Maternity shortages 'risk lives'

Stillbirth figures have remained static for a decade

Many more midwives, obstetricians and anaesthetists are needed if childbirth is to be made safer, say experts.

The warning comes in a report by the Royal Colleges representing UK health workers involved in childbirth.

Only 26% of units have enough midwives for one-to-one care, while only about half ensure an obstetrician is on ward duty for at least 40 hours each week.

Figures suggest 13.1 mothers die per 100,000 pregnancies in the UK, and 8.6 babies die per 1,000 births.

This figure, which includes both stillbirths and neonatal deaths, has remained static for the last decade.

The Royal Colleges for Obstetricians and Gynaecologists, Midwives, Anaesthetists and Paediatricians' report examines how safety could be improved.

It also highlights the fact that in the decade between 1995 and 2005 obstetric-related litigation payouts totalled £1.5bn, nearly tripling in value in the five years between 1996 and 2001.

Calling consultants

The report's recommendation that all women in established labour receive one-to-one midwife care echoes recent guidelines issued by the National Institute for Health and Clinical Excellence (Nice).

Mothers and babies are still dying unnecessarily Professor Martin Whittle RCOG The midwife made all the decisions

But in order to provide this, the Royal College of Midwives says an extra 5,000 trained professionals are needed in England alone.

For its part, the Royal College of Obstetricians and Gynaecologists says the number of consultants across the UK needs to increase immediately from a the current 1,600 to at least 2,100 and ideally 2,500.

The guidelines call for all obstetricians to spend more time on the ward.

All units with between 2,500 and 4,000 births per year - which account for most units in the UK - should increase ward coverage from 40 hours to 60 hours by 2009, it is suggested.

At the same time, units with 6,000 or more births per year should have a consultant obstetrician present 24 hours a day, the report said, while stressing that all units should strive to have a consultant present as late as possible into the evening.

This is because several major studies have shown that deaths, when they happen, tend to occur in the hours between 2200 and 0400, when there is least likely to be a consultant on duty.

A duty anaesthetist must also be immediately available for the obstetric unit 24 hours a day.

Epidurals must be given within half an hour of being requested

Women should not be waiting longer than half an hour for an epidural once requested, and should only wait an hour in exceptional circumstances.

Staying at home

The report focuses mainly on improvements in hospitals, but the authors also backed the government's desire that every woman should have the choice of where she gives birth, be it at hospital, at home, or in a midwife-led unit.

It would be utterly wrong to give the impression of a maternity service with falling or insufficient staff numbers Department of Health

While giving birth outside a consultant-led ward is generally felt to reduce the amount of medical intervention, there is research suggesting that when problems do arise, the outcome for mother and baby may be worse.

As many as 30% of first time mothers giving birth outside hospital will need to be rushed in as emergencies. Units needed to be properly staffed to deal with these, the report stressed.

The Department of Health said safety was the NHS's top priority, but that the UK was one of the safest places in the world to give birth.

A spokesperson said: "It would be utterly wrong to give the impression of a maternity service with falling or insufficient staff numbers - there are 2,084 more midwives and 474 more consultants in obstetrics and gynaecology since 1997."

The National Childbirth Trust said it welcomed the report.

"The emphasis on preventing problems from occurring by investing in sufficient midwives and obstetricians is particularly important," said chief executive Belinda Phipps.