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How cuts to maternity services are threatening health and care

Director of Maternity Action Rosalind Bragg explains how cuts to NHS maternity services are impacting on care.

There is a growing sense of frustration at the short-sighted nature of cuts to NHS maternity services.

The Care Quality Commission and the Royal College of Midwives have each raised the alarm about midwifery numbers. Even the Daily Mail, not known for its evidence-based analysis of Government policy, expressed outrage that breastfeeding rates have been affected by cuts in maternity funding.

Campaigners from the voluntary sector and union movement have begun mobilizing to protect quality maternity care.

The UK is experiencing a baby boom. Between 2001 and 2010, the number of babies born each year has increased by 21%. During this time, midwifery numbers have increased by just 15%.

The growing number of births is not the only source of pressure on maternity services. An increasing proportion of pregnancies are complex due to the age, health and social circumstances of mothers.

A useful indicator is the number of women over the age of 40 giving birth and this figure has almost trebled in the past decade.

It should go without saying that supporting women with complex pregnancies involves more midwifery time. Midwives can’t support women with complex health needs or complex social needs in the standard antenatal appointments. Attempting to do so reduces the time available for women without complex needs, which is not helpful to either group of women.

Cuts to advice and support services have placed a further burden on maternity services. Without ready access to support agencies, midwives cannot refer on women who need more help.

Cuts to violence against women services, asylum services, and homelessness services have all impacted on maternity care. If midwives can’t find a bed for a homeless new mother, then the woman is housed on the maternity ward until accommodation is sorted out. This cuts into already over-stretched maternity
budgets.

The long term lag in midwifery numbers has left maternity services without a cushion to manage the current round of ‘efficiency savings’. Cuts are directly impacting on service delivery.

A recent Care Quality Commission report found that nearly one in seven trusts providing maternity services do not meet the recommended midwifery ratio of one midwife for every 28 births. They also identified problems with recruitment and retention of supervisors of midwives, which are important roles for overseeing and supporting midwives to provide quality care.

The Royal College of Midwives has calculated that another 5 000 midwives are required to protect the quality of maternity services. Their 2011 State of Maternity Services report examined the maternity workforce in England, Scotland, Wales and Northern Ireland. England fared particularly poorly, with a substantial shortfall in midwifery numbers and an ageing workforce.

The consequential impacts are beginning to show. Recent research reviewed breastfeeding initiation and drop off rates against changes in maternity spending. Unsurprisingly, there was a strong correlation between cuts to maternity services and declining breastfeeding outcomes.

Reducing support for new mothers from midwives and breastfeeding professionals translates directly into increased costs to the health system for both mother and baby. Over their lifetime, breastfed babies have reduced rates of many infectious and immunological diseases, reduced rates of some cancers, better cardiovascular
health, and reduced rates of obesity. Mothers who breastfeed have reduced rates of breast and ovarian cancer.

A monitoring programme which is of particular importance in a context of declining resources is the confidential review of maternal deaths. This triennial report collates detailed investigation of each maternal death in the UK and provides valuable insight into the emerging trends in maternal health and services. Substantial delays in resolving the future of this programme mean that we will be waiting until 2014 for the review of deaths occurring during 2009-2011.

The Government’s response to the growing problem within maternity services does not inspire confidence. In May 2012, the Minister announced that women will have one named midwife to oversee their care during labour and birth. This will require a substantial increase in midwifery numbers.

However there is no mechanism to support this announcement: no new money, no stipulation in commissioning arrangements, and no monitoring process to assess compliance. Without any framework for implementation, the announcement is viewed with some cynicism.

The Valuing Maternity campaign, led by Maternity Action, is bringing together groups who are concerned about the unfair and growing burden placed upon pregnant women and new mothers during the recession. A coalition of parenting organisations, health groups, women’s organisations, advice services and unions, the campaign is calling for services to support a safe and healthy pregnancy, job security for all women during maternity, and maternity and parental leave which promotes real equality.

The Government repeatedly states its family-friendly credentials. Now would be a good time to demonstrate them.

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