Adam Morris: Increase in premature babies pushes NHS to breaking point

Published on Wednesday 23 September 2009 09:45

IT'S a nerve-wracking time for any mother-to-be as her due date approaches.

But growing numbers of expectant mothers are not going through that period of mounting nerves and anticipation. For over the last generation there has been a dramatic rise in the number of premature babies, a study by Edinburgh University researchers has found.

The first comprehensive study of its kind has found a 16 per cent rise in the number of early births over the last 25 years.

But the report by Professor Jane Norman, director of the Tommy's Centre for Maternal and Fetal Health Research at Edinburgh University, is not as alarming as it might sound.

First and foremost, most expectant mothers are unaffected, with the proportion of babies born early enough to give rise for concern still less than 7 per cent.

Another key finding was an equally dramatic improvement in the survival of premature babies.

It does, though, highlight some issues which do give rise for concern.

One message from the report is clear. An increase in diabetes and high blood pressure among women today was the main reason for the hike in early deliveries, and not the previously assumed "older mum" theory.

It hands women some power to heighten the chances of a normal birth, by keeping healthy. Diabetes, for instance, is closely linked with obesity. What is unavoidable, though, is the strain on already hard-pushed maternity units across the NHS. The care of one premature baby is significantly more demanding than that of a timely arrival.

NHS Lothian has had to plan increased investment at the Simpson's maternity unit at Little France and to expand services at St John's Hospital in Livingston in order to cope.

There has been a drive to recruit extra midwives, but NHS Lothian still has the poorest midwife to birth ratio in Scotland, according to the latest figures.

Official figures show Lothians' hospitals having 29.7 births for every midwife, although health chiefs say the situation has improved to nearer 28, bringing it within the 29-to-one limit set by Nursing and Midwifery Council guidlines.

Pressures in maternity units earlier this year meant seven heavily pregnant women a month were being turned away from Edinburgh's main maternity unit at Little France and transferred to St John's because there was no room for them.

Midwives at the ERI operate a traffic-light system in the ward and if the light switches to amber because there are not enough staff or too few beds, mums-to-be have to be diverted, effectively "closing" the unit to new entrants.

In her report, Prof Norman calls for action, describing the rising number of premature births as a major problem.

"The rates of (premature] births need to be reduced and, for Scotland at least, ways will have to be found to reduce the rates of both spontaneous and induced pre-term births.

"The increase in diabetes as a factor in premature births is also interesting and may be because there are more women with pre-existing diabetes – which is linked to obesity – as well as better diagnosis of expectant mothers with gestational diabetes."

Director of the Scotland Patients' Association, Dr Jean Turner, says the report highlights an ongoing problem for the NHS.

She says: "There is a shortage of midwives not just in Lothian but across the whole country.

We need more midwives, nurses, neo-natal nurses, beds, hospitals and incubators. The problem with the NHS is that it is all run so tightly that as soon as anything slightly unpredictable happens it all falls apart.

"Of course there are consequences to more premature babies surviving. The priority has to be getting them out safely and in a controlled environment.

"We do have to react quicker, not just to women when they come to hospital, but to those who would like to be mothers in the future. We need to get to them and begin getting the information needed about health, but, again, this all takes more staff."

The reality is that just as this trend has taken years to establish itself, it will also take a long time to tackle. It will take years to turn around the health of the nation's mothers-to-be and years to create the kind of expanded maternity services being demanded. As a result, the impact on thousands of families across the country, not to mention beleaguered hospital staff, doesn't look like easing any time soon.