When hard labour brings its rewards

To increase the number of women able to opt for home births and to see a midwife directly instead of a GP, experts predict there will need to be a huge expansion of services and 3,000 extra midwives recruited nationally.

The Royal College of Midwives maintains that more effective planning is essential if maternity services are to keep pace. According to Dame Karlene Davis, general secretary of The Royal College of Midwives: "Action is needed by the Government to adequately resource maternity services, especially when the number of NHS midwives fell at the last count. Newly qualified midwives are not getting jobs because of the [NHS financial] deficits, midwifery training commissions are dropping and antenatal classes and postnatal care are being cut or reduced."

She adds: "Every woman has the right to a caring and safe birth in a place of her choice. This goal is pie in the sky as long as the service depends on too few midwives." Despite the challenging climate within the NHS, midwife Mavis Machirori has gained much satisfaction and fulfilment from her work at St Mary's NHS Trust in Paddington since she qualified a year ago.

Originally from Zimbabwe, where she graduated with a degree in economics, Machirori, 26, came to the UK four years ago when her grandmother suggested she retrain as a nurse. "But after doing some research I decided to train as a midwife," shesays. "It's a three-year degree course: in the first year I covered the relevant biology and science and studied normal delivery. In the second year I studied abnormal deliveries and in the third year I was linked to a practising midwife who acted as a mentor. You work alongside them - you need the experience of being with women and caring for them. Before qualifying, a student midwife needs to be present at 40 normal deliveries."

A newly qualified midwife's salary starts at £19,166 per year excluding payment for unsocial hours and on-call rota, while a consultant midwife can earn £60,000. While midwives once qualified as nurses before training in midwifery, the courses are now taught separately. Machirori says: "We cover basic nursing skills over a couple of months. Now the course is much more about specialist knowledge and depth of study."

Students can also access shortened midwifery courses following a nursing qualification if preferred.

A midwife does more than just deliver babies. She is usually the first and main contact for the expectant mother during pregnancy, and throughout labour and the postnatal period. She helps mothers make informed choices about services available. She carries out clinical examinations, provides health and parent education and supports the mother and her family throughout the childbearing process.

Machirori is based at St Mary's maternity unit full time, rotating across the antenatal, postnatal and labour wards, but midwives also work in smaller stand-alone maternity units in private maternity hospitals, group practice, birth centres, with GPs and in the community. They are required to work shifts, do day and night duty, and travel between a hospital or institution and a mother's home. You can enter the profession by undertaking a midwifery course at diploma or degree level.

Machirori is clear on the rewards of her role: "The daily challenges and highs of my job often move me to tears. Perhaps I'll be on the postnatal ward and I see a mother struggling to breastfeed her baby. Sometimes the baby latches on successfully while you're there and the look of joy on that woman's face is incredible."

St Mary's NHS Trust: www.st marys.nhs.uk. The Royal College of Midwives: www.rcm.org.uk. NHS Careers has a database of all universities that provide midwifery courses: www.nhscareers.nhs.uk.

Nursing and Midwifery Admissions Service (NMAS) processes applications for diploma courses in England: www.nmas.ac.uk.

Nursing and Midwifery Council: www.nmc-uk.org.uk