sitdownpleasegeorge got this from homebirth.org
What about staffing shortages?
Women planning a home birth are sometimes told that the local health authority may not be able to provide a midwife on the day, because of staffing problems. If you hold out for a home birth in these circumstances, you may feel guilty that you would be taking midwives away from other women who need them on the labour ward. This is an understandable concern, but it is important to remember that staffing levels are the health authority's responsibility, not yours. You may sympathise with their problems, but remember that ?where there's a will, there's a way?. Trusts which are fully supportive of home birth find a way around this problem; so can yours.
While sympathising with the health authority's staffing problems, you can ask what they are doing to resolve their staffing problems. Advertising vacancies is insufficient - perhaps providing their midwives with more autonomy and job satisfaction, for example with the opportunity to attend births at home, would improve their retention of midwives.
If women are persuaded to abandon their home birth plans on the grounds of staff shortages, the health authority will have no incentive to improve its services for other women - so by holding out for a home birth you are helping to improve choice in your area, and helping to make midwives' jobs more interesting - and you are also saving money for the NHS (see below).
Every health authority has access to what are called 'bank midwives', and most use them regularly when they have staffing problems in the hospital. These are midwives who work on a temporary basis, sometimes for just one shift at a time (a bit like supply teachers). Some will be midwives who are employed by the same health authority, who are taking on extra work - doing overtime - and others will be midwives who want to work part-time but who have not obtained a permanent part-time job, or midwives who are currently taking a career break to look after their own children, but will work occasional shifts, or semi-retired midwives. All 'bank midwives' are all fully-qualified midwives. If there was a genuine shortage of midwives on the labour ward then the health authority should always be able to arrange cover on the ward from a bank midwife, thus freeing up a community midwife to attend home births.
In some areas, independent midwives work as 'bank midwives' when they are not needed by their own clients. On occasion, independent midwives have attended home births on behalf of health authorities who could not arrange cover from their own employees. Sometimes such arrangements are made in advance - when people talk of arranging an 'extra-contractual referral' to an independent midwife, they mean that an independent midwife would be booked to attend you, but would be paid directly by the health authority.