Funding cuts and midwife shortages puts babies and mothers at risk

We are coming up to Christmas. Whatever your beliefs, this festival is based on the birth of a child, one who had quite a future ahead of him. In The Big Issue of November 22, John Bird’s words “Let’s not dance around the need to plan for the future” struck a chord with me.

Having been a registered midwife for more than 30 years, I see my profession as bound up with considering the future. Each birth is a new beginning of life for the family. What happens during that pregnancy, birth and afterwards will impact the wellbeing of that woman and that baby for the rest of their lives. The most recent State of the World’s Midwifery Report demonstrates globally how the presence of a midwife at that crucial time saves lives.

The report states: “The evidence indicates that investing in midwives facilitates positive birth experiences, improves health outcomes, augments workforce supply, favours inclusive and equitable growth, facilitates economic stabilisation, and can have a positive macroeconomic impact.”

Midwifery on the global stage is political and significant in the support of women and families. Yet, across the UK, news outlets in recent weeks have had headlines pointing to the crisis of a shortage of midwives impacting on the provision of care. News hacks have been quick to share stories of poor care and experiences.

For those of us in the profession this crisis has been an accident waiting to happen. In 2013 the Royal College of Midwives’ State of the Maternity Services report pointed out the high number of midwives over the age of 45 who were on target to retire. In 2016 the UK government removed the bursary payments for nursing and midwifery students, and introduced tuition fees. It was argued strongly at the time this would disproportionately impact students and this has clearly been the case. Students have been struggling with debt and survival.

Over the course of the pandemic many midwives chose to, or were persuaded to, stay on to help rather than retire. This year they are walking away, exhausted and demoralised, along with many others. Newly qualified midwives have felt unsupported in their new role; many are unable to continue with poor physical and mental health.

An estimated shortfall of 2,500 to 3,000 midwives has been quoted since 2015. The current government promised funding for around 1,000 new midwives over 2021/22, yet the latest figures from the Nursing Midwifery Council show an increase of just 594 up to September. Some of those on the register are also not currently practising clinically. The numbers are not adding up.

On November 21 a group of doulas, birth supporters, lay-people and health professionals organised national vigils outside birth units and in city centres across the UK. Their goal was to raise the concerns of women and birthing people about stress levels and the lack of midwives in services.

The March for Midwives highlighted the crisis the shortage is causing for not only women and families but midwives too. Many current and former midwives, online and in person at the events, related harrowing stories of relentless shifts, working 12 to 14 hours at a time, often without time for drinks or food or bathroom breaks, and caring for more than the expected number of women and babies. Concerns about safety and the potential for mistakes were mentioned regularly, as was the need for funds in order to retain staff and the issue of student tuition fees.

The event moved me as it felt that someone was listening and trying to do something to help for once. Over the years of my career across clinical practice and now education and research, I have watched funding and services being eroded to the detriment of the midwives, students and, significantly, the women and birthing people in their care. The increase in multiple deprivation means women also need increasing input to meet their needs.

Never has the shortage been so bad than in the past 10 years. Women and babies are not seen as important or significant within the political arena – see the recent attacks on Stella Creasy MP, for example. Yet, as I said at the outset, getting the right care at the very start of life has a lasting effect on the health and wellbeing outcomes for that mother and baby.

Midwives are worth fighting for on the streets and in the political halls, for the sake of the generations to come. We can only hope that those holding the purse strings will realise that investing in the best care at the start of life will prevent major problems in society in the future.

Dr Jenny Hall is an independent midwifery educator and researcher.

@hallmum5