A shortage of midwives and lack of clear national training routes for mental health specialists is fuelling a “crisis” in maternity services, a panel of experts has told a parliamentary committee.

There is no clear route to specialise in perinatal psychiatry currently in Scotland, which has left the discipline “very vulnerable”, MSPs were told.

Holyrood’s health committee is undertaking an inquiry into perinatal mental health, with half of new mothers experiencing an emotional or mental impact following the birth of a child.

Suicide is the leading cause of direct maternal death within the year after birth.

Student midwifery places are set to rise by 6.3% this year, to 287 in total – but increasing numbers of leavers and unfilled vacancies means the workforce is facing “chronic shortages”.

Figures released yesterday show nursing and midwifery vacancies are at their highest recorded level, with 5761 whole time equivalent posts unfilled across Scotland as of September.

Midwifery training in Scotland is restricted to just three universities, which means areas far from these institutions can struggle to attract newly qualified midwives.

Dr Mary Ross-Davie, Director for Professional Midwifery at the Royal College of Midwives, said staffing pressures meant some high-risk mums are unable to build relationships with a midwife.

Dr Ross-Davie, a former perinatal mental health specialist midwife herself, said interactions with new mothers were a “a great point of entry in terms of building relationships of trust with authority and health figures.

"So, for a midwife to be able to provide consistent presence and support during the pregnancy is absolutely vital and it doesn’t exist in every area.”

Professor Marian Knight, Professor of Maternal and Child Population Health at the National Perinatal Epidemiology Unit, added complexities in the maternity care system made it harder to spot those in need of extra care.

“The pattern we see amongst the women who die by suicide is that they have had multiple contacts with different individuals,” she said.

“So, they might have seen the GP on one occasion, emergency department on another, health visitor on another, with concerning symptoms that have been either normalised or dismissed and nobody has recognised the overall pattern.

“So, for me, it only takes one person but there does need to be that one person who knows an individual well enough to recognise that deteriorating pattern of symptoms.”

Selena Gleadow Ware, Perinatal Faculty Chair of the Royal College of Psychiatrists (RCPsych), said there was a lack of effective workforce planning:

“We do not yet have clear pathways that are discipline specific, that highlight the numbers we need to train to ensure we have sufficient numbers that accounts for a drop off or loss or changes in careers.

“For example, in perinatal psychiatry there’s no national perinatal training numbers and at the moment we’re very vulnerable to the other challenges in the mental health workforce such as general adult psychiatry which means we could lose the gains we’ve made.”

Dr Ross-Davie called for shortened programmes for qualified nurses and new routes into midwifery for maternity care assistants to help staffing in the north of Scotland.

“What is difficult when you have staff shortages is that it reduces the amount of time midwives are given for continuing professional development, and what we’ve seen is they are expected to take this in their own time. Having ringfenced time for education through your career is an absolutely vital element.”

 

Read more: ‘Warning siren’ over new mums’ mental health; New mums mental health charities get funding boost; Review of stillbirths after pandemic increases

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