Our maternity services are now at breaking point

Ministers need to do their maths: we urgently need more beds and midwives, says Karlene Davis
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Your article detailed the Healthcare Commission's first review of mothers' experiences of maternity services, "the most comprehensive assessment of maternity services to be conducted in England" (Mothers-to-be get guide to the best and worst NHS care, January 25). Thirty-one hospital trusts were categorised as "least well-performing", which has become a euphemism for a lack of resources.

You reported "inadequate checks on whether staff intervene effectively to prevent unnecessary caesareans", and that "too many trusts do not adequately support mothers in breastfeeding and too few offer comfortable delivery rooms to encourage natural birth".

I was quoted in response to the prime minister's acknowledgment that "an extra 1,000 midwives were needed". But this number needs putting into a wider context. Ambitious guarantees were made last April in the government's new strategy, Maternity Matters, which aims for England to have a first-class maternity service by the end of 2009. However, the review highlights a shrinking maternity service and an overworked midwifery workforce - without pointing a finger at the maternity funding crisis.

The Royal College of Midwives has calculated that England needs 5,000 more full-time midwives to deliver the government's maternity strategy in the light of the current birth rate, the highest since 1993. In 1997 there were the equivalent of 18,053 full-time midwives in the NHS. The most recent figures, however, saw only a 4.5% rise by 2006. Meanwhile, between 2001 and 2006 the number of births rose by 12.7% - in short, midwives in 2006 coped with 71,935 more babies than five years earlier. The furore this week over the pressures that immigration poses for maternity services rams our point home - not that we are against immigration, but the government has to ensure there are enough midwives to cope.

Your article is correct in pointing out that "hospitals in the north scored particularly well and those in London did badly, with 19 of the capital's 27 trusts relegated to the bottom division". But in the capital the number of births increased by 16.1% over five years.

Moreover, there has been a drop of 16% in student midwife places over the past two years. Health secretary Alan Johnson did acknowledge that "more had to be done to modernise the service". But he needs to do his maths. Our members tell us that the gaps in service are basic. There aren't enough midwives or beds, and they hate that they don't have time to give the care and reassurance they want to provide for expectant mothers. They are reinforcing the review's findings of a "failure to recruit enough midwives for one-to-one care during labour".

We feel that maternity services are now at breaking point. Given the staffing shortfalls, we need real figures underpinned by the demographic changes facing this country - rising birth rates and the retirement of baby-boomer midwives - if the government is to honour its guarantees for maternity care. Otherwise we will be failing mothers, babies and their families.

· Karlene Davis is general secretary of the Royal College of Midwives

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