It's not just more midwives we need

To fix the maternity care crisis we should call on the experience and judgement of its practitioners, says one, who prefers to be anonymous

Related Topics

Childbirth has been going on for a long time. You'd think we would have got the hang of it by now, but the way we are going in this country we're making it harder and harder. Before the last election the government promised to recruit an extra 3,000 midwives, but last week the National Audit Office revealed that the country is 2,300 short of this figure.

The NAO also points out that a fifth of the National Health Service maternity budget is spent on medical negligence cover. Cathy Warwick, chief executive of the Royal College of Midwives, said last week: "There are still a significant number of trusts not meeting standards of one-to-one care in labour and if there isn't a midwife in the room then it's harder to pick up problems early, intervene early and prevent problems later on."

As a midwife of more than 20 years' standing (and an apolitical one, I should add), I can only agree, and pretty well anyone in the business will support me. Much of my time is wasted trying to magic up some pillows or a thermometer. I am constantly working longer than my shift because I can't down tools and abandon my colleagues, or having to skip my meal break. And I have lost count of the number of times I have been emotionally blackmailed to scrap my day off because I know what pressure my colleagues are under. We do it because we can't help it. It's in our nature, but it isn't really good enough if we want to attract people to the profession.

The Government, advised by the RCM, is quite rightly wanting to increase "normal" births (including more home births, supervised by a midwife) and less needless and expensive surgical intervention. Yet there are countless times when expectant mothers arrange for a home birth, only to be called into the hospital because a midwife isn't available on the day.

So, by general agreement, we need more midwives, but I don't mean to whinge about the wickedness of the Government. The insurance issue needs to be addressed at the same time as the staffing levels. Hospitals are terrified of being sued, and are trying to get their insurance premiums down by reducing risk. This means that many of the midwives we do have spend too much time ticking boxes and keeping the lawyers at bay, rather than doing the job from which their profession's name derives (midwife: being "with woman").

The assumption is that by doing more observations on the mother and baby, for instance, the more likely you are to spot something amiss early. Intuitively that sounds right, but in this field there can be no certainty. Besides, you could be using a formula to look for something that only close human contact, experience and training can bring to light.

Since I started as a midwife, this "defensive" practice has gone up hugely. It's a clear case of too much time being spent on medicalising healthy women and taking valuable time away from caring for women who really need it. After a birth, midwives are so busy checking temperature and the heart and respiratory rate on perfectly healthy babies that they often don't have time for important issues such as enabling breast-feeding. The most common (and dispiriting) complaint we get from new mothers is: "I could see how frantic you were, so there didn't seem any point in staying. I thought I might as well go home."

Another issue is postnatal community care. Again, it is an admirable thing to offer, but are four visits in the first two weeks really necessary for, for example, a web-savvy mother on her third child? The mothers who need most care are the ones who are ill, through obesity, diabetes and high blood pressure, smoking and so on, or with babies which fail to thrive. Of course everybody needs monitoring, but sometimes a phone call will be more convenient and cheaper – and just as human – for all concerned. The "one size fits all" model is out of date.

We also underestimate the value of healthcare assistants. Many are trained to take blood and help breastfeed. Some midwives worry that hiring more healthcare assistants would devalue the midwives' role, but I can't agree. On the contrary, it would leave them freer to do the specialist stuff.

The real message is, as David Cameron would say, yes, we need more midwives, but we also need to let the ones we have use their judgement and discretion in a more flexible system. We need to let decisions be made not by professional bean-counters but by the professionals themselves.

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Recruitment Genius: Finance Director

£65000 - £80000 per annum: Recruitment Genius: Finance Director required to jo...

Recruitment Genius: Medico-Legal Assistant

£15000 - £25000 per annum: Recruitment Genius: This is a unique opportunity fo...

Ashdown Group: (PHP / Python) - Global Media firm

£50000 per annum + 26 days holiday,pension: Ashdown Group: A highly successful...

The Jenrick Group: Quality Inspector

£27000 per annum + pension + holidays: The Jenrick Group: A Quality Technician...

Day In a Page

Read Next
David Cameron faces the press as he arrives in Brussels for the EU leaders summit on Thursday reuters  

On the Tusk of a dilemma: Cameron's latest EU renegotiation foe

Andrew Grice
John Profumo and his wife Valerie Robson in 1959  

Stephen Ward’s trial was disgraceful. There can be no justification for it

Geoffrey Robertson QC
Homeless Veterans appeal: 'You look for someone who's an inspiration and try to be like them'

Homeless Veterans appeal

In 2010, Sgt Gary Jamieson stepped on an IED in Afghanistan and lost his legs and an arm. He reveals what, and who, helped him to make a remarkable recovery
Could cannabis oil reverse the effects of cancer?

Could cannabis oil reverse effects of cancer?

As a film following six patients receiving the controversial treatment is released, Kate Hilpern uncovers a very slippery issue
The Interview movie review: You can't see Seth Rogen and James Franco's Kim Jong Un assassination film, but you can read about it here

The Interview movie review

You can't see Seth Rogen and James Franco's Kim Jong Un assassination film, but you can read about it here
Serial mania has propelled podcasts into the cultural mainstream

How podcasts became mainstream

People have consumed gripping armchair investigation Serial with a relish typically reserved for box-set binges
Jesus Christ has become an unlikely pin-up for hipster marketing companies

Jesus Christ has become an unlikely pin-up

Kevin Lee Light, aka "Jesus", is the newest client of creative agency Mother while rival agency Anomaly has launched Sexy Jesus, depicting the Messiah in a series of Athena-style poses
Rosetta space mission voted most important scientific breakthrough of 2014

A memorable year for science – if not for mice

The most important scientific breakthroughs of 2014
Christmas cocktails to make you merry: From eggnog to Brown Betty and Rum Bumpo

Christmas cocktails to make you merry

Mulled wine is an essential seasonal treat. But now drinkers are rediscovering other traditional festive tipples. Angela Clutton raises a glass to Christmas cocktails
5 best activity trackers

Fitness technology: 5 best activity trackers

Up the ante in your regimen and change the habits of a lifetime with this wearable tech
Paul Scholes column: It's a little-known fact, but I have played one of the seven dwarves

Paul Scholes column

It's a little-known fact, but I have played one of the seven dwarves
Fifa's travelling circus once again steals limelight from real stars

Fifa's travelling circus once again steals limelight from real stars

Club World Cup kicked into the long grass by the continued farce surrounding Blatter, Garcia, Russia and Qatar
Frank Warren column: 2014 – boxing is back and winning new fans

Frank Warren: Boxing is back and winning new fans

2014 proves it's now one of sport's biggest hitters again
Jeb Bush vs Hillary Clinton: The power dynamics of the two first families

Jeb Bush vs Hillary Clinton

Karen Tumulty explores the power dynamics of the two first families
Stockholm is rivalling Silicon Valley with a hotbed of technology start-ups

Stockholm is rivalling Silicon Valley

The Swedish capital is home to two of the most popular video games in the world, as well as thousands of technology start-ups worth hundreds of millions of pounds – and it's all happened since 2009
Did Japanese workers really get their symbols mixed up and display Santa on a crucifix?

Crucified Santa: Urban myth refuses to die

The story goes that Japanese store workers created a life-size effigy of a smiling "Father Kurisumasu" attached to a facsimile of Our Lord's final instrument of torture
Jennifer Saunders and Kate Moss join David Walliams on set for TV adaptation of The Boy in the Dress

The Boy in the Dress: On set with the stars

Walliams' story about a boy who goes to school in a dress will be shown this Christmas