More midwives needed to fulfil Lansley's one-to-one care pledge

Soaring birth rates coupled with an ageing workforce mean that maternity services across the country are under intense pressure. Last month, Health Secretary Andrew Lansley promised action, pledging a named midwife for every pregnant woman, as well as one-to-one midwife care during labour and birth.

He also promised better access to therapeutic care for women with postnatal depression and for those who have lost a baby.

For the first time, the NHS will be measured against how well it looks after parents who have miscarried, suffered a stillbirth or cot death. As part of this, parents will be asked to rate their care.

The government has already increased funding for midwifery training, with 5,000 trainees undertaking the three-year course needed to join the profession.

But the Royal College of Midwives (RCM) warns that this figure is still not enough to make sure that women receive Lansley’s vision of personal care from a named midwife.

Extra midwives needed
The RCM says that an additional 5,000 midwives are needed on top of those already training, as well as incentives to encourage midwives to retire later and persuade those who have left the profession to return.

“Midwifery has an ageing workforce,” says Sean O’Sullivan, head of policy at RCM. “There will be a proportion of the 5,000 in training who are just replacing those who are leaving.”

A further 5,000 midwives would mean that midwife-to-birth ratios in some areas could be brought down to the RCM’s recommended safe level of one midwife to every 28 births, O’Sullivan says. According to Department of Health figures, the ratio across England is 31 births per midwife.

Last year, the RCM estimated that 1,015 extra midwives are needed in South East England alone due to a 20 per cent increase in the birth rate in the region since 2001.

But further action is also needed because of a rise in more complex cases for midwives, involving women over 40 years old and those with obesity and diabetes, says O’Sullivan.

Another issue is that cash-strapped health authorities are not recruiting midwives, despite the need for an increase in professionals on the frontline. Some newly qualified midwives are struggling to find work and “others have to settle for part-time roles,” O’Sullivan warns.

An NSPCC survey of new mothers published last month was the latest to highlight poor quality maternity care and support for many vulnerable parents.

It found that mothers at risk of postnatal depression were among the hardest hit, with more than half of the 516 new mothers it surveyed saying they felt isolated with no one to turn to. Those from disadvantaged backgrounds were the least likely to have attended antenatal classes, it also revealed.

The findings echo 4Children’s Suffering in Silence report into postnatal depression, which was published last year. This found that one in 10 women suffer from the condition, but half of those affected by it had not sought professional help.
The report warned that healthcare professionals including midwives and health visitors were too often failing to spot the early signs of the condition or signpost therapeutic support.

Barbara McIntosh, head of children and young people’s programmes at the Mental Health Foundation, is disappointed that Lansley’s announcement failed to recognise the value of investing in perinatal health services, which run specialist mother-and-baby units for women with postnatal depression at crisis point.

These units offer vital “intensive support and focus on strengthening the bond between mother and baby”, she says, but there are only 11 such units in the country.

Instead, much of Lansley’s announcement centred on preventative work and ensuring that health visitors play a greater role in supporting mothers with postnatal depression, an idea that rests on the government’s long-standing pledge to recruit 4,200 extra health visitors by 2015.

Dave Munday, professional officer at the Community Practitioners and Health Visitors Association (Unite/CPHVA), says the government’s recruitment drive is bolstering local health visitor numbers. 

“One area of the South East I have been in contact with would normally have 30 health visitors coming through training into roles in a year,” he says. “This year there are 170.”

But there are concerns about the ever-growing range of demands that could be placed on new health visitors, from contributing to early years provision to working with troubled families, and now improving mental health support.

Joined-up working
Another focus of Lansley’s announcement was a greater focus on “joined-up working” across health, social care and family support services to support pregnant women.

Anne Longfield, chief executive of 4Children, will be lobbying to make sure that this drive includes an emphasis on building relation-ships between GP services and children’s centres. “We hear horror stories of GPs dismissing postnatal depression as ‘baby blues’,” she says. “We want to ensure there is proper training for GPs and that therapeutic support is accessible to women in the community.”

The Nursing and Midwifery Council (NMC) and the RCM believe that maternity networks, where maternity units in a region link up to share expertise, could help improve services.

Such networks already exist in some areas informally and could also help maternity services have a “bigger voice” when dealing with local clinical commissioning groups, which are being set up under the government’s NHS reforms, says O’Sullivan.

However, the government’s focus on increasing competition in the health service remains a concern for the CPHVA and RCM. Earlier this year, NHS Wirral became the first trust to award a contract to a private firm to run maternity services. “It will be hard for NHS services to compete with a private firm coming in,” Munday says. “But is that fair, given the level of cuts going on in the NHS?”

The RCM is worried that increased competition will fragment care and make it harder for women to access support. “The insurance needed to run maternity services can be high because of the risks involved and has put some private health providers off,” explains O’Sullivan.

“What could happen, though, is that private providers carry out some less risky parts of maternity services, which could further fragment care.”

Lansley has promised to involve groups such as 4Children and the RCM in his drive to improve maternity services, with a Department of Health spokeswoman promising that the government will “continue to listen closely to any concerns around maternity care and make further improvements”.

The children’s health sector may be impressed with Lansley’s enthusiasm for improving maternity services, but he clearly still has a long way to go if he is to convince them that his promises can become reality.

Baby boom

22%
increase in the birth rate in the past decade
5%
increase in the the number of practising midwives in the past decade
75%
proportion of mothers that had not previously met any of the staff caring for them during ?labour and birth
Source: Office for National Statistics, Nursing and Midwifery Council, Care Quality Commission

Maternity care – the current policy context