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Midwife shortages costing lives

Fergus Walsh | 00:00 UK time, Friday, 1 April 2011

Spare a thought this Mother's Day for women around the world who don't have access to the kind of care on offer in the UK to pregnant women. Whilst maternity services in Britain do sometimes fall short, it is unusual for women to give birth without any skilled help. Deaths in childbirth here are rare.

A report from Save the Children, timed to coincide with Mother's Day, has highlighted the alarming shortage of midwives in the developing world. Entitled "Missing Midwives", it says nearly 48 million women - one in three - give birth each year without expert help.

Save the Children says that of the 1,000 women and 2,000 babies who die each day, most succumb to easily preventable birth complications. For example it says more babies in poorer countries die from lack of oxygen at birth than from malaria. It estimates that 42,000 lives a year could be saved if there was someone present who could dry and stimulate a newborn baby to help it breathe.

Some of the comparisons are staggering. For example, the NHS employs 26,825 midwives and there are 749,000 births a year in the UK. By contrast Rwanda has 46 public midwives and there are 400,000 babies born each year.

I remember filming in a brand new maternity hospital in Sierra Leone a few years ago. It had no ultrasound scanner and no intensive care unit. The two doctors there provided care for a population of nearly 300,000. Despite the lack of staff and equipment, it was saving many lives.

Rather than relying on traditional birth attendants, often with no training, local women were being encouraged to attend ante-natal clinics. The birth attendants were being offered medical education and in the meantime were being paid by the hospital for each woman they persuaded to give birth at hospital.

The shortage of midwives is part of a wider problem - a massive shortfall of trained healthcare workers. Midwives and doctors cannot be created overnight. Even with political will, co-operation and funding, it is an issue which will take many years to put right.


  • Comment number 1.

    Perhaps one way forward would be a version of the chinese ' barefoot doctor' scheme where local women are given some basic training and paid a small sum to do basic checks and assist in delivery where the woman is unable to get to a hospital. It isn't ideal but may help where just a little knowledge may make all the difference. Some of these women may then go on to do more extensive training to become midwife aides and even fully qualified midwives.

  • Comment number 2.

    Please, use the correct name of "Mothering Sunday".

  • Comment number 3.

    Why not just show the mothers how to dry off & stimulate their babies?
    Most unattended deliveries are uneventful, otherwise we'd be extinct as a species by now.
    If it's a given that there is currently a great shortage of midwives then it might make sense to just train the mothers in the meantime.
    I like "Mothering Sunday", too. We just have "Mother's Day" in the States.

  • Comment number 4.

    Perhaps a good use for the 'international aid' that the governments persists in giving despite the country being broke would be to send our large number of unemployed midwives to go show these countries how to look after mothers-to-be, thus providing them work and helping other nations to meet their duty of care to their citizens.

  • Comment number 5.

    We don't have enough people already? Do we need another million? Sorry, has to be said - there is a serious overpopulation problem, especially in the 2nd and 3rd worlds. Lack of midwives is second to lack of family planning

  • Comment number 6.

    This comment has been referred for further consideration. Explain.

  • Comment number 7.

    mscracker, I agree with your comment however completely agree with 1963Tiger's comments.
    I'm currently a final year student midwife, and whilst the jobs in my area are sparse, the unwanted pregnancy rates are extremley high. Some women do not see termination as an option and therefore continue with their pregnancies. Better advice regarding family planning is vital and midwives can play a key role in providing this.
    I agree that there is are serious overpopulation problems in 2nd and 3rd world countries, not to mention the sexually transmitted infection rates - some family planning methods could prevent could prevent both unwanted pregnancies and transmission of STI's - the respective governments should outweigh the costs of antenatal/intrapartum/postpartum/STI treatment with providing better family planning services.

  • Comment number 8.

    Contraception and condom protected sexual intercourse should be provided by health workers in every country

    By the time the midwife is involved .. many mothers and babies are already seriously at risk that has little to do with the delivery process - or the number of midwives.

  • Comment number 9.

    If I was a mom in a third world country I'd be very leery of outside help judging from some of the comments above.
    I've heard from folks in Africa that medical clinics were overflowing with contraceptives provided by international agencies but no antibiotics or simple electrolyte solutions. The perception was that the developed world was not interested in African children's survival.

  • Comment number 10.

    I think that maybe the goverment should respond to the demand by firstly making training more available for midwifery in local colledges and universities around the u.k, and also provide part funding for those wanting to train as it is for the benefit of the N.H.S and a relatively simple solution to encourage people to train and fill the need soon.

  • Comment number 11.

    I remember that Labour government imported a lot of foreign nurses and doctors to the UK. Is this still necessary? We have a lot of youth unemployment. Why not let young people join NHS?

  • Comment number 12.

    When I was pregnant few years ago in Reading, I was misdiagnosed by a foreign midwife. She failed to detect that my baby was in the wrong position, which nearly cost our lives. It is hard to believe that such practice happened in our NHS.

  • Comment number 13.

    I understand where a lot of the people commenting on here are coming from, but seriously, look at the bigger picture. These poor women with such 'unwanted pregnancies', become pregnant as a direct result of rape, can she seriously stop her attacker to remind him to use a condom. Other women have to turn to prostitution just to feed and clothe her family. The world is perfectly aware of the situation with HIV and STI's is rife in Africa, but with countries so poor that they have to reuse veinous access cannula's (because lack of equipment means you have to risk transfer of blood born infection, or just let the woman die), how can you expect them to be able to afford more qualified staff or provide safe methods of termnation. After watching a recent BBC documentary on maternity care in Africa, and seeing the barbaric methods used by healthcare workers and the desperate measures women take to terminate unwanted pregnancies (in this case resulting in the womans death due to sepsis), it made me far more appreciative of maternity services within the uk. No it's not ideal, but what in this world is perfect? Be grateful of what you have. As fir universities training more midwives, what is the point of the uk having more unemployed midwives? There are plenty of unemplyed midwives in the UK, who aren't practising due to NHS job limitations and freezes. And @ Lynn, I appreciate you had a bad birth experience, but and midwife could have made that mistake. She is only human and does not have x-ray vision to see what way your baby wad lying. Sometimes breech babies palpate like a cephalic baby, I'm certain it was not intentional. Midwives from abroad, still have to complete and gain a UK degree before they can register to practice. Please don't be offended, I am merely trying to highlight that it could happen anytime, by any midwife and her nationality does not rule her an unfit midwife.

    I fully agree that healthcare workers in 3rd world countries need better training and equipment, but whilst these countries are often goverened by greedy dictators who have more interest in their own wealth than the health and wellbeinh of the population, I don't know how things can improve. I would be quite happy to travel to Africa to train midwives on neonatal resusitation and adequate care in labour, but a lit of these poor women who die or experience stillbirth, do infact deliver at home, what is the point. There will never be community based resusitation facilities, just like here. Women in the UK who have a planned homebirth, are closely monitored. Any concern or deviation from progress, they are quickly transferred to hospital. A half hour journey is of no comparison to the 3 day journey's these women sometimes need to take to get emergency medical intervention.

  • Comment number 14.

    I'm a newly qualified midwife in the UK, and am currently unable to find work as a midwife. Competition is very high for midwifery posts. Whilst there is a midwife shortage, and this will only get worse in the area I live, as there is currently a birthrate increase, there is limited funding for midwifery posts. I don't think that extra funding for training posts in the UK is the answer at present, further funding for actual midwifery posts would be far more beneficial. I am not the only one in my situation. At a job I applied for recently, there were over 60 applicants for 4 posts. I love midwifery and would love to be able to use my skills for which the government has paid upwards of £35,000 to equip me with.


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