Midwives are in the news today on both sides of the Irish Sea. In Ireland, it has emerged that midwifery staff at the Midland Regional Hospital in Portlaoise had written to two Irish government ministers in 2006 expressing concern over staffing levels at the hospital. In the 2006 letter to then minister for finance Brian Cowen and then minister for health Mary Harney, the hospital’s midwifery staff said they had “a real fear” that a mother or baby will die in their care before these issues are addressed. In the letter, seen by RTÉ’s Investigation Unit, they also said they had made their concerns known to management on a number of occasions but that nothing had happened.

The letter was written prior to all of the deaths of four babies examined in last night’s documentary ‘Fatal Failures’. The babies died in similar circumstances over a six-year period at the hospital. They were all alive at the onset of labour, but died either during labour or within seven days of birth. The Irish Health Service Executive has apologised unequivocally to the families.

In an unrelated development, RTÉ News also reported on the last baby being born at Mount Carmel Hospital in South Dublin on the day that 200 staff members have been made redundant. Another 128 staff will lose their jobs over the coming weeks. Staff attended a mass this evening to mark the closure of the hospital. Afterwards around 20 staff said they were planning a sit-in at the premises. The provisional liquidators confirmed that 572 maternity patients have been affected since the hospital went into liquidation last Friday. Four babies were born today and the final arrival was a girl.

In Westminster, the House of Commons Public Accounts Committee, like its Oireachtas counterpart, is playing an important role on the issue of health services, especially maternity. Channel 4 News reports that in a damning investigation into the state of maternity care, the Public Accounts Committee criticised both the British Department of Health and NHS England for being unable to tell it who is accountable for “ensuring something as fundamental” as whether the NHS has enough midwives. It said it had gathered evidence that “many maternity services are running at a loss, or at best breaking even, and that the available funding may be insufficient for trusts to employ enough midwives and consultants to provide high quality, safe care”.

The report added that “although there has been a welcome increase in midwives, there is still a national shortage in Britain of some 2,300 midwives required to meet current birth rates. Pressure on staff leads to low morale and nearly one-third of midwives with less than 10 years’ work experience are intending to leave the profession within a year. Over half of obstetric units do not employ enough consultants to ensure appropriate cover at all times.

The committee reported that rates of infection among new mothers, infection to the baby and injury to the baby “are all higher at the weekend”. It added: “Although there have been substantial improvements in levels of consultant presence on labour wards in recent years, over half of obstetric units were still not meeting the levels recommended by the Royal College of Obstetricians and Gynaecologists at September 2012.”

Labour MP, Margaret Hodge, who chairs the committee, said: “The vast majority of women who use NHS services to have their babies have good experiences, but outcomes and performance could still be much better. Despite an overall increase in the number of midwives there is still a shortage of 2,300 that are required to meet current birth rates – a truly worrying figure. What’s more, the Department of Health and NHS England struggled to tell my committee who is accountable for ensuring something as fundamental as whether the NHS has enough midwives. As things stand, there is evidence that many maternity services are running at a loss, or at best breaking even, and that the available funding may be insufficient for trusts to employ enough midwives and consultants to provide high quality, safe care.”

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Cathy Warwick, chief executive of the Royal College of Midwives (RCM), said: “Maternity services are many thousands of midwives short of the number needed to deliver safe, high quality care. The birthrate remains exceptionally high and as this and the National Audit Office report states, births are also becoming increasingly complex. This puts even more demands on midwives and maternity services. We are seeing areas such as antenatal and postnatal care in particular suffering because trusts often do not have enough midwives to provide consistent and high quality care before and after pregnancy.”

RCM Chief Executive Cathy Warwick Photo: © Jess Hurd/RCM

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She added: “At the moment there seems to be a gap between the actual cost of maternity care and the amount of money hospitals get to provide it. This cannot continue and maternity services need to see the money they receive meet the cost of care. If this does not happen I fear services will be cut, choice will be reduced and care will suffer.” Details of the RCM’s report on the state of maternity services in the UK (2013) can be found here and the full report is available here. It was launched in London on December 11th.