Rowan Pelling: Mums-to-be and the midwife crisis

The strain on our maternity services is robbing women of the most crucial element in childbirth

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'I am horrified by the scale of the crisis in our maternity services. Choice has been rendered meaningless by midwife shortages .... There are beacons of hope, but I am convinced things will get worse before they get better. And that will be reflected not just in statistics, but in human tragedy."

This was my doom-laden conclusion to The Truth About Childbirth, a documentary I researched and presented for Channel 4 in the winter of 2004. A far cry from my habitual Sukie Sunbeam brand of blitheness. "Are you sure you want to set out such an apocalyptic vision?" asked one of the commissioning executives. It was as if he hadn't watched the rushes.

The programme explained that all childbirth professionals agree that the most important factor in labour was one-to-one continuous care - this came from midwives, obstetricians, the National Childbirth Trust and natural birth gurus. In other words, mothers should be attended throughout by a devoted birth professional - ideally, a trained midwife. In reality most maternity units were woefully understaffed and it was commonplace to hear of midwives running between four women in labour. The Royal College of Midwives said forlornly (and still does) that at least 10,000 extra practitioners are needed to bring the maternity services up to scratch.

Staff shortages led to much higher rates of medical interventions because there are not enough experienced midwives to steer women through the minor complications that commonly crop up in labour. Midwives round the country told me "near misses" were a regular occurrence. "What do you mean by near misses?" the nervous Channel 4 exec asked. "Is that an acknowledged medical term?" I nearly decked him: "I mean lives hanging by a thread; there but for the grace of God goes that baby, or that mum."

Several midwives told me, off the record, about times when they had been looking after so many women they had nearly missed signs of foetal distress or dangerously high blood pressure in the mother.

Perhaps the most galvanising part of my research revolved around new mothers. Psychologists estimated that around 11 million women in the UK population were suffering from some form of post-birth trauma. The cousin of one of my closest friend's experienced a devastating catalogue of errors at a London hospital which resulted in her little boy's death and a damning verdict from the coroner.

Two years on, the sad truth is that my apocalyptic vision is edging closer to reality. This newspaper reported three weeks ago that "record numbers of women are being harmed or dying as a direct result of childbirth in what doctors are labelling a 'crisis' in maternity care." Our maternal death rate is among the worst in the developed world. Stillbirths have also increased in recent years, after decades of falling - and although some of these deaths are clearly due to increasing numbers of premature babies, I have yet to see a full and convincing explanation.

What about those "beacons of hope" I mentioned in my documentary's conclusion, eh? Two years ago I met a number of innovative birth professionals, such as the Albany Midwives in Peckham, south London; they are renowned in childbirth circles for bucking national trends by ensuring continuous care from a midwife who the mother already knows. Many of Albany's expectant mothers plump to stay at home (a staggering 47 per cent against a national average of 2 per cent), which means low intervention rates, few C-sections and hugely positive feedback.

Lynne Leyshon, who heads maternity services across the Torquay health trust, has achieved something similar on a larger scale. Although I was about as far from being a tree-hugging, natural birth advocate as any woman can be, these amazing midwives and their irrefutable statistics convinced me that the vast majority of our maternity units have got things arse-over-tip, as my dad would say. Too many births are subject to crisis management, rather than soothing support. Creditable research backs up the hippy-dippy sounding notion that stress and fear affect birth hormones in labouring women, de-accelerating the process.

So how can expectant mums forestall the impending apocalypse? I have only two pieces of advice. One is to read Tina Cassidy's wonderful and revelatory new book Birth: A History. She persuasively demonstrates how we are just as much victims of contemporary childbirth trends as our parents, grandparents and ancestors before us. The second is that I would advise any mum-to-be who can afford it to secure the services of a doula or independent midwife - even, or "especially", if she plans to go down the hospital route. Tragically (shoot Patricia Hewitt, not me, I'm only the messenger) this is the only way a woman can guarantee that she is supported by a professional who knows her throughout her labour.

The only problem with this advice is that the Government proposes to pass legislation making professional indemnity insurance (PII) a prerequisite for independent midwives to register and practise. This is utter bloody nonsense, since it's a well-known fact that no insurer will provide cover for independents. In effect the Government is outlawing independent midwives, because if they continue to assist labouring women they will be committing a criminal offence. Since these extraordinary women are the mainstays of home births (which many NHS trusts can't provide), they are effectively outlawing those too. So much for the Government's much vaunted "maternal choice".

I urge everyone who reads this to sign the "One mother one midwife" petition and the "save independent midwifery" petition. Even if you're the kind of gal who wants all the drugs and tech they can throw at you. You may change your mind after having it. I did.

www.onemotheronemidwife.org.uk www.saveindependentmidwifery.org

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