Warning over shortage of midwives

The Government must address the “serious shortage” of midwives, the Royal College of Midwives said, as an independent report found that numbers of staff are one of the main challenges facing maternity services.Warning over shortage of midwivesLong term vacancy rates for midwives have steadily increased in recent years, the Care Quality Commission (CQC) report found.

Although births in England increased by over 21% between 2001 and 2010, the number of midwives only increased by around 15%, from 18,048 to 20,790.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said: “This supports and highlights all we have been saying for many years about the shortage of midwives and the need for serious investment in maternity services.

“A failure to have adequate numbers of midwives leads to mistakes and lower quality care.

“We recognise investment in midwifery training but this will be wasted if the newly qualified midwives cannot find jobs. Once qualified, they need support from experienced midwives whist they consolidate the skills learned during their training. Many of these midwives are those whose jobs are currently under threat.

“This Government must take this issue much more seriously and give it more attention than they are doing. If they do not mothers, babies and their families are the ones who will suffer the consequences of this Government’s failure to ensure that maternity services have the resources to meet the demands facing them.”

The union has launched an online petition Recruit 5000 more NHS midwives in England calling for more midwives in the NHS in England.

The CQC report, which is based on findings from unannounced inspections of 14,000 health and social care providers in England, found that across the board one in 10 institutions were failing to meet staffing standards.

“The non-availability of temporary staff and organisations leaving vacancies open for a number of months – particularly for qualified staff – can lead to compromises in the quality of care given to people, and staff training and supervision,” the CQC said.

From: http://www.independent.co.uk/warning-over-shortage-of-midwives

Caesareans operations to be offered due to midwife shortages

Caesareans are to be offered to all pregnant women who ask for them, new guidelines state, amid concerns that some are too scared to give birth naturally on Britain’s overstretched labour wards.Caesareans operations to be offered due to midwife shortagesA lack of support is leading to “traumatic” natural births, say experts, resulting in women fearing a repeat experience.

Studies show that up to 10 per cent of women in Britain suffer from a serious fear of natural childbirth, called tokophobia.

Now the National Institute for Curbing Expenditure (NICE) is recommending that women should always have the right to a caesarean, even if they have no physical or mental health need.

The guidelines, state: “For women requesting a CS [caesarean section], if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.”

Malcolm Griffiths, a consultant obstetrician and gynaecologist at Luton and Dunstable Hospital, who chaired the guidelines development group, said most women were not interested in having a caesarean.

“It is a major operation, about as major as a hysterectomy,” he said.

Nonetheless, 25 per cent of births in Britain are now by caesarean. Between a third and a half of them are pre-planned.

Figures show that rates in Nordic countries are much lower, at about 15 per cent.

Many obstetricians want the UK rate to come down, but believe that is impossible without better midwifery services.

Mr Griffiths said: “I think probably key to the difference is support during labour, with one-to-one midwifery care and support in Nordic countries.”

Better midwifery care was “key to reducing the caesarean rate”, he added.

Nina Khazaezadeh, a consultant midwife at St Thomas’ Hospital in London and a member of the guidelines panel, said some women opted for caesareans because they feared childbirth after a “traumatic” first experience in an understaffed ward – a condition known as “secondary tokophobia”.

She said: “We might see a rise in secondary tokophobia where women have already had a birth that they have found very traumatic, and the perceived lack of support will have had an impact on their decisions for the next pregnancy.”

Cathy Warwick, chief executive of the Royal College of Midwives, said: “There is very clear evidence that one-to-one support in labour reduces caesarean rates”.

However, she welcomed the new Nice guidelines, saying it was “absolutely acceptable” that a woman who feared childbirth should be offered a caesarean.

Coincidentally, the RCM publishes a new report today claiming that England faces “massive midwife shortages” and needs another 5,000 of them.

Even though numbers have increased since 2001, they have “failed to keep pace with the rocketing number and increasing complexity of births”, it warns.

The number of births has risen by 22 per cent in a decade, with midwives having to deal with 120,000 more in 2010 than in 2001.

Mothers also tend to be older and heavier than in the past, which both raise the chance of complications.

Belinda Phipps, chief executive of NCT, said: “Most women want a straightforward birth, some need a caesarean. When women are treated with respect, and are offered support and information tailored to their concerns, very few of them will choose a caesarean birth unless there are clear health reasons.

“However, our services fail women badly at the moment, with midwifery numbers well below the level required to guarantee safe and satisfying care.”

She went on: “If caesarean rates go up following the change to the guidelines, it will be evidence that women are not getting the quality of midwifery support they need.”

The guidelines do recommend that a woman requesting a caesarean should be made to talk about her fear of childbirth before an operation is granted.

From: http://www.telegraph.co.uk/Caesareans-to-be-offered-to-all-amid-fears-over-midwife-shortages

Unions’ strike means thousands of operations to be postponed today

Hospital managers are planning to postpone thousands of non emergency operations today, because of the public sector unions striking over pension changes.Unions' strike means thousands of operations to be postponed todayPatients across the UK have been sent letters warning them of the disruption.

Diagnostic tests and outpatient appointments will also be delayed, but hospitals insist emergency and critical care will not be affected.

Managers say they are preparing as they would for Christmas or bank holidays.

An estimated 400,000 nurses and healthcare assistants, as well as paramedics, physiotherapists, and support staff like cleaners and administrators have said they will join the action on 30 November over changes to public sector pensions.

However, the main medical unions – the Royal College of Nursing, the Royal College of Midwives and the British Medical Association are not taking part.

The Department of Health in England said it was expecting at least 5,500 non-emergency procedures like hip and knee operations to be rearranged.

More than 12,000 patients are likely to have diagnostic tests postponed, and 40,000 outpatient appointments are expected to be rescheduled.

On an average day, 28,000 patients have planned treatments or operations in England and there are 60,000 diagnostic tests.

However, managers say they are putting plans in place to make sure people can still get emergency or urgent care, in the way they do on bank holidays or at Christmas.
999 calls

Patients needing urgent treatment like chemotherapy and kidney dialysis will still be able to get it, and maternity units will remain open.

Calls to 999 will still be answered, but patients are being urged to think hard and only call if it is a genuine emergency.

The Health Secretary, Andrew Lansley, said health service workers should not take action that harms the interests of patients.

“I would ask staff to consider carefully whether going on strike is the right thing to do,” he said.

Midwife shortages in England risking lives

Parts of England are facing big midwife shortages putting mothers and babies at risk midwives have warned.Midwife shortages in England risking livesThe Royal College of Midwives says a 22% rise in births over 20 years has led to shortfalls across England, but some areas are worse than others – it highlights the East Midlands and East.

The RCM wants 4,700 more midwives and says the prime minister has backed away from a pledge to raise numbers.

The Department of Health said record numbers of midwives were now being trained.

Midwives say births are becoming increasingly complex because of growing numbers of obese and older mothers-to-be, who often need extra support.

The Royal College of Midwives says the extra 4,700 midwives are needed across England to keep pace with the added pressures.

And it says a new analysis of midwife numbers across England reveals big variations – with limited shortages in some areas and serious shortfalls in others.

The calculations were done by measuring the number of midwives in an area against the number of babies born there. The RCM estimates that one midwife is needed for every 28 hospital births and 35 births in a midwife-led unit or at home.

The North East and North West of England had a shortfall of less than 10%.

But according to the figures, the East Midlands and East of England need 41% more midwives, and the South East is also more than a third short of staff.

The college says the disparity is down to different levels of investment in different areas; women living in places with bigger shortfalls are at risk of having less choice over how and where they give birth.

It says Scotland, Wales and Northern Ireland do not have midwife shortages at the moment.

“This is a real problem in England,” said Cathy Warwick, RCM General Secretary. “We believe women should have the same choice over giving birth wherever they live. Once you get to really critical shortfalls, maternity services won’t be safe.”

It’s a sentiment echoed by the head of midwifery at Wansbeck hospital in Northumberland, where they say they have enough staff to offer high-quality care.

Janice McNichol has delivered more than 1,000 babies in her career, and prides herself on making sure every mother has a positive experience.

“It’s about safety and quality of care,” she said. “Making sure midwives are there when mum needs them, to answer questions and help her through the process.”

The charity Action against Medical Accidents, AVMA, said the situation in some areas was desperate.

“Having a baby should be the happiest time in a couple’s life, but failure to deal with this problem is all too often turning it into a tragedy,” said AVMA chief executive Pater Walsh.

“Maternity services should be the NHS’s first priority for improving patient safety and having enough trained midwives is an absolute must.”

From:  http://www.bbc.co.uk/news/health-14859228

Nurses and midwives urged to get flu jab

Nurses and midwives are being urged to get their flu jabs after figures reveal less than a third did last year.Nurses and midwives urged to get flu jabAll front line healthcare workers are meant to be vaccinated to stop them going off sick with influenza and spreading the virus to patients.

Last year only 30% of hospital nursing staff in England got immunised compared with 43% of GP practice nurses, 38% of GPs and 37% of other doctors.

Nursing and midwifery groups say having the jab is a “professional duty”.

This is the first time the figures have given broken down by occupation.

The number of healthcare workers getting the vaccine had increased from 26.4% in the 2009 winter to 34.7% in 2010.

However, the majority of nurses who work with the most critically ill over the winter months and midwives who work with pregnant women, were left vulnerable to flu, its potentially life-threatening complications and passing it on to patients and family, says the Department of Health which released the figures.

The data also shows that only 25.2% of youngsters aged six months to two years in at-risk groups were vaccinated last winter, compared with 51.7% of those aged 16 to 65.

Those at risk include people with conditions such as asthma, diabetes, heart disease and liver disease, as well as the over-65s and pregnant women.

Last winter people in at-risk groups were 11 times more likely to die from seasonal flu than people with no underlying health problems.

Chief Medical Officer Dame Sally Davies said: “It is never too early to start thinking about flu. So as NHS staff return from their holidays, I urge them to plan ahead and get vaccinated.”

Dr Peter Carter, of the Royal College of Nursing, said while NHS staff should not be forced to get immunised, they had a professional duty to do so: “Patients and healthcare staff suffer when nurses are off sick.

“It is vital that nurses do all they can to take responsibility for their own health and of those around them. The RCN will be working with our members to ensure they have access to all of the relevant information to enable them to make the right decision about the uptake of the vaccine.”

Louise Silverton, of the Royal College of Midwives, said: “Midwives are strongly advised to encourage all pregnant women to be vaccinated against seasonal flu.

“In addition midwives as key health workers should themselves seriously consider being vaccinated to prevent transmission of influenza to the women for whom they care and also to their own families.”

A National NHS Staff Seasonal Flu Vaccination Campaign launches later this month and will use resources like Twitter and Facebook, as well as leaflets, to encourage more healthcare professionals to get vaccinated.

From: http://www.bbc.co.uk/news/health-14792570

Obese pregnant women have more complicated births new research finds

Overweight pregnant women are more likely to be overdue and have more complicated births, a study has found.
Obese pregnant women have more complicated births new research findsWomen who were overweight or obese before they conceived were more likely to have a longer pregnancy, need to have labour induced artificially and to go on to require caesarean section births.

The research was conducted by a team at Liverpool University who examined the records of almost 30,000 women who gave birth over four years.

Three in ten obese women were overdue, defined as still pregnant ten days after their due date, compared with around two in ten of healthy weight women.

More than a third of obese women had their labour induced, compared with just over a quarter of normal weight women, the study published in the British Journal of Obstetrics and Gynaecology found.

In addition almost three in ten obese women had an induction of labour which later resulted in a caesarean delivery compared to less than two in ten normal weight women.

However, more than seven in ten obese women still gave birth naturally and the rates of complications in labour and for the baby were the same as in normal weight women.

Other studies have found that maternal obesity is now one of the biggest risks in childbirth. In 2007 it was found that half of all women who died during pregnancy or soon after giving birth were overweight.

Maternity units have had to order special operating tables, wheelchairs and other equipment to deal with the increasing number of obese mothers and doors have had to be widened to accommodate them.

Management of obese prolonged pregnancies is often difficult as induction of labour is associated with a high risk of caesarean section and the possible complications that follow including infection, bleeding and clots.

Dr Sarah Arrowsmith, from the University of Liverpool’s Institute of Translational Medicine, and lead author on the paper said: “Maternal obesity has become one of the most commonly occurring risk factors in obstetric practice including greater risk of prolonged pregnancy.

“The importance of this research is that it investigates delivery outcomes for women who are obese with prolonged gestation and receiving labour induction. The fact that the majority of obese women did have a vaginal delivery, with labour complications being largely comparable to normal weight women, suggests that induction of labour in obese women with prolonged pregnancy is a safe method for managing these difficult pregnancies.

“Our findings were somewhat unexpected, given the well-reported complications surrounding obesity in pregnancy, but were clinically reassuring.

“Our current research is focused towards underlying causes of prolonged pregnancy, which can affect up to ten per cent of women, as currently we know little about it.”

Professor Philip Steer, BJOG editor-in-chief said: “Maternal obesity is on the rise and is associated with pregnancy complications. The risk of caesarean section is heightened when the woman is induced, however, it is promising to see that a large number of obese pregnant women delivered vaginally.”

From: http://www.telegraph.co.uk/Obese-pregnant-women-have-more-complicated-births-research

Pregnant women denied flu jabs say midwives

Pregnant women were denied the seasonal flu jab in some parts of the UK, before swine flu began claiming more lives, because not all GPs were aware that mothers-to-be had been made a priority group to receive the jab this winter.
Pregnant women denied flu jabs say midwivesLouise Silverton, deputy general secretary of the Royal College of Midwives, told the Guardian that a number of pregnant women had been refused the vaccine by family doctors in autumn.

“In October, when GPs started telling patients to come for immunisation, some pregnant women got it and some didn’t. GPs sent some of them away because they thought they didn’t need it, because no one had told them that pregnant women had been added to the list of groups of people considered ‘at risk’,” she said.

Research shows pregnant women are four times more likely to develop serious complications if they catch H1N1 swine flu, which is the main strain of seasonal flu circulating this winter. There has been concern that takeup of the jab protecting against all three strains of flu has been low among pregnant women.

Silverton also criticised the decision by the health secretary, Andrew Lansley, to cancel the usual advertising campaign intended to prompt the 16 million Britons classed as vulnerable to have the jab.

“It was short-sighted of the Department of Health not to have the usual campaign, she said. “It was done to save money. I agree with the government’s overall aim of reducing government advertising, but they should have been more selective and kept the campaign for all at-risk groups.

“Usually there are posters on buses and all sorts, but this year there was nothing. It was a wasted opportunity not to have the awareness campaign stressing the importance of people in at-risk groups being vaccinated.”

A majority of the 50 people to die from flu so far this winter had not had the three-in-one jab at least two weeks before falling ill, the Health Protection Agency said.

The outbreak has so far claimed 50 lives and left 783 people in intensive care, amid vaccine shortages and low takeup rates of the seasonal flu jab.

From:  http://www.guardian.co.uk/pregnant-women-flu-jabs-midwives

Maternity postcode lottery revealed in NHS figures

Midwives have criticised the postcode lottery in maternity care after official NHS figures revealed caesarean rates are twice as high in some hospitals as others.
Maternity postcode lottery revealed in NHS figuresIn some cases even neighbouring hospitals have widely varying rates of caesarean section, revealing that it is not necessarily down to the characteristics of the local population.

The proportion of women having their first antenatal appointment within the first 12 weeks of pregnancy varies 11-fold, according to the data published by the NHS Information Centre.

This may be due to women recognising that they are pregnant later but also reflects on how well organised services are.

The figures show that almost nine in ten women were seen in the first 12 weeks at the Royal Cornwall Hospitals NHS Trust compared with less than one in ten at Walshall Hospitals NHS Trust in 2009/10.

Similarly more than three in ten women had a caesarean birth at Imperial College Healthcare NHS Trust, in London – twice as many as at Shrewsbury and Telford Hospital NHS Trust in Shropshire.

However the variations cannot be completely explained by deprivation as neighbouring hospitals will had large differences in rates.

At Rotherham NHS Foundation Trust 87.6 per cent were seen in the first 12 weeks, five times higher than in neighbouring Barnsley Hospital NHS Trust where 17.2 per cent were seen.

There were twice as many caesareans at Hereford Hospitals NHS Trust than at nearby Shrewsbury and Telford.

Nationally more women are being seen within the first 12 weeks in 2009/10 compared with the previous year and the caesaearan section rate has remained for the last year at around one in four of all births, the majority of which were conducted as emergencies.

The figures show that the proportion of births delivered by doctors instead of midwives has increased from less than one in four in 1989/90 to almost four in ten in 2009/10, as a result of more caesarean and instrument deliveries due to greater numbers of older and obese mothers giving birth.

Tim Straughan, Chief executive of The NHS Information Centre, said: “The figures show that the experience women have of NHS maternity care varies markedly across the country and even within regions.

“Rates of caesareans and access to antenatal assessment in the first 12 weeks of pregnancy vary according to which hospital they use.

“In some trusts, there may be specific demographic or clinical reasons that explain why they carry out, for example, more caesareans. But others will need to examine closely the full range of reasons why their rate is different from the national average of about one caesarean delivery for every four deliveries.”

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM), said: “These results show that there is a postcode lottery when it comes to maternity services, and this is worrying when those services are part of a ‘national’ health service. Women should expect and receive high quality care wherever they live, not care that is based upon chance and plain old good luck.

“Superficially the huge variations revealed in this report are a concern and further analysis is needed to find out why they are occurring.

“The variation on the first antenatal booking is astonishing and those on caesarean section rates – already widely known – are worrying in their persistence at such a level.

“Midwives are the experts when it comes to normal births and will deliver the vast majority of women having their baby in this way. The fact that midwives’ involvement in birth has decreased will be reflected in the increase in caesarean rates and instrumental deliveries over the years.

“I think some of the large variations could be linked to staffing levels; as we know one-to-one care from a midwife increases the possibility of a normal delivery but I am sure this is not the whole story. It could also be related to how services are organised.

“In the statistics around intervention, maternity units need to be looking at each other’s practice to see where they can learn from each other, and make their services better for women and their babies.”

From: http://www.telegraph.co.uk/Maternity-postcode-lottery-revealed-in-NHS-figures

Ministers broke midwife pledge claims RCM

The Royal College of Midwives (RCM) has accused the government of backing down on a pre-election pledge to increase midwife numbers in England.

It says mothers and babies will suffer unless the 3,000 extra midwives it says were promised are delivered by 2014.

RCM general secretary Cathy Warwick told its annual conference there are too few to cope with a rising birth rate and increasingly complex births.

The Tories said the rise was now not needed as the birth rate was stable.

She said: “Just before the election, both the prime minister and the deputy prime minister told us that they would commit to continuing the previous government’s promise to give us more midwives.

“We’ve just done a survey of all the heads of midwifery and they’ve got vacant posts but they’re having difficulty filling them.”

The RCM survey of 83 out of 194 heads of midwifery suggested maternity units were already seeing budget and staffing cuts.

Some 30% said their budgets had fallen over the past year, while a third had been asked to reduce staff.

And two-thirds surveyed said they did not have enough midwives to cope with demand.

Meanwhile, the number of live births in England has risen by 19% between 2001 and 2009, to 670,000 a year.

The RCM said births over the same period had become more complex, with obese pregnant women and older or teenage women needing extra support.

The Royal College of Obstetricians and Gynaecologists (RCOG) said maternity services were facing many challenges.

President, Dr Tony Falconer, said: “As well as need for more midwives, there is a need for more consultants to deal with the increase in the number of high-risk pregnancies.”

A Conservative Party spokesman said: “The commitment to 3,000 midwives made in opposition was dependent on the birthrate increasing as it has done in the recent past. It was not in the coalition agreement because predictions now suggest the birthrate will be stable over the next few years.

“People can be absolutely clear that our commitment to meet the needs of expectant mothers remains, and we will continue to train new midwives to meet the demands arising from the births.”

From: http://www.bbc.co.uk/news/health-11772485

Midwives have no time to care for new mums- report warns

New mothers are left frightened and alone after childbirth, because midwives do not have time to care for them, a major study has warned.
Midwives have no time to care for new mums- report warnsThe report by the National Childbirth Trust (NCT) says staff shortages have left increasing numbers of mothers feeling isolated at a time when they are desperate for reassurance.

The charity’s poll of more than 1,200 first time mothers found 59 per cent did not get the “emotional support” they felt they needed after giving birth – compared with 51 per cent in a similar survey a decade ago.

Women who had undergone a caesarean section were the least happy about their experience.

Asked about the 24 hours following birth, 66 per cent said they had not received enough support, compared to 57 per cent of those who had a natural labour in hospital, and 24 per cent of those who gave birth at home.

Mothers who had gone through traumatic labours said they had been left to cry themselves to sleep, while others said overstretched midwives had no time to offer a kind word of reassurance.

In total, 42 per cent said there were not enough midwives to care for them, compared with 33 per cent, when the question was posed in 2000.

Those who gave birth at home, or in a midwife-led birth centre, were less likely to describe shortages of midwives.

The NCT findings show that despite a large investment in maternity services, and pledges from the last Government to make care “woman-centred” with a choice of where to give birth, many women are being denied even basic care.

Among the poll of 1260 first time mothers, 44 per cent said they did not even get the physical help they needed, while 55 per cent said they did not get enough information or advice in the weeks after having their first child.

Anne Fox, the head of campaigns and public policy for the NCT, said; “It’s clear postnatal care urgently needs improvement – our report paints a dreadful, shocking picture of care in the UK – we’re letting women and their babies down.

“Many of the problems these women highlight seem to be due to staff shortages or lack of visits once they had left hospital – and this issue needs to be addressed if the quality of postnatal care is to be improved, particularly for vulnerable women.

In the report, new mothers describe being “absolutely terrified” and alone during their first night in hospital, frightened to ask for help from staff who responded to them rudely.

One mother said: “As soon as the baby was born, I felt I was on my own. I spent the first night after the birth of my son in floods of tears and unable to sleep as every time I closed my eyes the nightmare of my birth experience came flooding back.

“Nobody came to check on me to see if I was OK, even though I know I was sobbing loudly and uncontrollably.”

Louise Silverton, Deputy General Secretary of the Royal College of Midwives, described the report’s findings as “disappointing,” but said the study sent a compelling message to those in charge of NHS budgets, about the need to keep investing in maternity services.

From: http://www.telegraph.co.uk/Midwives-have-no-time-to-care-for-new-mums-report-warns