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'Stark and Sobering' Strain on Maternity Services in England, Report Says

A combination of staffing shortages, rising obesity levels, and women giving birth later in life are having a "stark and sobering" impact on maternity services in England, according to an  assessment by the Royal College of Midwives  (RCM).

Its new annual report, State of Maternity Services 2023, estimates that the NHS in England is short of 2500 full-time equivalent midwives. New recruits joining the workforce are being mostly eclipsed by older, experienced midwives leaving the profession.

Shifting Demographics, Increased Complexity of Care

The analysis identified increased complexity of maternity care as a major factor putting pressure on midwifery – notably an increase in births to older women. 

Whilst in 2011, 48.6% of births were to women aged 30 and older, by 2021 this had risen to 59.6%. By the following year, only in the North East and Yorkshire region was the average age of a woman at the time of her booking appointment younger than 30 years, whilst in London the average age was 32.

Another indicator of changing demographics was seen in rising BMI levels, with the proportion of women recorded as being obese at the start of pregnancy rising from 18% in 2017 to 25% in 2022. Over the same 5-year period, the proportion of women recorded as having a BMI in the healthy range fell from 40% to 36%.

"To provide high-quality, safe care to the changing profile of women who are using maternity care simply requires more midwives and other staff," the report states. Instead, the profession experienced a staffing shortfall, which the report attributes to "historical failures to invest appropriately in maternity services". 

The NHS workforce in England rose by 14.1% between December 2019 and March 2023, but the number of midwives increased by just 1.1%. If the number of midwives in England had risen at the same pace as the overall health service workforce since 2019, there would have been 3100 additional midwives working in the system, rather than just 427, the RCM calculated.

Midwifery Training Boost

The RCM notes that the Government delivered on its 2018 commitment to open more places on midwifery courses, with an increase from 2380 in the 2015-2016 academic year to 3720 during the last academic year . However, it cautions that it could be some time before the rise translates into qualified midwives entering the system. In the meantime, the report warns that annual declines in the number of midwives had occurred for the first time, with the workforce down by 327 in the year to September 2021 and another 438 for the following year.

However, one encouraging trend has since emerged in monthly annualised figures. The first quarter of 2023 broke the trend of 17 months of decline, with numbers rising again compared with 12 months earlier.

The RCM called for "a renewed focus on retaining the staff we have as well as training new, additional staff", citing examples of "more flexible working opportunities, more support for learning and development, and tackling unacceptable behaviours and poor workplace cultures".

In a statement sent to Medscape News UK, the Department of Health and Social Care said  it had committed £165 million of additional money per year to grow the maternity workforce and improve neonatal services. 

A spokesperson said: "The NHS recently published the first ever Long Term Workforce Plan, backed by over £2.4 billion in Government funding to deliver the biggest training expansion in NHS history to help meet the challenges of a growing and ageing population by recruiting and retaining hundreds of thousands more staff over the next 15 years."

Birte Harlev-Lam, executive director midwife at the RCM, commented: "The Government has promised much with the plan, and we will be watching to make sure they honour those promises."

England: State of Maternity Services 2023, Royal College of Midwives. 12 July 2023.

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