New mums need more old hands

Midwives can no longer cope with long hours, low pay and the incompetence that surrounds them
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The Independent Online

Childbirth inherently involves high risks, but in our medically advanced 21st century we have come to view infant mortality as an obscene aberration - something that belongs to the Victorian era. For decade after decade since the last war, the number of such deaths has steadily fallen. So it's extremely alarming to discover that the Office for National Statistics has recorded a sudden rise in stillbirths from 3,159 in 2001 to last year's 3,585. We are also told that nobody, as yet, knows the reason why.

Childbirth inherently involves high risks, but in our medically advanced 21st century we have come to view infant mortality as an obscene aberration - something that belongs to the Victorian era. For decade after decade since the last war, the number of such deaths has steadily fallen. So it's extremely alarming to discover that the Office for National Statistics has recorded a sudden rise in stillbirths from 3,159 in 2001 to last year's 3,585. We are also told that nobody, as yet, knows the reason why.

Really? Is it a coincidence that over the same period of time barely a month has gone by without news that disillusioned midwives are haemorrhaging from the NHS? That they are leaving exhausted and often inexperienced colleagues to cope with ever more stressful conditions. At the same time, more births are complicated because babies tend to be larger; fertility treatment means more multiple births; many mothers are older and there are more women with drug and alcohol addiction. The words recipe and disaster spring to mind.

I am painfully aware that my own labour in April of this year at Cambridge's Rosie Maternity Hospital could have gone awry without the swift intervention of a decisive registrar. After 16 hours of unproductive and drug-free labour, a cheery but alarmingly youthful midwife and her trainee colleague hooked me up to a Syntocinon hormone drip to move things along. This induced a ferocious rush of contractions which sent the baby's already erratic heartbeat off the scale. The registrar rushed in and swiftly established that the baby's spine was facing my spine, which makes labour far more awkward, and that the child's oxygen levels were depleted. Within minutes, I was in the operating theatre.

My son spent the first 24 hours of his life in a special unit but he was eventually fine. Nevertheless, the line between triumph and catastrophe was brought home to me by an acquaintance whose labour was near identical in every detail.

But a harassed midwife missed the warning signs, declined to call in the consultant, and a perfect 9lb boy suffocated inside her. I later learnt that in both our cases a truly experienced midwife would have recognised the spine-to-spine positioning herself, and would not have administered the Syntocinon; far better to encourage a mother to walk around for an hour, which speeds up labour of its own accord.

A close family friend who is an experienced midwife and mother of four was horrified but not surprised to learn of the stillbirth figures. She had just come off duty at a big Home Counties hospital where a mother with placenta previa (a condition where natural labour will result in fatal haemorrhaging) had been forced by a shortage of beds to move into a ward some distance from the delivery unit. My friend told me that if the mother had suddenly gone into labour - which was likely - there was no way on earth she could have reached the delivery theatre in time to save the child. Meanwhile, up to a third of her colleagues are off work at any one time suffering from stress, and there aren't enough staff to supervise the birthing pool. She said the new breed of midwives are all trained on degree courses where they spend only one or two days a week gaining practical experience. Her own generation trained as nurses before they specialised (so they were already conversant with epilepsy and diabetes: common causes of birth complications), and then spent 18 intense practical months shadowing other midwives. By contrast, a trainee in her own unit neglected to take a frail baby's temperature last week because she "had to finish my essay for the coursework".

My friend can no longer cope with the long hours, the low pay and morale, the incompetence around her, and the tiny babies born with heroin dependency that she sees with depressing regularity. She handed in her notice last week, driven from a job she loves by a system in terminal breakdown. Earlier this year the National Institute for Clinical Excellence tried to curtail the provision of elective caesareans on the NHS. Last week they suddenly abandoned this directive. Again, mere coincidence? Or could it be that health professionals secretly know that in many hospitals the safest birth plan currently available is one that involves the surgeon's knife?

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