Since 2011 the Royal College of Midwives has produced a State of Maternity Services report, highlighting some of the workforce concerns. The most recent reports, now with one for Wales as well as England, have just been published. Jenny Hall, Maternity and Midwifery forum editor, comments on the results.
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Did you know there is a lack of midwives at the moment? You have probably been feeling the extra pressure on services over the last few years. The latest release of two of the Royal College of Midwives’ State of Maternity services reports for both England and Wales shows why in part. The part is because this data only reaches to 2021, though the England report does add some in for 2022. We know a lot has happened since that date to influence the movement of the workforce. The RCM first produced this report in 2011, when it was identified that with an increasing birth rate, there was a suggested shortfall of midwives of nearly 5000. It pointed out at that time the changing demographic of the workforce to being older, and therefore warned there would be a problem when this workforce retired. The report then, and subsequently, included a summary from all four countries. In recent years the reporting has been for separate countries, presumably for political reasons, and we can assume something similar for Scotland and Northern Ireland will on its way.
The current England report estimates a shortfall of 2500 midwives. Though there is more stability in the Wales workforce figures, the changing age profile for midwives is of concern, with a larger drop-out in those between 46-55. This means a lot of expertise is lost to the profession. Neither report ventures as to why this age range may leave, though mention going forward staff retention should be a priority. It is well known though that many in that group may have been under old NHS pension arrangements that enabled retirement at 55. It may also be that this is the prime age for menopausal symptoms to kick in and, though NHS England have recently signed up for improving menopause support in the work place, it is likely some of this group of leavers may have not had such support. The Covid-19 pandemic will not have helped with subsequent stress. Time will tell if such initiatives filter down to the services in time to help retain more.
The last report in 2018 also included mention of international recruiting. It is a shame this has not been included this time, with the changes to workforce patterns since Brexit. The reports also do not consider the increase in recruiting of Maternity Care Workers and, in some cases, nurses. With the recent NHS Long term plan stating that: maternity support workers and registered nurses should be employed in appropriate places to complement the unique contribution made by midwives (p43) it is vital this increase is carefully monitored to ensure the roles are not taking over midwives roles.
The reports also do not consider where midwives are working, as many of the numbers presented may not be always clinical facing. This is important when considering the workforce calculations against birth rates. Though the NHS long term plan modelling suggests a predicted birth rate fall, the Wales report points to being cautious when considering this, as birth rates can suddenly change due to changing populations and we should not be complacent. The reports also address the fact that there are increasing needs for the population who are giving birth, which is increasing the workload for all maternity areas. Both reports mention the increased weight of pregnant women, which may or may not lead to more complex births. In Wales this figure is nearly 60% with around 25% for the England report. The Wales report only brings up the mental health of women at booking, nearly 30% revealing they have had or have some form of mental health need. It is surprising that the England report misses this out as a health priority, as this will have a major impact on midwife time, particularly in the postnatal period. The Wales report also include smoking rates, breastfeeding and homebirth rates. It is also a shame the England report does not include the latter, as it would be helpful to know how women’s choice is being facilitated. Particularly it would have been helpful to see how many midwives are working in continuity of care teams in all areas, as this is part of the transformation plan and will be part of any workforce calculation going forward.
The education of student midwives is touched upon. There has been an increase of available student midwife places since 2018, with a following increase of applications. This year it has just been reported that there has been a drop of applicants of around a fifth, particularly in Scotland and Wales. It is clear more must be done to change the narrative about midwifery in order to encourage applicants. In the NHS long term plan it is pointed out that nearly 30% of student midwives cited flexible working as a reason to recommend their placement. More must be done in education therefore to increase opportunities of flexible education that will support parents and carers to be able to develop as midwives in the future.
It is yet to see how changes will evolve in maternity services over the next year. The warning signs were already there back in 2011 and it remains a disappointment that they were to a large part ignored. Funding has come, but too little too late could be the message with many lost to midwifery in the meantime. Let us hope some of these may be willing to come back, if the promises for better support and creating more flexible working patterns comes to fruition.
July 2023
Dr Jenny Hall
Editor,
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