Midwives can help tackle Wales’s public health challenges

By Helen Rogers - RCM Director for Wales on 06 November 2018 Maternity Services

Each year’s State of Maternity Services Report looks at the ‘big picture’ trends that are taking place in the midwifery workforce. For the first time this year, the Royal College of Midwives is publishing a standalone report for each of the four parts of the United Kingdom.

The England and Scotland reports are out, this week sees the publication of the Wales report – both in English and Welsh – at an event in the National Assembly, and the Northern Ireland report will soon complete the set.

We are seeing several helpful trends in Wales. The number of babies born each year is reducing gradually, meaning that every year the pressure on maternity services in Wales edges down just a little. Indeed, 2017 

saw a drop of 2.3 per cent on the previous year, but overall births are down 10.5 per cent since the high of 2010. Falls have been fairly even across Wales.

The number of midwives is rising slowly too, up 10.6 per cent since 2009. This should continue in the years ahead following the decision by the Welsh Government to expand training places by 40 per cent in 2017/18, an expansion that has been maintained this year too.

It is important that this is maintained as the age profile of midwives shows that a growing proportion are in the older age categories, approaching retirement. In March 2011, for example, just over a quarter of midwives in Wales were in their fifties or sixties (27.9 per cent). By November 2017, this had reached just over one in three (34.5 per cent). 

Thankfully, the number in their twenties and thirties has risen over the same period from 31.2 per cent to 37.2 per cent. Wales must continue to rebalance the age profile of the midwifery profession, and that means continue to train good numbers of midwives every year.

Births edging down and midwife numbers edging up means, we hope, that maternity services are going to be better placed to deliver better care for women and babies, ensuring Wales’s newest residents get the best start in life and that women receive the care they want and deserve.

Challenges persist however. Whilst the number of births overall is down, for example, that fall is confined purely to women below the age of 30. In every age group of women giving birth over the age of 30, births are up over recent years. Not every older mother will need more care than younger women, but it is true that, on average, they will need more care and support. This means that as the age profile of mothers gets older, more midwives will be needed.

In terms of smoking and obesity, the public health challenges facing Wales remain. Over a quarter of women accessing maternity care in Wales are obese, and almost one in five is a smoker. In some areas, the numbers are higher still.

It is important to remember that midwives are perfectly placed to tackle these deep-rooted public health challenges. Pregnancy will be the first time in a long time that many women access NHS care, and may be the last time they access it for a long time too. So, it is the perfect opportunity to encourage people to get their health on the right track – to improve their diet and help them quit smoking. Every pound invested in maternity care and recruiting midwives and maternity support workers has the potential to be repaid several times over through improvements in the health of the nation.

The challenges facing Wales are not as grave as elsewhere. We do not face the equivalent of England’s shortage of 3,500 midwives, for example. But we have challenges nonetheless. Action is being taken, and that’s positive, but we need to keep that up because midwives can be an important part of the answer to the wider public health challenges facing us here in Wales.

You can read the report in full in English and Welsh here.