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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 April 14; 334(7597): 768.
PMCID: PMC1852039

More funding for maternity services is needed if women are to get choice over place of birth

An NHS guarantee to give women in England a full range of choices relating to birthing, including home births and ongoing care from a midwife they know and trust, has prompted calls for urgent provision of the necessary staff and resources.

The NHS's new maternity strategy, published last week, promises that by the end of 2009 women will be able to choose the type of antenatal care they would like, whether midwifery care alone or care that is led by doctors as well as midwives. They will also be able to choose between giving birth at home, in a midwifery unit, or in hospital with midwives and doctors, depending on their medical history and circumstances.

Allan Templeton, president of the Royal College of Obstetricians and Gynaecologists, welcomed the strategy “as an opportunity to bring back the spotlight to maternity care in this country.” But he cautioned: “If we are to provide mothers with more choice, then this can only happen when our places of birth are fully staffed. We will need more consultants and midwives if both women's expectations and standards of care are to continue to improve.”

Karlene Davis, general secretary of the Royal College of Midwives, agreed: “NHS decision makers must deliver enough midwives and enough investment in maternity services—and they must make a start on that now.” Currently 19 000 midwives work in the NHS, but she considered that another 3000 would be needed over the next five years to fulfil the promises made in the strategy. She was concerned that midwifery posts were currently being cut because of financial problems in the NHS.

Patricia Hewitt, the health secretary, said it would be up to NHS trusts to decide on staffing levels, although she said another 1000 midwives would graduate from training by 2009. She added that no additional money was being earmarked for maternity services, which currently receive £1.7bn (€2.5bn; $3.3bn) a year, although the overall NHS budget was rising by over 7% in real terms this year.

Only about 2% of the 600 000 births each year in England take place at home, although this varies from 1.2% in the North East to 3.7% in the South West. Research by the Royal College of Midwives has shown that only a fifth of women are given the option of a home birth in the first place.

The strategy considers that giving a choice of birth setting could lead to an increase in the number of women seeking to give birth away from a hospital, such as in the home or a birth centre. It says, “Services will need to be developed, and have sufficient suitably trained staff available to provide such options according to local changes in demand.”

Belinda Phipps, chief executive of the National Childbirth Trust, a childbirth and parent charity, said, “To meet the new standards, contracts need to specify what must change and indicate clearly the need for increasing rates of direct access to a midwife in early pregnancy, all women being offered choice of place of birth, more one to one care during labour, a rising normal birth rate, a reduction in late booking and more targeted welcoming services for disadvantaged communities, and action to address dissatisfaction with postnatal care.” She added, “To meet these 2009 choice guarantees it is clear more midwives are needed, especially within community services.”


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