THE BLOG

We Have an Opportunity to End England's Midwife Shortage

13/12/2013 18:50 GMT | Updated 12/02/2014 10:59 GMT

A quarter of new mothers are left alone in labour, according to a new survey from NHS watchdog the Care Quality Commission (CQC). That is about 175,000 women in England each year, and it is a rate that is up on the last time women were surveyed by the CQC three years ago. One woman in that position would be one too many; 175,000 represents failure on a massive scale.

The findings of this survey, based on the responses of more than 23,000 women who gave birth in February this year, echo those of by the National Audit Office (NAO), published last month. The NAO's investigation found that there were too few midwives in the NHS in England - a shortage, they estimate, in the thousands - and that we don't know whether or not we are training enough new midwives to meet future needs.

In 2012 there were more babies born in England than in any year since 1971, meaning that few midwives, perhaps none, practising in the NHS today have experience of this level of demand. Overall, the number of births rose 23 per cent between 2001 and 2012.

Given this rise, it may come as no surprise that my own organisation, the Royal College of Midwives (RCM), estimates that the NHS in England is the equivalent of 4,800 full-time midwives short of what it needs to provide care at the level that women expect and deserve.

There are some positive signs, not least that the number of births may fall this year, easing the scale of the workload. The number of babies born in England in the first half of this year is 18,000 down on the same period in 2012. That said, as the number-crunchers who put together the RCM's own State of Maternity Services report 2013 calculated, there would have to be a drop in births of almost 130,000 before the midwife shortage would be eliminated without the need to recruit more midwives.

There is hope too when it comes to training new midwives. There are around 6,000 at some stage of their training, but the big question there is: will employers offer these newly-qualified midwives jobs once they emerge from the universities?

If the number of births does begin to dip however, or even if it just remains stable, without continuing to boom, then we have an opportunity. Since the baby boom began in 2001, we have been running to catch up; new midwives have been hired, but their efforts have simply been absorbed by the ever-rising boom.

If the wind is leaving the sails of the baby boom and we continue to see new midwives trained and brought into the NHS then that shortage, of 4,800 midwives, will begin to fall dramatically. But all that depends not just on the boom easing, but also on whether the decision is taken to keep and not cut training places for midwives and to hire those who qualify.

Those with their hands on the levers of power within the NHS face a choice: they can keep up the investment in new midwives that we have seen in recent years, and drive down and potentially eliminate what has been an enduring shortage of midwives, or they can take the short-sighted, opportunistic option of ending efforts to tackle the shortage, cynically using the end of the baby boom as an excuse, with the result that the shortage is embedded long-term.

This is a moment of decision that will be felt by women using NHS maternity services in England for years to come. We must get it right.