Midwife shortage? Hello? 28 births per midwife per year?

[Ushy]

I don't want to midwife bash because I know how hard some work but I couldn't believe it when I read that midwives are complaining that they are overworked and they want to reduce their workload to 28 babies PER YEAR from around 32 or 33!!! PER YEAR? I thought I must have misheard and they meant a month but no, a year. How come then, there is not already enough midwives for every woman to have good quality one to one care in labour and postnatally without us tax payers having to pay for more? Can someone explain?

[Iggly]

Er there's plenty out there saying that MWs are in short supply plus you might need two.

Where did your stats come from?

[OddBoots]

And all the antenatal and postnatal care?

[Ushy]

Iggly and Oddboots I got it from the BBC - sorry can't actually find the exact page because that was about the recent story but this is an earlier link that has got similar stats news.bbc.co.uk/1/hi/health/8000744.stm I accept the antenatal and postnatal care but I doubt that I spent much more than three hours one to one with a midwife ante-natally and postnatally altogether. (Actually if that!) They have well over 10 whole working days for each woman.

[VivaLeBeaver]

Yes, it's true that the Average is about 34 births per year per midwife.

First of all, that is per registered midwife. Not whole time equivalent. Midwifery is generally a part time job, few do five days a week as we,re just too burnt out to cope. So that probably makes it 68 births per year.

There are more midwives in community, in clinic and on the an and pn wards than on a labour ward. So maybe 30% of a trusts midwives will be labour ward midwives. So that makes it about 150 births per year per labour ward midwife. And remember most of those are working three days a week.

And it's births, not labour. The average first time labour takes 19 hours. A birth takes a couple of minutes. It's not unusual for me not to deliver a baby for a whole shift, however during that shift I could quite easily be caring for two labourers and someone who delivered just before I started.

So I'd still be run off my feet rather than sat on my arse.

[VivaLeBeaver]

So do you really think I spend nine days out of ten sitting around waiting for my next birth? Talk about clueless.

[VivaLeBeaver]

I'd say that my rough figures are probably quite accurate really. If you work three days a week that's about 150 shifts a year, maybe a bit less after annual leave.

I'd say that one delivery a shift is probably about right on balance. Sometimes you get none, usually one, often two, my record is three in a shift.

[Sirzy]

Ushy, you seem to be very much underthinking the role of a midwife. The actually delivery part is only a small part of the role of a midwife.

Perhaps if there were more you would have got more than " 3 hours one to one" with them ;)

[Ushy]

Viva Not saying that but it could be that the available staff aren't being used very well. It is not a personal criticism of you.
You said the numbers are per midwife even if part time - that is absolutely not the case and it is not what the BBC say either - they say full time. If only 30% of midwives are on labour ward may be that is the problem. May be you just need more on the labour (and I would say postnatal) wards. I completely agree that labour can last 19 hours but at 33 births per year there is still an awful lot of change out of 10 days.

[Ushy]

Sirzy you say perhaps I might be underthinking the role of the midwife. I agree - may be I am. But bear in mind the big complaints are lack of one to one care and poor aftercare. What are these 'other functions' that soak up those ten days that mean these two don't get priority? What exactly fills all the other days?

[Quidsi]

This is the second MW bashing thread I've seen today.

[VivaLeBeaver]

Well I can promise you it doesn't work out like that in reality. I can promise you we,re run off our feet. I can't remember the last shift where I had a cupmof tea or something to eat.

How can midwives be moved from community into labour ward? There wouldn't be enough midwives left to run the clinics? How can midwives be moved from the an/pn ward to labour ward when they're already running on an average ratio of one midwife to 13 women?

There aren't more midwives to put on labour ward. Not safely anyway.

[VivaLeBeaver]

It's the third I've seen.

Seriously if you think the job is such a doodle why don't you train to be a midwife? I mean it must be the easiest job in the world, sitting around for weeks on end with nothing to do.

[VivaLeBeaver]

The other functions as you put it are caring for women in labour, caring for women who have just given birth, providing postnatal care both in and out of hospital, antenatal clinics, hospital clinics, assessment centre drop in sessions.

What's hard to understand about that?

[Sirzy]

The midwives role is so much more than just the labour though. I wonder how many woman your average community midwife is expected to see each day? How often they don't have the time they need to sit with a new mother and help with breastfeeding or whatever else they need support with.

[Ushy]

Viva I agree - I thought that the midwives were run off their feet when I had my ds and dds and I am not midwife bashing! I am asking a question.

Each woman, based on the numbers, should be getting an entitlement to midwife time of around 8 full one to one days allowing 2 days for paperwork and record keeping. They get nothing like this.

Statistically there is enough time for this so how is this time being spent?

[piprabbit]

Sorry I've read that article twice now and I don't think they are talking about each MW being responsible for 28 births per year.
They are talking about using the number of births in an are to calculate the no. of MWs needed - so an area with 280 births a year would be staffed by 10 MWs.

They just want to improve the staffing ratio of MWs caring for pregnant women - not reduce the workload of individual MWs.

[Quidsi]

Sirzy - I agree with you. With my second pregnancy there were complications and my MW was always on hand to take a phone call, and even rang me after one scan to see how I was. Only a couple of minutes out of her day but imagine if she does that for everyone - that adds up to a hell of alot of extra hours. She was an absolute star.
Surely people aren't that stupid to think a midwifes work is purely about the birth of the baby? Eh Ushy?

[Sirzy]

I don't quite understand this entitlement to 8 days one to one midwife care idea? How do you figure that?

You working on 10 day cycles would mean a mw would only see about 36 patients a year!

[Ushy]

piprabbit yes, you are right - 280 births a year should, according to the claim, be staffed by 10 midwives. On average that would allow over 13 midwife days per woman as opposed to just over 10.

But in terms of individual care, women are getting nothing like this. So what is the time being spent on? It is not a hostile question - just a question.

[VivaLeBeaver]

While no one gets 8 days of specific one to one care there are many of women who will get that once it's all added up and worked out.

The high risk women who have to have growth scans at the hospital every two weeks and then have a 20 or 30 min appt in hospital clinic on top of community midwife appts.

The woman who is quite poorly antenatally and spends four or five weeks in hospital. Yes she's not having one to one care if the midwife is looking after another ten women but if you divide the total hours she is there by ten (24 hours a day) it will add up.

The woman who has two midwives with her for the length of her section, one midwife tom scrub and then another to receive the baby. Who will then have one to one care for at least an hour afterwards.

The woman who is on high dependency for a few days after a major pph and has one to one care for the whole of those few days.

The woman with an iud, or the one having a pool birth, or the one with twins or the one with an epidural who has one to one care for all her labour.

The woman who stays on the postnatal ward for a week or two after giving birth for whatever reason, and there are many who need to. Again not getting one to one care but over the length of her stay the hours spent looking after her add up.

Of course this could all be ollocks and maybe we,re just eating chocolates in the staff room.

[Ushy]

Sirzy currently, there is one midwife to around 30-34 births per year. So per woman, the maternity services are staffed to give each woman over ten days of individual care BUT obviously there is some non-contact time for admin and other duties. Say we say 20% is a reasonable figure for that. That means maternity services should be staffed for each woman to get 8 days one to one face to face care.
Well they don't get that - they don't even all get one to one care in labour - the most crucial time. So how exactly is all that time being used because on the face of it 28 or 32 births per year per midwife does not seem unreasonable.

[Haribojoe]

Can only echo the comments from Viva.

An "average" shift for me may include an actual birth (or more than one), but may also involve supporting labouring women, giving advice on telephone to women with concerns, assessing women who are coming in in early labour or with complications. Assisting colleagues in their care of women, checking medication, going on transfers with women who require specialist care at other hospitals and responding to emergency calls.

Not trying to argue just attempting to answer your question of what is the time being spent on.

[piprabbit]

In my personal experience I came into MWs in the following roles:

1. Community MWs - visits to my home and clinics at local GP surgeries.
   
2. MWs running AN clinics for consultants.
   
3. MWs working in EPU.
   
4. MWs working on the separate unit looking after women with problematic pregnancies (ectopics, MCs etc.)
   
5. MWs on AN ward - you can get some patients who are on these wards for a long time, weeks, not just popping in on their way to labour.
   
6. MWs on Labour ward.
   
7. MWs on PN ward.
   
8. Community MWs - home visits to check myself and baby.
   
   And that's just the ones I came in contact with.

[VivaLeBeaver]

I get it to allow for 8 days a year not 13. We get six weeks holiday a year and you can probably take another two off for training.

[Quidsi]

Ushy not every pregnant woman needs 8 days one-to-one care. I know I didn't with DC3. But with DC2 I did. And I got above and beyond that.
With DC3 I think I saw MW 3 times including the 3hours they were at my house for the birth. I didn't require anymore than that.