Maternity units are being forced to shut their doors to expectant mothers because of a shortage of midwives. Hospitals in England are more overstretched than those in the rest of the UK, with centres closing temporarily last year for a total of 170 days.
Across the UK, 39 units closed for a total of 4,081 hours. During this time, women would have been turned away from expert help. A survey shows that 24 of the 39 maternity units had to close for periods of 24 hours or more.
The findings, collated by the research organisation Dr Foster, will raise questions about how the government will deliver its controversial plans to reconfigure maternity services, outlined last week by the 'children's tsar', Dr Sheila Shribman. The report she published, Making it Better for Mother and Baby, says dozens of units could close in a nationwide shake-up, resulting in women having to travel further distances to give birth.
The report also emphasised the importance of midwives. It says women should expect their care to be directed and delivered by midwives in the community and only expect obstetricians to take over if their labours become more complicated. There has been little detail published on how the government will meet its 2009 election promise that every woman would have a named or known midwife for their labour.
The survey shows that many units cannot cope with the demands being placed on them as the birth rate rises. Experts say that economic prosperity, family-friendly government policies such as increased parental leave, and the higher birth rate among many immigrant communities are among the factors behind the rise. The figures also reveal that in some regions fewer than two thirds of units were able to offer one-to-one care - the gold standard where a woman is looked after by one midwife throughout pregnancy and which is popular with pregnant women.
One of the worst affected areas is London, where only one quarter of units are able to guarantee that, before the birth, women meet the midwives who will take them through labour. Medical cover is also patchy - just 38 per cent of units in Scotland have on-site obstetricians, whereas 94 per cent of units in London insist on this.
Louise Silverton, deputy general secretary of the Royal College of Midwives, told The Observer: 'We welcome the reconfiguration plans - but there is one big piece missing. Where are the midwives going to come from?
'Currently we have 25,000 midwives in the UK but 55 per cent of them work part-time. We estimate we need 10,000 more. As well as a rising birth rate, the government is asking us to do much more - such as assess women for domestic violence. We are not saying we don't want to do these things - we just need more midwives to achieve them. Yet instead of increasing numbers, we are finding trusts are freezing posts so newly qualified midwives can't get jobs.'
The issue of maternity care is becoming politically fraught for the government as many regions have begun to discuss closure of the smaller, midwife-led units. Some prominent Labour MPs, including cabinet minister Hazel Blears, chief whip Jacqui Smith and health minister Ivan Lewis, who is responsible for maternity services, have been campaigning to save their own local services.
A spokeswoman for the Department of Health said: 'There are various factors that influence the decision to close a maternity unit for a period of time, including staff and bed availability and the number of women and complexity of care needed. It is important that in circumstances where a unit considers or actually does close, systems are in place to ensure pregnant women continue to have access to alternative maternity services and safe provision of care.
She added: 'We have already achieved one target - to increase the number of midwives employed in the NHS by 2,000 by 2005. Through more investment in training staff and finding ways for midwives to come back to work in the NHS, we expect to see further increases in the midwifery workforce, but clearly there is still more to be done.'
Sorry, we're closed
The 10 worst units for closures to expectant mothers last year, and the number of hours they were closed:
Rochdale Infirmary, Rochdale, 469.
Princess Royal Hospital, Haywards Heath, 459
Royal Sussex County Hospital, Brighton, 305.39
Southmead Hospital, Bristol, 205
Eastbourne District General Hospital, 145
University Hospital of Hartlepool, 126
University Hospital of Wales, Cardiff, 122.5
St Thomas' Hospital, London, 105
Conquest Hospital, St Leonards on Sea, 102
Kingston Hospital, Kingston upon Thames ,96
For full survey details go to www.birthguide.co.uk
