A new report finds large increase in midwife-led units co-located with obstetric units, increasing birthplace choice for pregnant women – but also describes variation in availability of staff, facilities and services.
Commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme, the National Maternity and Perinatal Audit (NMPA) is the largest evaluation of NHS maternity and neonatal services undertaken in Britain. It aims to help maternity services to identify good practice and areas for improvement in the care of women and babies.
Only 22% of trusts and boards offer the full range of birth settings (home birth, freestanding midwife-led units, alongside midwife-led units and obstetric units**). These low numbers may be due to geographical factors, such as remote or rural location. Where feasible, commissioners, trusts and boards should ensure that all women have access to all four birth settings either within their own maternity service, or in close collaboration with neighbouring services.
An Royal College of Midwives press release discusses a new report on the threats faced by maternity services.
The report ‘The gathering storm: England’s midwifery workforce challenges’ outlines how issues such as rising levels of complexity in pregnancy, midwife shortages and financial constraints in the NHS are ramping up the pressure on England’s maternity workforce and services.
The report also puts forward solutions to the problems in maternity services. It sets out ways in which decision makers across government and England’s NHS can tackle the situation. These include a more adaptable approach to requests for flexible working, and allowing the NHS Pay Review Body free reign to recommend staff pay wards. This will help retain midwives and not push them into costlier agency work. Implementing other changes will also help too, such as ensuring more low-risk women give birth outside of obstetric units.
The Royal College of Midwifery has published State of Maternity Services Report 2016. The report examines emerging issues and trends in relation to maternity services. It highlights that over a third of the UK’s NHS midwives are nearing retirement age; the increase in births to older mothers, who may require more care throughout their pregnancies; and rates of obesity which are placing additional demands on maternity services.
The National Federation of Women’s Institutes (NFWI) and National Childbirth Trust have published Support overdue: women’s experiences of maternity services 2017. This report presents the findings of the NFWI’s and NCT’s second survey of women’s experiences of maternity care, providing insights into key aspects of the experiences of 2,500 women. Women are generally positive about the maternity care they receive and many praised the professionalism of the staff who cared for them but some findings gave cause for concern.
The National Institute of Health and Clinical Excellence (NICE) published its guideline for safe midwifery staffing in maternity settings (NICE Safe Staffing Guideline NG4 2015) in February 2015. This publication from the Royal College of Midwives supports senior midwives and NHS managers implement the NICE safe midwifery staffing guideline.
Guidance from the Royal College of Midwives which explains the role of the midwife, the limits and scope of the role, its relationship with other professionals and care givers and the approaches which are most likely to lead to safe and effective staffing decisions.
“The role of the midwife is clearly described and demarcated. The evidence shows that
it is in the interests of women to receive the majority of their care from a small group
of midwives they know and trust. Midwifery services should be staffed to enable this
The recommendations take account of the significant variation in service provision around the country in terms of workload complexity, geography and current middle-grade staffing. Therefore, the report recognises that there is no single solution to delivering safe maternity and gynaecological services.
The report specifically looks at the need for some degree of resident consultant working as a solution to workforce issues and recommends the use of hybrid rotas, which include both resident and non-resident out-of-hours shifts.
The report also includes case studies demonstrating how this model is working in practice across the country, and proposes RCOG standards for consultant job descriptions and job plans to support the recommendations.