Gillian Smith: Midwifery faces mother of all battles

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It is interesting to look into maternity services and recognise that it is really only in the last few years that the health service has paid any great attention to them.

One wonders, if this had been a service that was about men would we have waited so long?

The chief medical officer, the cabinet secretary and many others repeatedly tell us that what happens in the womb can influence the child’s entire life and future generations. So, why are we not investing more in seeing it has the right start in life?

A wise politician once said if you want to see the health of the nation, look in the prams. When projecting the expected number of births, the government got it seriously wrong and now we are paying the cost of that.

The maternity team is expected to do more with either the same or fewer resources and staff.

Midwifery is a unique profession in that instead of one patient we have two, the woman and her baby. This is often forgotten by people who manage maternity services and suggest that it is an expensive service.

Staffing levels are really important and the right level of staff to be able to provide a safe and effective service is paramount. We know that women who have one-to-one care in active labour from a midwife have better outcomes and a more positive experience. In Scotland, we are reportedly almost meeting this target.

The worry is when labour wards are full and have no beds or staff, is this really happening and, is this target really being met?

Women are kept in the main ward area, not in the labour ward and the staffing levels there are sometimes not enough to allow the high quality and constant care women need in labour. In effect, they are silently labouring and are not counted in the statistics, so we perhaps don’t have a true picture of whether women really are getting this level of care.

To make sure that we get it right we need to have robust workforce planning across the service because the number and availability of other health workers in maternity services, such as obstetricians, will have an impact on the midwives and the women and vice-versa.

Good teamwork across all maternity services is also fundamental to delivering the best care.

In the midst of this, it is not all about just getting the baby out and all will be well.

The postnatal period is often an area that is seriously understaffed. This period after the birth is so important and new mothers and their families need support.

For example, we know Scotland has one of the lowest breast feeding rates in Europe. How can we help women without the support necessary to do this?

This support does not always have to be carried out by midwives, and we are fortunate across Scotland 
to have some excellent maternity support workers who have made a real impact.

Let us throw down the gauntlet to those people who hold the purse strings. Let us get it right now so future generations don’t pay the price.

• Gillian Smith is director for Scotland at The Royal College of Midwives


THE Evening News told this week how health chiefs have admitted urgent action is needed to ensure Edinburgh’s main maternity hospital can operate safely for mothers and babies.

The Simpson Centre at the ERI is coming under increasing strain due to a staffing crisis, while the service is struggling to find enough room for the increasing number of cases coming through its doors.

Pregnant mums from Edinburgh are being diverted in “increasing” numbers to St John’s Hospital in Livingston because of a lack of beds. A review of staffing and capacity is now under way.