Maternity in Scotland: Obesity, ageing mothers and stagnant midwife numbers causing pressure on NHS services

Obesity, ageing mothers and stagnant workforce numbers are leading to increased pressure on Scotland’s midwifery services, with opposition politicians warning of “dangerous staffing levels” in maternity wards.

Women giving birth later in life, health inequalities and stagnant workforce numbers are heaping pressure on Scotland’s NHS midwifery services and leading to “dangerous staffing levels”.

A report from the Royal College of Midwives (RCM) Scotland also shows that a majority of women using maternity services in Scotland are overweight or obese, placing additional demand on dwindling staff.

The number of student midwives in Scotland has increased, something the RCM credits the Scottish Government with, but warns the rate of increase can’t keep pace with the number of midwives leaving the profession.

A report from the Royal College of Midwives (RCM) Scotland also shows that a majority of women using maternity services in Scotland are overweight or obese

“Worryingly, if we look at what is happening with the workforce itself, we do not see these ever larger surges in midwives coming out of the universities making a difference to overall numbers,” the RCM’s researchers said.

“Instead, the churn rate within the profession is such that the workforce shrinks back down between these surges.

“Nor are the current access routes meeting the needs of all [health] boards or increasing diversity in the workforce.

“The big risk is that rather than sustainably building up a strong workforce, the effect of these new midwives just seems to fizzle out as staff leave.”

As a result, the number of Scottish midwives has remained steady at around 2,500 since 2018.

Scottish Labour’s health spokesperson, Jackie Baillie, said: “For years, the SNP has failed to support Scotland’s nurses – leading to dangerous staff vacancy levels.

“We cannot have the staff in post being worked into the ground to cover vacancies – this will only lead to more nurses leaving the NHS.

“It’s time the SNP got to grips with this situation and delivered a proper workforce plan.”

The stalled recruitment and retention strategy has compounded the pressures placed on the service by demographic changes and Scotland’s general health.

Women are choosing to give birth later in life, which increases the likelihood of complications, and a majority of women giving birth in Scotland are overweight or obese.

“Women are giving birth later in life, with the number of babies born to women in their twenties dropping over the past decade,” the report’s authors said.

“With this shift can come increased risk, both for the woman and her baby, requiring more support for them from the NHS.

“This is compounded by the increase in intervention rates and associated workload.

“At the same time, a majority of women using maternity services are now overweight or obese, which itself places additional demand on the workforce to provide the care that all women expect and deserve.

“These developments – along with the increasing recognition and prioritisation of perinatal mental health, the devastating impact of inequalities and racialised disadvantage on pregnancy and afterwards – are just some of the factors adding to pressures on our maternity services.”

Jaki Lambert, director for RCM Scotland, said that investing in Scotland’s maternity services “is investing in Scotland’s future”.

“All the evidence shows that babies that thrive during pregnancy have a better start in life – and so much of that is dependent on good maternity care,” said Ms Lambert.

“We need to ensure that our midwives are supported to provide the best care for women and families, from how we train them to how we retain them.

“Midwives are utterly committed to what they do, to supporting women and families through pregnancy, labour, birth and into the postnatal period.

“How much better would it be if we were to maximise that commitment by investing in them, by supporting and rewarding their career progression whichever route they take and by developing a sustainable maternity workforce?

“We already know that recruitment in our rural and remote areas is a real challenge, but these measures could help turn the tide.

“Midwifery is an incredibly rewarding career. We want to reverse the recent downward trend in application numbers by offering careers that recognise and reward excellence in care ensure that Scotland has a midwifery workforce that is fit for the future.”

The RCM is calling for the Scottish Government to boost the midwifery workforce using new approaches, such as widening access through accessible maternity care assistant education to support progression to midwifery apprenticeship. The RCM said this “is an absolute priority”.

“To get the workforce right we need to see services using a new midwifery workforce planning tool that is fit for purpose,” the report concludes.

“We need a renewed focus on the retention of skilled, experienced midwifery staff.

“The NHS needs to offer career options and pathways with rewarded progression that will keep midwives in the NHS for their whole working lives, and reward them.”

A spokesperson for the Scottish Government said: “We value the work of our midwifery staff and are extremely grateful for the skill and dedication they have shown, particularly over the last few years.

“That’s why NHS Agenda for Change staff have received a pay deal worth more than £1bn over the last two years – ensuring midwives in Scotland remain the best paid in the UK.

“We have also set up a Nursing and Midwifery Taskforce which will develop recommendations to improve recruitment and retention to support longer-term workforce sustainability.”

Chaired by health secretary Michael Matheson, the Nursing and Midwifery Taskforce includes “recognised nursing and midwifery workforce experts”, alongside academia, NHS and Scottish Government representatives.

The Royal College of Nursing and the RCM are also represented.

According to the Scottish Government, “it will build on efforts to make Scotland the best place for nurses and midwives to come and work by developing plans for the retention of the existing nursing workforce, as well as looking at recruitment”.