Meeting of the Parliament 08 May 2019
I welcome the debate and thank Monica Lennon for bringing the issue to Parliament. I, too, thank Scotland’s midwives for the incredible work that they do.
The motion and the Government amendment agree on the importance of the continuity of carer. The 2016 Cochrane review found that the midwifery continuity of carer model made women more likely to have a normal birth. The best start recommendations recognise that all women should have continuity of midwifery carer from a primary midwife. That gives midwives a real chance to get to know mothers and families and to take individual circumstances into account. That is key.
The relationship provides an opportunity to ensure that every growing family in Scotland that requires expert advice on or help with financial or other matters gets the help that they are entitled to. Midwives are ideally placed to identify, at the earliest stage, families where children are at risk of falling into child poverty, but of course those midwives require sufficient capacity, resources and time to do that. It must be acknowledged that serious concerns have been expressed about whether the best start recommendations can be implemented with current staffing levels. In December last year, there were more than 114 vacant midwifery posts in Scotland, and there has been a year-on-year increase in the number since 2015. Those serious concerns are described clearly in the open letter from midwives in Lothian to which the motion refers.
I recognise that the Government is taking steps to address capacity issues. It has increased the number of training places and has increased the student bursary, which I welcome, and I am optimistic that the Health and Care (Staffing) (Scotland) Bill will help to ensure appropriate staffing levels. However, those measures alone will not solve the problem. As we have heard, there are concerns about retention, as more than a third of midwives are over 50. Consistently, a significant proportion of the midwifery workforce is aged over 55 and could therefore retire at any time. That is a lot of invaluable experience that will be lost, and it means that new midwives are dealing with complex cases without essential back-up and support.
The birth rate in Scotland is falling but the demand for midwives is growing. As we have heard, that is due to a rise in older women and women with a high BMI accessing maternity services and requiring more complex care. According to the Royal College of Midwives, more than half of women accessing maternity services are now obese or overweight. We know that there is a well-established link between deprivation and obesity. Healthier mothers reduce midwife workload.
Maximising pregnant women’s income is one way that we can tackle the strain on midwifery services. In 2017, the Greens secured a commitment from the Scottish Government to roll out the healthier, wealthier children scheme across Scotland. I am keen that we do not lose momentum on that and I will continue to monitor progress on the roll-out. Midwives and other antenatal service staff as well as health visitors and others have played a huge part in the scheme thus far, so I offer my thanks for their hard work.
Miles Briggs was right to highlight the impact of community-based projects such as the Pregnancy and Parents Centre in my region. Such projects help parents to have the healthiest pregnancy possible and provide invaluable support to pregnant women and mothers, which can in turn ease the strain on midwives. However, cuts to services are undermining that.
In Lothian, as we have heard, vital face-to-face help for breastfeeding mothers has been slashed by 60 per cent. Five weekly, half-day specialist breastfeeding clinics in community centres were shut in December 2017. It would be very helpful if the minister could respond to those concerns when she closes the debate, because we should imagine what it would be like for someone to wait for a week, worrying that they will be unable to feed their baby.