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Health: Midwives

Volume 743: debated on Monday 25 February 2013


Asked By

To ask Her Majesty’s Government, in the light of the continuing increase in births, what is their response to the recent report by the Royal College of Midwives, which states that there is a shortage of around 5,000 midwives.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In so doing, I declare an interest as a fellow and vice-president of the Royal College of Midwives. My other interests are in the Lords register.

My Lords, there are some 1,381 more midwives in the NHS than there were in May 2010, and there are a record 5,000 in training. The Government have committed to ensuring that the number of midwives matches the needs of the birth rate. Most women already have choice and one-to-one maternity care, and we are working closely with the Royal College of Midwives to ensure that personalised, one-to-one maternity care is available for every woman across the country.

My Lords, I thank my noble friend for that very encouraging reply. I suspect that every single Member of your Lordships’ House has been touched by a midwife. They are a remarkable and very committed profession. Is my noble friend aware that although there is what the Royal College of Midwives describes as a tipping point in the increase in the number of midwives attending women in labour, the real crisis is in postnatal care, where new mothers require advice, support and help in cherishing and feeding their newborn baby? Is he also aware that this requires continuity of a midwife? He has just told us that continuity is being carried through, but a recent survey shows that 40% of new mothers always see a different midwife. How does he propose that we put this situation right?

My Lords, women should expect to have one-to-one care from a midwife during labour, birth and immediately after birth, and to continue to have the support of their midwife after the birth. This is especially important for those women who are susceptible to, or have, depression during pregnancy or postnatal depression. My noble friend is absolutely right about continuity. This depends on each woman having an individualised postnatal plan of care, taking into account her circumstances. To assist the NHS, the department has asked the National Institute for Health and Clinical Excellence to develop a quality standard for postnatal care, which it is anticipated will be published in July this year.

My Lords, my noble friend may have had a chance to look at the report published today by the Refugee Council and Maternity Action on the deficiencies in the support for pregnant asylum seekers. Will his department hold discussions with the Home Office on amendments to the guidance for those women to make it compatible with NICE guidance on the maternity care of women with complex social factors? Will the department and the UK Border Agency jointly look into the negative impact of the current dispersal and relocation policies on the healthcare of women asylum seekers?

My noble friend raises a number of complex and important issues. My department provides approximately £1 million a year for health assessments of asylum seekers in UKBA initial accommodation in England. The aim of the health assessment is to identify and address immediate healthcare needs, including pregnancy, and to recognise ongoing and non-urgent care needs for attention in the dispersal areas. The use of experienced health teams and interpreting services to record medical history also avoids more expensive arrangements at GP-registration stage later on. My officials met Maternity Action on 19 February to discuss the report’s recommendations and were assured that the maternity care provided by NHS midwives was appropriate and in accordance with NICE guidelines. Following that meeting, officials have briefed the Home Office.

My Lords, the fact that Edge Hill University, for example, had nearly 900 applications for 22 midwifery places shows considerable enthusiasm for acquiring this skill. However, experience shows that many midwives withdraw during training or the early years of practice. Has the Minister any statistics on such withdrawals and does he know any of the reasons for them?

My Lords, as regards the statistics on trainees who drop out, I am advised that the average rate is around 22%, which is quite high, but that can be for a number of reasons. I am, however, encouraged by the statistics that I have on the number of commissions that are currently in train across the country. On conservative assumptions, this year and next, we should see about 1,900 midwives emerging from training.

My Lords, how many midwives are familiar with the minority languages that are spoken by British women in areas such as Leeds and Bradford? Are there sufficient numbers who know the local language, rather than having a general notion which does not really suit the language that the women are speaking?

The noble Baroness raises another important point. This will be a particular issue for the local education and training boards, which we are setting up under the auspices of Health Education England, to get a local feel for the needs of patients in an area. The language skills of midwives will be a very important ingredient of that.

My Lords, in the light of the original Question of the noble Baroness, Lady Cumberlege, would the Minister advise the House as to whether NICE will be asked to produce guidelines based on what it believes is needed or based on the current shortfall in midwives? If it is based on the current shortfall, we will suffer the same problems.

As I mentioned, we are doing our best to address the shortfall in the number of midwives in training. However, NICE has been asked to produce a quality standard that will be a benchmark against which the quality and outcomes of midwifery practice can be judged.