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Birth at a midwifery unit with helpers
Health Series: Expert Comment

Delivering next generations

Maria Garcia de Frutos comments on the psychosocial, economic and political impact of COVID-19 on women and the future midwifery workforce in the UK

by Shamim Quadir (Senior Communications Officer)

Maria Garcia de Frutos is Lecturer in Midwifery at City, University of London.  Published in the British Journal of Midwifery, her new comment piece outlines the impact of the COVID-19 pandemic on pregnant mothers and their families and the midwifery workforce in the UK.  

Whilst she acknowledges how the pandemic has presented many novel challenges for political leaders and healthcare systems, she reminds that there is strong evidence to suggest that during crisis, women are most affected, with experts in the field of midwifery and human rights concerned about how pregnant women and families have been treated from the beginning of the COVID-19 crisis.

She comments on the state of the midwifery workforce in the UK before and during the pandemic, and what it could be afterward , highlighting how an already weakened healthcare system in the UK has been exposed by COVID-19, impacted by years of austerity.

Garcia de Frutos shares that there are currently an estimated 9.3% of posts where a permanent midwife is not available to work in the NHS, and that the projected increase in midwife numbers is not sufficient to meet the projected demand in 2021. Despite Government’s 2018 proposal to expand the midwifery workforce, she highlights that little attention has been paid to ensure there are enough midwifery lecturers and clinical placements to mirror the step change in training numbers; the impact of the abolition of bursaries; and the introduction of university fees. She addresses issues around staff retention and the challenges posed by Brexit, citing the NHS’s long term reliance on European professionals to fill in the gaps in the workforce.

She also puts these figures into the context of the pandemic, including how emergency registers have been set up for midwives who have left the profession within the last three years to opt in, and the unprecedented pressures placed on student midwives in their personal and professional lives, some of whom have and will volunteer in  extended clinical placement within the NHS, and needing extra emotional and educational support.

Conducted by the Royal College of Midwifery at the end of March 2020, a  survey to heads of midwifery and midwifery directors in the UK, suggests that over a fifth of local midwife-led maternity units had been closed, with almost a third of areas stopping home births and the number of vacant midwifery posts doubling since the outbreak of the pandemic.

Garcia de Frutos welcomes new guidelines emerging on COVID-19 that reinforce women's choices during pregnancy and childbirth, including the importance of birth companionship. However, she says that despite these, and with the reduction in services, women continue to be frightened to go to hospitals and be alone during labour. Not to mention the physical and emotional outcomes that these restrictions will have in years to come.

Reflecting on the comment piece, Maria Garcia de Frutos said:

There is a clear demand for midwives. The solution is also clear: increase the midwifery numbers. However, without political willingness and an investment in both academic and clinical resources, the conflict will remain and we will be failing women and generations to come, particularly in times of global crisis like the one we are living through.

Find out more


Read the comment article, ‘Delivering next Generations’ in the British Journal of Midwifery.

About the academic

Maria Garcia de Frutos is Lecturer in Midwifery at the School of Health Sciences, City, University of London.

She teaches at undergraduate and postgraduate level as well as supporting students in clinical practice. Her main interests are in public health and sexual and reproductive health, with particular interest in women with complex socio-political needs, migrants, refugees and displaced populations.

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