There are about eight hundred Peers eligible to work in the House of Lords. There’s no room for them all.

It is not widely known, many are commodiously accommodated in an elegant building across the road.

It is listed and has been cleverly adapted, into offices and meeting rooms, whilst preserving the architecture.

As you might expect, security is tight but cramped. Airline style, x-ray and what-not. Perfectly satisfactory for all normal events and visitors.

The unexpected arrival of 18 midwives and mums, half of whom turned up with babes and buggies, and the pressure was on!

No, it wasn’t a good idea to put a baby in a red tray and whiz them through the scanner!

Yes, the buggies will drive the metal detectors barmy!

No, the lifts are not really designed for the sort of work the lifts in Mother-Care used to take in their stride!

Somehow everyone arrived safely in the 3rd floor meeting room and the discussions began. If you really want to know what’s going on, ask the people most involved.

It looks to me midwifery, like so much of our workforce, is heading for the buffers.

One in three midwives in England are now in their 50s or 60s. The number of midwives aged under 50 has actually fallen since 2010.

There were the equivalent of 1,600 more full-time midwives in England by September 2016 compared to May 2010… but…

… the RCM says that as the number of births and the age profile of pregnant women rises, more midwives are needed; we are about 3,500 full-time midwives, short.

The calculations based on taking the number of live births in 2015, and dividing it by the number of births, 29.5, (the NAO benchmark) that a full-time midwife can handle safely.

BTW; Are there any better ways of more accurately forecasting population and demand?

The latest numbers are dire; the NHS is losing 29 midwives for every 30 trained.

Hence the Long Term Plan statement that;

‘… by March 2021, most women (will) receive continuity of the ‘person’ caring from them during pregnancy during birth and postnatally…’

… is plainly bonkers.

That ‘person’ cannot be a midwife, or an obstetrician. It can only be a midwife-healthcare-assistant or some such chimera we are about to create, or a compromise team-based-juggle.

The concept of one midwife, one woman, with the midwife on-call, is unachievable with the workforce we have and beyond the ability of the most willing midwives, to drop family responsibilities and be available 24-7.

Our meeting got underway with each of the women telling me their experiences of birthing and working in the NHS. It was a depressing forty minutes. Lack of continuity, errors, avoidable emergencies… ugh.

Somehow the babes knew how important it all was. Cradled and cuddled, they looked on, in all but silence…

Is there any hope? Well…

Neighbourhood Midwives, a private midwifery service, were, until recently, contracted to a CCG. The experiences of the women working with them and giving birth with their help… entirely different.

Their model, not dissimilar to Buurtzorg’s, self-managed teams, created a flexibility that meant all women were supported with impressive continuity and no member of staff ever, ‘had to miss a sports-day’.

Very smart… leave it to the people doing the job to sort it out.

Can it work at scale? At the Royal Free Trust, 20% of their 8,500 births are based on the community, continuity model. With impressive results; savings and safety.

The present tariff favours births in hospital, expensive and medicalised. Well-managed out-of-hospital births, penalised.

Inflexible rota makes it tough on older midwives and those with families and no flexible working.

Training struck me as chaotic and preceptorships, a lucky dip.

Solutions? More of the same? No, we are on the road to failure. A radical rethink?

• Remove midwifery and the money from Trusts.

• Establish a stand-alone National Midwifery Service,

• Delivery through the community hub model, first highlighted in the National Maternity Review, Better Births.

• Base the working model on self-managed teams …

• Big-up examples of continuity, no matter how small, to encourage diffusion of ideas, make it exciting.

• Give ourselves three years to see how close we can get to proper, continuity of care.

Amazing what you can come up with when you ask the right people.

At the very least, we need a new narrative, replacing the of fear of out-of-hours working. Get the in-hours properly organised and the out of hours will follow;

‘… continuity of care is the gold standard come back to midwifery, stay to help us make it a reality. Together we can achieve it. We know it’s not easy but we won’t make it any harder.’

My thanks to; Annie, Gabriella, Debbie, Lucy, Katelyn, Emma-Jane, Katie, Emily, Kathy, Flo, Astrid, Shona, Louise, Charlene, Michala, Joanna, Julia and to Cyril… who, very elegantly, on top of everything else, did the biscuits.

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Reproduced at by kind permission of Roy Lilley.