AIBU to think I am being forced out of midwifery?

[ThisMustBeMyDream]

I've been a midwife for 12 years. I have a wealth of experience and skills.
But I am also a single parent (not through choice).
I have no family support. Ex husband doesn't involve himself with the children.
I'm in so much debt from paying for a Nanny so I can keep on working.
I can't do it anymore.
Work won't help.
I feel absolutely lost and distraught that for 12 years, I have fought hard to make this work (I was a teenage mum when I started my training). And now I can feel it slipping out of my fingers.
All I wanted was to work as a community midwife so I can use regular childcare. But no, this can not be accomodated due to the government deciding 80% of women should have continuity of carer (Better Births recommendation, which was then used in the NHS Long Term Plan). The traditional community model is going to go to a caseloading model which involves community days, along side hospital shift work. My employer has stated even if I could do the caseloading model, I can not stay part time either (I am currently part time as I have 3 children to manage, and one has additional needs).
These changes are allegedly happening in all Trusts as a result.
I'm going to lose my career. What the hell am I going to do?

Another option I haven’t seen mentioned is working for BPAS or Marie Stopes. They have lots of jobs in my area and it’s office hours whilst remaining clinical. Just looked at a job this morning for BPAS which was tue, wed and thur 9-5.

Also, do look around at other trusts. You will be so in demand with 12 years experience. A friend of mine purely does agency and makes a killing. There must be some office hours roles in your hospital too.... get promoted? Band 7 team leader? Apply for every single specialist role that comes up as well.

EastEndQueen, I didn't see your post before replying. That is incredibly useful to know.
Nothing is on paper yet. The only plans are that anyone who wants to reduce their hours can't (eg. People coming back off mat leave or those who are semi retired etc). Anyone starting at the trust will not be employed on less than a 30 hour contract.
There will be a core of midwives in the hospital doing long shifts. The rest (majority) will do a combination of long shifts and community days. No plan on the on call element as yet. This was all given to me in the handover room when I asked the matron could I arrange a meeting with her to discuss working arrangements.
No one else has been given any information. As I discovered when I started asking my colleagues what they were going to do.
I am in the union. I do not have confidence in our rep however.

You don't have to go with your nearest rep. You can call the branch.

Every trust is expected to move to the continuity model so moving is not an option. Most midwives who qualified from 2000 onwards are direct entry midwives and not dual trained so unable to move into nursing roles. Our HV training courses are uni based and intake is once a year so would mean waiting until places are advertised and applying along with potentially hundreds of other midwives who are all in the same boat. Very few specialist positions available and no Marie Stopes or similar here as those services are run by sexual health nurses. This is all we talk about at our unit and having met midwives from around the country I hear the same anxieties and worries. Moral is so low and many colleagues are looking to take early retirement resulting in a loss of skills and so many excellent midwives. We are already struggling to recruit enough staff and this can only lead to shortages and disappointment as women are promised the earth and maternity services can't deliver.

Withdrew my last comment as the last thing I want is to be identified.

The continuity of care model does seem to be good for women. But I don’t really understand why the COC model means that midwives MUST work on a COC basis or lose their jobs.

There's research suggesting it works well, but that research doesn't consider the impact of it being provided by midwives who've effectively been forced into that working model nor the impact of losing trained staff who can't or won't participate in it.

I don’t get the need for continuity of care at all. Demanding the same midwife? Why? Personally I’d rather have someone rested, content with their career, experiences etc than the same person all the time, unhappy and stressed and likely to be much younger and less experienced. Plus all the advantages of other people looking at you, different ideas and experiences- much much safer in a healthcare situation imo. Not to mention actually recognising the midwife is a person too with a whole life outside work.

Maybe look to emigrate and move somewhere which will appreciate you.

I fundamentally disagree with the caseload model for midwives. I was much happier with a team of MWs than I would have been with one MW.

What is certain is that the continuity model
will mean that all ‘community’ midwives are going to be doing some intrapartum care connected to a caseload of women and it is unlikely you will be able to opt out of this totally going forward.

HOWEVER with firmness and good union support (as others have said, if your union rep is hopeless then contact union directly via details on website) especially as you are experienced, have long service in the trust and have mitigating circumstances (does you teenager have an official diagnosis/ statement?) you should be able to achieve working set days and shorter shifts - as you would have done under the old system in community - it’s just that some of those will be delivering babies and some in the community.

No one will hand this to you however and you will probably have to fight for it sensibly and calmly.

Remember in desperate measures that your GP is likely to be very sympathetic to fellow NHS workers struggling with shift work (I have always found this to be the case) and may very well be willing to say you cannot so long days/ nights because of stress - particularly if you have caring responsibilities for a SN teenager. I wouldn’t use this as the first resort at all, but remember it’s there as a last resort option

Some areas (inc mine) are implementing it in a team style. So 6- 7 midwives in a team. The idea is you get to know the team during your pregnancy but one main midwife and a second main one. The midwives will be on call one night a week. So when a woman goes into labour she gets whoever is in call from that team.

So in effect no continuity. The woman either meets all 6-7 midwives and seeing as there's barely more scheduled appts than that she gets a different midwife every appt. or she only sees her main or 2nd midwife and has continuity in pregnancy but likely to have a midwife she's never met before in labour. So no different to now. And the ccg and trust are throwing money at this like it's going out of fashion.

I live in a country where almost all births are obstetrician led. You get continuity of care, from your obstetrician. You also get an appointment to be induced shortly before term at a time of your obstetrician’s choosing. Nearly all women have epidurals to cope with the pain of induction. Forceps and episiotomies are also the norm.

Those obstetricians will be paid quite a bit more than NHS midwives are, which would be a big help with the childcare costs!

Yes, but it is still a difficult job. Obviously not all births conveniently wait for a suitable late morning slot in the obstetrician’s diary.

Giving birth in absolutely ideal circumstances for the mother, the baby and the birth attendant is a very tough call. Surely we can recognise that we all need to make compromises in order to optimise outcomes for all concerned? MWs shouldn’t be treated as if they were slaves.

A private obstetrician is unlikely to caseload as many women as a uk midwife is allowed to.

Plus part of the problem here is a massive change in working conditions/terms for the OP. An obstetrician has chosen to work in this manner so the working pattern must be ok for them. I'm sure if their working pattern was changed they'd moan.

Do look at neighbouring trusts.

Ours has a continuity team. But, each area within the unit is implementing a degree of continuity, without the on calls for intrapartum care.

Have you an option to rotate to an area in the hospital if you don't want to change trusts?

Of course obstetrics is a very difficult job! That much was never in question. But the OP is literally being forced out because she isn't going to be able to afford suitable childcare, amongst other reasons, and unlike obstetricians in the country you're in (the US I'm guessing?) this isn't what she signed up for.

But I am also a single parent (not through choice).
I have no family support. Ex husband doesn't involve himself with the children.

Hope he’s paying for them.

How on Earth is this getting past EQIA in Trusts?

Private obstetricians work in public hospitals and do have a lot of births to manage simultaneously, hence the time slots!

And, no, most definitely not the US.

Out of interest does the obstetrician care for the woman throughout labour or leave that to a nurse/midwife and then get phoned when the woman is fully to swan in and do an epis and pull the baby out?

Because if it's the latter it isn't comparable.

Ironic really that women are having to leave their beloved role as a midwife becausee they are unable to look after their own children.

That said who plans these models without properly consulting the workforce and how it will affect them, esp as they are predominately women who will be having babies of their own at some point in the future who grow into children all of which need flexible childcare.

Midwives having children, needing childcare, this all needs to be at the heart of any plan along with the patients.