We need to talk about the crisis in maternity services

[worriedstmw]

If you are about to have a baby in the UK, I'm really sorry, this is not meant to scare you or cause more anxiety. This needs to be discussed openly, as not everybody knows what is happening, and it affects all of us.

After a consultation in which 75% of respondent midwives and maternity support workers asked to be balloted, the Royal College of Midwives will be balloting in Scotland, England, and Wales on industrial action this Autumn
• 60% of UK midwives surveyed in 2021 were considering leaving the profession
• 57% said they have plans to leave the NHS in the next year
• More than 80% of those planning to leave cited inadequate staffing levels and more than 67% said they were unhappy with the quality and safety of care they are currently able to deliver
• Between April 2021 and April 2022, England has lost around 600 midwives - midwife numbers have fallen in every single region in England
• In contrast, birth rates are climbing in every region except London. About 10,000 more births happened in 2021 than 2020, meaning fewer midwives are having to contend with even more patients, drastically compromising safety
• As of July 2021, 41% of all maternity services are rated “inadequate” or “requires improvement” for safety
• Newly qualified midwives earn only £24,907 a year but graduate with an average debt of £41,000 to pay off
• The 2022 Government pay offer of 4% falls significantly below current inflation levels of around 10% - representing a real terms pay cut for almost all maternity staff
• 91% of student midwives in Scotland, Wales, and NI reported their training bursaries were inadequate to live on
• 96% of student midwives reported mental health problems since the start of their training.

On July 25th 2022, the Health and Social Care Select Committee’s Expert Panel declared there is “no credible government strategy to tackle the situation” in maternity care.

They simply do not care about women’s health. Nor do they care about the majority female workforce. Watching maternity services crumble around me is heartbreaking.

It is really frightening, I'd be very worried if I wanted more children. Huge respect to all those overworked and underpaid midwives holding it together. I can't imagine how stressful it must be, you could never pay me enough to be a midwife.

The facts in my post are taken from the March with Midwives group, reference list can also be provided. Credit where credit is due.

I cried on my way home from 2 out of my last 3 shifts. I knew I'd given shit care all day, my women were annoyed and frustrated with the care they received from me. No amount of apologising helps, because it isn't acceptable. I didn't even manage to keep on top of their pain relief. I didn't stop from 7am till 8pm, I didn't get a break.

I am a 3rd year student midwife. I am supposed to be supernumerary, I am there to learn, I do not get paid for the 37.5 hours I work each week while on placement. I have a mortgage to pay, the 5k bursary doesn't touch the sides in the cost of living crisis we are living through.

I try work 12 paid hours per week on top of my 37.5 hours per week at the hospital for extra cash. But where do I find time to write my assignments and study for my exams when I'm working 50 hours per week? The situation feels impossible, I feel like I'm scrambling all the time. And I can't even get my post section women
pain relief on time because there's no staff and it's seems to be emergency after emergency.

The whole system needs urgent reform because it's not working.

Sorry for any typos, I probably sound deranged and incoherent. I promise I do normally function ok. I'm just desperately tired and so mad about this situation.

I had a baby two weeks ago. The care on delivery suite was excellent (I assume they prioritise this above everything else) but the postnatal ward was where I could really see the staffing crisis. One midwife told me that there were 2 midwives looking after 27 mums and 27 babies, so 54 patients between the pair of them. Each mum and baby has their own individual needs. I felt really sorry for them as they were absolutely trying their hardest. It delayed us being discharged because no one could do the discharge paperwork (and I could hear loads of other mums asking to be discharged too) so it causes a bed blocking situation. My mum used to be a nurse many moons ago and she was completely shocked by it all when she was visiting me.

@Brandybucks ah congratulations on your new baby. Im glad you received good intrapartum care.

Yes, the babies aren't counted in our patient numbers postnatally. I don't know why, as they often need lots of care. It doesn't make sense does it?

I should add - I had booked an elective section because I was so nervous about the midwifery crisis. I ended up going into labour whilst in hospital waiting for my section and I felt happy enough with the care that I continued with labour and had a normal delivery in the end - but I think it is worth noting that I was so concerned about whether the care was going to be good enough that I was choosing to have major surgery without medical need. I think that is a very worrying state of affairs.

@Brandybucks gosh, that's awful. Having choice in mode of delivery is really important, but being scared into a section because of how bad the care might be in labour is hardly choice is it.😔

I had my second baby this year, a vbac, precipitous labour and shoulder dystocia. I was alone, my partner was at home with our little boy. The care I received was outstanding, both during labour and on the ward. But the ward was just me and one lady whose baby was in nicu, neither of us needed anything except regular painkillers and feeding. My baby was absolutely fine after resuscitation, no feeding problems so no support needed.

I had a cesarean back in 2019. The theatre team were great, professional. But the ward care was atrocious. I was on a full bay of 8 beds, my baby struggled to feed, and no one would help me pick him up while I was still numb even. I cried and cried trying to feed him, and their solution at 3am was to take him away and give him formula because his crying was disturbing everyone else... It took them a full day to discharge me when i was begging to leave.

Completely different experiences, 3 years apart, same hospital.

As with things like care, nursery, etc, wages need a significant uptick and conditions need improving or we're screwed. I don't know where the money would come from though.

Starting pay is £27,055. Agree with your premise but the stats need to be accurate.

It’s horrible. I have an 8 month old and was so impressed by the great care I had at birth (I’m an icu nurse so I know the problems in the hospital and the maternity unit is massively stretched.) The midwives were amazing but completely run off their feet and I would 100% not blame any of them for leaving for an easier job.
There were a number of very entitled mums and their partners who seemed to think they had their own private midwife (not on labour ward where you do- on pre and post natal.) As a nation we are also having our babies later in life, we are fatter and unhealthier and that must be making more work for maternity units. The unit hasn’t been expanded in over 30 years whilst the population of the city has boomed- the hospital also has a nicu which many of the surrounding hospitals don’t (or only take babies 35 weeks +.) It really is frightening.

You're right, beginning of b5 is now £27,055. I didn't clock that!

This worries me so much. I just had a baby last week, and one of the reasons I wanted a homebirth was because you are guaranteed (as long as the shift is covered) tow midwives - one for the mother, one for the baby. I categorically did not want to be on the postnatal ward as I'd heard such awful stories. It was a fantastic experience in the end, but from the conversations I was having with my midwives, the service is in dire straits and I felt so badly for them. Midwifery is actually something I am potentially interested in as a second career - but not right now. I really really hope it changes. It has to.

@justanoldhack Ah how lovely, I love a home birth!

The way it runs at my trust is 2 community midwives are on call each night for home births. But they don't take into account the midwives usually shift patterns.

So you could have worked all day doing your normal community midwife role, get home at 7pm, put your feet up and then bam! You get called out to a home birth that you could be at all night long until the next days worth of community midwives come on duty at 8am.

I've been to a home birth like that before and all was well, but it might not have been. A tired midwife isn't a safe midwife. Women, babies and midwives deserve better.

Again so sorry for the typos😬 I'm typing faster than my brain can think!

I had a home birth booked for DD’s birth two weeks ago but unfortunately, when the shift change happened at 4pm, they suspended home births, so I had to travel to hospital 6cm dilated. The midwife who had been with me at home followed in her car in case I gave birth on the side of the road!

Once there, the care was great but the situation in our local hospital is that they are regularly suspending home births and closing the midwife led unit in order to staff up the labour ward. I was able to get the only room with a birthing pool and my birth was very straight forward so I was able to go home 6 hours later but before I did so, they’d reached capacity and were diverting women to another hospital.

There were no beds left on the postnatal ward so I never made it there and stayed in the delivery room until we left. The midwife who delivered DD (there was not a second available so a student assisted) said that they were 22 midwives down and had called in staff from other local hospitals in order to function over that weekend. It felt scary.

@worriedstmw in my trust we have a dedicated homebirth team but I know the midwives also get called onto the ward, so it works the same way. Having people working such long hours is clearly unsafe. I wish it were better

@justanoldhack me too

There are so many applications for midwifery but not enough places, that is something they should look at. Id imagine the cause of many of the issues is extended critical understaffing

Im due my second baby in March and terrified tbh

@hellosunshineagainxxx there aren't enough midwives to work with each student. Often student midwives have to double up with midwives which isn't ideal at all.

Their new bright idea is to get 3rd years to mentor 1st years on placement. It's being branded as the amazing new solution. Personally I think it will mean 1st years missing out on quality education provided by experienced qualified midwives.

3rd years don't know it all, we're still learning ourselves!

I start my training as a midwife very soon. And I'm having a huge wobble about it. I'm in a secret and the march with midwives group so can see the first hand stories of how it just isn't working.

Huge well done for getting to third year. Hopefully the MWM movements will start seeing progress :(

its been steadily getting worse over the last few years.
I had my first baby in hospital in 2015, and it was horrendous even then. The midwife attending me in labour also had multiple other labouring mums to look after. Aside from that, the whole experience was something I’d never willingly repeat. My 24 hour stay (should have been 24, I discharged both myself and my baby after about 18 hours) on the postnatal ward was awful too.
Second baby (2016) was a planned homebirth and the care I received was outstanding. Cannot fault any of it.
Third baby (2019), was another planned homebirth, but I was told multiple times during pregnancy that due to ongoing staffing problems, a midwife may not be available to come out to me. I made it very clear I would rather freebirth at home without a midwife than give birth in hospital again. As it turned out, baby 3 wasn’t waiting for man or beast, and arrived only a few minutes after a midwife got to my house. Again, although I’d laboured on my own and my baby was halfway born by the time the midwife got to me, the care I received in the time she was with me, was outstanding.
Midwives are amazing, skilled, and want to be providing the best standard of care possible…but they’ve repeatedly been done dirty by the government’s abysmal underfunding. And it’s dangerous. For the birthing women and their babies, but also for the staff themselves! A friend of mine is a midwife, and she often works a 13/14 hour shift without so much as a toilet break. She’s exhausted all the time, and her health is starting to suffer as a result.

It’s so important we talk about this. My second baby is 3 months and like a pp said the delivery ward was ok but postnatal ward was hell on earth. I don’t even have words to express how awful it made me feel.

Defintely not the fault of any individual staff member, there just weren’t enough of them and that combined with no overnight visitors meant I was completely broken by the time I left and if I’d been advised to stay another night I would have left anyway at risk to myself because it was so bad. I was starting to put my baby at risk through exhaustion as there was just no help. It wouldn’t have been safe for the baby to stay with me another night like that.

There was no continuity of care through my pregnancy, never saw the same midwife twice. The whole thing is at breaking point.

There’s no way I’m having another baby but I’m so worried for my sister and friends who are TTC now or will be in the next year

Believe me, it’s something that is looked at regularly but can’t be changed. There has to be enough placement capacity for all the students at the local university. You can’t have 20 students per shift on the Labour ward. If the Labour ward can only take x amount of students per shift that will affect how many students the university can take. People spend their entire jobs number crunching placement capacity to maximise it.

I also think it’s very unfair on 3rd year students. When I qualified the idea was you shouldn’t even have a student for the first year of being qualified so you could consolidate your skills. It can put extra pressure on the 3rd year. Plus it isn’t practical on Labour ward which is where placement capacity issues causes the main blockage. It’s not fair on the woman to have a midwife and 2 students with her in Labour. It dilutes the experience for the students and who counts the birth in their numbers! You’ll end up with nobody getting their required numbers to qualify as they can only count half the births.