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.

Jesus Christ, is that salary figure accurate? Why on earth are they being paid so little??? I'm on the same salary and I am in a pretty unskilled role with zero actual responsibility. All the training they go through and all of the heavy shit they have to cope with for THAT??? I had no idea :-(

I'm due my next baby in May and had my last may 2021. The care i did get was exemplary but it was patchy at best. Covid rules were still in place so partners could only be there 2 hours a day max. The problem with that is there weren't enough staff to help when mums and babies needed it.

I know people have a thing against partners staying so this may be controversial but my experience post tricky birth would have been made a lot easier with some help from my husband. If there aren't enough staff they need to relax the overnight visiting rule IMO.

I left against medical advice because I couldn't cope alone any more and my mental health was in tatters, I did better at home.

Starting: 27,055
After 2 years: 29,180
After 5 years: 32,934

However in reality, after 2-3 years many will move to a Band 6 position:

Starting: 33,706
After 2 years: 35,532
After 5 years: 40,488

As with other public sector roles, wages are lower compared to private as the defined benefit pension is considered part of the total remuneration package.

I don't think I'll have another baby now because of how poor the care was with my pregnancy in 2021. I wanted three but I can't go through that a third time. I'm not the only person I know who won't have more babies due to birth trauma. Individual midwives generally seem committed to care (aside from a small number) and yet the system is so messed up.

I had my first in 2017 and ended up putting in a complaint with the hospital as my postnatal care was woeful due to understaffing. Luckily my other two were much simpler so I needed less help but it's heartbreaking seeing midwives who are genuinely trying be unable to help because they're so overworked. Sadly this isn't new.

I have read on another March with Midwives page that 29 out of 30 trained midwives leave the profession. I honestly can't believe this statistic. Getting that 29 stat down has got to make the biggest difference. There is no point training so many new midwives if so many of them leave the profession as you are just perpetuating the stress / understaffing / dangerous care cycle.

As a complete layperson (but someone who gave birth last year and is planning #2 so a vested interest!):

1. if 80% are planning on leaving due to staffing, training more midwives wont help in the short term, and neither in the long term if 29 out of 30 are going to leave. Could you chuck enough money at the problem to solve it to enable more midwives to stay? For example, could govt try to recruit qualified midwives from abroad to ease the pressure on the wards, and therefore enable students coming through to be properly supported in the training and want to stay? Therefore breaking the cycle of understaffed wards?

2. if debt is the issue, could govt bring back bursaries for fees but eg. tie it to a min length of service as a midwive, eg. 5 years? Again, thereby getting more people into the system and relieving some burden on understaffed wards to support more midwives coming through as those initial ones work through their 5yr service period?

3. on pay, i cannot believe so many leave due to pay when it is very clear what the pay is before training. yes they should be paid more, but so should the entire public sector and there are constraints in all public sector pay. this is probably the trickiest to solve at the moment. Hypothetically, would giving all midwives a £10k / £20k payrise attract those back to the profession who have left? Or would the staffing shortage increase but those left getting paid more to compensate for the rubbish working conditions (but still not addressing the lack of care for mums and babies)?

I had my baby in June 21 - she spent 2 weeks in NICU / SCBU and i had a 1 night antenatal / 5 night postnatal stay so we saw first hand how stretched everyone was. I've seen loads of stuff on social media about the issues but does anyone have a plan for what will actually solve it? What do the RCOM want from govt? Do they ever ask you for your opinions on questions like the above and lobby govt?

Sorry if any of that is blunt but i'm really interested to hear what you think will make the biggest difference as a person at the start of your career and speaking to your colleagues.

I'm just about to have baby 3 by planned c section and partners are no longer allowed to stay post covid and I'm terrified. I genuinely don't know how I'm going to manage overnight without dh when the ward is so understaffed. With my previous births dh had to empty my catheter bag as it was so full, he had to pass the baby to me all night as my spinal didn't wear off until midnight so I couldn't get to the baby. When I did ring my buzzer it took ages for anyone to come and that was with partners there assisting. How long will the wait be when midwives are having to do everything?!

I'm planning to formula feed this time and have been told I'll have to give the midwives my formula and they will keep it in their office and bring it to me when I need it. No fucking way is that happening! I'm not waiting god knows how long with a screaming hungry baby for a midwife to be available to bring me my own formula!

It's so sad as all the midwives I've met have been genuinely caring people who want to provide the best for their patients, but they're stretched so thin they just can't do it. I've been missed off drugs round post section due to understaffing and it's an absolute disgrace to leave women in pain after major surgery but when staffing levels are so low mistakes do happen

It's terrifying. I had to wait 26 hours for a bed on the labour ward with DC1 in 2017 (laboured at home for 12 hours - the 26 hour wait was after waters had broken & I'd been admitted. Contractions stopped maybe 10 hours in tho maybe had I progressed normally they would have found me a bed I don't know). DC2 (different hospital, now 16wks old) there was a bed available immediately in the delivery but post natal there were no staff I didn't see a single member of staff for 8 hours after being moved to the post natal ward (had emergency c-section, without the NHS he wouldn't be here you guys are amazing) and if I pushed the bell for help it would be at least 15-20 minutes before anyone was available. They just didn't have the staff. In fairness everyone I've encountered are clearly trying their best and care about what they do, I can't fault them but the pressure they must be under is insane. I didn't know how bad/difficult the training and hours were, how is anyone supposed to survive like that?!! I have no answers (besides upping the bursary and salaries considerably, and if you need to pay for registration/annual membership I'd scrap that too plus you'd have free parking etc). Tbh given the amount of responsibility you have the pay is shockingly low. Desperately needed as you are I wouldn't blame anyone in the slightest for leaving, you could get the same money for more sociable hours and considerably less stress.

I had a wonderful experience in 2020 and so far my midwifery care for DC2 has been absolutely brilliant. I don't recognise what you're saying.

Well then you’re very, very privileged and lucky. On the other end of the experience spectrum you could end up like me with ptsd from birth trauma from both the birth and post natal “care”. I’m currently having recurrent miscarriages and a part of me is worried it’s my body not ever wanting to be put in that position again. I’m desperate for a second child but the thought of birth, even after extensive emdr and therapy to fix what the midwives did to me is still scary as hell. And so many of my friends have had similar experiences and are stopping at one or saving money for private midwives and c sections. It should not be like this and we’ll done to the OP for talking about it.

@QuebecBagnet I have so many of my own competencies and skills to be getting on with, I can't imagine taking responsibility for a 1st year student at the same time.

I feel all of our teams are very junior at the moment, I don't remember the last time I worked directly with a band 6 midwife. It's mostly newly qualifieds (who are great!) sometimes it's just nice to work with a really kind, experienced, 'old school' midwife.

@NoIncomeTaxNoVAT
Yes, you’re right. For every 30 new midwives that qualify, 29 of them either never start, or leave within the first 12 months. It’s an appalling figure, but to me it’s a very believable one. Our newly qualifieds get very overwhelmed, the level of support for them is none existent, and they cry on shift all the time. It’s really sad to see.

I think your first option would be most helpful. We need feet on the ground. Although the real terms pay cuts are demoralising, it’s not really a pay issue (imo) if you offered the people leaving another 10k a year, I don’t think they’d stay. I wouldn’t anyway. The current situation is making the job impossible to do. People are stressed, ill and burnt out. It’s making them hate coming to work and all roads lead back to poor staffing.

Your experience is not the norm. It's very very far from it.

I'm due my second at the end of the year and I'm terrified, quite frankly. I hope to god they consider me to be lower risk than last time so I can birth at home.

I'm so glad there are still people out there receiving fabulous care. But believe me, you have been lucky, and I'm sure you can tell from the responses from other women on this thread, you are in the minority.

It’s dreadful. I’m a nurse and can see midwifery is even worse and a really frightening place to be a patient and staff member. The pressure NQ staff are put under immediately is incredibly unfair. I also teach at the local university and it would be impossible to take on more students. Lack of funding in HE and lack of placements is also a huge issue and it just can’t be managed with practice as it is.
FWIW I had children in 2018 and 2020. My expectations were low and I was expecting to have to advocate for myself and be bolshy if I needed support. Both times the births were completely different and both times the staff were absolutely wonderful. I am so grateful to those incredibly busy, wonderfully capable and insanely knowledgable women that delivered and cared for my baby especially when DC1 was unwell.
It’s so sad. And I don’t know how or when it will improve.

Thank you to all the women sharing their experiences, I've read them all.

Hearing the affect poor staffing has had on you is really confronting.

Isn't it crazy that the government openly admit they have no plan, they aren't even pretending to do anything. I wonder how and when things will change. Maybe the strike will lead to some sort of action?

What do we do about it? I’d write to my MP but he’s Labour so not actually in a position to really do anything

I think the thing about “for every 30 midwives trained, 29 leave”, doesn’t actually mean 29 of those newly qualified ones leave. It’s talking overall stats, so the majority of those 29 leavers will be either retiring or jacking it in because they’re fed up but hopefully not so soon after qualifying.

what it does mean is though that the staffing crisis is not being solved at any great pace.

another thing is the majority of midwives are only part time. Not because of child care commitments, etc but because working full time would break people. It’s unsustainable. I only ever worked 22.5hrs a week as I couldn’t mentally or physically cope with any more than that. Even then I left after 12 years. I wouldn’t go back even if I was paid 60k. The pay is not the issue. The workload is the issue, combined with the blame culture and long shifts and the erosta system which means you have no say/control or pattern over your shifts.

Students to oversee other students? Correct me if I’m wrong, but back in the days when nursing was a train-on-the-job profession wasn’t midwifery a subspecialism of nursing that required therefore extra training and extra experience, not just some poor student landed with another?

You are not complaining unnecessarily, the system is fucked. All health care is poor in Britain but the care for this specifically female specialism has been deteriorating for a long time. When my mum had her kids she got to stay in hospital for a week afterwards, and that is still standard practice in at least one European country. In Britain they just expect us to come in for the hour and chuck us out asap as if it’s a production line instead of the biggest health risk most humans will ever undergo.

In 2010 when I had my eldest the hospital tried to prevent me from coming in until the last minute because they were so busy. Midwives there were having to do their own cleaning as there was no money for dedicated overnight cleaners, and there was still blood on the curtains in the triage room: I hate to think what it’s like there now after 10 years of ideological austerity.

Plus significantly more with enhancements for nights/ weekends etc.

I do not get paid for the 37.5 hours I work each week while on placement.

And this habitual practice nowadays is bloody disgusting. No one should be having to work in skilled professional jobs for free, and I don’t think much of forced indentured servitude as a solution either. Training used to be free! How is this progress? What so-called governments have done to this country, to the young, mostly female staff in health and education, to education itself, and also the lies told to the general public to make them think this is acceptable, is beyond sickening. It is third world.

I'm suing maternity for the way they treat me.

@roarfeckingroarr I think a lot of it is the luck of the draw - how much support you need. With dc1 I had a week in postnatal war hell and it was genuinely traumatic.

Dc2 was a much easier birth and I didn't really need much help afterwards. I stayed on the ward for one night and it was fine, but would probably have been as bad as my first experience if I'd needed much.

Hi, I’m in Redditch and deciding between giving birth either at Worcester Royal or Birmingham Women’s hospital. I haven’t been to either of these hospitals before but I know the cqc review is much better for Birmingham Women’s than Worcester. Does anyone have any experiences they can share if they gave birth at any of these hospitals to help me decide please? Thanks.

@Neroli2023 you would be better off starting your own thread.