IN many ways, Scotland’s maternity services are in pretty good shape – they are certainly doing relatively well on the total number of midwives – but the pressure is growing. According to a report from the Royal College of Midwives (RCM), the service in Scotland, good as it is, is increasingly struggling to cope, with Mary Ross-Davie, the RCM’s director in Scotland, saying that the service may buckle unless action is taken as a matter of urgency.

There are several different factors that have brought us to this point, the first of which is the profile of the midwives themselves. Not only do staff aged 50 or over make up about 41 per cent of the workforce in Scotland, which is the highest in the UK, the proportion of older midwives has also been increasing in recent years.

Of course, there are many positives to having older staff, who bring many years of valuable experience to the job, but it also means that with high numbers of staff getting closer to retirement, there is the real prospect of a serious shortfall in future unless the recruitment of new, younger midwives keeps pace with the change. It helps that there has been an increase in student numbers in recent years, but it is still not enough: we need to recruit more student midwives.

The changing profile of the patients has also been increasing the pressure on maternity units. First, more women are having children in their thirties and forties and the trend is particularly striking in Scotland. Between 2000 and 2015, the number of women having children after the age of 45 in Scotland increased by 393 per cent to 143 a year, and because older mothers can mean more complications for mother and baby and more caesarean sections, that takes up more staff time and resources. If the trend continues, which seems likely, more staff will have to be recruited to cope with the demand. More money also needs to be invested in maternity care to ensure that older mothers get the quality of care they need.

Patients are also changing in another, more troubling way, with just over one in five pregnant women in Scotland now classed as obese. Again, this can mean more complications and demands on staff, although there is very little that the maternity staff can do to change the long-term trend. That requires investment from government to change eating and lifestyle habits and warn prospective mothers of the difficulties and problems of falling pregnant while obese.

What all of these factors taken together amount to is a pincer movement on Scotland’s maternity services, with the profession ageing fast at precisely the same time as the demands on it are growing.

It helps that Scotland’s maternity services are better off than elsewhere in the UK and are relatively well staffed for now, but the RCM has made it clear where the risks are and where action needs to be taken.

More students need to be recruited and brought into the service. More also needs to be spent to ensure that the service can cope with the changing profile of pregnant mothers. The maternity service faces changing circumstances and must change with them.