...JFHC's deputy editor Rob Mair highlights the reasons why  

Midwifery is facing more challenges than it has seen in the past 30 years, as it contends with an ageing workforce and ever-tightening budgets. But those two challenges alone don't account for the state of flux the profession is in.

For many midwives, one of the biggest concerns is the proposed changes to the NHS contained in the Health and Social Care Bill, especially as it comes on top of the £20 billion in efficiency savings the NHS is expected to find in the next four years.

The Royal College of Midwives (RCM) is staunchly defending the profession in the face of the proposed cuts, and has been vocal in its opposition to the Bill.

"The bill is a massively expensive distraction from the challenges that the NHS faces in trying to improve healthcare at a time of severe spending restraint," said RCM chief executive Cathy Warwick.

"The Royal College of Midwives supports many of the Government's aspirations for the NHS, such as clinically-led commissioning, greater engagement of service users in their care and more integrated services, but the fact of the matter is that these can all be achieved without the need for this divisive and costly bill.

"Independent analysts have calculated that implementing the provisions in the bill will cost the NHS an extra £2 billion to £3 billion on top of the £20 billion in efficiency savings the NHS has to find in the next four years."

As well as the cost, the RCM is concerned the bill won't even achieve its aim of providing sufficient improvement to the NHS:

"The Government has failed to present sufficient evidence that its proposals are necessary," Cathy said.

"They have failed to present evidence that the upheaval will result in an improvement in services to the people of England. And, they have failed to answer the concerns of the people who fear for the future of the NHS under these plans.

"Breaking up what we have, embracing the private sector, and injecting full-blown competition and market forces is not what the NHS needs or what health professionals and patients want. We join the growing chorus of voices calling for the bill to be withdrawn, and the proposed reforms stopped in their entirety."

The RCM has also expressed concern over midwife numbers, especially in the context of the Conservative Party's pre-election pledge to get 3,000 more midwives in post.

Last year, the RCM had to revise its own estimate and called for an extra 4,700 midwives to cope with the rising birth rates and pressure on services from more complex and complicated births.

Cathy explains: "Before the last election David Cameron pledged to recruit an extra 3,000 more midwives in the NHS in England. Once [he] was safely inside Number Ten however the pledge was dropped. The excuse was that the number of births was no longer rising. This is bizarre in the extreme given that in 2010, the latest year for which we have figures, the number of births in England was actually at its highest level for 40 years."

But there is hope that at least some of the RCM's concerns will be addressed. The RCM has welcomed proposals put forward recently by the NHS Future Forums, although, of course, these would need to be adopted by the Government if they are to be pushed through.

Jacque Gerrard, England director of the Royal College of Midwives, said: "The upcoming reform of the NHS has generated a number of concerns among midwives about how it will affect the quality of care in maternity services. If accepted by the Government, a number of the Forum's recommendations will go some way to addressing these concerns.

"In particular the RCM is pleased that the Forum has recommended that health and social care should integrate around the needs of the patient. The suggestion that the NHS should be refocused towards preventing poor health and promoting healthy living, including improving the health of NHS staff is a positive step. Midwives have a vital role to play in promoting and improving public health that is often overlooked.

"There is also no doubt, as the Forum recommends, that workforce planning and education should be responsive to the changing nature of maternity care.

"To ensure the safest services and so that women and their babies receive high-quality care it is crucial that midwives have access to on-going professional development so that their skills are up-to-date. Too often, the pressures of inadequate midwife numbers and the demands on maternity services mean that this does not happen, so the recommendation to support this is very welcome indeed."

But the pressure of inadequate midwife numbers is being exacerbated by its ageing workforce, and it would appear the issue is not just confined to the delivery rooms. In a survey of midwife lecturers, the RCM discovered more than half were over 50 years of age, and only six per cent were under 40. Combined with increasing class sizes, the RCM expressed concern at the standards of teaching.

Cathy said: "The future of midwifery will be shaped and determined by leadership in education and research today. Knowledge development and dissemination are critical components of any professional organisation, the recruitment and retention of midwifery educators is a growing challenge, especially as we face an ageing midwifery workforce and a rising birth rate, which is already stretching the workforce and impacting morale."

Elsewhere, ensuring birthing facilities remain available and of a high standard is another key concern - particularly after the RCM expressed its disappointment at the closure of two birthing centres in Derbyshire.

The centres - Darley Dale Birth Centre and its sister site in Buxton - offered an alternative to hospitals for pregnant women with low risk of birthing complications, but had seen a dramatic fall in numbers from around 120 a year to just two at Darley Dale by October 2011. The decision to close the facilities is in direct opposition to the RCM's principles of offering women the choice to give birth where they want.

Jacque Gerard: "Midwives are devastated at the loss of their local birth centres as women's choices for childbirth are reduced and they now have to access maternity services in a doctor-led obstetric unit, where medical interventions are more likely, rather than a midwife-led unit."

With Caesarean rates rising all the time, this is a real concern. Here at Journal of Family Health Care we aim to continue to offer support to our hard-working and overstretched midwives. As a result, we fully support the RCM's petition urging the Government to fulfil its promise regarding midwife numbers, and would urge all midwives and health professionals to sign it.

The petition can be found at: http://epetitions.direct.gov.uk/petitions/13716.