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Is this a revolution for maternity care?

02 January 2019
Volume 27 · Issue 1

Maternity services appear to have been given a much-needed boost for 2019, with proposals from the Secretary of State for Health, Matt Hancock, to make the UK ‘the best place in the world to give birth’ (Helm and Savage, 2018). Plans address the whole maternity care spectrum and include funding more specialist neonatal nurses; physiotherapy for women who experience incontinence after childbirth; evidence-based breastfeeding programmes; and the digitisation of the child health record (the ‘red book’) (Helm and Savage, 2018).

There is also a renewed commitment to the promises made by Mr Hancock's predecessor, Jeremy Hunt, to increase continuity of care and halve rates of stillbirth, maternal and neonatal death, and brain injuries during or shortly after birth. This means that the target is still in place to provide continuity of care to one-fifth of women by March 2019, and to the majority by 2021 (Press Association, 2018).

The timing of this announcement could be seen as a distraction from Brexit, which poses many unanswered questions. Will training a further 3000 midwives (Royal College of Midwives (RCM), 2019) be sufficient to replace any EU midwives who leave the NHS? Will Brexit affect how much money the plan actually receives? Will it in fact mean that these plans are sidelined and forgotten?

Brexit aside, issues remain from Mr Hunt's tenure, such as how to translate the number of graduates into practising midwives, and how to retain staff. Increasing numbers is a start, but a supportive and flexible culture is essential if recruitment to be sustainable.

Mr Hancock has said that the money will come from the £20.5 billion increase that the NHS is due to receive in 2023/24, but whether inflation will have an effect is unknown. There are no projected costs for specific elements such as digitising the red book, and it remains to be seen whether this will be an essential investment, or a costly project that lacks the necessary infrastructure to be delivered to a health system that still uses fax machines.

Whether the new plans will affect the Government's target to halve stillbirths, birth injuries and maternal and neonatal deaths by 2025 is also uncertain, especially if funding is not due until 2023/24. Reports mention that safety initiatives will be introduced (Helm and Savage, 2018), but these are not elaborated. As a result, the RCM (2019) has called for a range of services to be funded: not just those specifically related to stillbirth or maternal death, but wider public health initiatives too, such as smoking cessation and obesity.

This is an ambitious and comprehensive project that could have an enormous impact on the health of women and babies. If it is viewed with caution, perhaps it is only because the NHS has become somewhat accustomed to lacking money, staff and resources, but let's hope we will be pleasantly surprised. Despite the midwifery focus, improvements in maternity services of course require investment in the health system overall—a systemic change, rather than a sticking plaster.