Guest post: "Midwives want better postnatal care too, but we need support"
Helen Miller says working conditions for midwives and hospital staff have to improve before we can achieve better postnatal care for mothers and babies
Posted on: Thu 15-Jun-17 16:20:44
(51 comments )
I am a midwife and a mum of two. I wanted to write an account from a midwife's point of view in support of the Better Postnatal Care campaign. Not to make excuses, but because midwives know how much those early days count and we want to see improvements too.
It has been about five years since I worked on a postnatal ward; since then I have worked in antenatal services. I know that the trust I work for is not alone in its determination to improve postnatal care, and I know that changes have been made for the better, but I fear that the difficulties I experienced as a midwife remain. One issue being that of staffing levels.
A shift would quite often start with lower than recommended staff numbers. Then, during the shift, it wasn’t unusual to get a call from the Delivery Unit asking for a member of staff to move there because they were short-staffed too. I worked on a 28-bed ward; the ideal number of staff was five midwives and two healthcare support workers, but frequently there were only three midwives and one support worker for 28 mums and about 28 babies. With so few staff to patients it is incredibly hard to deliver the care that is needed.
There are medical ward rounds, observations rounds and drug rounds. There are new admissions from the delivery unit and women to discharge home. On a standard postnatal ward in a hospital obstetric unit (so not in a midwife-led unit or birthing centre) there are also mums with various complications. There must be frequent observations for mums back from high dependency care; hourly blood pressures for women with pre-eclampsia; blood sugar monitoring for babies and mums; bilirubin measurements for babies with jaundice; emotional support for mums with babies in NICU; IV drug administrations; and scoring of babies who are withdrawing from maternal opiates.
The quality of postnatal care, staff well-being and staffing levels are all intrinsically linked. You can't have one of these without the others
There are also time-consuming cases involving social services. Then there are the stacks of paperwork. All these supersede the basic emotional and practical support new mums need, want and deserve. Building a relationship with a mother and her family is pivotal in providing the care they need, but to do this time is needed - a precious commodity that is rarely available during a shift.
Midwives get through most shifts with no more than a toilet break. ('Eating' means scoffing chocolates left by patients or a snack eaten in secret behind the desk.) If you forget to bring a bottle of water, the chances of getting a drink are slim. They told us not to drink at the midwives' station because it looked unprofessional. Leaving a shift on time is a rarity. Stress levels are high. Retaining newly qualified staff is a huge problem because they just don’t receive the support they need.
The pressure on beds is considerable. I remember being told to discharge a new mother against my better judgement; she had given birth the previous day and was medically fit for discharge, as was the baby, but she clearly needed support with breastfeeding. I was told to discharge her because the bed was needed to clear a space on the delivery unit; she would have to try to get the support she needed from the (overstretched) community midwifery services. I was disgusted and ashamed. Midwives are autonomous practitioners, which means we are accountable for our own actions. Every decision we make we must be able to justify, but our autonomy is squeezed by pressures on services.
So often I would feel physically and mentally exhausted. I would go home wondering if it was my fault. Were my time management skills lacking? Maybe I just wasn't up to the job? Had I let the team down? Had I let the women and their families down? At the end of some shifts staff would go home in tears. Tempers flared in sheer frustration.
Many reports over the years have recognised postnatal care among other areas of maternity as needing major improvement. More recently reports have also recognised the need for better working conditions too. The Royal College of Midwives found in a survey that 48% felt stressed at work every day or most days with over half of respondents worried about making a mistake because they are exhausted and 62% said they were dehydrated at work because they didn’t have time to drink water.
We all (NHS leaders, midwives, women and families) want the same outcome. How can we get there? How can we offer an excellent standard of care and create a good work-life balance for staff? The quality of postnatal care, staff well-being and staffing levels are all intrinsically linked. I don't think you can have one of these without the others.
To put it simply we need more midwives, highly trained maternity support staff and good clerical staff before we can start to attempt to implement a better maternity service. We need change, and we need it now.
By Helen Miller
I hope it gets better for you. (Most) midwives are genuinely amazing, so thanks
Completely agree, I could not fault any member of staff I encountered on either post natal ward I went to however it was obvious they were understaffed and wanted to help more but couldn't.
I'm afraid I could fault most of the midwives I dealt with. Failure to check me properly lead to me being discharged too soon and becoming very ill.
I feel really bad not supporting this post but I had three live births and the midwives were so awful to me that I can't get over it.
There was no excuse for the way that they spoke to me, I am a nurse and would never have treated patients the way that they treated me, stressed or not.
I'm a lurker around here, but I just had to post to say thank you. Thank you for all that you give, every day, day in day out, and I'm so sorry it's not enough for you or for those you are giving your care to...but that's not your fault. You do an amazing job under unbelievable pressure and I've been luckily enough to receive support from your colleagues for 2 ectopics (medically and surgically dealt with) and 2 deliveries - one theatre forceps and one text book 20 mins labour...thank you to each and every one of you and I despair of a system that doesn't allow you proper breaks...how many of us would put up with that in our working lives?
I've got to be honest and agree with some of the other posters. I wish the midwives I had for all my births were as conscientious as you.
Yes I must say that they way I was treated by midwives and the incompetence of a couple of them has been an important factor in my decision not to have any more children. I remember 3 good midwives though, I was grateful for them and I let them know at the time!
Just wanted to acknowledge others posts, it's so sad to hear. I feared poor care as I've seen awful care in other health settings. I was very very lucky - in our local hospital they were all wonderful and brilliant. I'm so sorry others have had bad experiences
This is very sad.
There needs to be serious governmental - not Virgin or any other private company - investment in maternity wards (and NHS in general).
Comparing that to the maternity care in the rest of North-Western Europe (there's more staff and decent funding)..well. It's shocking quite frankly.
I recognise myself in your post Laura. Nearly every day I'd blame myself - was I just really rubbish at time management? But there simply were not enough hours in a shift or staff members on the ward to give the basic care needed. And sadly it's things like breastfeeding support that get pushed down the priority list.
Now I'm going through Canadian training to work as a caseloading midwife here. It's a dream by comparison. Something needs to be done.
I do feel sorry for you midwives when you are stretched, i had a really bad experience with my first born and im so nervous for my 2nd due any day now, i laboured for 47 hours, with a midwife popping her head in now and again to offer pain relief, then ended in emcs- was dreadful- the aftercare was even bad, waited far too long for pain killers, and was forced to shower alone when I couldn't barely stand, baby hadnt even had the tag on his ankle fitted for security! However i dont blame the midwives as it was horrendously busy and had to close the labour ward, i hipe things do get better for everyones sake
I think it's really clear on wards that they are seriously understaffed. More midwives equals better care.
I recently gave birth and cannot fault the care I was given. It really irks me having read some of the criticisms on the threads here. Ok, some of the food isn't amazing but it's not a hotel. I had a sandwich for tea following my c-section and I was grateful for it. I took my own pain relief with me so I wouldn't have to trouble the staff who were clearly having to deal with more complicated cases than mine. Yes it was stuffy and difficult to sleep with visitors etc on the ward but I think you have to accept a little of this. What I couldn't fault was the care or the cleanliness. I made of it what I could and came out with my two lovely health babies, which was the ultimate aim.
It really irks me having read some of the criticisms on the threads here
It 'irks you' that some women are completely traumatised by the treatment that they had?
Is it beyond the realms of comprehension that just because you had a good experience, others did not?
You dismiss this as an annoyance?
No what irks me are the petty criticisms relating to things such as the quality of the food and the wards being too hot. Also just because some had bad experiences doesn't mean mine wasn't good.
Love your post. The midwives on my ward were so lovely and did the best they could despite rushing around all over the place. They were all so knackered when they were at the end of their shift.
I have a midwife friend who says they can't have a drink on shift... err Wtf!? That's very wrong.
I would have cheerfully swapped food for decent post natal care.
I haven't read anyone complaining about food. Or if it got mentioned that was in passing.
I am horrified that, 10 years on, it sounds now better. And the attitude of midwives 10 years ago was dreadful.
Molly I really don't think most complainants are about minor things
I had friends experience the most horrible treatment (one - post c section was told to "stop being a spoilt bitch" when she asked if someone could pass her the glass of water placed out of reach that she'd been able to drink from for several hours)
Again, mine were wonderful. This thread actually prompted me to write to compliment them. But please know, some women have horrific care.
Mollybloom you took your own medication while admitted to hospital? How irresponsible. Sounds like you had a very good experience and lack the knowledge or imagination to understand other people didn't. MN has tons of threads full of people's very negative (to put it politely) experiences. In my case my midwives' incompetence lead to:
Putting my baby's life at risk (growth restriction not spotted despite my protests)
Me having to live with incontinence symptoms (mismanaged birth, transverse lie back-to-back baby). This was completely avoidable.
Also I remember it was 27 degrees in the night in our ward - poor building design and 1 fan for an 8-bed bay, not the staff's fault. Nobody complained but this caused more work for the staff - mums dehydrated, babies distressed.
Some paracetamol and ibuprofen for pain relief, hardly irresponsible!
I trained as a midwife in the early 80's. Absolutely LOVED it! Due to personal circumstances - haven't worked in Obstetrics for many years - nothing has changed - it was exactly the same back then.
My granddaughter was born a few months ago in Edinburgh Royal Infirmary - the staff were .... FANTASTIC/PHENOMENAL!
I think the comments on here are revealing. The midwives I dealt with at a renowned and then brand new London teaching hospital were vile. (With exceptions). In my first labour I was shouted at, laughed at for not coping with pain apart from the fact that they missed the baby was posterior, missed the fact the cord was wrapped round his neck, and became compressed leading to a traumatic delivery.
The unit was not busy, only two babies were born that day. There were more midwives than women yet I have never heard more whinging about working in any other environment. They literally did not stop complaining about being overworked yet there was no evidence they were. I find it difficult therefore to take seriously their complaints now.
Community midwifery at home via a different hospital was equally poor. Similarly rude midwives (exceptions), five of them in ten days, inaccurate recording if notes, inconsistent advice, failure to diagnose mastitis and the same complaints about being overworked. Visits lasted more than twenty minutes and there was a great deal of non related chat and therefore no evidence if over work
This was 22 years ago now. Midwives didn't stop complaining.
Second birth very high risk, obstetric led care and better, except for some excruciating comments again from midwives including "you must have wanted It if you are this upset" when I was hysterical after surgery for retained placenta.
Third baby born at a different hospital, again with obstetric led care. It was much busier but far more woman centred and kinder. But still complaints about being overworked - 19 years ago. By then though I was very assertive and challenged errors and rudeness having learnt the ropes.
I'm sorry ok whilst you may be a dedicated caring midwife many in your speciality aren't and there need to be far reaching changes. There is no point having more midwives who are incompetent, unkind and moany. We need good, professional, well trained midwives who also have high standards if expertise, nursing skills, social skills and wards that they insist are kept clean.