“There’s a desperate need for more midwives and better facilities … the shortage of midwives and the continual financial crisis in the NHS in England is jeopardising the quality of care that women receive” - Dame Karlene Davis, General Secretary of the Royal College of Midwifery.

Patricia Hewitt, the Secretary for Health, recently unveiled “Maternity Matters”, Labour’s vision for the future of maternity services which, amongst other issues, acknowledged a current shortage in the number of midwives. The important questions are first, what is the impact of the shortfall and secondly, how many more midwives do we need?

In answer to the first question Louise Silverton, the Deputy General Secretary of the Royal College of Midwives (RCM) has said that the shortages mean that women will not get the care they deserve and “will cost the NHS more in the long term because they will result in more litigation and large payouts”.

In Miss Hewitt’s recent announcement we were told that there are 1,000 midwives in training but is this enough? The RCM has said that although an additional thousand midwives is helpful, it is not enough to stem the human and financial costs of substandard care in maternity units. At the launch of “Maternity Matters” the RCM praised the Government’s initiative but warned that to make the vision a reality “The Government has to invest in maternity services if it is serious about its plans” and suggested that to fulfil the Government’s vision the equivalent of 3,000 more full-time midwives is needed.

Whilst it is clear that not all mistakes in maternity care are as a result of a shortage of midwives, the impact of these mistakes is enormous both in emotional terms, to staff as well as the patients and their families, and financially. The National Patient Safety Agency reported that in the last four years 18,000 women suffered harm as a result of maternity care and of this number 246 women died and 1,000 suffered “serious harm”. The financial value of the consequent claims against the NHS has amounted to nearly two billion pounds, since 1995.

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Issues in maternity care are making the news. Following an undercover investigation at two leading maternity units the BBC programme Panorama highlighted the resourcing issues and claimed that maternity wards are buckling under the pressure of a midwives shortage. Just this week the BBC reported that midwives are being stretched by delivering 25% more babies (on average 33.7 babies annually per midwife) than experts believe is appropriate



Help for midwives in their non clinical duties is being provided in some Trusts by Maternity Support Staff but a recent study which hit the headlines raised concerns that untrained support staff are being involved in patient care. In response to the study Frances Day-Stirk, Director of Learning Research and Practice Development at the RCM, said that the support staff “must not in any way be used as substitute for qualified midwives because women deserve care from an expert.”

The Government’s commitment is to provide a “gold standard” of maternity care for women. In order to achieve its goals it appears that the Government will need to continue its discussions with the RCM so as to be clear what numbers of qualified midwifery staff are needed.

Where is the money going to come from and where are such a number of high quality new applicants to be trained? In Issue No. 21 Matthew Trinder also described proposals for compulsory professional indemnity cover for independent midwives that is being perceived in the profession as “a direct threat to the future of the 200 or so independent midwives in this country."