The UK is facing the biggest maternity crisis of modern times as a worsening midwife shortage coupled with a baby boom cripples maternity care across the country, removing choice from women at a time when it matters most.
Research by an international team of researchers has also found that pregnant women in the UK are three times more likely to die around the time of pregnancy than in other countries surveyed, such as Norway and Denmark. Out of the eight countries in the study – including Denmark, Finland, France, Italy, the Netherlands, Norway, Slovakia and the UK – only Slovakia ranked higher in terms of the risk of maternal mortality.
The Royal College of Midwives has also reported to GLAMOUR that there is a shortage of over 2,000 midwives in England at the moment and in the past year 600 midwives have left the service.
In September, St George’s Hospital in London – one of the largest hospitals in Europe – has temporarily suspended its midwife-led unit, Carmen Birth Centre, due to staff shortages. This has left many expectant parents unable to have the birth they want. While the hospital’s main delivery suite is available and efforts have been made to accommodate preferences there is still no option of a water birth, which has led to parents quickly seeking alternative options.
Midwife-led units provide holistic, woman-centred care in a home-from-home environment for those who are considered low-risk during pregnancy and are an incredibly popular choice for expectant parents who wish for a natural birth.
The Royal London Hospital’s Barkantine Birth Centre has also recently closed due to ‘operational pressures’ and the problem is not just seen in London. Wantage Maternity Unit and the Cotswold Birth Centre, both part of Oxford University Hospitals, have also closed, Royal United Hospital Bath has suspended home births, Salford’s only birthing centre, Ingleside Birth and Community Centre, has been shut since January alongside the indefinite closure of hospital-based birth units at Huddersfield Royal Infirmary and Dewsbury & District Hospital.
While hospital trusts are keen to push that they are still largely offering some birth services, these are extremely limited in the options available. It seems, once again, choice has been taken away from women at a time when it matters most of all.
Importantly, a huge amount of research has shown that midwife-led units are safest for straightforward births – they lead to better outcomes for women at low risk of developing complications. National Institute for Health and Care Excellence (NICE) guidance says that more women should be encouraged to give birth at midwife-led units rather than traditional labour wards and the NHS also states this in its Best Practice Toolkit.
And yet, with a maternity crisis gripping the country and showing absolutely no respite, this research seems to have been completely disregarded.
One pregnant mother-to-be who was booked in to the now-closed midwife-led centre at St George’s Hospital, London, told GLAMOUR: “Personally, I had mentally prepared for a water birth, and it has been difficult to come to terms with the fact that I know that won’t happen and that I won’t experience it. I still can’t imagine the process of actually giving birth to my daughter not in water. While I know I can create a positive experience outside of the birth centre, there’s still a part of me that feels hard done by.”
It's important to note that water births can never be guaranteed even when services are fully up and running – the facilities may be in use or the woman giving birth may not meet the right criteria for a water birth.
Another expectant mother told us: “I suffer really badly with White Coat Syndrome and anything too clinical sets me off. I chose my local midwife-led centre because it felt so different from the traditional labour ward. I have been low risk during my pregnancy and I wanted a relaxed birth in a calming setting. I feel this has been taken away from me entirely. I expect if this was a man’s experience things would have changed by now, women like me feel completely stripped of choice.”
It’s not just the closure of midwife centres that’s a problem, a lack of investment into maternity services has led to a wealth of other issues.
Last summer, I gave birth to my first child and was told I needed to take him to my local children’s centre when he was just five days old for a routine heel prick test which screens for various health conditions. Due to cuts, there was no health visitor or midwife available to come to my house so I was expected to make the 20-minute car journey to a place where there was no actual parking or “take a 15 minute bus ride” which required 10 minutes of walking at both ends.
This is something deemed acceptable just five days after a woman has pushed a baby out of her vagina, suffered a grade 3 tear and is mentally and physically recovering from an extraordinary ordeal, all while trying to understand this new tiny human who wants to be fed every 10 minutes. The situation worsening for someone who’s had a C-Section i.e. major abdominal surgery, not to mention to those new parents who are suffering from postnatal depression or don’t have a partner they can rely on for transport.
One new mother told GLAMOUR: “Before the baby arrived I felt super supported but since it’s arrived it’s gone from 100 to 0.” She added: “Day five was also my first day home after being in hospital so after two hours at home I had to struggle out to the clinic and then to make matters worse, they told me my baby had jaundice and that we would need to go back to hospital as it was obviously missed, it was really deflating.”
Another new mother told us of her ordeal in hospital after having a C-Section: “I had to beg for my painkillers which often went unanswered – they were just too busy.” She added: “Then my catheter was taken out before they checked I could walk which I barely could…I was left to go and shower on my own and couldn’t get my compression socks off or stand properly. Most of the showers were broken so I was hobbling from one to the next in excruciating pain just hours after being in theatre. It was genuinely scarring.”
In our investigation, GLAMOUR surveyed 40 new mothers and found that 30% of the group were still being offered their 6-8-week postpartum appointment on the telephone in lieu of in person. Even if GPs welcomed them into the practice after the call, in these instances it was up to the mother to schedule an in-office check-up. A physical examination is crucial, particularly to review stitches at risk of infection, blood pressure and mental wellbeing. After all, new mothers don’t always know what ‘normal’ looks like and they won’t necessarily ask for help on a phone call.
Former health secretary Steve Barclay made a statement to the House of Commons recommending that the NHS spends its time focusing on prioritising urgent and emergency care and cutting waiting times, but there was no mention of tackling the huge problem of maternity care.
Birte Harlev-Lam, Executive Director Midwife at the Royal College of Midwives (RCM) told GLAMOUR: “The bottom line is we have too few midwives in the UK, particularly in England where there is a shortage of over 2,000 midwives. Understaffing compromises the delivery of safe care.”
She added: “Midwives themselves are desperately worried they cannot deliver the care they want to due to understaffing. It’s time for the Government to wake up and take urgent action. How can they sit back and continue to watch after years of underinvestment in UK maternity services which is now resulting in widespread safety issues.”
According to the RCM, things are about to get a lot worse as recent figures from the Office of National Statistics (ONS) show there were 10,000 more births across the country from 2020 to 2021. “At the same time midwife numbers have dropped across all the English regions increasing the overall shortage of midwives.”
Harlev-Lam said midwives are working their hardest “in a system that is against them” and said even “vital training is postponed” because there aren't enough staff on shift.
She told GLAMOUR newly qualified midwives are reconsidering their careers after joining the NHS “at breaking point” while experienced midwives feel forced to leave “due to the unsustainable pressures which are impacting their physical and mental health.”
She added: “The Government can no longer ignore the crisis engulfing maternity services .They owe women, their families, and maternity staff urgent action now to address the issues, they cannot allow this desperate crisis to continue to unfold in front of them.”
This week, over 30 organisations representing the maternity sector signed a letter to the government, coordinated by UK charity Birthrights, calling for “urgent and meaningful intervention” to make their 2019 manifesto commitment of making the “NHS the ‘best place in the world to give birth” a reality.
An NHS England spokesperson told GLAMOUR: “The NHS is committed to providing safe maternity services and is taking significant action to improve care for pregnant women and their babies, including a £127 million investment this year to boost our workforce, strengthen leadership and increase neonatal cot capacity – which is on top of an annual boost of £95 million for recruitment and training announced last year.”
GLAMOUR reached out to our new health secretary Dr Thérèse Coffey to find out what urgent measures the government will take with improving maternity services.
A Department of Health and Social Care spokesperson told us: ”We want the NHS to be the safest place in the world to give birth. That’s why we’ve invested £127 million, including more than £50 million to boost staff numbers in maternity and neonatal services across the country, £34 million for culture and leadership programmes, and £45 million to increase the number neonatal cots across England.
“Additionally, £95 million has been invested to recruit 1,200 more midwives and 100 more consultant obstetricians, to ensure we have the staff in place to deliver high-quality care.”
I, like many, am an avid supporter of the principles of the NHS and understand the pressures it faces but however much indebted we feel, the current state of the maternity crisis needs to be challenged and we need to see vast and visible change which impacts maternity care at every level. While promises of funding and investment might sound great on paper, is this really reaching the places it needs to be? Is the government actually taking the situation seriously?
As women we are expected to be grateful for the care we receive rather than apoplectic. Don’t be afraid to raise concerns, make a fuss, hold your ground, fight your cause.
For a department so intrinsic to a nation’s survival, it's high time someone listened.
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