20 January 2014
Chief Executive, Royal College of MidwivesAppeared in BioNews 738
The pressure on the UK's midwives is at its highest for decades. In England, for example, there were more babies born in 2012 than in any year since 1971. In Scotland, Wales and Northern Ireland, births are also at recent highs, well up on the numbers at the turn of the century.
Births to women in the oldest age groups rose fastest. In Scotland, births to women aged 40 to 44 were up 71 percent between 2001 and 2012, and up 165 percent for women older than that. In Northern Ireland the respective increases were 64 and 53 percent.
In England, births to women aged 40 or above were up 85 percent over the same period; in Wales that figure was 64 percent. In several areas of the UK, figures show that well over a quarter of births are to women aged 35 or over.
These women will typically carry a higher risk of complications and therefore need additional care. This won't be true for every older mother, of course, but it is true for older mothers overall. This means more midwife time is needed to give them the care they need, expect and deserve. In other words, the NHS needs more midwives.
These are some of the key findings of the latest State of Maternity Services report from the Royal College of Midwives (RCM).
I have heard it said that when midwives like myself refer to figures about older mothers we are trying to make the women concerned feel guilty. Let me make it absolutely clear: I am not suggesting and the RCM would never suggest that these women are any less deserving of maternity care. They should not feel guilty and we would never want them to feel guilty.
The reason we point to statistics such as these is simply to highlight the growing demands on the profession. We want to give older mothers all the care they need, but we need to eliminate the shortage of NHS midwives in order to ensure we can do that.
What is behind the big rise in births to older women? Some have suggested that IVF may play a role; in other words, that women feel they will have the fallback option of IVF should they leave it into their 40s before starting a family. I am not convinced by this, although it is an interesting proposition. Instead I suspect it might be more about factors such as the cost of living, particularly with young people being priced out of the housing market, or a rising proportion of women entering the workforce.
There has been some suggestion in recent years, such as in this report in the Daily Telegraph, that there is a higher risk of maternal death after IVF treatment; further analysis suggests however that this risk may well be overstated.
Other evidence (see BioNews 737) points to a higher risk of complications for women conceiving using IVF. While less serious than an enhanced risk of maternal death, higher risk of complications will drive up demands on midwives generally, demands which underline our call for more midwives to be trained and recruited into the health service.
It is not just the RCM saying that more midwives are needed. The National Audit Office (NAO) looked into NHS maternity services in England, and their report, published in November last year, found the health service to be thousands of midwives short. The NAO is the body tasked with ensuring that public money is spent wisely, so having them say that is significant.
The number of midwives is up, which is good, but it is not up by enough. Let us hope that for the sake of all the women who use maternity care, of whatever age, decision makers in the NHS continue to train and recruit the midwives we need.