THE MIDWIFE CRISIS

They bring us into the world, conservative and unflappable. But now they are angry - so angry that they could go on strike. Angela Lambert looks at the humiliations that have stirred rage

More than a labour of love: the Government's offer of a 1 per cent pay rise to midwives is `the final insult, the final humiliation'

The midwife used to be as much a pillar of the community as the gravedigger. You came into the world at the hands of the one, and were laid to rest by the spade of the other. The two professions had a sacred, sometimes ribald, always fundamental role in the life of everyone. They were treated warily and with respect.

In Ronald Blythe's anatomy of a Suffolk village, Akenfield, a former district nurse who doubled as a midwife remembered midwifery in the mid- Twenties: "Not many people were taken away to infirmaries. They were born at home and they died at home. I knew the children so well, they could have been my own children. I knew their homes and in most cases I had delivered them.

"There were so many dirty children in those days - lice, impetigo - but there's nothing like that now. Children have never been so beautiful as they are today.

"I knew them all, body and mind. It's different now because the young men drive all over the place and find girls. Nobody moved a yard in the old days. People thought of me as the person who was present at the beginning of their lives, but in most cases I was present at the end, too."

Today, that cherished role at the heart of the community has almost been lost. Midwives work in groups of half a dozen or more and home deliveries are increasingly rare. Thirty years ago, perhaps a third of babies were born at home. Today, that figure is down to barely 1 per cent. This is partly the result of what midwives call "the greater medicalisation" of childbirth; partly of the large-scale building of specialist maternity units in the Seventies; and partly of the increasing demand from mothers themselves for pain-free births.

Midwives remain central to the process, however: a midwife is assigned to every expectant mother, and will see her far more often than either her GP or a harassed obstetrician. Nevertheless, the Government has downgraded both their status and their pay, and the Royal College of Midwives' recent ballot reflects a fury that is being felt by their members nationwide.

Yesterday, in their elegant 18th-century headquarters just a stone's throw from Harley Street, the college gave a televised press conference under the benevolent eye and winsome smile of a full-length portrait of their patron, the Queen Mother. Outside, angry posters proclaimed: "Midwives . . . undervalued, downgraded, demoralised!" Inside, beneath a resplendent plasterwork ceiling painted in three shades of pink, journalists sat awaiting the arrival of the College's UK Council. In they came, right on time, modestly unaccustomed to this degree of media attention.

Phyllis Watters, chairman (her choice of title) and Julia Allison, general secretary, both look just as you would expect a midwife to look: calm, ample, reassuring, benevolent. Do not be deceived. They and their 36,000 members are deeply angry about the shabby way in which this government, in particular the Department of Health, has treated them. Baroness Cumberlege's committee in 1994 issued a report called Changing Childbirth, which recommended that the power over childbirth should be moved away from doctors and put back as far as possible, in cases of normal delivery, into the hands of midwives and, above all, mothers.

What this meant, in practice, was that a community midwife's statutory care of a mother was paramount. It began as soon as a pregnancy was confirmed, continued throughout that pregnancy, rather than merely during the birth of the child (whether this took place at home or in hospital), and was not relinquished until the baby was 28 days old. Despite their willingness to co-operate and to undertake the extra work this involves, midwives have been rewarded with a down-grading of their status, which often means pay cuts.

And now comes the unkindest cut of all: midwives have been offered a pay increase of, to use Phyllis Watters's word, a "measly" 1 per cent. This was, she explained, "the final insult, the final humiliation, and the trigger for our present situation".

This anger has come as a surprise. Midwifery had always been regarded as one of the most conservative and unflappable branches of the medical profession. Less militant than nurses, less technologically minded than doctors, midwives have continued to provide the bedrock of mother-and- baby care in this country, even though home deliveries have fallen to around 1 per cent of all births. Midwives are still the principal carers for 800,000 women and babies every year. Today's hospital deliveries tend to be on a production line basis, with most mothers back home with the new-born after as little as 24 hours. After that, the midwife takes over. A hospital stay of more than two or three days is available only for those who need medical attention, or, of course, those mothers who choose to give birth in private maternity hospitals.

Perhaps the old-fashioned image of midwives, combined with that low home- deliveries statistic, emboldened the Department of Health to think that midwives could be ignored or even exploited. Many, especially in Manchester and the North, found themselves being regraded downwards, from Grade G (equivalent to a senior nursing sister) to Grade F: equivalent to a pay cut of up to £3,000.

Others complained that, although their influence had apparently been increased, the changes were so badly managed that implementing them was fraught with difficulties. They found themselves with so much paperwork that they became almost more like social workers than midwives.

The results of their national ballot were announced yesterday. The overwhelming majority - 82 per cent - voting to overturn the 115-year-old policy of no industrial action took everyone by surprise, including their own governing council. In a ballot that was of necessity taken at very short notice, of the total number who received ballot papers - 30,790 -just over half were returned.

Reporting these figures, the general secretary, Julia Allison, said, "I make this announcement with a heavy heart, as I know that many RCM members voted with the same feeling. We find ourselves on a path which is not of our choosing, and put the blame firmly on the Government's shoulders."

Maud Hepworth, a senior midwife in Truro, regrets that the ballot was necessary, but feels that there was no alternative, given the "derisory" pay offer of 1 per cent.

"I'm at the sharp end: in the delivery suite. I work with young midwives and students, and I see how much work these young girls do to further their careers. Every midwife does a statutory 371/2 hour week, but if their work calls for them to go over the allotted time - for instance, if a mother is in the middle of giving birth - they do not just walk away. On top of this, they have a legal requirement to do the documentation, which can take another two hours. They do not just have to write it all down nowadays - they have to feed the information into the computer as well.

"These student midwives - who have already completed their nursing training - earn £12,000 a year: that's for a full-time Grade E midwife. Someone like myself, a fully qualified senior midwife with 30 years' experience, at the top of the grade table, gets £19,000 a year. I work a nominal 40- hour week, perhaps longer. It depends how many babies are coming into the world."

What next? One Lancashire midwife, Ishbel Kargar, believes that the profession will not vote for strike action - "I can't see any midwife walking out of the labour ward, leaving a woman in labour" - but that they will withdraw from doing the kind of essential administrative tasks that save doctors time and trouble.

"The greater focus on midwives as givers of care to women before, during and after childbirth, has greatly increased their workload and their hours. They welcome this new focus and greater responsibility, but feel that they deserve some financial recompense, which they are being denied."

One young mother, Paula Middleton, who gave birth to three of her four children at home, has nothing but praise for midwives.

"They're saints, really," she declares. "They see people in extremis, during one of the great dramatic, yet painful, moments of their lives, and they have immense compassion. They are very happy to supervise at a home birth, yet they are incredibly supportive when it comes to intervention. Some people have this idea that midwives are radical feminists, obsessed with natural birth and not keen on pain relief - gas and air or analgesics. I haven't found that to be the case. They are very kind, very committed, and very professional.

"I think the Government's pay offer is an insult, not just to midwives, but to mothers as well."