Maternity Units Seriously Short of Staff

A report by the Commons Public Accounts Committee has said most maternity units do not have enough senior doctors, with poorer care at weekends leaving women at higher risk of complications. The report said women and babies were being left at higher risk of infections and injury at weekends because of shortages of staff, with just 47 per cent of units having enough consultants, and a national shortage of 2,300 midwives. MPs said shortages of midwives and lack of beds meant more than a quarter of maternity units had to close to new patients for half a day or more between April and September 2012.

Half of maternity units are short of senior doctors warn MPs The Telegraph 31 January 2014

Midwifery workloads well above recommended levels

Health organisations recommend that each midwife should handle no more than 28 births a year in order to help ensure safe high-quality care for women. However, in 2012 only the north-east reached that level, with a rate of 28.1 births per full-time equivalent midwife. Maternity units in the NHS South Central region are furthest away from meeting that target, with each midwife handling 40 births last year. But the south-east (36.2 births each) and east of England (35.8) were also nowhere near the figure.
The amount of money going to maternity units in five of the NHS's 10 English regions of the country fell by up to 15% in 2012-13 compared with the previous year. The East Midlands saw the biggest drop, 15% less in 2012-13 than 2011-12. London, North-East, South-West and Yorkshire and the Humber regions also saw lower spending.
The National Childbirth Trust, the baby and parenting charity, accused ministers of breaking pledges to improve maternity care. "It makes no sense that, while birth rates are rising, maternity services are being cut back", said Belinda Phipps, its chief executive. "It is shocking to find that just one English region is meeting recommended staffing levels for maternity care and particularly disappointing after the pledges made by the government to increase midwife numbers", she added.
maternity-care-funding-nhs-cuts The Guardian 13th November 2013

Breath tests to target smoking in pregnancy

Pregnant women should be tested to see if they are smoking, and if they are they should be helped to quit, according to the body which issues guidance to the NHS. The National Institute for Health and Clinical Excellence (Nice) says midwives should give carbon monoxide tests to all women they see at antenatal appointments. An estimated 21% of women smoke during pregnancy. This harms foetal growth and development, with smokers three times more likely to have a baby with low birth weight — a leading cause of infant death.
Pregnant mothers to be tested to see if they are smoking, under new NHS guidance - The Independent 12 May 2013

Postnatal depression more likely after unplanned pregnancy

Women who get pregnant unintentionally are four times more likely to suffer from postpartum depression, according to new research. The study, published in BJOG: An International Journal of Obstetrics and Gynaecology, found that postpartum depression was more likely in women with unintended pregnancies at both three and twelve months after birth.
The study, conducted at the University of North Carolina prenatal clinics questioned participants about pregnancy intention at 15-19 weeks gestational age. The increased risk was highest at 12 months and indicates that this group of women have a long term risk of depression.
When age, education level and poverty status were factored into the results, women with unintended pregnancy were still twice as likely to have postpartum depression at twelve months.
Louise Silverton, director for midwifery at the Royal College of Midwives, said:
"We are seriously short of midwives in England and we know that postnatal care is suffering because of this. We are hearing of midwives having to make fewer postnatal visits, if at all. This is a concern because the problems this research highlights may go undetected and the consequences of this can be serious, for the women, for families and for the health service."

Unintended pregnancies increase the risk of postpartum depression - Female First 8th May 2013

Shortage of midwives means some women get more postnatal visits than others

Almost two-thirds of new mothers feel let down by the NHS after giving birth, according to a report. In some places women get three postnatal visits at home, while in neighbouring areas new mothers will see a midwife just once. The report from the National Federation of Women’s Institutes and NCT said the vast majority of maternity units are having to cope with shortages of midwives.
Belinda Phipps, chief executive of the NCT, said ‘We are extremely concerned about the shockingly high number of women who have been let down by their maternity care.
‘It is equally worrying to see that the level of care given to parents varies so significantly by postcode.’
Cathy Warwick, chief executive of the Royal College of Midwives, said ‘We are 5000 midwives short in England. Without enough midwives to cope with the increasing demands on maternity services I fear that we will not see the situation depicted in this report improving.
‘Postnatal care has been an area of concern for some time. This is a vitally important period for women who need support, guidance and advice when they return home after giving birth. Too often resources are taken away from this key area leading to fewer visits by midwives and less contact with them for women."
2 May 2013 The Daily Mail

Independent Midwifery Under Threat

As of October 2013, it will become illegal for midwives to practice without insurance, due to an EU directive. Because there are too few Independent Midwives – around 200 – and just one claim could stretch into the millions, the premiums on offer would be prohibitively expensive. Currently IMs work without insurance and their clients sign a form in acceptance of this. IMs argue that insurance is a profit-making industry, and that it is good standards of practice that make midwifery safe, not insurance policies. They also point out that by making insurance a compulsory prerequisite of registration, there are implications for the freedom of all midwives, not just independent ones. Potentially, the legislation could further erode birth freedom for women too, with insurance companies gaining a say in where and how they might be happy for births to take place.

There is a petition asking for government help in securing workable and affordable commercial insurance to find a way forward.

The Telegraph 25 March 2013

Independent Midwives – Crisis in Maternity Care

by Emma Ashworth

Last week, we published Emma Ashworth’s birth story. She gave birth at home with an independent midwife. As it will effectively become illegal for independent midwives to practice from September 2013, she is campaigning to save independent midwives.

What are Independent Midwives (IMs)

IMs work outside the NHS, caring for women and their partners throughout pregnancy, birth and the post natal period. Usually IMs support women who are delivering their babies at home, although they will stay with their clients if a hospital transfer is required.

Why are IMs important?

Despite the Government’s targets, it is not common for mothers to see the same midwife throughout her pregnancy, and usually she will have a different midwife (or multiple midwives) for the birth, even if she chooses a home birth. Antenatal appointments may be just 10 minutes long, which does not allow either the midwife or the mother to really discuss any issues or questions properly. IM appointments can be however long the IM and the mother agree – usually an hour or longer – giving plenty of time to really develop a deep relationship between the IM and the parents, as well as to give time to get really in-depth clinical support. The trust that can build up between an IM can make a huge difference to a labouring mother, allowing her to relax better in labour, making it more likely that the mother will experience a safe, positive birth.

During labour a mother will know who will be with her, and her midwife will usually stay with her throughout the labour, giving 1:1 care rather than 1:4 or so in a hospital. That continuity of care is very important to many parents and has been shown to give a better birth outcome.

IMs have skills which in many cases have been lost within the NHS. Many IMs will be skilled in assisting women who are delivering multiples or breech babies (bottom first) vaginally. Because they are able to really get to know each and every pregnant woman that they work with as individuals they are able to really evaluate the risk of anything which deviates from straightforward in a person by person way, rather than solely on the basis of risk across the whole community. Using the relationship then built up with the parents, mutual respect and understanding, a very personal care plan can be implemented giving the best chance of the very best outcome for mother and baby. A healthy mother and baby and a positive, enjoyable and empowering birth experience.

Some women choose IMs because they recognise that they are more likely to have a positive, natural birth. Others choose IMs because they have had a traumatic experience within the NHS (in a previous birth or for other reasons) and they are afraid that their experience may be repeated. There is a serious risk that without the option of IMs, these women will be forced to risk delivering their babies in fear (which is much more likely to lead to problems with the labour), and some women have indicated that they would rather deliver alone, without medical care, than engage with the NHS again.

No IMs = No Choice of care leaving the NHS as the only option for maternity care within the UK, a situation not found in virtually any other area of health care in the UK.

Independent Midwifery is in Crisis!

In September 2013 it will no longer be legal for IMs to practice. For years IMs have had no choice but to practice without insurance. This is because there were not enough IMs in the country for any insurance company to believe it worthwhile to put together a specialist insurance package. Parents have had to accept this situation for the past 10 years, reassured by the statistics showing the excellent outcomes with IMs. Tragically, in September 2013 a European Directive comes into force which makes it illegal for a whole range of practitioners – which just happens to include IMs – to practice without insurance. This essentially makes Independent Midwifery illegal and takes away any choice in maternity care in the UK.

What can be done?

The situation is now desperate because once we get to early 2013 IMs will no longer be able to take on clients if they are due from September onwards. Various supporters of Independent Midwifery including NCT, AIMS (Association for the Improvement in Maternity Services), Independent Midwifery UK and many passionate individuals have been trying to work out solutions, both through legal channels and the Government but the problem has been that not enough parents have been aware of the problem and that’s where we need you.

Could you:

• Write to your MP and MEP stating your concerns and asking them to get involved with finding a solution (see letter template below)

• Contact Independent Midwifery UK to offer any skills or time you may have (http://www.independentmidwives.org.uk/)

• Tell as many people as possible! Spread the word, talk about what’s happening and try to encourage other people to write letters, too

• Check out Facebook Groups like http://www.facebook.com/groups/fightingforims/

We cannot lose our Independent Midwives. We must find a solution, for ourselves, our daughters and our grand daughters we need choice, and most importantly we need those skills that, once lost, can never be recovered.

See: http://www.nct.org.uk/sites/default/files/Independent%20midwives.pdf for the NCT statement on Independent Midwifery

MP Letter Template  

You can find details of your MP here, your MSP here, your AM here or your MLA here. Many MPs, MSPs, AMs and MLAs also have websites which give their contact details including email address. You can also attend a constituency surgery to discuss your concerns with your representative – again their website usually explains how to arrange an appointment. He or she may also be on Twitter (you can check here for MPs and here for MLAs), in which case you can remind them about the fight to save independent midwifery publicly too.

[YOUR ADDRESS]

[DATE]

[NAME OF MP/MSP/AM/MLA]
[House of Commons
London
SW1A 0AA]

[Scottish Parliament
Edinburgh
EH99 1SP]

[The National Assembly for Wales
Cardiff Bay
Cardiff
CF99 1NA]

[Northern Ireland Assembly
Parliament Buildings
Ballymiscaw
Stormont
Belfast
County Down
BT4 3XX]

[By email to [MP’S/MSP’s/AM’s/MLA/s EMAIL ADDRESS]]

Dear [NAME OF MP/MSP/AM/MLA]

INDEPENDENT MIDWIFERY

I am one of your constituents and I am writing to draw your attention to the imminent threat to independent midwifery in the UK. This threat comes against a background of an increasing birth rate and a shortage of midwives within the NHS, leading to a higher demand for independent midwifery services. Currently, women have the option to opt out of the NHS system of maternity care by using an independent midwife. The reasons why women may wish to do this are many and varied but the key benefit to them of using an independent midwife is continuity of care throughout their pregnancy and labour. You can find further information from the professional association for independent midwives, Independent Midwives UK: www.independentmidwives.org.uk. The UK Government heralds independent midwifery care as the gold standard towards which the NHS should strive.

However, by October 2013 it will become illegal for independent midwives to practise as they do now. EU Directive 2011/24 on patients’ rights in cross-border healthcare, once implemented in the UK, will require all healthcare professionals to have professional indemnity insurance or an equivalent guarantee or other scheme to be in place. The legislative proposals for implementation of this Directive have not yet been published for consultation but it is assumed that insurance cover will be made a condition of registration as a midwife with the Nursing and Midwifery Council. In 2002 the last commercial insurer offering insurance to independent midwives withdrew from the market as it was not commercially viable given the small numbers of independent midwives in the UK. As a result professional indemnity insurance is no longer commercially available for self-employed independent midwives. 

The Government in England has worked with Independent Midwives UK to provide a solution whereby independent midwifery-style care can be commissioned into the NHS (through schemes such as Neighbourhood Midwives and One-to-One). It is not yet clear whether all women will be able to access this care or what areas it will cover. Independent Midwives UK has invested a colossal amount of time and energy in looking for a solution and continues to explore options with commercial insurance brokers to make professional indemnity cover available to independent midwives who continue to work entirely outside the NHS, but there is no guarantee that this will be available by October 2013. The situation at the present time is that women will lose the option to have their maternity care with an independent midwife outside the NHS from next year. Many independent midwives will of course lose their employment. [It is not clear what action is being taken by the healthcare administration in [Scotland/Wales/Northern Ireland] and I should be grateful if you would investigate this and report back to me on what is currently being done.]

[ADD A COUPLE OF SENTENCES ABOUT HOW THIS ISSUE AFFECTS YOU PERSONALLY E.G. IM FACED WITH LOSING LIVELIHOOD, USED A IM FOR PREVIOUS BIRTHS, WOULD LIKE TO USE A IM FOR FUTURE BIRTHS, PREVIOUS EXPERIENCE OF POOR CARE OR TRAUMATIC BIRTH]

There is growing support for real choice in maternity care from women and their families, evidenced by campaigns such as Freedom for Birth (www.freedomforbirth.com) and The Birth I Want (www.thebirthiwant.org.uk). The loss of independent midwifery would be a further limitation on a woman’s fundamental human right, recognised at the European Court of Human Rights in Strasbourg in the case of Ternovsky vs. Hungary in 2010, to determine the circumstances in which she gives birth.

In its response to the Finlay-Scott Review of the requirement to have insurance or indemnity as a condition of registration, the [Department of Health/Scottish Government/Welsh Assembly Government/Department of Health, Social Services and Public Safety] has pledged to take forward work on a case-by-case basis to facilitate a solution to enable the continued availability of services provided by groups for whom the market does not provide affordable insurance or indemnity. Please would you write to the [Secretary of State for Health, Jeremy Hunt MP/Cabinet Secretary for Health and Wellbeing, Alex Neil MSP/Minister for Health and Social Services, Lesley Griffiths AM][Minister for Health, Social Services and Public Safety, Edwin Poots MLA], asking [him/her] to:

*set up a guarantee or other scheme equivalent to professional indemnity insurance to satisfy the requirements of Directive 2011/24; or

*delay implementation of the professional indemnity insurance requirement under Directive 2011/24, if necessary seeking a derogation from the European Union, to give more time for a solution to be found from the commercial insurance market.

Thank you for your attention to this matter and, I hope, for your support in saving independent midwifery.

Yours sincerely

[NAME]

 

Midwifery shortage leaves pregnant women unsupported

A survey in the annual state of maternity services report by the Royal College of Midwives found that four in ten women see up to nine or ten midwives during their pregnancy instead of being able to build a relationship and confidence in one, as is recommended. Also one fifth of women are left alone during labour, contrary to guidelines saying women should have one to one care.

Midwives are overstretched due to a baby boom and increasing numbers of women over the age of 40 having babies who require extra care due to a high risk of complications, experts said. The birth rate has increased rapidly and the rise in midwife numbers has not kept pace, the College said, meaning around 5,000 more are needed to meet the one-to-one care in labour pledge. Cathy Warwick, general secretary of the RCM, said: “In antenatal care, the problem for women is they are not getting the continuity of care they need."


The Telegraph 20/1/13

NCT Members Asked to Support Campaign

The NCT is supporting this campaign. Please help by signing this petition:

For every mother-to-be to have one to one midwifery care and choice of place of birth

Responsible department: Department of Health

Every mother-to-be should have their own 'named' midwife throughout pregnancy and birth and for the immediate weeks after the baby is born. She should also be able to choose where she has her baby, be it in a hospital, a birthing unit or at home.

http://epetitions.direct.gov.uk/petitions/34513