Webchat with Cathy Warwick, RCM Chief Exec, on Tuesday 23 May at 12.45pm

[BojanaMumsnet]

Hello,

We’re pleased to announce a webchat with Professor Cathy Warwick CBE on Tuesday 23 May at 12.45pm. Professor Warwick is Chief Executive of the Royal College of Midwives (RCM), and has recently been part of a major review of maternity services in England (Mumsnet was also represented on the Review).

The RCM aims ‘to influence policy on behalf of women, forging collaborative relationships with a broad range of organisations with common interests and working closely with obstetricians, gynaecologists and paediatricians and their Royal Colleges.’

Commenting on our campaign for Better Postnatal Care: Aftercare, not Afterthought, Cathy has said: ‘For women the postnatal period can often be a very difficult time – and this is when the highest level of care and support is needed most for some women. It can also be an extremely exhausting and worrying time, particularly for first-time mothers. Surveys of women's views of maternity care including this latest one repeatedly inform us of their unhappiness with the current provision of postnatal care and in 2017 this is certainly not good enough. If we are to invest in better postnatal care for women we must invest in more midwives. England currently remains 3,500 midwives short and our maternity services will continue to struggle in supporting women if the shortage is not addressed. More midwives means women will get the care, time and support they truly deserve.”

Please do join us on the day - Tuesday 23 May at 12.45pm - but if you can’t make it, post a question in advance on this thread.

Please remember our webchat guidelines: one question each, with a follow-up to the webchat guest's response if appropriate; please don't keep posting 'what about me/please answer my question'; and please be civil/polite.

Thanks
MNHQ

[MissShittyBennet]

No response to my question from Cathy, then. Quelle surprise.

[BojanaMumsnet]

Hello all,

Please take five minutes to answer a survey about your webchat experience today.

Whether you’re a lurker, a regular or someone who’s wandered in off the wilder shores of t’internet - we want to know how Mumsnet webchats are working out for ya

There’s a lovely PRIZE of vouchers for the store of your choice for one lucky respondent

(We’ll be posting this link on lots of upcoming webchat threads as we want to get a wide range of views)

Thank you!
MNHQ

[CathyWarwick]

Great hearing all your points - I hope I've managed to respond to them adequately but often it needs quite a lengthy discussion... hopefully I'll be back!

But rest assured I've been very interested in all your points. I'm here with one of our policy colleagues as well as Rona and we'll be feeding back your comments.

Thanks again.

[CathyWarwick]

@RowanMumsnet

Hi Cathy

Thanks for coming on today.

Can you say what advice you'd offer to a pregnant woman about to have her baby, who might be a bit worried about what could happen on the postnatal ward if she stays on one?

And if there are any women reading this who are currently on a postnatal ward and feeling undersupported, what should they do?

And finally - what would you like all of us to do to improve the situation?

I think the first point of contact for any mother who is worried about her care whether it's postnatally or earlier, is to talk to the head of midwifery at her local maternity service. Even if this isn't the right person, she will be able to point you in the right direction. I think talking to the head of midwifery is really useful because then she becomes aware of women's concerns and might be able to take some action to help in the longer term as well as helping you specifically.

Again, if you're on the postnatal ward and things aren't going well, I'd suggest asking to speak to the midwife in charge. Many maternity services have people called matrons who have overall responsible for that area of the service and they may be able to do something to improve things.

If it's before you have your baby, and there is more than one maternity service in your area, it may be worth exploring options in a nearby maternity unit and considering changing where you choose to have your baby. For women whose pregnancy is straightforward, many of our midwifery centres - freestanding midwifery units - or alongside midwifery led units, will have different postnatal facilities, and it may be looking at them may give you more options. And of course one of the major benefits of choosing a home birth is that you're in your own environment right from the word 'go'.

In terms of improving postnatal care more generally, I thought the Mumsnet survey was really interesting. It's often the little things that are the most troubling. E.g. people using their mobile devices in the middle of the night. I thought the RCM could do more to highlight some of these things that aren't rocket science to change and don't need more resources but we could do better.

From your point of view, one of the ways to improve maternity care is to join the local Maternity Voices group. This used to be called the MSLC but it's a forum where women can share their experiences and contribute their ideas to improvements. We've tended to focus a lot on improving care in labour and I think the time has come to do a lot more about postnatal care. This is in England but in Scotland there will be similar groups, as well as in Wales and Northern Ireland. You can find these groups by asking your midwife who visits you antenatally or postnatally, or by contacting your head of midwifery or possibly by contacting the PALS service (Patients Advice and Liason of your hospital). They may also be listed on the website. The names of these organisations might be slightly different across the 4 countries, but they are around.

Other than that, we need more women talking to their MPs (now's the perfect time!) and saying it's critical that we have enough resources in our health services to ensure high quality care. If there are two areas that are most important, I would argue the beginning or life and the end of life are absolutely critical.

[CathyWarwick]

@Sparklyuggs

Cathy, as a first time mother I've been frequently told by midwives that breast is best but offered very little practical support about how to breastfeed and what to expect. Do you feel there is more midwives can do to help women who want to breastfeed and often stop due to a lack of preparation and/or support?

I think this is one area where we should be really developing the role of the maternity support worker, and I notice there were other questions about maternity support workers and what they can do. We should also be using more peer support and encouraging them to work with us on our postnatal wards.

It's not that midwives can't give breastfeeding support - they can and they should. But we need the people who have time to sit with women and really give them in-depth support.

[RowanMumsnet]

Hi Cathy

Thanks for coming on today.

Can you say what advice you'd offer to a pregnant woman about to have her baby, who might be a bit worried about what could happen on the postnatal ward if she stays on one?

And if there are any women reading this who are currently on a postnatal ward and feeling undersupported, what should they do?

And finally - what would you like all of us to do to improve the situation?

[Ginlinessisnexttogodliness]

And on the subject of multi agency and joined up working I also have had two very negative experiences with my last two babies. There was no joined up care at all, there were very different responses to issues such as tongue tie, newborn examinations, diagnosis of problems, breastfeeding advice and their drops in birthweight. For vulnerable, isolated and less educated mothers or parents factors such as this can really exacerbate problems and often the end results is seldom seen or less franchised communities of parents.

I worked for the NHS for a long time and I hate being critical of it when I know times are so hard, but the reality is joined up care and cross professional dialogue isn't uniform or consistent. Even just living from one part of a commissioned locality to another brings variations. For example I have recently moved and It's took me practically all day to find numbers for my new community midwives. If you don't know where to start and you are not referred by your doctors this sort of thing is utterly baffling.

[CathyWarwick]

@Ginlinessisnexttogodliness

I totally agree with *@Tumtetum*, sadly - and with the greatest of respect - I think the issue of partners on wards got a bit of a politician's answer.

I'm not vulnerable and I've not suffered a trauma at the hands of a strange man but I don't want my husband or anyone else's slumped in a chair next to me and my newborn baby in a shared ward at 3am. I think it is a total invasion of a woman's privacy at one of the most critical times on her life that she might need it.

I also think that it's naive to say that the RCM would be shocked if the reason so many women want their partners on the wards is because care is substandard. It's probably the major reason, especially given the discussions and anecdotes on here about basic care not being met like water, food, catheter care, wound care and pain management, never mind the hugely emotional aspects of postnatal care for the patient and her baby.

OK, good point. I think that's a very useful comment to take back. I think it's one we should use in our lobbying for better resources. I would argue that if there is any move to have more partners to stay overnight it absolutely shouldn't be for this reason.

[CathyWarwick]

@Tumtetum

On the issue of men staying overnight on post-natal wards, I don't think you have fully answered the question. You have said that the solution is better designed wards with separate facilities for those who want partners to stay - and yes, that would be ideal.

However, as that is not the case in the majority of hospitals, it means that men would be staying on bays with other women. The fundamental problem is that many women do not want to sleep overnight, at an extremely vulnerable point in their lives, with a thin curtain separating them from an unknown man. It is not possible to respect the rights of women who do not want to share their sleeping space with an unknown man if you are essentially forcing them to do so! Many women would also feel unable to complain about this but that doesn't mean they would be comfortable with the situation.

I definitely don't think any woman should be forced to sleep next to a man even if there is a curtain if she doesn't want to. So I think the policy should be absolutely clear that the women who want their partners staying can only have that possibility if there are separate spaces or all of the other women on the ward agree it is okay. And they have to be asked that in a way which doesn't pressurise them into saying 'yes'. This is the basis of many of the policies that I have seen. There are also units that do have more beds than they usually need and what they will do is offer to move a woman who wants her partner staying to a different bed if the other women are not comfortable. So the bottom line is no-one should be feeling forced to do something that isn't appropriate.

[CathyWarwick]

@84CharingCrossRoad

Hi Cathy. I would like to know how many maternity units have a special room away from the maternity ward for bereaved parents?
When my eldest son was born prematurely 22 years ago he lived for two hours. After he died I was placed in a private room in the middle of the maternity ward and had to hear women in labour and newborn babies crying.
I wouldnt wish that on anyone. I think every maternity unit should have one and if they dont how long till they do?

I agree. Every maternity unit should have not just a special room away from the maternity ward for bereaved parents, but should also have a midwife who specialises in this area and can ensure that all of the guidance provided by wonderful charities like Sands is being implemented. It's so sad to hear of your experience. I don't actually know how many of our maternity units do have special rooms, but I'd hazard a guess from my own visits to maternity units that it is at least 50% and I very much doubt that any maternity unit that is being rebuilt or refurnished wouldn't ensure that such facilities are provided. So hopefully we will see this improve significantly over the coming few years.

[Ginlinessisnexttogodliness]

I totally agree with @Tumtetum, sadly - and with the greatest of respect - I think the issue of partners on wards got a bit of a politician's answer.

I'm not vulnerable and I've not suffered a trauma at the hands of a strange man but I don't want my husband or anyone else's slumped in a chair next to me and my newborn baby in a shared ward at 3am. I think it is a total invasion of a woman's privacy at one of the most critical times on her life that she might need it.

I also think that it's naive to say that the RCM would be shocked if the reason so many women want their partners on the wards is because care is substandard. It's probably the major reason, especially given the discussions and anecdotes on here about basic care not being met like water, food, catheter care, wound care and pain management, never mind the hugely emotional aspects of postnatal care for the patient and her baby.

[CathyWarwick]

@Loftyjen

Would love to know what Cathy's views are on improving collaboration with health visitors.
As a HV myself, I'm v aware of the recommendations of more effective collaboration to the benefit of families, particularly around fully establishing HV's antenatal contacts and enabling smoother transition into parenthood, but not aware of MW's being so aware/wanting to work with us.

Again, great point.

Collaboration is the name of the game these days - midwives shouldn't be working alone.

I think there are many midwives who are working very closely with their health visitor colleagues and seeing the benefits of this, so I'm very sorry if this isn't the case in your area.

I think the visits made by health visitors in the antenatal period are very important. We know that you are critical to the early postnatal care that women receive. Let's think about what we can do in the RCM to make sure that the good collaboration I'm aware of is universal.

Something that could help this in the future would be community hubs, which are a feature of the Better Births review in England. There are some early adopter programmes where these are being developed already. The idea is that these are local facilities where all of the services that women need come together close to her home. They could be based in community centres, large GP practices, in a small maternity unit - it's a local choice. The Best Start review in Scotland also picks up on the benefits of this.

[CathyWarwick]

@space83

Hi Cathy,

As a RN and a mother it is interesting to see how focus is very much on the Baby to the detriment of Mothers' health. Very often basic understanding of Adult physiology is lacking - and this can be attributed to the direct entry onto midwifery courses.

Would not a return to an 18mth top course be more appropriate so recognition of the deteriorating patient/ signs of distress within the mother can be noted earlier and acted upon? I ask this as someone who has also been on the inpatient side of post natal care and had a crashing BP with associated tachycardia but only 2 nurses (both 'old school') noted the signs of this. The others weren't aware of monitoring for allergic reaction during transfusion - this is basic nursing care.

I understand that staffing is an issue - I do permanent bank across a wide range of areas both acute and community - and the quality of nursing care has declined whilst the demands have increased - a lot of this is changing demographics in the nursing profession and the increased cost of training plus the emphasis on university theory to the deficit of practical placements with quality mentorship.

So in terms of question - would you be prepared to say that there is a deficit in nurse training which is undermining the quality of care Mothers receive post natally (after all,, although childbirth is natural when a mother has an inpatient stay there is the suggestion that there are underlying causes separate to fetal development - such as CRF/ CHD/ T2DM/ PreEclampsia/ Recognition of HELLP etc etc) separate to staffing levels?

Birth is an important milestone in many womens' lives and it is unfortunate that so many women feel overlooked and undervalued considering the immense nature of the task of birthing. The concept of 'getting on with it' and 'getting over it' when faced with difficulties really puts back feminism as whole and promoting womens' values. After all, women know their own bodies and know whether through gut instinct or past experience when something 'isn't right' and this is soo soo important to acknowledge in clinical practice alongside interpretation of results - especially when faced with a medical profession overladen with male consultants.

RNs and RMs primary purpose should be the return to health where possible and the advocacy of the patient - both mother and child.

Thanks in advance.

Great question and quite a lot of detail! But the general principle, is one that is being raised by a lot of people. Ie now that most midwives are not training as nurses first, are our midwives capable of looking after women who might be described as having an 'illness'? At the moment, the training of our midwives definitely prepares them to look after the ill woman and it certainly trains them to understand adult anatomy and physiology as it pertains to women. I guess the issue is whether they have as much experience as a nurse might have had of looking after women who might need high dependency car or extensive medical care.

This will depend really on their clinical placements during their training. What we try and do is once midwives are qualified is give them additional experience to help them rectify any lack of experience in training. It works both ways - some of our midwives are qualifying without ever attending a home birth and many are now seeing women deliver either by caesarean or with forceps. So I think my response is that it is a potential problem, but it is one we can address. It may be that we need to increase the length of midwifery training and the Nursing Midwifery Council that takes responsibility of this training is currently reviewing the whole course. It will take quite a long time but by 2022 midwives will be emerging having done what could be a very different training.

There are some maternity units that have busy high dependency units where women with serious medical conditions will be looked after when they are pregnant or after they've had their baby. Even midwives who have got a nursing qualification can feel out of their depth in such units and in that case nurses are being employed. This seems to me to be a really sensible solution. We wouldn't have midwives working in intensive care units, equally our maternity theatres are rarely staffed by midwives. They are staffed by experts in this area with midwives going into the theatre to support the mother and to look after the baby. But I think you know all that as I think you said you are a nurse midwife!

[Tumtetum]

On the issue of men staying overnight on post-natal wards, I don't think you have fully answered the question. You have said that the solution is better designed wards with separate facilities for those who want partners to stay - and yes, that would be ideal.

However, as that is not the case in the majority of hospitals, it means that men would be staying on bays with other women. The fundamental problem is that many women do not want to sleep overnight, at an extremely vulnerable point in their lives, with a thin curtain separating them from an unknown man. It is not possible to respect the rights of women who do not want to share their sleeping space with an unknown man if you are essentially forcing them to do so! Many women would also feel unable to complain about this but that doesn't mean they would be comfortable with the situation.

[danigrace]

Thank you very much Cathy. You make very clear points. It just feels a very sad and desperate situation that even with the best ideas and the best will in the world the majority of the necessary changes simply cannot be implemented without a significant increase in financial investment, which sadly just doesn't seem to be on the horizon.

[CathyWarwick]

@Caffeinesolution

What do you think about Bounty ladies being allowed on postnatal wards? Are there any other wards where you'd like to see commercial sales reps wandering around so long as they pay the NHS a bit of money for the privilege, or is it only postnatal women who are fair game for this?

Thank you.

Going back to an earlier point: everything we do in maternity care should be centred on what the woman wants and her needs.

There are lots of things that happen on our postnatal wards that don't give women enough choice about what happens. With things like Bounty reps, it's best if women can be advised that they're available and make their own choices about whether they would like to access them or not - for example, in a separate room.

There are lots of different views about these issues - but the most important thing is women have choice.

[CathyWarwick]

@Batteriesallgone

I know lots of women who have lied about complications / their health post birth in order to avoid the hellish post natal wards in this area. I think the lying, while obviously because we're all terrified of postnatal, is also because of two reasons:

1) The awful language still used around birth - the word 'allowed' crops up a lot, and it is wrong to imply the woman has no autonomy in her care. Surely it is safer if the woman is encouraged to be honest, told about the risks, but still supported to go home if she is terrified of postnatal? In my first pregnancy, I asked about the process for discharging myself if I was admitted PN and was told I 'wouldn't be allowed' - this is wrong, isn't it?

2) How long it takes for a woman with minor complications to get out of postnatal once admitted. Is there any way to fast track such women out of hospital if they are desperate to go home? If one night really meant one night and going home the next morning, women might not feel they have to lie in order to get out of there.

On your first question: This is an interesting question. I think we should eliminate the word 'allowed' from the language of maternity care. What's important is that women do what they want and choose the type of care that's most important to them. Maternity services then need to ensure the services meet these needs. There isn't any other area of our lives where we accept an approach that says 'you're not allowed to' except where it's against the law. And that's very rarely the case in maternity services.

In terms of this relating to going home from a postnatal ward, nobody should be pressurising a woman to stay on the ward if that is not what she wants. I know that the professionals will often have the interest of the mother and the baby at heart, and they may feel it would be easier to provide the care they think is needed if she stays in hospital, but really if the mother doesn't want to be there, that isn't going to help. Some alternative way needs to be found to ensure the care can be provided when she goes home.

We're lucky in the UK to have community maternity services. Other countries don't have these. There would be no reason why a specific pattern of postnatal visiting couldn't be organised to enable you to go home.

Your other point, about how long it takes to get women home once they are ready to go, is another issue dear to my heart. I was working on a midwifery led unit - the woman I was looking after had had her birth, and was all ready to go home but there seemed to be a million things to be done before that could happen. Not least filling in the computer, waiting for the paediatrician and in my particular case, even waiting for a survey to be undertaken of the postnatal care! We really need to sort these things out, and I hate to sound like a broken record, but some of it is about having the right resources, e.g. enough computers, so that midwives aren't queuing up to use them or enough people to do the baby examinations.

Sometimes though, it is not about resources and it's about thinking innovatively about service provision and how it is truly centred around the needs of mothers. I think sometimes when you are a midwife working on a busy shift, you can lose sight of how long people have been waiting. And we need to address these problems.

[CathyWarwick]

@HandbagKrabby

What do midwives think postnatal care should be?

I feel there was a real disconnect between the light touch care, poor facilities and self reliance expected of postnatal patients and the reality of wards full of women recovering from surgery, needing to manage medical conditions and dealing with poorly babies. I feel everyone who might have benefitted from the care being offered went home six hours after giving birth. Is there a case for postnatal to be a medically led ward?

Yes - I think you've made a really good point.

We have been really keen on the idea that in the postnatal period women aren't ill - yes, they're getting used to having a new baby and most support needs to be directed towards helping women care for their baby and be self-reliant. I think our postnatal wards are becoming more like medical wards: the caesarean section rate in most units is around 30% so 1/3 women have had major abdominal surgery and others may have major tears. So I think there is a case that this needs to be recognised and staffing levels adjusted accordingly.

I do think midwives and maternity support workers can give this care - but there has to be enough of them.

I think all of this also means that our medical staff need to get more involved with postnatal care. In the past its been more left to midwives, but I think we need to see more doctors visiting new mothers and making sure that they are getting the right treatment for things like underlying conditions or surgical wounds.

[CathyWarwick]

@danigrace

You, along with the majority of other relevant health professionals, all reiterate that many more midwives are needed for things to be improved. This seems to have been the case for a long while. Why in your opinion has this not happened? Do you think campaigns like this will help get the attention to get the necessary funds?

We've obviously already touched on staffing in this webchat. The RCM definitely thinks that we are short of midwives. One of the reasons why postnatal care could be described as the 'Cinderella' of the service, is that hospitals are short of midwives and when these shortages happen, midwives are all pulled to work on the labour ward where people perceive they are most needed. I think the results of the Mumsnet survey show how much we need midwives on the postnatal wards. And that takes good staffing. The reason that we haven't got enough midwives is, I think, fundamentally about maternity and health service finances. We have guidelines about how maternity units should be staffed and how maternity services should follow these guidelines. But at the end of the day, if there isn't enough money, the posts can't be created to employ the necessary midwives. This is why the RCM keeps lobbying the government about health service funding. We also do keep in contact with maternity services and try to insist that they do assess their workforce needs because then they can point out to the government that their staffing isn't safe. We need more than just the RCM's voice making these points.

You might be interested to know that we also worried about the impact of Brexit on our midwifery staffing. At the moment there are around 1,500 midwives working in England who come from countries like Italy, France, Spain, Poland and they are mainly working in London and the South East. One London maternity unit has one third of its midwives from other EU countries. If these midwives aren't allowed to remain, and if others can't come, it will compound our problem. One of the other reasons we don't have enough midwives is that a lot of midwives are leaving the profession, partly because they are reaching retirement age. But also we are seeing some younger midwives leaving because they feel they can't do the job they wanted to do, largely because of not enough midwives! So it is a vicious circle we've got to try and put an end to.

[CathyWarwick]

@PMHull

Given the RCM's aim ‘to influence policy on behalf of women', what action is the RCM taking to stop NHS Trusts/hospitals refusing maternal request caesareans?

Just recently, a woman contacted me after receiving a leaflet from OUH, which was followed up with further confirmation that it does not support caesarean choice (despite 2011 NICE guidance and the 2015 Supreme Court judgment):
caesareanbirth.org/2017/04/12/nhs-trusts-still-refusing-maternal-requests/

Thank you

Lots of you are asking about choice in childbirth: should every woman be able to have an epidural, should women be able to choose elective sections. There seems to be a feeling that myself and the RCM only think some choices are acceptable, what I have actually tried to say is that all women should be able to make an informed choice - and the important word here is informed.

If a woman decides to have her baby by caesarean section, it is important that she is fully informed about all the aspects of this choice. If her choice is then to continue with an elective caesarean section, then at the end of the day it is the woman who makes that decision. But it is the role of any responsible healthcare professional to make sure that she has adequate information and support whether she wants to have a caesarean, vaginal birth, water birth or epidural.

One of the thing that I think can improve discussion around these choices is continuity of care. The patient and midwife can form a trusting relationship, options can be discussed openly and it is much less likely to result in conflict.

[CathyWarwick]

@Bearfrills

I have two questions but one is a bit similar to the question posted by Idontmeanto so I'll go with the other.

Lots of women on the Better Postnatal Care thread (and other threads elsewhere on the site) have said that they are not comfortable sleeping in shared bays with overnight partners/strange men for various personal and cultural reasons. A major hospital where I live was going on allow partners to stay overnight in shared bays and had to cancel the scheme before it even began due to the volume of complaints and objections received. There are a lot of women out there who do not want partners to stay overnight in shared bays (private rooms are another matter however most wards are shared bays so often a private room isn't an option).

Given that all providers of NHS-funded care are expected to eliminate mixed-sex accommodation, except where it is in the best interests of the patient or reflects their personal choice, why are women expected to share sleeping space in multi-bed bays with unfamiliar men/partners if this goes directly against their personal wishes and is not in their best interests? Nowhere else in the NHS would this sort of scenario be accepted as the norm so why is it foisted on women and - in your opinion - would recruiting more midwives remove the need for partners to stay overnight in order to plug gaps in care?

This issue of having partners on the postnatal wards is a really interesting one. In some surveys, what we've heard is that it makes a huge difference to women if their partner can stay with them. This is partly because the partner prefers it, because they are not missing out on the early hours after their baby's birth and partly because the woman feels she has someone to help her with the smalls things needed after birth. There is no way that partners should replace the need for midwives or maternity support workers and the RCM would be shocked if this was the rationale for having partners staying overnight.

Other women however do feel as you do - that their privacy is being invaded and that there is a lot of noise and that it is really just not very comfortable. The problem is that many of our postnatal wards are not designed to meet these needs. And I think the solution is that we need better designed wards, more space in our maternity units, we need a greater number of beds, so that women who do want partners staying are in a different facility. Meeting women's individual needs means we need the resources to meet this. Many of our freestanding midwifery units do have lovely facilities which allow women to have their partners staying overnight in their rooms. It would be lovely if this could be the norm in all hospitals.

Essentially, I think we can enable partners to stay overnight, but it needs to be thought through very carefully and a lot of consideration needs to be given to make sure all women's needs are met. For example, ground rules need to be set - if a partner was being offensive or using their mobile phone in the middle of the night - it has to be perfectly clear that is not on and they would have to leave.

Interestingly, there are maternity units where it is now the norm to offer this option to women. Not everyone chooses this option but for those who do, it's working extremely well and they've managed to introduce it in a way which doesn't seem to be upsetting women who are on their own.

[CathyWarwick]

@Sairelou

I will be watching this thread with interest tomorrow afternoon!

With the removal of the government funded bursary for midwives and nurses do you expect a decline in the volume of applications for university places? We are constantly told through the media that there is a lack of midwives and nurses which may be to detriment of care, however there seems to be very heavy competition for university places. Why is this?

Certainly at the Royal College of Midwives, we think that there's a real danger that young people will be put off applying to university because of the cost.

It's interesting that in Scotland and Wales they've decided not to introduce a bursary, and Northern Ireland could go the same way.

In England we may see student midwives qualifying with up to £60,000 of debt if they have previously gone through university. It would be a real shame if we saw a drop not just in the number of applicants but in the number of people coming into midwifery training with life experience.

Whilst at the moment we still have a lot of people applying to be midwifery students, our midwifery teachers are telling us that most of these applicants are school leavers. Although these students will no doubt make excellent midwives, lots of women do want a midwife who has got that life experience.

[CathyWarwick]

@Idontmeanto

Is it university-educated professionals we need more of when most of the complaints registered on the Mumsnet thread were about dirty facilities, lack of accessible food and water, inconsiderate fellow patients and their visitors, and polite, compassionate, respectful care?

There's no doubt that there are a large number of women who need really good care after they've had their baby. And by that I mean help with getting their meals, getting up to the toilet, getting washed, really just the basic things in daily living. I think all of our midwives should be able to help women with these sort of things. But because we have a real shortage of midwives, what's probably going to happen int he future is that we're going to use more maternity support workers to provide this sort of care.

And I don't have a problem with that as long as women and babies get what they need. I don't think this is really about whether people are university graduates or not, that shouldn't stop them being caring. I think it is much more about whether as a nation, we are prepared to ensure that we have enough midwives. But even if we had all the money in the world, it's probably right that we concentrate our midwifery skills in providing the real expert care you all need.

[CathyWarwick]

Hello,

I'm here with Rona McCandlish, another RCM adviser. I hope that together we can answer your questions - listen to what you have to say and take that back into the RCM to think about as we do our work to improve how we give services to you.

[CathyWarwick]

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