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

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The Independent Online

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.