The Government must urgently tackle midwife shortages within the NHS that are at the root of life-threatening delays in maternity units, a Labour MP has warned.
Pregnant women are being forced to wait days longer than recommended time for urgent inductions of labour as a result of inadequate staffing levels and a lack of beds, i previously revealed.
Bell Ribeiro-Addy, a member of the All-Party Parliamentary Group on women’s health, told i that staff and bed shortages are being exacerbated by NHS waiting lists.
She warned: “At the root of these women’s traumatic experiences are longstanding staffing shortage in midwifery – around 2,500 according to the RCM [Royal College of Midwives] – and bed shortages exacerbated by treatment backlogs and declining health in the wider population.
“There’s an urgent need to address midwifery shortages, especially with the rising demand we have seen in recent years.”
Ms Ribeiro-Addy accused the Government of showing “no interest” in addressing staffing and capacity issues.
The Department of Health told i that investment to improve maternity and neonatal care will rise to an additional £186m a year from 2024/25 to “improve the quality of care for mothers and babies” as well as increase staff numbers.
But baby loss charity Sands said failures in maternity care are contributing to “avoidable baby deaths”.
It comes after it was revealed that the Care Quality Commission (CQC) watchdog has noted concerns about induction delays in at least 10 hospitals run by six trusts since last year. At least two NHS trusts also reported the issue in board papers published in the six months to September.
A 2018 report by the Royal College of Obstetricians and Gynaecologists said delays to induced labour was a key contributory factor to stillbirth, early neonatal death and severe brain injury occurring during labour.
Clea Harmer, chief executive at Sands, called on the Government to help improve staffing levels and make sure guidance is followed to help prevent further tragedies.
She said: “Adequate staffing is essential for the delivery of safe care, and the Government must ensure appropriate resources are in place so everyone can access best practice care and to save babies’ lives.”
Ms Harmer added that “nationally-agreed standards of care are too often not being followed, which is contributing to avoidable deaths”.
In 2021 the National Institute of Clinical Excellence (Nice) issued new guidance recommending induction at 41 weeks, instead of between 41 and 42 weeks. It acknowledges that the rise in inductions has created an increased workload for maternity units.
What is an induced labour?
An induced labour is one that is started artificially with medical intervention.
One in five labours in the UK are induced, according to the NHS.
It is encouraged when a baby is overdue, waters break more than 24 hours before labour or if the mother or baby has a pre-existing health condition, such as diabetes.
The NHS website states that inductions may be delayed by 24 to 48 hours but that inductions are delayed beyond 48 hours “very rarely”.
In one CQC inspection earlier this year, women who were classed as “high risk” were forced to wait as long as five days for induction.
The CQC rated maternity services run by County Durham and Darlington NHS Foundation Trust as inadequate after inspections found delays to inductions of labour, including babies categorised as high risk, due to understaffing.
A spokesperson for County Durham and Darlington NHS Foundation Trust, said it is in the process of recruiting to new roles dedicated to supporting women requiring induction.
The most recent CQC report for University Hospitals of Morecambe Bay NHS Foundation Trust found that around one in six (17 per cent) of inductions of labour were delayed, mainly due to staffing challenges.
Tabetha Darmon, chief nursing officer for the trust, said since the CQC inspection it has launched an escalation “pathway” for induction delays.
She added: “This pathway ensures that women whose care is delayed are clinically reviewed at two hours, eight hours, 12 hours, 18 hours and 24 hours to ensure any evolving risks are identified and reviewed by our maternity team.”
Medway NHS Foundation Trust, where delays in inductions linked to staff shortages were highlighted by the CQC, said they are working hard to improve their maternity services.
Jayne Black, chief executive of Medway NHS Foundation Trust, said its work to address delays includes the introduction of a dedicated induction of labour team and “an active midwifery recruitment programme”.
Inductions at two maternity services run by University Hospitals Leicester NHS Trust (UHL) were paused or delayed due to staffing levels, the CQC reported following its last inspection.
UHL chief nurse Julie Hogg said: “On September 1, we introduced new processes for communicating with women on the day of induction and we have recruited additional maternity staff, including labour suite and maternity co-ordinators.
“We have also implemented a new system for both booking and prioritising inductions of labour.”
Hull University Teaching Hospitals NHS Trust (HUTH) said it is committed to addressing the areas of concern, including delays to women being medically reviewed, highlighted by the CQC.
Lorraine Cooper, director of maternity services for HUTH, said: “An action plan is in place, and progress made is being monitored regularly through the Trust’s Quality Committee.”
Manchester University NHS Foundation Trust said it has made “significant improvements” and reduced waiting times since the CQC inspection in March, which highlighted delays in inductions and elective caesareans.
Liverpool Women’s Foundation Trust is planning to create a specific induction of labour lounge following delays “due to the high acuity and occupancy in maternity services”, the trust said in board papers published in September.
In June, the CQC found eight high-risk women at Blackpool Victoria Hospital waiting up to five days to be induced amid staff shortages. Blackpool Teaching Hospitals Foundation Trust did not comment.
Nicola Wise, interim director of secondary and specialist healthcare at the CQC, said: “Trusts should be making sure women and their babies are observed closely and that regular assessments are carried out to identify and prioritise those at greatest risk.”
An NHS spokesperson said: “The NHS is investing £165m annually to grow the number of midwives and obstetricians, strengthen leadership and improve culture.”
They added that a new Maternity and Neonatal Care Plan will also support trusts to make improvements.
A Department of Health and Social Care spokesperson said: “The NHS Long Term Workforce Plan will make sure we have an NHS workforce that meets the changing needs of the population over the next 15 years and will put it on a sustainable footing for the long term.”
They added that investment to improve maternity and neonatal care will rise to an additional £186m a year from 2024/25 and “help improve the quality of care for mothers and babies as well as increase the number of midwifery posts available”.
