Power in numbers: the future of maternity services

By Head of Health and Social Policy, Sean O'Sullivan on 14 September 2021 Maternity Services Midwifery

Planning for the right number of midwives and maternity support workers (MSWs) over the coming years will be critical to improving the safety and quality of maternity services. This message is at the heart of evidence that the Royal College of Midwives (RCM) has submitted to Health Education England’s (HEE) strategic review of the health and social care workforce in England.

Our evidence will inform work that HEE is undertaking to develop a detailed and broad picture of the impact that factors like demographic and technological change will have on the demand for and availability of staff, as well as the way in which changes to jobs, roles and ways of working will influence careers within health and social care.

In our evidence, we identify those factors that are likely to have a significant bearing on the size and shape of the future maternity workforce. The first, and perhaps most significant driver is the way in which current demands on maternity services are being driven by increases in the complexity and acuity of many pregnancies and births. Although the birth rate in England has fallen steadily in recent years, this has been more than offset by the increasing proportion of pregnancies and births that are to women with a range of medical and social needs, including pre-existing physical and mental health conditions.

Concerns about the safety of maternity services and the need to improve safety outcomes, including reducing maternal mortality and morbidity, stillbirth and neonatal death rates, have led to significant demands on the midwifery workforce. Midwives and midwifery leaders are tasked with implementing the plethora of safety initiatives and recommendations, auditing current practice, processes and outcomes and developing new approaches to ensuring learning from adverse events. This current focus on safety is likely to have a profound impact on the maternity workforce for the next 10 to 15 years at least.

More staff will also be needed to tackle the disparity in outcomes and quality of care experienced by women from minority ethnic and socio-economically disadvantaged backgrounds. While the NHS has launched many commendable initiatives aimed at reducing inequalities, successful implementation of these objectives will require the employment of more midwives with specialist skills and greater availability of training for all maternity care staff.

The implementation of new service models, particularly continuity of carer requires proper investment and the employment of sufficient midwives to ensure that continuity teams and core services are both safely staffed. Unfortunately, progress on implementing continuity has stalled as so many midwifery services are short of staff and struggling to provide safe care. Midwives are particularly concerned that the demands of working in a continuity model will impinge on their family commitments and life outside of work.

This goes to the nub of the problem, which is that just at the point when more staff are needed, the negative experiences at work and limited opportunities for career progression are leading to a loss of experienced midwives. The bottom line is that without urgent action to improve the working lives of midwives and MSWs, and raise their career aspirations, an increasing number of staff will vote with their feet and leave the profession.