Shortage of doctors and midwives putting lives at risk – report

Lack of trained obstetricians is worrying, experts say, because of high risk of serious complications during and after birth

Childbirth experts have warned that mothers’ and babies’ lives in Britain are being put at risk after an NHS inquiry into its maternity services uncovered serious shortages of doctors and midwives in maternity units.

Almost nine out of 10 (88%) units are struggling to recruit enough middle-grade doctors to ensure proper staffing levels, according to an unprecedented in-depth NHS audit of childbirth services across Britain.

The experts said that the widespread lack of obstetricians was “extremely alarming” because of the high risk that complications can occur unexpectedly while a baby is being born. Researchers also found that the midwife shortage is so acute that fewer than one in six of the 750,000 women who give birth a year sees the same person throughout her pregnancy and aftercare, despite promises that this should happen.

Prof Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists (RCOG), said: “The difficulties in securing staffing in obstetric units is particularly worrying. Moving forward, it is anticipated that rota gaps will persist and worsen in most units. The pressures on maternity services are growing, which could compromise the experience for women and their families,” she said.

The lack of midwives is so severe that many women are not getting the one-to-one care during labour that they are entitled to, according to the first national maternity and perinatal audit (NMPA). It also means some women are getting as few as two chances after the birth to discuss key issues such as breastfeeding and mental health with a midwife at a home visit or at a clinic. The help women receive after giving birth – continuity of care – is patchy and too often “low”, the report’s authors concluded.

Elizabeth Duff, senior policy adviser at the parenting charity NCT, voiced concern that the inquiry “reveals a number of problems including staffing shortages that puts safe care at risk, and postnatal care that often leaves mothers struggling alone because they cannot contact a midwife.

“While midwives lead on care for healthy women and babies, they may need to refer for medical backup at any time. The lack of obstetricians is extremely alarming as a complication can arise very quickly in labour.” Complications can include fetal distress, in which the baby suffers a lack of oxygen, which can lead to severe brain damage, and severe blood loss in the mother just after the birth. A doctor’s presence and direction is vital in both scenarios.

Duff added: “Inadequate staffing levels cause ‘red flag’ events when women don’t receive essential care in a timely fashion. This may include delayed provision of prescribed medication such as painkillers or antibiotics, risking exacerbation of a dangerous infection.”

The research was funded by the NHS’s Healthcare Quality Improvement Partnership (HQIP) and covers maternity services in England, Scotland and Wales. It said it was “the largest evaluation of NHS maternity and neonatal services undertaken in Britain”.

The findings show that the NHS still needs to make a lot of progress in order to fulfil pledges made by successive governments and NHS leaders to make childbirth a more positive experience.

For example, last year NHS England promised to introduce “personalised care, centred on the woman, her baby and her family” as part of which “every woman should have a midwife, who is part of a small team of four to six midwives, based in the community, who knows the women and family, and can provide continuity throughout the pregnancy, birth and postnatally.”

The audit also highlights that key aspects of maternity care have improved over the last decade. For example, the number of midwife-led units situated beside acute hospitals has quadrupled to 124. That has given women – especially those whose pregnancy is deemed low-risk – what advocates of midwife-led care say is a much greater chance of giving birth in a more natural environment rather than having a more medicalised birth involving pain relief or a caesarean delivery.

In addition, the number of NHS trusts and boards across Britain now offering women a choice of having their baby at home, in a midwife-led unit or a unit where consultants are in charge has risen to 77% overall. However, that still falls short of giving mothers a choice of access to all four settings – the above three plus a standalone midwife-led unit, not based at a hospital – which the National Institute for Health and Care Excellence (Nice) advises that every woman should have.

And 19% still do not have a midwife-led unit, sometimes because the area they serve is too rural or its population too small to justify one. Furthermore, 3% do not have any consultant-led units.

However, the audit, which received evidence from all 155 NHS trusts and boards in the three countries, also found other problems, including that:

  • 37% of women who who give birth do not have a private bathroom in their birth room, which compromises their dignity;
  • Although 97% of trusts and boards use an electronic maternity information system to record women’s care, mothers at only 10% of them can access their own record, even though all should be able to do so;
  • Only 62% of maternity units allow birth partners to stay overnight on the ward after the baby’s arrival, and 71% after labour has been induced;
  • Few units let parents sleep there when their baby is in neonatal intensive car;
  • Only two-thirds (68%) of trusts and boards belong to a clinical network intended to improve mothers’ mental health, despite problems such as postnatal depression being widespread.

“It’s worrying that so few women are seeing the same midwife or group of midwives. Continuity of care is crucial to ensuring safe, high-quality care,” said Mandy Forester, head of quality and standards at the Royal College of Midwives.

The inquiry was

undertaken jointly by the RCOG, the royal colleges representing midwives and paediatricians, and academics from the London School of Hygiene and Tropical Health.

NHS England stressed the progress that the inquiry had revealed. “This report shows the NHS is stepping up its game delivering more personalised choice and joined-up care with better team working, as well as importantly looking at a number of ways to improve continuity of care for new mums,” a spokeswoman said.

“There’s no ‘one size fits all’ approach to maternity care, and the report will act as an important benchmark for local areas, helping identify where improvements can be made, including ensuring the right staffing levels for the women and babies they care for.”

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By:   Health policy editor

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