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

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 the National Federation of Women’s Institutes (NFWI) and NCT 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.

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.”

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.”

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.  

-ENDS-

Notes to editors:
Research:  Almost 2,500 (2,493) women who gave birth over the past three years in England and Wales completed an online survey about their antenatal, birth and postnatal experiences. 30% of respondents answered in relation to a birth in 2014, 48% in relation to a birth in 2015 and 22% in relation to a birth in 2016.

NICE: ‘A midwifery red flag event is a warning sign that something may be wrong with midwifery staffing. If a midwifery red flag event occurs, the midwife in charge of the service should be notified. The midwife in charge should determine whether midwifery staffing is the cause, and the action that is needed.’ Some red flags include:
- Missed or delayed care or delayed time critical activity (for example, a delay of 60 minutes or more in washing or suturing)
- Missed medication during an admission to hospital or midwifery led-units
- Delay of more than 30 minutes in providing pain relief
- Any occasion when one midwife is not able to provide continuous one-to-one care and support to a woman during established labour
- Delay in being referred to other services

* The full report, Support Overdue, Women’s experiences of maternity services 2017, is available on request.  
* 96% of delegates at the National Federation of Women's Institutes' AGM in London on 30th May 2012 voted to support a resolution calling for the Government to invest in the employment of more of midwives.  The full resolution is as follows: "There are chronic shortages of midwives. The NFWI calls on the Government to increase investment in the training, employment and retention of midwives in England and Wales to ensure services are adequately resourced and are able to deliver a high standard of care"
* This is the second research report conducted by the NFWI and NCT.  The first report, Support Overdue – published in May 2013, can be downloaded here: https://www.thewi.org.uk/__data/assets/pdf_file/0006/49857/support-overdue-final-15-may-2013.pdf
* The WI is the largest voluntary women’s organisation in the UK with approximately 220,000 members in 6,300 WIs.  The organisation plays a unique role in enabling women to develop new skills, giving them opportunities to campaign on issues that matter to them and their communities, and provides wide-ranging activities for members to get involved in.  For further information please visit http://www.theWI.org.uk
* NCT is the UK’s largest parent charity.  It has been campaigning for over fifty years to improve the support provided to new parents during their First 1,000 Days. Each year the charity helps millions of parents, offering expert information and trusted practical and emotional support through its website, helpline, the nationwide network of over 300 local branches, antenatal and postnatal classes, breastfeeding counselling and peer support schemes. For more information, call NCT on 0300 330 0770 or visit www.nct.org.uk.