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Under pressure

By Neil Stewart, Editorial Director, Maternity and Midwifery Forum

If you have been watching the media at any point in the past year you will be aware midwifery units are struggling with staffing.  We know too this is a global concern. In this article Neil Stewart, Editorial director for the Maternity and Midwifery Forum, addresses the pressures



It is hard to think of a time when midwifery and maternity services were more under pressure.


It is traditional for government to insist that while things are difficult, services are coping, and services are stable.


The ministerial answer was traditionally that they would be training a thousand more or recruiting thousands more as though this was enough.


But on 13th July 2022 NHS England sent out a remarkably frank letter from Chief Nurse, Ruth May “Retaining our nursing and midwifery colleagues” acknowledging the serious problem of retention and listing a series of actions.


Like the water companies there is now a recognition that pouring more trainees into the services is not enough if there are leakages all along the career path.


The student who does not complete their degree, the student who completes their degree but does not go into practice, the dropout rate in the preceptorship period and early career, the handling of maternity leave and midwifery service experience for midwives ( new Australian research suggests midwives having babies experience specific traumas), the career midwives who feel stuck in one track without options, the midwives taking retirement as soon as it comes round.


The NHS England letter addresses the whole list of leakages that midwives have been complaining about for years.


And it is a fascinating and encouraging list.  There is a new nursing a midwifery retention self- assessment tool, the results of which will be fascinating to see, if painful for many units when they see what midwives are really feeling, thinking and planning – but it should also point to solutions and more diverse career options.


It is recognised that preceptorship programmes are “variable” in their quality, which has long been a complaint from new midwives.  So, the National Preceptorship Framework due in Sept 2022 is welcome.


Mentoring and interventions throughout midwifery careers are increasingly recognised as key to retaining and extending the service the NHS gets from Midwives and several initiatives are designed to extend the working life, highlighting new roles, options in midwifery all to extend the time midwives feel happy to give to the service.


The national pension seminars are designed to inform about options and bring more flexibility, can they provide attractive options to persuade the most experienced to give a few more years that could make all the difference. Everyone should grab the chance to attend and think long term.


One of the most welcome calls to action is to “Develop a menopause policy/guidance”.  While this now seems blindingly obvious after the huge coverage of the menopause in the media it is a terrible reflection on the NHS with its huge female workforce that policy making is just discovering the impact of the menopause and starting to address intelligent approaches to supporting midwives and nurses through it both for their own wellbeing but also for the needs of the service.   If you want to know what patriarchy looks like, the male dominated policy making though 74 years of the NHS that ignored the impact of the menopause is a classic case study.


It is one thing to have a shortage of midwives, estimated at 3000 by the RCM, which has been a background demand for years.


But when you combine that with a growing threat of a pay dispute, the demoralising impacts of maternity scandals like Shrewsbury, East Kent, the pressure of CQC reports finding maternity units falling short with calls for services to abandon Continuity of Care policies which midwives have fought for years to develop, and add the continued pressure from COVID infections, then a service under pressure needs to retain every midwife it can.



Neil Stewart

Editorial Director, Maternity and Midwifery Forum

August 2022