Greater numbers of women giving birth later in life, an ageing midwife profile and a nationwide shortage of the profession is putting unprecedented pressure on maternity services.
And the situation could reach crisis point as analysis of the NHS Sustainability and Transformation plans shows around 11 maternity and neonatal units across England may be facing closure or consolidation.
Midwifery chiefs expressed disappointment that many of the STP plans make little or no mention about maternity services.
The Royal College of Midwives were concerned that many of the plans - particularly those outside of London - do not give many details about maternity changes and transformations.
Areas that were highlighted as making no mention of maternity services include West Yorkshire, around Bristol and Kent, Cambridge and some parts of the Home Counties.
Those who make passing reference with little or no detail include Lancashire, Cheshire, Merseyside, Suffolk and Surrey Heartlands.
The areas that do include substantial information on maternity services plans include places in the North East, Humberside, the West Midlands and large parts of the South West.
London is leading the way on maternity with all the STPs including substantial detail about their plans for maternity services.
Jacque Gerrard, director for England at the Royal College of Midwives, said: “Following the publication last year of Better Births, the report of the national maternity review in England, maternity services in England are meant to be embarking on a programme to transform their services in order to make them safer, more effective and more responsive to women’s needs.
“It was natural to link up Better Births with STPs and it was then called the Maternity Transformation Programme.”
Although Dr Gerrard says the College expressed disappointment that some STP plans were sketchy when they came to maternity plans, they are very supportive of the Maternity Transformation Programme.
The plans include more midwifery units and birth centres and improving the choice and personalisation of maternity services.
Dr Gerrard said: “There is a lot going on but it is still very early days.
“There are ambitious things such as looking at more personalised care plans, better unbiased information and digitalised maternity tools that women can access.
“There is also work going on into looking at improving antenatal and postnatal care and trying to do it via a personalised maternity care budget.
“There are pioneer sites in Cheshire and Merseyside testing this model.
“In a nutshell, it means where the woman goes, the budget should follow her such as she wants for things such as hypnotherapy on top of her agreed care.
“Woman on the pilot sites will not be asked to pay any top ups.
“But until we test it, we don’t know how the personalised maternity care budget will work.
“Everything is a theory at the moment and the pioneers need to test it.”
Dr Gerrard says evidence shows births in midwifery units is safe and she strongly refutes any suggestions that “women will be going back to Victorian times.”
She said: “Midwives are skilled and educated and trained to degree level and base their care on evidence.
“There is no foundation to the claim we will be going back to Victorian times and evidence shows it is safe to birth in a midwifery unit. There are certain women with complications you would not advise to go in there.
“Midwives view it as a positive to have more births at home and in midwifery units if that is what the woman wants.
“At the end of the day, it is the woman’s choice and it is up to the midwife to make it happen.
“Regarding the issue that sometimes things go wrong in labour, midwives are skilled and trained to pick up on deviations from the norm sooner rather than later and women are transferred to a consultant when needed.”
Dr Gerrard says the midwifery transformation plans include more midwifery units, more professional and family friendly care and being able to support women to have choices based on their individual needs and circumstances.
She says: “These plans are about promoting a culture which is innovative and evidence based with continuity of care and choice.
“Women will not only have a healthy safe outcome, they will have a more positive birth experience.
“That is all women irrespective of their needs complexities and background.
“How can we not be supportive of that type of service?”
Staffing levels are the real area of concern when it comes to maternity as there is a shortage of 3,500 midwives across England.
And with many midwives approaching retirement, the profession fears it is facing a staffing timebomb.
Figures show one in three - 33 per cent - of midwives in England are now in their fifties or sixties.
Dr Gerrard says: “Older midwives can bring great experience and are great assets to the NHS.
“But it is a concern that such a large proportion of the midwifery workforce is so close to retirement.
“More students need to be trained and brought into the health service as a matter of urgency if we are to turn this situation around.
“More midwives are needed and in England, where births are on the up, we calculate the shortage to be the equivalent of around 3,500 full-time midwives.”
In their recent State of Maternity Services report, the Royal College of Midwives stated: “The midwifery profession is ageing fast just as the demands on it are growing.
“We are standing on a cliff edge and need swift action now.”
Dr Gerrard said: “We are not against the STP plans and are very supportive of the Maternity Transformation Programme.
“It is staffing levels we are concerned about.
“We need the right number of midwives in the right places to make it happen.
“If we are going to achieve these ambitions, we need the midwives to deliver them.”
AGEING PROFILE OF MOTHERS
A long term trend affecting maternity is the ageing of the profile of mothers.
Across the UK, there are fewer births to younger women and more to older women.
In every region of England since 2010, there are more babies born to women in their thirties or older and fewer to women under 30.
Since 2001 in England, there has been an increase of over 12,000 in the number of births per year to women aged 40 and older.
The age group to see the biggest rise in births in Scotland has been women in their late thirties with 2,000 more births per year compared to the year 2000.
In Wales, births per year to women aged 40 and older has now passed the 1,000 mark.
In Northern Ireland, births to women in their thirties are up by almost 3,000 since the start of the century.
The Royal College of Midwives says: “Taken as a whole, women who give birth later in life will need more care from the NHS.
“This will not be the case for every woman in that category but it will be true on average.
“They are perfectly entitled to that care of course but the added complexity and cost means more needs to be invested in maternity care to ensure they get the quality of care they want, need and deserve.”
GOING BACK TO VICTORIAN TIMES
“We are at risk of returning to Victorian times with more women dying in childbirth.”
That’s the view of Jessica Ormerod, maternity spokesman for the National Health Action Party, which is fighting to save the NHS from being turned into a US-style health service,
She believes a push for more home births or births at midwifery led units could cause women who experience problems during labour to be at risk.
She says: “The STP plans seem to suggest fewer hospitals so that means people will have to travel further to get the care they need.
“Maternity is already massively underfunded and understaffed across the country and has been for years.
“Women who have no problems and are young and healthy can give birth at home or in a birth centre.
“But when it comes to labour, it can be so unpredictable and you can go from being a healthy individual to dead very quickly.
“A woman may spontaneously have a post partum haemorrhage and unless you can stop them bleeding, they can die.
“Sometimes, these things just happen.
“The important thing is that any woman, whatever kind of birth she chooses, needs to be able to access acute care quickly should she need it.
“But if the STPs reduce acute care centres and hospitals with A&Es, they won’t be able to do things like blood transfusions and surgery.
“If you are in a hospital that does not have acute services and have complications, you will need to be transferred to one.
“It seems we are going backwards and going back to big hospitals which will not be able to give individual care properly.
“It will be more a conveyer belt system.
“More women will not make it to hospital on time and give birth in unsafe conditions without a midwife and in the car or at the side of the road.
“There is a real worry that we will return to Victorian times and more women will die in childbirth.”
Maternity/neonatal - units facing closure or consolidation
1 - (Lancashire and South Cumbria); 2 - (West Yorkshire and Harrogate); at least 1 (South Yorkshire and Bassetlaw); 1 (Lincolnshire); 2 (Leicestershire and Rutland); at least 1 (Birmingham and Solihull); 1 (Milton Keynes); 1 (Dorset), 1 (Coventry and Warwickshire)
LIST OF UNITS:
Lancashire and South Cumbria - Consultant-led maternity care at West Cumberland Hospital under review
West Yorkshire and Harrogate - Downgrade of A&E and maternity at Dewsbury and Huddersfield already planned
South Yorkshire and Bassetlaw - “Reshaping” of children’s and maternity services due to lack specialist staff
Lincolnshire - Maternity services centralised at Lincoln
Leicestershire and Rutland - Maternity service to close at Leicester General Hospital and birthing centre planned to shut in Melton Mowbray
Birmingham and Solihull - Increase in maternity units led by midwives
Milton Keynes - Concern that maternity services in Milton Keynes could be reduced or merged with provision in Luton or Bedford
Dorset - Very premature babies (born at 27-32 weeks) to potentially no longer be cared for at Dorset County Hospital
Coventry and Warwickshire - :: Maternity and children’s care to move from George Eliot Hospital to University Hospital, Coventry