There appears to have been a surge in media coverage regarding the provision of midwifery services. The effects of austerity are still being felt and we continue to reap what others have sown.
Under the Freedom of Information Act it has been revealed that, in England at some point in 2017, nearly half of maternity units closed to new mothers (Labour Party, 2018). Capacity and staffing issues were the most common reason for closures. Maternity units are understaffed and under pressure.
The national midwife shortage continues. The NHS in England is short of the equivalent of almost 2500 full-time midwives (Bonar, 2019), despite the fact that, in 2015, the National Institute for Health and Care Excellence (2015) issued guidelines covering safe midwifery staffing in all maternity settings.
Closure of units and lack of staff have an impact not only on mothers and their families but also on those midwives who are striving to practice to the highest of standards.
In 2013 the Morecombe Bay outrage, which saw 11 babies and one mother die avoidable deaths at Cumbria's Furness General Hospital between 2004 and 2013, was, until now, the worst ever maternity scandal in the history of the health service (Kirkup, 2015). Investigations into serious failings at Shrewsbury and Telford Hospital Trust are ongoing. Between 1979 and 2017 it is alleged that some mothers and several babies died in what appear to be avoidable circumstances (Lintern, 2019; Ockenden, 2020). There are obvious parallels here with the events that were uncovered at Furness General Hospital and, once again, the familiar mantra, ‘have any lessons been learnt?’, is being heard. The failings are not one-offs, they are indicative of underlying systemic problems. It becomes even more pressing that investigations and inquiries are robust to help recognise why (in at least two organisations) these tragedies are occurring and what can be done. The Kirkup report (2015) presented some simple but far-reaching measures that would benefit all maternity units. Had these measures been put into practice then the chances of further large-scale disasters would have been greatly reduced.
The safety of women and their children will only improve if teams work together and if they are prepared to learn together. The spate of serious failings means that safety has to be constantly on everyone's agenda, the outcomes for women and their babies must remain the highest priority.
A coroner at Essex Coroner's Court reported on a fatality where a woman bled to death following a postpartum haemorrhage (The Guardian, 2019). She noted that there was a lack of leadership to deal with the situation, along with a lack of co-ordination and teamwork. Delays in care on the busy maternity ward, delays in attempting induction and delays in performing the C-section, as well as delays in surgical management, all contributed to the mother's death. The coroner concluded that there were serious failings in care.
Our midwifery colleagues want to deliver high-quality safe and effective care to women and their babies but there are a number of factors that can mitigate against this. All organisations must cultivate a positive, open and transparent culture where continuing professional development is encouraged and provided, where midwives and others are constantly trying to deliver woman-centred evidence-based care. This approach is the key to safety.