The safety of maternity care in Britain's hospitals is under the gravest threat from an over-stretched, underresourced service which is putting mothers and babies in danger, experts have warned.
Fourteen NHS trusts have significantly raised baby death rates which are up to twice the national average. Shortages of staff, a rising birth rate, lack of training, inadequate equipment and poor leadership are leaving women in childbirth exposed to unacceptable risks.
The president of the Royal College of Obstetricians told The Independent that to ensure the safety of women and children in the face of staff shortages, maternity care must be concentrated in fewer, larger "baby factories" which can provide 24-hour consultant cover. The proposal will mean the loss of local maternity units and women having to travel further to have their babies – and is certain to meet fierce opposition.
David Cameron pledged 3,000 extra midwives before the election but the Government has failed to honour the pledge. The Royal College of Midwives says 4,500 extra midwives are needed to deliver a safe, high-quality service.
The dangers were highlighted by the death in January of a healthy 27-year-old mother and her daughter following an emergency Caesarean at Queen's Hospital, Romford, Essex.
Sareena Ali suffered a ruptured womb which triggered a heart attack after being left for two hours without being checked. Her family solicitor described the tragedy as the "worst case I have been involved with", adding: "In the 21st century we should not have mothers and babies dying on hospital wards."
Queen's Hospital is part of Barking, Havering and Redbridge NHS Trust which was under investigation by the health watchdog at the time of the catastrophe. The Care Quality Commission (CQC) ordered the trust to improve staffing and the availability of equipment and warned it would be liable to prosecution if it did not comply.
It is one of three trusts issued with improvement notices after inspections revealed serious lapses in their maternity care. The report of its inspection is to be published this week. Eastbourne and Milton Keynes hospitals are also under orders from the CQC to improve their maternity services.
The 14 NHS trusts with high baby death rates ringing alarm bells about their safety are highlighted in a report by the Centre for Maternal and Child Enquiries, but they have not been named. National death rates for babies had fallen over the past decade, the report said, but it found wide variations between regions ranging up to 50 per cent. The safety of mothers was also being put in jeopardy, it said. More than nine out of 10 women who died from pre-eclampsia – a condition causing potentially dangerous high blood pressure affecting one in 10 pregnant women – received inadequate care, it said.
But the annual review, described as "vitally important to the improvement of care for women and their babies in the future" by researchers is under threat after the Department of Health withdrew funding last week.
The problems in Britain's maternity services have been growing for a decade, driven by a rapidly rising birthrate, up 19 per cent in 10 years, and the failure of staff and resources to keep pace – midwife numbers have increased by just 12 per cent. The pressure is greatest in London which has seen the fastest increase in births.
In February a study of 94 babies who died in childbirth in 2008-09 in the West Midlands concluded 35 received sub-standard care and their deaths might have been avoided. The West Midlands Perinatal Institute report said the maternity service was overstretched and understaffed.
Professor Jason Gardosi, its director, said: "Many midwives were working in a very stretched service which did not allow them to provide the level of care they wanted. In many cases this led to a series of errors and ultimately to perinatal loss [death of the baby]."
The CQC has found that one in five women were left alone during labour and sent home without support or advice on feeding their baby. Fewer were also offered antenatal classes.
Cathy Warwick, general secretary of the Royal College of Midwives told The Independent: "All these reports point in one direction – to a shortage of midwives."
Tony Falconer, president of the Royal College of Obstetricians, said: "The number of deliveries is going up, the complexity of the cases is going up and the outcomes are not as good as they could be. There is a major shortfall in midwives and we need 1,000 more consultant obstetricians. Why should a woman have a different level of expertise at 3am from 3pm? Even Liverpool maternity hospital, with 8,000 deliveries a year, only manages 24-hour cover on three days a week. The situation is very serious. Some hospitals are on the edge with staff working all the hours. Then something snaps."
A Department of Health spokesperson said: "Already since May 2010, the number of midwives has increased by 254. And last year there were a record 2,493 midwives in training. For 2011-12, there will be a total of 2,490 planned places available. We will continue to work with the Royal College of Midwives to make sure we have an appropriately resourced and skilled maternity workforce based on the most up-to-date evidence."
Tragedy of mother left to die in pain
The deaths of Sareena Ali and her daughter in childbirth at Queen's Hospital, Romford, in January shocked even the most experienced professionals.
Mrs Ali, 27, who has having her first child, was taken to the hospital for a planned induction. Her husband, Usman Javed, said soon after the induction began she was in "unbearable pain" and pleaded with midwives to help her, but she had been admitted to the ante-natal ward and was left unattended for over two hours.
By the time doctors saw her she had suffered a cardiac arrest due to a ruptured womb and they were forced to perform an emergency Caesarean. Her baby was stillborn and Mrs Ali died five days later.
Sarah Harman, a solicitor representing the family, said: "I have been rocked by this case. You don't expect an intelligent and glamorous young woman, slim as a reed, to die." Two midwives were suspended and Barking Havering and Redbridge NHS Trust apologised and admitted liability.