Midwife and Maternity Services

Henry Smith Excerpts

Tuesday 17th January 2012 Commons Chamber

[Henry Smith (Crawley) (Con)]

Thank you, Mr Speaker, for the opportunity to hold this debate on midwife and maternity services. It is particularly important because, as I speak, there is a baby boom in the UK. Last year, a baby was born every 40 seconds—the highest number in 20 years—and in certain areas of the country maternity units are under considerable pressure and midwives are working harder than ever. England has seen a 22% increase in the number of births, compared to Wales at 17%, Northern Ireland at 15%, and Scotland at 12%. The number of live births in England in 2010—the latest year for which figures are available—was well over two thirds of a million, representing an increase of 22% since 2001.

The Royal College of Midwives recently published its “State of Maternity Services” report, and I was pleased to be at its launch in Westminster Hall. The report looks at a number of indicators of the pressures on maternity care and the resources available to cope, and for the first time it does so for all four nations of the Union. The report finds that a significant increase in the number of births in each of the UK’s constituent parts and a trend towards older mothers are increasing the pressures on maternity services significantly. The extra work load placed on midwives by more older women giving birth has been exacerbated by an increased complexity in their work load.

The number of births to women aged 40 or over rose by more than 70% between 2001 and 2010—a level not seen since 1948. In England that has led to a substantial deficit in the work force needed to provide a safe level of care to women and their babies. Furthermore, the existing midwifery work force in England is ageing. We can therefore anticipate an even greater strain on services over the next 15 years, if the situation is not properly addressed. One region of England actually cut midwife numbers between 2001 and 2010. Between those years, the north-west experienced a 19% increase in the number of live births, but a reduced number of full-time equivalent midwives.

The only way to get large numbers of new midwives into the profession is through training student midwives, yet the record on student midwife numbers is patchy. In the 2005-06 academic year, for example, there was even a 16% cut in student midwife numbers, and it took five years for those numbers to climb back up to their 2004-05 level. With an ageing profession, a substantial and consistent rise in student midwife numbers is the only way of rectifying the enduring problem that there are too few midwives working in the NHS in England.

I very much welcome the increased number of midwives and trainee midwives introduced by the Government. That is fundamental. I also very much welcome the increase in NHS funding over each and every year of this Parliament, including the greater investment in maternity care as part of the solution. However, the financial limits resulting from the historically high debts that the previous Administration left us mean that innovative ways to address the work force shortages need to be considered.

I know that the Royal College of Midwives, for its part, is realistic about the financial challenges facing the NHS. The “State of Maternity Services” report recommends, for example, providing more midwife-led units and appropriately integrating maternity support workers as two ways to make better use of the limited financial resources available. The report also recommends at least maintaining, and in some regions increasing, the number of student midwives to ensure that more midwives are available to meet future needs.

Maternity services in England are approaching a critical point. London, along with many parts of the south and east, is particularly overstretched, with some maternity units currently having a midwife vacancy rate of over 20%. Maternity services in Scotland, Wales and Northern Ireland are in better shape. According to the Royal College of Midwives, an average ratio of one midwife to 28 births is a safe level. At the moment the figures for the UK are as follows: in England there is one midwife for every 33 births, in Wales there is one for every 30 births, in Northern Ireland one for every 28 births, and in Scotland one for every 26 births. There are clear variations in care across the UK that need to be addressed. It is clear that with adequate midwife numbers to match the birth rate, mothers and babies receive a higher standard of care.

The situation in England is a concern, but it is certainly not hopeless. The midwifery shortage can be solved; it is simply a matter of policy will and using resources innovatively. For example, giving expectant mothers real choice when deciding where to give birth could alleviate the shortage problem in England. In essence, a mother has three main choices when choosing the location of birth: a midwife-led unit, a consultant-led unit or at home. Most women choose a local hospital, usually for convenience and because of the perception of safety and security. Encouraging more births at midwife-led units, however, would help with NHS work force planning. Births at home or in midwife-led units require fewer interventions and are less demanding on midwife time. According to calculations, for every 10,000 births moved from a consultant-led to a midwife-led unit or to the home, the required midwifery work force would be reduced by the equivalent of 71 full-time midwives.

There are significant variations in home birth take-up, which suggests that the message of choice is not getting through to all mothers. For example, in Somerset 11.4% of births are at home. At the other end of the scale, however, in Wansbeck, just 0.1% of births are at home. By encouraging real choice we could enable mothers across the country to receive higher levels of care during and after their pregnancy.

Choice of location of birth—that is, of course, a specific coalition policy set out in the NHS White Paper—is far too important to be denied to mothers, particularly when it is readily available in other parts of the country. According to the Office for National Statistics the percentage of home births decreased to 2.5% in 2010 compared with 2.7% the previous year.

Research by Oxford University’s national perinatal epidemiology unit has given further weight to the evidence that suggests women at a low risk of complications should be given full and frank options when it comes to choosing where to give birth. The general secretary of the Royal College of Midwives, Professor Cathy Warwick, welcomed the research, saying:

“This ground-breaking research makes a very important contribution to the evidence base for women and health professionals about the safety of childbirth planned in different settings for women at a low risk of complications. The RCM hopes that its findings will be widely used and will help health professionals support women to make informed choices about their options when considering where to give birth. It should also influence the planning of high-quality maternity services across the UK.”

Maternity support workers who have been adequately trained, and are appropriately supervised and suitably deployed, can also provide a significant reduction of the pressure on midwife time.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this matter to the House. He will be aware that some 70% of midwives oversee the birth of a child without a doctor’s support. He has not mentioned that it can cost up to £45,000 to train a midwife. Some of our midwives, certainly some from Northern Ireland, are going to Australia to gain experience. Does the hon. Gentleman see some way of retaining midwives here in England, where, as he has said, there seems to be a shortage? Might there not be some way for the regions to help each other in this respect?

[Henry Smith]

The hon. Gentleman has raised an important point, which reinforces my view that there must be proper investment—the Government are already making a good start—to ensure that student midwives learn how to help mothers give birth in a safe environment so that in most cases there are no complications. It should be emphasised that consultant-led maternity units, although obviously vital, do not represent the full picture, and that midwife-led units play an important role in increasing capacity. Midwife training in each part of the United Kingdom should be at least maintained, and in some regions increased. It is necessary to maintain the numbers who begin training to ensure that an adequate supply emerges at the other end, and I repeat my commendation of the Government in that regard.

Let me end by referring to a matter related to my constituency. Yesterday evening, during the Opposition day debate on the NHS, I mentioned that 10 years ago, in 2001, the maternity unit at Crawley hospital had regrettably been closed and moved nearly 10 miles up the road to East Surrey hospital. The move has created extra pressure at that hospital, and mothers and their families have a more difficult journey to attend the unit at for check-ups and for births.

I am personally very grateful to East Surrey hospital. It is where my children were born. My daughter Georgia was born there in 2003, my son Isaac was born there in 2006, and I feel that it is important also to mention that my son Ethan was stillborn there in 2005. The care that the hospital provided for us was second to none. Nevertheless, I think it important for mothers and families to have access to midwife-led services that are closer to their communities. It is certainly one of my hopes and desires that we may be able to establish a midwife-led unit for Crawley—and, indeed, many more such units throughout the country.