In recent years a number of factors have had a significant impact on the capacity of maternity services and midwives to deliver quality care. Many more women and families are recognised as having complex physical and social needs including women and families living in poverty; migrant women who do not speak English as a first language; teenage mothers; women who are misusing drugs and alcohol; women who are obese and those who have long-term conditions such as diabetes. In addition the average age of first birth is now years compared with years in 199910 and increased use of fertility treatment has meant a higher rate of multiple.
