity has produced highlighting the issue. Over the last year fewer than 200 extra nurses have been recruited. ...

BBC NEWS 15 October 2008

Caesarean section rates show no signs of coming down, according to official statistics, in spite of concern that they are too high.

The NHS Information Centre said yesterday that just under a quarter of deliveries, 24%, were caesareans in 2006-7, as they were the year before. About half of those were emergencies and the rest pre-planned. Efforts to persuade more women and their doctors to attempt a normal delivery seem to have had little impact. The UK rate is considerably higher than the World Health Organisation's target for no more than 10-15% of deliveries to be by caesarean section.

The Royal College of Midwives said the rate was "worryingly high" and linked it to a shortage of midwives. "There is clear evidence that some caesarean sections are unnecessary and put women and babies at risk," said Cathy Warwick, general secretary designate of the RCM.

The National Childbirth Trust agreed the rate was too high. It was also concerned by figures from the NHS Information Centre showing women were going home sooner after caesareans - just over a quarter spent four days or more in hospital, compared with just under a third in the previous year. "Women who are recovering from caesareans will need more help and support and guaranteed midwife home visits, especially if they have had previous health problems," said chief executive Belinda Phipps.

Guardian 26 September 2008

Funding promised by the Government to improve poor standards of care for mothers and newborn babies is failing to reach maternity units, The Times has learnt. ...

Rising birth rates and a shortage of midwives have put huge pressure on the system, meaning mothers are often left without care during labour.

The Times submitted questions under the Freedom of Information Act to all 152 Primary Care Trusts (PCTs) in England, the local bodies that distribute 70 per cent of the total NHS budget.

Of 85 trusts who responded, only eight claimed to have received additional funding for maternity this year as Mr Johnson promised.

The extra money was for the implementation of “Maternity Matters”, a policy that recommends that every woman giving birth in England should have one-to-one care from a dedicated midwife.

Ministers also aim to give greater choice over where babies are born, with more home births and deliveries in local units staffed by midwives rather than hospital consultants expected as a result.

One head of midwifery in the South West, who did not wish to be named, said: “Despite all of the Government’s announcements, we have not seen any of this additional funding. ...

The Times 06 September 2008

Some NHS trusts in England need to do more to make maternity services safer and improve choices for mothers, says the Healthcare Commission.

A survey of 150 trusts by the watchdog found low staffing levels and poor facilities in some hospitals. ...

The report revealed some trusts had as few as two beds available per 1,000 births, meaning that each bed was used, on average, by more than one woman in 24 hours.

Only 16% of units had one bathroom per delivery room, and fewer than half of the women surveyed reported that the toilets were "very clean". ...

BBC NEWS 10 July 2008

An independent report has highlighted a huge variation in the quality of maternity care across England.

Trusts in London came out particularly badly, something that Sam Brown experienced firsthand when she gave birth to her first child.

She had been due to go into the midwife unit at her local hospital in East London but when she went into labour, staff shortages meant she ended up on the main labour ward.

She was then left to her own devices.

Feeling the need to push, Sam sent her fiancé, Adam, to fetch a midwife.

"I will never forget this. She said: 'You're in a dream world girl, it's your first child, it's going to be hours'.

"They didn't talk to me like I was a real person, the fact I wanted help was a real inconvenience to them."

A passing cleaner had to tell her how to use the gas and air and the entire hospital was "filthy", she says.

After about 40 minutes of being left in agony and "absolutely terrified", Adam called for another midwife who had just come on shift.

It was then discovered the baby's heart rate had started to drop and the consultant was called ...

BBC NEWS 25 January 2008

The Liberal Democrats have uncovered figures revealing how much the workload of midwives has increased in the last six years, with midwives in some areas having to deal with up to 25% more births each since 2001.

Figures from Parliamentary Questions show the number of births per midwife across England has increased:

England overall: 6.5%
East Midlands: 25%
South Central: 19%
North East: 16%
South West: 15%
Yorkshire and the Humber: 10%
West Midlands: 10%
North West: 8%

Commenting, Liberal Democrat Shadow Health Secretary, Norman Lamb said:

"These figures show that our maternity services are under huge strain around the country.

"There simply aren’t enough midwives to deliver on the Government’s promises of one-to-one maternity care.

"With the birth rate rising and many midwives set to retire over the next decade, the situation will only get worse. A chronic shortage of midwives could also force the closure of small childbirth centres across the country.

"The Government needs to stop burying its head in the sand and launch a national review of capacity in maternity services."

Lib-Dems 09 January 2008

Scores of premature babies may be dying unnecessarily across England because the NHS mismanaged a reform of neonatal units in 2003, parliament's spending watchdog reveals today.

Health ministers provided £73m over three years to link up hospital neonatal units in 23 regional networks that could provide specialist services to save premature and low birth weight babies.

But the National Audit Office finds that the Department of Health did not issue instructions for the units to be adequately staffed. As a result the service was overstretched. Its specialist nursing workforce was nearly 10% below strength.

There were not enough cots to respond to every emergency and there was a lack of specialist 24-hour transport to move babies and mothers to other hospitals.

Jacqui Smith, when health minister in 2003, said she agreed with recommendations from the British Association for Perinatal Medicine for minimum staffing ratios. But the government did not order NHS trusts to implement them.

The NAO says there was "confusion" over whether staffing ratios were mandatory, making it difficult for unit managers to convince NHS trusts they needed more staff.

Half the 180 units providing neonatal services did not meet the approved ratio for high dependency care of one nurse to two babies. And only 24% met the intensive care ratio of one nurse to one baby. ...

The Guardian 19 December 2007

Thousands of women are left alone during and shortly after labour, leaving them feeling vulnerable and potentially at risk, a survey shows.

A Healthcare Commission poll of 26,000 women found one in four had felt worried when left alone by medics.

Midwives said the findings raised concerns as one-to-one care was key to spotting problems that may arise.

The poll also identified significant variations in care among 148 NHS trusts across England. ...

Louise Silverton, of the Royal College of Midwives, said: "It is a serious concern that too many women are left alone during labour, leaving them feeling worried and vulnerable.

"The main way to solve these problems is simply to improve midwife numbers.

"Without this the government's targets will just be broken promises, and we have seen this too often in the past." ...

BBC NEWS 27 November 2007

... the price paid by the NHS for deliveries going catastrophically wrong has risen 59 per cent to £259m – enough to fund the consultants and midwives needed to save thousands of babies and mothers from harm.

The dangers of childbirth in the modern health service are highlighted today by figures showing that £665m has been paid out over the past three years to settle medical negligence claims where obstetric deliveries have gone catastrophically wrong.

The size of the payout – enough to hire 1,000 extra consultants – reflects the enormous and growing burden of medical negligence on the health service, which is diverting scarce resources from patient care. ...

Last year, for the first time, the NHS Litigation Authority ranked maternity units in a league table according to their level of risk, based on a new standard for maternity care. Out of 154 maternity units in England, 18 are currently ranked Level 3 (the safest) and 54 are ranked Level 1 (least safe), with the remainder ranked Level 2. ...

The Independent 08 October 2007

The Health Secretary has approved plans to close “vital” hospital services, which will cost lives, an MP has said.

A long-running review of NHS services in Greater Manchester and Cheshire ended yesterday with Alan Johnson’s endorsement of an independent panel’s recommendation to close maternity units at Fairfield in Bury, Rochdale Infirmary, Trafford and Salford Hope. Salford will also lose its neonatal intensive-care unit.

The Independent Reconfiguration Panel has also backed plans to down-grade Rochdale’s accident and emergency unit and end emergency surgery at Fairfield Hospital.

The changes are expected to happen within five years and are likely to mean more home births and deliveries in units staffed by midwives. ...

Sunday Times 26 August 2007

No doubt Alan "postman pat", will not make his constituents suffer the same indignity. Will he sleep at night when the first deaths occur in direct response to these cuts?

roger, york

Up to 1,000 babies that are born dead each year could be saved if doctors and midwives were better trained to spot vital warning signs, according to one of the UK's leading experts on stillbirths. Health experts say the numbers of stillbirths in the UK are alarmingly high – 10 times the level of cot deaths – and most are unexplained.

New research to be presented at an international conference in Birmingham next week will hear that "sub-optimal care" is a key factor in many of the deaths. In many cases, midwives are having to deal with too many births.

The conference will hear important new evidence of a vital link between foetal growth restriction and stillbirths that can provide doctors with an early warning system that could save countless lives and spare families the loss of a child.

Almost 4,000 babies were stillborn in Britain last year according to the latest government figures. Despite falling since the 1960s, the rate of stillbirths has remained stubbornly unchanged for more than a decade ...

The Independent 23 September 2007

Just months after the IoS highlighted the crisis facing Britain's maternity services, a row has broken out over the Government's decision to axe bursaries for trainee midwives at a time when the profession is desperately short of staff.

Dame Karlene Davis, general secretary of the Royal College of Midwives (RCM), said: "The Government's decision to scrap bursaries for trainee midwives and further limit job opportunities after they qualify, while leaving them to deal with chronic shortages across the country, multiple closures of maternity units and a rising birth rate, smacks of hypocrisy." ...

The Independent 23 September 2007

The health secretary, Alan Johnson, yesterday chose the eve of a bank holiday weekend to announce the closure of a series of maternity units across the Greater Manchester area.

Among the units to be axed is the one at Hope hospital, which is in the Salford constituency of Mr Johnson's cabinet colleague, the communities secretary, Hazel Blears. Its threatened closure last year prompted Ms Blears to break with the government and join a picket line in protest. However, the group which advised Mr Johnson recommended that Ms Blears's constituency should still have a stand-alone midwifery unit. ...

The Guardian 25 August 2007

A government plan to cut senior staff in paediatric wards and neonatal units and replace them with trainee doctors will put infants at risk, doctors and patient groups have warned.

Under the Government's controversial Modernising Medical Careers (MMC) programme, senior staff on some paediatric wards will be replaced by trainee doctors from August.

The move is part of a government plan to reform training for NHS doctors. Patricia Hewitt, the Secretary of State for Health, said recently that this was needed "not just for junior doctors themselves, the workhorses of the NHS working quite outrageously long hours, but also for the sake of patients".

Busy paediatric wards have up to seven specialist paediatric senior house officers (SHOs) - doctors with up to four years' experience. Most could be replaced under MMC.

In future, trainee doctors with one or two years' experience will spend four months in paediatrics before moving on to another specialism, and would not necessarily have any interest in that area of medicine.

The move has alarming implications for the 45,000 babies born prematurely each year. Babies born at 23 weeks have a 17 per cent chance of survival and require expert medical support, while half of all babies born before 30 weeks suffer from apnea, which causes them to stop breathing. ...

The Independent 17 June 2007

Extra workers drafted in to help hard-pressed midwives could actually be putting mothers and babies at more risk, a report has claimed. Maternity support staff are supposed to free up midwives' time by helping with paperwork and non-clinical duties.

However, Kings College London found some trusts in England try to use them to care for pregnant women, even though they are not sufficiently trained. Experts stressed support staff should never replace midwives or doctors. ...

BBC NEWS 29 May 2007

Maternity Support Staff, or maternity care assistants, were first introduced into the NHS in 2005 in response to growing concerns over staffing on maternity wards. ...

The new role was brought in to ease midwife workload by taking some of their duties. While this varied from hospital to hospital, this could mean anything from clerical work and answering the telephone, to helping out in ante-natal clinics by helping to run parentcraft classes and accompanying midwives on community visits. ...

BBC NEWS 29 May 2007

The Royal College of Midwives says the shortage of staff and facilities on labour wards has reached "crisis" point. The Royal College of Obstetricians has warned of a lack of skilled obstetricians and a looming recruitment crisis as the number of UK medical graduates choosing obstetrics has halved in a decade. On Wednesday, MPs demanded urgent action to address the problem in a Commons debate. A BBC Panorama programme broadcast this week, filmed undercover in two hospitals in north London and Manchester, claimed wards were buckling under the midwife shortage. ...

The Department of Health says that there are 2,084 more midwives working in the NHS since 1997 (to 2006) and there has been a 44 per cent increase in students training to be midwives. The Royal College of Midwives says that though numbers rose in the earlier part of this period, they fell by 375 between 2004 and 2006. A poll of 102 out of 216 department heads found that two-thirds said their units were understaffed and one in five said they had lost staff in the past year.

The college complains that while other parts of the NHS have seen huge increases in staff and resources over the past decade, midwifery has not benefited to the same extent. The proportion of the NHS workforce represented by midwives dropped from 2.1 per cent in 1997 to 1.7 per cent inn 2005.

Doctors claim that only one midwife in three is working at any time, as more choose to work part-time for agencies, which supply staff to the NHS to cover holidays, sickness and unsocial hours. A midwife working long hours could potentially earn up to £80,000 a year at agency rates compared with £24,000 to £26,000 for the NHS. ...

The birth rate is going up. There were almost 50,000 extra births in England in 2005 compared with 2001, a 9 per cent increase in five years from 564,871 to 614,237. ...

The Independent 04 May 2007

Women may no longer be entitled to one-to-one care from a midwife during labour, after a shift in Government policy set to be announced this week.

The Royal College of Midwives says any plans to go back on earlier pledges by allowing hospitals to use cheaper and less-skilled maternity support workers will increase the risks for women and babies.

Several recent reports have suggested that standards of maternity provision are falling as NHS trusts battle huge deficits, and more women are encouraged to have their babies at home. One report by the Conservatives suggested that around one in six of England's 282 maternity units could be shut down.

In its 2005 manifesto Labour promised that by 2009 all women would be cared for by a midwife throughout the pregnancy, and receive continuous care during the delivery. But "Maternity Matters", the strategy to be announced by Patricia Hewitt, the Health Secretary, this week, is ex-pected to suggest that some women could give birth without the care of a midwife.

Ivan Lewis, the health minister, said "a skilled professional" - either a midwife or a maternity support worker - would be present throughout every birth. "What matters is that the woman feels she is well cared for," he said. ...

Telegraph.co.uk 02 April 2007

'I am horrified by the scale of the crisis in our maternity services. Choice has been rendered meaningless by midwife shortages .... There are beacons of hope, but I am convinced things will get worse before they get better. And that will be reflected not just in statistics, but in human tragedy."

This was my doom-laden conclusion to The Truth About Childbirth, a documentary I researched and presented for Channel 4 in the winter of 2004. A far cry from my habitual Sukie Sunbeam brand of blitheness. "Are you sure you want to set out such an apocalyptic vision?" asked one of the commissioning executives. It was as if he hadn't watched the rushes.

The programme explained that all childbirth professionals agree that the most important factor in labour was one-to-one continuous care - this came from midwives, obstetricians, the National Childbirth Trust and natural birth gurus. In other words, mothers should be attended throughout by a devoted birth professional - ideally, a trained midwife. In reality most maternity units were woefully understaffed and it was commonplace to hear of midwives running between four women in labour. The Royal College of Midwives said forlornly (and still does) that at least 10,000 extra practitioners are needed to bring the maternity services up to scratch. ...

The Independent 25 March 2007

The lives and health of thousands of women on maternity wards are being put at risk every year, with many suffering permanent physical and mental scars.

According to a study by the National Patient Safety Agency (NPSA) ... 18,000 mothers have been physically injured as a direct result of being in maternity care. This figure includes 246 cases where pregnant patients died and another 1,000 where women suffered "serious harm", including from perforated bowels during surgery. This means that in some cases women have needed a temporary colostomy.

The findings are based on the NPSA's study of 60,000 maternity care blunders that occurred between November 2003 and June 2006. Even the 10,000 injuries rated as "low harm" in the NPSA report, including perforated bowels repaired during birth, would be considered traumatic by most people.

The patient safety watchdog claims that the majority of women receive "high-quality maternity care" from the NHS. But experts insist that these complications and, in many cases, avoidable deaths of women during childbirth are a growing phenomenon. They blame them on a lack of qualified medical staff, including midwives and obstetricians, and the rise in the number of cases of Caesarean sections.

Professor Jason Gardosi, a senior obstetrician, said the problems with maternity care in the UK were "endemic", that the injury and death figures were "the tip of the iceberg" and that substandard medical care was not being detected because of a lack of proper monitoring.

Ind 04 March 2007

There has been a rise of 21 per cent in deaths of pregnant women in the care of NHS maternity services. Deaths over the past three years now total 391, up one fifth on the comparable period, and 17,000 women have suffered physical harm while on labour wards. ...

Experts are warning that 10,000 more midwives are needed to prevent a further rise in blunders and deaths. They say there is also a shortage of trained obstetricians, desperately needed now that doctors perform more Caesarean sections, largely because of staff shortages. More than one in five births in Britain are by Caesarean section, a figure significantly higher than World Health Organisation guideline of 15 per cent.

The NHS Institute for Innovation and Improvement, set up to improve healthcare for patients, said that about two-thirds of maternity units either have too few staff or have an "inappropriate" balance of skills.

Professor Jason Gardosi from the NHS's Perinatal Institute, which aims to reduce deaths in childbirth, warned that failings in British maternity care were "severe and endemic" and that substandard medical care was going undetected because of a lack of proper monitoring.

He told The Independent on Sunday: "Staff are doing their best within the confines they are given but in many instances, mothers and babies survive only because they are lucky. You would not allow an aeroplane to fly without a full crew, but midwives have to make do without a full staff. It is little wonder we see so many avoidable deaths." ...

The Independent 04 March 2007

Some English hospitals should be stripped of doctor-led maternity care and specialist children's services, a government adviser says.

Dr Sheila Shribman, the children and maternity tsar, calls for regional super-centres instead.

Hospitals that lose maternity units may get midwife-led services and more support for home births will be provided to give women greater choice.

Dr Shribman said the move would improve care, not damage it as critics say.

Some have argued that hospital cuts are being driven by NHS deficits - the health service finished last year over £500 million in the red.

But Dr Shribman said EU restrictions on working hours meant specialist services could not be safely provided in every local hospital. ...

BBC NEWS 06 February 2007

Serious flaws found in NHS maternity care

Women giving birth on virtual conveyor belt

Maternity services report: Key points

Mothers at risk in care crisis

Four maternity units to be shut ...

Baby units 'near breaking point'

Health trust chief and MPs attack maternity unit closures

The crisis on our maternity wards

Figures show Hewitt's birth care promise is unattainable

Hewitt promises more choice for expectant mothers by end of 2009

Big shake-up for maternity care

Alert on depression in pregnancy