Maternity cuts: A ticking time bomb for the NHS?
23 January, 2017
Update, May 2017:
Following our report below, a freedom of information request by the Victoria Derbyshire Show has found that maternity staff record more than 1,400 mistakes on average per week in England. These mistakes include incidents that vary from records being lost, to the death of the mother or child. Such mistakes can have life-changing or fatal consequences, and the frequency that they occur is incredibly alarming. Additionally, these figures also only apply to 81 of the 132 NHS trusts in England, meaning the figure could actually be much higher.
In a four year period, between 2013 and 2016, 305,019 incidents were recorded. In the same period, 259 deaths of mothers or babies occurred in 39 trusts, which were recorded as unexpected or avoidable. Unfortunately, due to the pre-election purdah period, the Department of Health were unable to comment on the new figures, but Jeremy Hunt pointed out in October 2016 that since 2010 the government has invested almost £40m in maternity units in order to make ‘tangible physical improvements’. However, the Royal College of Midwives says this isn’t enough. Midwives are under extreme pressure, which compromises safety, due to the reduction in the amount of student midwives training, which means there aren’t enough in the profession and this extreme pressure leads many to quit, causing a circle of issues with staff and stress.
It remains to be seen whether the general election of 2017 will have any considerably influence on the maternity issues many currently face, but the truth is that these 305,019 incidents are likely to cost the NHS more money in the long run, either through compensation payments or treatments for mother and baby down the line which could have been prevented.
Original piece, January 2017:
New research has discovered that half of all women experience a ‘red flag’ event whilst in labour. These include delays of more than 30 minutes for pain relief during childbirth, waiting more than an hour for stitches, and missed medication doses. The ‘Support Overdue’ report by the National Childbirth Trust (NCT) and the National Federation of Women’s Institutes (NFWI) claims that these delays, and undelivered care practices, highlight a worrying shortage of midwives, and expose a crisis in maternity care. The new report found that 17% of women who were in established labour weren’t the recipients of one-to-one care from midwives. Others had delays in care, such as 15% who said that there was a hold up after giving birth for washing or suturing. Whilst 31% of women said that requests for pain relief took longer than 30 minutes. Women surveyed for this report also highlighted how they were made to feel like ‘cattle’ or just a ‘product on a conveyor belt’. Other mothers said they were either moved to another ward, or ended up giving birth at home after being sent away from ‘extremely busy’ maternity units. Mental health is a fragile thing for anyone, but especially new mothers whose hormone levels put them at risk of post-natal depression (PND), with 1 in every 10 women having it within a year of giving birth. Issues such as the delays mentioned in the report could trigger PND in some mothers, or may lead to physical issues that also require further care on the NHS. So are the NHS actually making things more costly and only causing more problems in the long-term by making cuts to maternity units?
Current figures from the Royal College of Midwives suggest that in England alone over 3,500 midwives are needed to improve the quality of care. Louise Silverton, from the Royal College of Midwives said that ‘The fact that half of women have experienced a red flag event is hugely worrying. It is a sign of services under too much pressure, with too few resources and not enough staff.’ She went on to say that ‘This ongoing shortage of midwives and underfunding of services is not delivering the service that women and their families need, and it is storing up health problems for the future that could be prevented.’ However, it’s not just during birth that problems are occurring, but also postnatally. As Elizabeth Duff, Senior Policy Advisor at the NCT said, ‘It’s shocking that so few women are able to see a midwife often enough postnatally, and more support is needed at this stage too.’ This neglect in care both during and after birth is only likely to contribute to PND, rather than help to prevent it. A lack of support postnatally also means that physical injuries are less likely to be picked up on.
However, it’s not necessarily that midwives aren’t doing a good job, as Marylyn Haines Evans, Public Affairs Chair of the NFWI said, ‘women have told us that midwives are working hard to do the very best they can, but that there are simply not enough of them to go around.’ The lack of midwives causes many to be treated insufficiently, and some women have even described it as ‘robotic’ care. We spoke to one mother, Helen, who told us that she believed her midwives to ‘have no heart’, but is it likely that the stress and pressures midwives are facing contributed toward that impression? Helen detailed her birthing experience at York Hospital in 2012 for us. She felt that the level of care she received as a first-time parent was unacceptable. She says that there was not enough communication between midwives and surgeons, nor between midwives themselves on different shift patterns. Helen unfortunately had problems birthing the placenta, which led to a painful manual removal with no pain relief. The procedure itself was very rough and left her feeling ‘shell-shocked’. This caused her to feel very faint, but midwives on following shifts were not aware of this and she was left frustrated and upset at midwives who made her feel ‘judged’ and questioning her ability to be a mum. She also says that health visitors did little to put her mind at rest after the birth which left her confused about her experience, and meant she did not report her concerns, which in retrospect she would. This echoes the statement from the NCT regarding a lack of postnatal care as well as birthing care, which only contributes to a feeling of secrecy and mistreatment towards midwives from patients.
Helen believes it took her at least 6 months to get over the trauma of her birth. It also left her worrying before the birth of her second child in 2014, who in a turn of events was born hundreds of miles away in London in a far more positive birthing experience. She was offered a bath straight away, unlike with the previous birth where she was left for over 24 hours. This suggests that midwifery care as it currently stands is really just a postcode lottery in regards to maternity care. However, with the current cuts to the NHS things are only going to get worse. By having more midwives a more relaxed and supportive environment would be created for mothers. Midwives would be less rushed and therefore more likely to be communicative between each other and with the parents, and it would allow them to provide the one-to-one care that the recent report suggests so many are missing.
The Department of Health, speaking to Sky News, said that there are currently 6,500 midwives in training and they are ‘absolutely’ committed to the improvement of maternity care. They added that they want the NHS ‘to be one of the safest places in the world to have a baby’. If this is the case, then why do these cuts continue to happen? The more cuts that take place the more issues will be raised by women giving birth who are not provided with the proper care. A freedom of information request by the Daily Mail found that ‘Around half of hospitals have to close their doors temporarily to women in Labour and divert them, as they are so busy’, and they link this to the increase in mothers who are high risk due to age or obesity. However, whilst this is likely to be a factor in the struggles for maternity wards, it is clear from the report by the NCT and NFWI that things cannot continue as they are, and this is largely due to governmental cuts. An increase in midwives would not only lessen the chances of mothers developing PND, it will also save the NHS money in the long-term as PND can be expensive to treat, and would avoid any potential injuries caused by rushing. This ticking time bomb for the NHS is not one that will benefit them, and it is clear that they need to invest heavily into maternity care to prevent future generations suffering a similar fate.