NHS on verge of midwife ‘exodus’, Royal College of Midwives warns

Midwives are being driven out of the profession by excessive workloads and poor staffing levels, according to a new report from the Royal College of Midwives (RCM).

The RCM's report, Why Midwives Leave, includes a survey of more than 2,000 UK midwives who have left the profession in the past 2 years, or are intending to in the next 2 years.

Published to coincide with the RCM's annual conference in Harrogate on 19-20 October, the report also makes a series of recommendations on how to prevent more midwives from leaving.

Midwifery not valued

The poll found that just one in ten of those surveyed said they felt midwifery was valued by the government.

Of those midwives that have already left the profession, more than half (52%) said they were not happy with staffing levels. Some 48% said they were unhappy with the quality of care they were able to give.

Of the responses from midwives intending to leave the profession, nearly two thirds (62%) said they are not happy about the staffing levels where they work.

More than half (52%) said they are not satisfied with the quality of care they are able to give, while 46% said the excessive workload was one of the key reasons they were planning to leave.

Staffing levels and workload

Midwives were also asked what would encourage them to stay in the profession or return. Over four fifths (88%) said they would very or quite likely return if staffing levels improved.

Almost the same number (83%) said they would very likely or quite likely return if the workload was eased.

A midwife who left after 40 years said the 'stress of under-staffing and the ever-increasing workload' had left her burnt out.

One who left the profession in the past six months said: 'I was often working 12.5 hours with no breaks. My unit was struggling with employing enough midwives - we had a shortage of 30 full-time midwives in the unit. I was not able to deliver the care I wanted as decisions were often made about women's birth without her full involvement.

'It was not safe to look after 15 mums and babies on a postnatal ward by one midwife. We were not listened to when we raised issues over staffing and safety.'

Others described in detail 'dangerous and unsafe' working conditions.

One midwife said: 'Maternity is the most litigious area in healthcare, yet we cannot actually practice safely and in a way that makes us proud, due to chronic staff shortages and cost-cutting.'

Recommendations in the report include:

• NHS organisations should review their maternity staffing levels using a recognised workforce planning tool to ensure staffing reflects the workload.
• Midwifery turnover and vacancies should also be reviewed, and recruitment and retention issues addressed. They should make use of recruitment and retention premia to counter existing shortages
• NHS organisations should sign up to the RCM’s Caring for You Charter to take action on flexible working, breaks and workplace culture.
• The government should end public sector pay restraint allowing the NHS Pay Review Body to make unfettered pay recommendations for NHS midwives and other staff, and break the 1% pay cap.
• The government should rethink its plans to abolish the bursary for midwifery students in England from August 2017.

Inadequate investment

RCM chief executive Cathy Warwick said: 'Maternity services are performing as well as they are on the backs of the selfless dedication of midwives and other maternity staff, and their capacity to go that extra mile for mothers and babies, day after day. However, this shows that many cannot fight that battle any longer.

'Enormous demands are being made on midwives and the services they work for, yet investment in these services from the government remains inadequate to provide the quality of care that women deserve.

'We are asking for employers and government to take action to keep midwives in midwifery. In particular we are asking employers to sign up to the RCM’s Caring for You Charter to try and improve midwives health, safety and well-being at work.' 

The RCM has repeatedly called for more midwives, saying there is a shortage of 3,500 across the NHS.

A Department of Health spokesperson said: 'We want midwives to feel proud of their work and that they have enough time and support to give good care.

'That's why there are over 1,800 more midwives on our maternity units since 2010, as well as over 6,300 currently in training, with our changes to student funding creating thousands more training places by the end of this parliament.

'The NHS is also launching a £5 million campaign to help improve the health and wellbeing of staff.'

Further information

Why Midwives Leave