Red flag events commonplace on labour wards as midwives are pushed to the limit

Released on: 17 January 2017

Dangerously low staffing levels mean that half of women (50%) experience at least one red flag event during childbirth, according to a new report from NCT and the National Federation of Women’s Institutes (NFWI) today.

According to The National Institute for Health and Care Excellence (NICE), “red flag events” are signs that there may not be enough midwives available to give women and babies the care they need, for example having to wait more than 30 minutes to get pain relief or over an hour to be given stitches.

The report, ‘Support Overdue: Women’s experiences of maternity services 2017’, is the second NFWI and NCT have produced and the latest findings suggest little progress has been made in the four years since the last publication.

• Almost one in five women (18%) did not see a midwife as often as they needed postnatally, resulting in delayed diagnoses of health problems at a critical time for mothers and babies.  Of these, 29% of women were forced to visit their GP, walk-in centre, or even an A&E department instead.

• 42% of women did not understand all the risks associated with their own circumstances and did not feel able to discuss them openly

• Most women (88%) did not know their midwife before they went into labour or gave birth.  Of these women, 12% said this made them feel alone and vulnerable, and 6% unsafe.  This finding is the same as the result from the 2013 research, suggesting that continuity of care remains an aspiration.

Elizabeth Duff, Senior Policy Adviser, NCT, said:

“Our research has exposed a crisis in maternity care.  No women should have to suffer a red flag event when bringing a baby into the world.  Severe staffing shortages must be acted on so that every family receives an acceptable level of care.  If a woman wants pain relief she shouldn’t have to wait 30 minutes to get it and no new mother should have to wait over an hour to be given stitches.”

“It’s shocking that so few women are able to see a midwife often enough postnatally and more support is needed at this stage too. Most maternal deaths occur postnatally, with suicide a leading cause of fatality.”

Marylyn Haines Evans, Public Affairs Chair, NFWI said:

“The findings from this report show that chronic midwife shortages (an estimated 3,500 in England alone) continue to undermine the delivery of high quality care for women and their families.  Half of the women we spoke to reported red flag events during their care, suggesting that staffing levels are at crisis point.

“Women have told us that midwives are working hard to do the very best that they can, but that there are simply not enough of them to go around. We are calling on the Government and the NHS to end this chronic midwife shortage immediately and take the necessary steps to ensure midwives are supported to remain in the profession.”

The report sets out a series of recommendations for maternity planners and the Maternity Transformation Programme Board to improve women’s experiences and facilitate better outcomes. NFWI and NCT urge service providers to:

• Review staff levels: Take immediate action to implement the NICE Guidance on safe staffing for maternity settings.

• Improve postnatal care: As a minimum standard, all women should receive a postnatal home visit by the same midwife at least twice.  NICE guidance states women should see a midwife as often as they require postnatally. 

• Ensure continuity of care: The recent National Maternity Review called for a continuity of carer model of midwifery staffing to improve safety. Providers must act immediately to support midwives to transition to this model. 

Research:  Almost 2,500 (2,493) women who gave birth in the three years between 2014-2016 in England and Wales completed an online survey about their antenatal, birth and postnatal experiences.

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