Midwife crisis over hours and workload

A serious shortage of midwives is depriving women of one to one care and pushing up the rate of caesarian sections and other medical interventions.

Long hours, low morale and intense pressure in under-staffed NHS maternity units is causing more midwives to consider leaving. This has created a vicious circle, which promises from the government about increases in midwife numbers have as yet been unable to break.

"Midwives don't want to work within the system," said Frances Day-Stirk, director of midwifery affairs for the Royal College of Midwives. "They feel unable to give the standard of care they want to, and so they vote with their feet.

"We know that midwife care is cost-effective and that with one to one support women have far higher chances of a spontaneous birth and shorter labour," she said.

The college says that its research confirmed the vicious circle of midwives, unable to give women one to one care because of shortages, becoming dissatisfied and leaving in turn.

A study from the English national board for nursing, midwifery and health visiting shows that there is a direct correlation between midwife shortages and medical interventions in childbirth.

Their figures comparing 1996, 1998 and 1999, show an alarming drop in the number of deliveries by a midwife rather than an obstetrician, from 72.3% to 71. 25% two years ago and down to 68.8% last year. Over that period, caesarian sections rose from 15.8% of births in 1996 to 18.1% in 1998 and 18.9% last year.

In 27 of the 233 maternity units from which the board collected data, there are less than 1,000 deliveries a year. The outcomes from these smaller, midwife-led units are quite different from the rest, says the report. "Rates of midwives' deliveries and home birth rates are higher, while caesarian sections are lower."

The government has acknowledged that there are problems and promised an extra 20,000 nurses and midwives in the NHS national plan published in July. But there is a problem with retention.

A lot of midwives leave in their first year after completing training. Others go when they have children of their own and find the hours too long and inflexible. Out of 5,744 midwives working in the NHS in March this year, 550 had joined in the last year but 531 had left, resulting in a net gain of just 19, or 0.3%.

A long-running and damaging dispute over grading appears to have been resolved, with a commitment in the national plan to put them on at least grade F. Most midwives earn somewhere between £15,920, which is the bottom of grade E and £21,635 which is the top of grade F.

But hours are still a serious cause of discontent. Many midwives are now called in during the night not because one of their clients is in labour but because of staff shortages on the ward. The overnight on-call payment is just £5.95 an hour, and some are offered time off instead, which because of shortages they are unable to take.