The new head of the RCM tells Lyndsay Moss that women must be given choice over childbirth
WOMEN are constantly told having a baby is the most natural thing in the world, a process to be endured but enjoyed. But for many, the prospect of giving birth can also be incredibly daunting and a time filled with stress and fear. For these women, a
ccess to good medical care and the services of a midwife are vital. But across the UK, it seems a shortage of midwives – or midwives not being based in the right locations – is hampering efforts to give women the best experience when having their babies.
Professor Cathy Warwick, the recently- appointed head of the Royal College of Midwives (RCM), believes more midwives are needed to give women the one-to-one care they need before, during and after the birth.
In her first interview since taking up the post, the Scot said giving women choice over how they give birth was crucial. "Across the UK, the RCM believes we are very short of midwives," she said. "We are talking about being around 5,000 short in order to deliver on government policies. But the situation in Scotland is relatively good.
"From my perspective, the issue here is much more about ensuring that the midwives are in the right place, rather than the numbers. Scotland has recently introduced a guarantee that newly-qualified midwives will have a one-year job, so they are not experiencing a problem where midwives are qualifying and their local board does not have a post.
She added: "But the problem in Scotland is more to do with the fact that there are peaks and troughs and midwives are living in areas where midwifery levels are relatively good and in other areas they are not so good and there is not the right number. So it is a question of, 'does the supply match the demand', rather than, 'is there enough supply?'"
Warwick, who was born in Edinburgh and trained as a nurse in the city, said Scotland's remote and rural areas posed a particular challenge to midwifery services.
"Scotland, like other governments, wants women to be able to choose where they have their baby – to be able to choose home birth or midwifery-led care, or obstetric care in a hospital – but that is obviously a big challenge to provide if you have got a very small population in a very remote area. The challenge will be to ensure that women are safe and can be transferred quickly and appropriately if necessary."
Warwick said it was important to protect midwife-led units, which have been threatened because of the small number of women using them. "All the evidence is that women get extremely high-quality care from midwifery-led units and services," she said. "Intervention rates are lower among women who are low-risk and going into midwifery-led units than women going into obstetric units. So I would certainly argue that we should be ensuring those services are provided and protecting them wherever possible. The issue is are they safe and are they cost-effective? And I think the evidence to date is that they are safe."
Warwick said women needed to understand that certain things would not be available to them in midwife-led units, such as an epidural. They would also need to know that, if something did go wrong, they may have to be transferred to another unit, which might not be on the same site.
A midwife for over 30 years, Warwick said she believed women should have the choice of having an epidural, but should also be informed of other methods of pain-relief, such as using a birthing pool. "A variety of methods of pain-relief should be available to women and they should know about them and how they work," she said.
She is also clear that women should not be left alone during their labour.
"I think the bottom line would be that all women, when they are in established labour, should have a midwife looking after them. You have got two people – a woman and her baby – who are going through a normal, but nonetheless critical process, and it's very important they have someone with them the whole time to support them and monitor that everything is going normally."
With efforts to reduce Caesarean rates – which are both costly and carry more risks – Warwick said midwife-led units could also reduce the need for surgical intervention.
"There seems to be a cascade of intervention," she said. "Once a woman is restricted in her movement, she might have an epidural, or her labour is accelerated, when she has one of these types of intervention, she is more likely to come out the other end with a Caesarean section.
"Why this is we are not sure, but in midwifery-led units where there are fewer interventions, there are lower Caesarean rates."
Warwick is also keen to stress the importance of midwives in helping meet another government aim – increasing breastfeeding rates. But she said work pressures meant midwives did not have time to help women as much as they would like.
"We have got to make sure that midwives are freed up to give women that support. There has been some work done that suggests midwives do have to spend a lot of time on paperwork and on administration. The sort of things we are working on is making sure there is enough admin support, enough support from other workers who can do the basic tasks and free up the midwives to give the support that's needed."
The full article contains 950 words and appears in The Scotsman newspaper.
