Friday, July 30, 1999 Published at 13:11 GMT 14:11 UK
Midwife shortage: The reaction
Midwives improve women's confidence in giving birth
The shortage of midwives has a knock-on effect on women's confidence in their ability to give birth, say campaigners.
The National Childbirth Trust (NCT) says surveys shows midwives make "a big difference" to women's experience of having a baby.
"They feel more in control during labour, are more likely to breast feed and less likely to suffer from post-natal depression," said the organisation's policy research officer Rosemary Dodds.
She said this increased confidence could extend to their ability to choose whether to have a Caesarian or not.
Figures show that the use of Caesarians has been creeping up with an average increase across the UK of 2.5% since 1994/95.
Ms Dodds said part of the reason was hospitals' fears that they would be sued if anything went wrong.
But another factor was doctors' "lack of confidence in women's ability to give birth".
She said this sometimes undermined women's own confidence.
"If you are told your baby will be safer if you have a Caesarian you are likely to go along with it," she said.
She added that doctors were sometimes too quick to resort to a Caesarian if women were not having a baby within an often arbitrary time limit.
Midwives could give advice and help women make choices and needed to be valued properly.
"Midwives are highly skilled autonomous practitioners, not handmaids to obstetricians," she stated.
But a spokeswoman for the Royal College of Obstetricians and Gynaecologists said it disputed the NCT's claims.
Claire Rayner, president of the Patients' Association and a trained midwife, said the argument that doctors were sidelining midwives had been raging for years and she feared mothers-to-be were becoming "the rope in the tug of war" between the professions.
But the RCOG says it has been working with midwives to improve care for women.
It recently published a joint report with the Royal College of Midwives, calling for an increase in both the number of consultants and the number of midwives on duty in labour wards.
"This is a question of safe practice," said the spokeswoman.
Ms Rayner believes having a midwife present at labour is the ideal, but she thinks women are more concerned about having a familiar person caring for them throughout their pregnancy.
"They don't want to meet a stranger in the delivery room," she said.
The Royal College of Midwives (RCM) also backs continuity of care.
Spokeswoman Louise Silverton said lack of continuous care could affect women's health.
Rosemary Dodds says women who have the same midwife throughout their pregnancy feel better informed and more confident in the delivery room.
But she says more emphasis should be placed on post-natal support from midwives, for example, to help women breast feed.
Both the Patients' Association and the NCT back the government's nursing recruitment drive. But the NCT says it needs to concentrate on retaining staff.
Ms Rayner warned: "It takes five years to train a midwife.
"The most important thing is to try and attract midwives back into the profession, but there are a lot of competing opportunities for nurses now and the key to recruitment is pay."
The Royal College of Nursing and the RCM say improvements in pay and conditions are vital to attracting more midwives into the profession.