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?

Tax credits and all that already utilised.

The issue with tax credits is they like to slash your payments on a regular basis. Three times this year I have needed my parents to bail me out so I could pay the Nanny. It is mortifying. The other issue is due to my earnings, I only get approx 50% towards my costs. To compound the issue even further, is the cost of a Nanny. I work 24 hours, 2 set shifts, and pay £1300 a month which is the maximum you can get help with. Which is one of the (several) reasons I can't work full time.
At the minute, I earn £1580. I'm top band 6 so no scope for earning increase through that.
The set shifts have been brilliant while I had a preschooler. The issue is that it wasn't a sustainable way to work because of the cost.
From September both are in school. But because I will need to pay from 7am-9am, then 3pm-8.30pm, no one will do it (my youngest is in preschool on my days in work already). No one wants to work split days like that. So I have to (and am currently doing) pay for the entire day. I am throwing away £120 a week, or over £6000 a year, on childcare where no childcare is needed. I basically have someone in my house for 6 hours a day paying them for work that I really don't need doing.
I can't carry this on. Which is where the conversation withthe matron came about.
I can't keep up the set shifts when it is causing so much financial hardship.
I did it as my only option whilst they were under school age.
Also, there are issues under UC with regards to paying for a Nanny, so I am aware that once migration takes place, I may be screwed on that front too.

I’m a midwife who is working on my exit plan as I don’t have any desire to work in a COC model. And I have to say. I don’t think it’s what women really want. Antenatally is it important? Absolutely, building a relationship with someone giving care over a long period of time is great, you tell them more, you get better care. When you come into hospital does that matter so much? Or would you rather have someone who’s skill set was much better suited to that area, who could respond to a quickly changing situation with skill and calm. So long as both of those people do their jobs with kindness and compassion do women really overwhelmingly want it to be the same person in both environments? I know from my own experience as pregnant woman I didn’t feel that way and it’s certainly not the feedback I get in person. I’m a labour ward midwife, I’m absolutely fucking brilliant at helping women give birth. Put me in community and I’d be bored out of my mind and you’d not get the same level of service. Play to peoples strengths and invest in the service. Don’t just impose a blanket ideal onto an already collapsing service. Sticking plasters won’t work and will just lead to dissatisfaction everywhere for both staff and women ☹️

Yes, I worry that there's a danger of midwives being jack of all trades and master of none.

If you were in labour and there was an emergency would you rather have someone caring for you who is only on call for labour ward once a week and may well not get called in on that day. Or someone who does 5 shifts a week on labour ward?

For a low risk, normally progressing labour it would be fine. But if you developed complications, ended up with lots of drips, pumps, tricky CTG to interpret, etc???

And caseloading used to be a normal model of care in midwifery. Before my time as a midwife but older colleagues say it was stopped because it didn't work. They all laugh and say how everything goes full circle and nobody remembers/learns from previous fuck ups.

flowerycurtain oh - ha, I forgot to include that he often travels with work. Important info to leave out!

Dreamingofkfc That was me who said most of the MWs don't have children. Admittedly it might be partly due to our staff demographic. I'm London-based so our workforce is mostly in their 20s and 30s. Once people want to settle down and start a family they move away because it's just not affordable here on a midwife's salary, even with London weighting. One of my friends pays £1400/month for a nursery place for her one child while her DP is at work. Her take-home pay is approx £1700/month. But I realise NHS staff certainly don't have a monopoly on that situation, and the simple cost of living in London is part of the problem. But part of the problem is also inflexible shift patterns and the idea that staff members' entire families should be expected to sacrifice their free time/ other obligations / emotional wellbeing on the altar of "the needs of the service". As an aside, our workforce is very junior; many of our band 7s qualified within the last 4 or 5 years, and the lack of experience is at times a problem.

I am in the union. I do not have confidence in our rep however.

Then please go higher and find someone you do have confidence in and will fight your case for you.

I’m sure you have already looked into this but is a nanny share a possibility to reduce your outgoings and mean you aren’t paying someone full pay to do nothing in the middle of the day?

Is this an English thing? The NHS in Scotland is a different organisation so perhaps move North?

If you are genuinely wanting a decent work life balance consider moving to Shetland. We need all different types of NHS staff, have an excellent midwife led unit where all midwives also work in the community. Visit Shetland.org or visit the nhs Shetland fb page

I have two friends who are part-time midwives with kids.

NHS Scotland is rolling out Best Start now, many changes being made and talk of rural midwives following their women into consultant units many miles away.

Conditions like this are one of the reasons midwives are leaving in droves. The trouble is there is such demand to get into midwifery that the experienced ones who leave can be replaced by newly qualified midwives, until they then leave as they are unsupported and conditions are crap and so it goes on.

In addition the issue as PP have said of wanting someone familiar with the labour suite if the shit does hit the fan.

But hey, as long as the NHS can still sell the narrative of listening to women so supporting COC and the idea of birth being a natural process so who needs all this pesky expertise anyway

ThisMust, realistically things are only getting worse for NHS staff so probably worth looking at other options. You could try a flexible working request as you have nothing to lose but of course they can refuse it.

Quite honestly I'd like to see a 30 year full time commitment enforced when doing an expensive to the taxpayer health care degree which could only be broken in cases of disability or permanent ill health to the individual in question.

Oh do fuck off. You wouldn't last 30 minutes in my nhs job, let alone the 30 hours I work a week.

@AHeartTiedWithString - I'm close to London so living costs and nurseries are expensive however I've so far been lucky that work have given me shifts when my little ones have had nursery and I've also worked the weekend when required. I don't think families need to sacrifice free time but I also know that working nights and weekends are part of my role. By being able to work nights and weekends and long shifts means I am around more in the week and don't have to pay a huge childcare bill. This doesn't help OP though, because my husband is on hand and his work are fleixble. I don't think I'd be able to work as a midwife if I was single with the 3 kids

I am in the union. I do not have confidence in our rep however.

Please contact your union head office- a decent Industrial Relations Officer would be all over this- especially with the issues you’ve outlined finding childcare for your dc with additional needs.

DH does this and it absolutely is possible to expect local management to be open to flexibility- don’t let an ineffective local rep stop you accessing advice which could really help.

A friend of mine whos pregnant couldnt believe it when was told same midwife up to birth. What happens if that midwife is on holiday she cant fly back to deliver my friends baby. Daft, better a team of 3-4 you know.

We have a shortage of midwives and they come up with this drivel?

COC is only any good if the care is good. I was under a team of 4 midwives. I used to hope 2 of them were not on shift. Dread to think what would have happened if I had been assigned to only one of them.

Do people really care that much of the person who is there is someone they know? Surely as long as they know what they are doing that's all that matters? They have your notes, that's all they need.

you aren't being forced out of midwifery, you don't want to pay the childcare needed

So only wealthy people or childless people can be midwives?

I think when better births was conceived questions were probably asked in a misleading way.

‘Would you like to have a good relationship with a known care giver throughout your entire pregnancy?’

‘Would you be happy to be cared for on delivery suite in a high risk situation by someone who works predominantly in community in order to achieve the above?’

I suspect the answer to those questions would be an enthusiastic ‘yes’ followed by a ‘um no not really’. Except that second question was never really put to people so they had no idea what they were asking for. So whilst I reckon COC is a great soundbite and really looks like we’re giving women what they want and this is what women demand, yet again it’s just a manipulated version of events.

This is ridiculous. You don't need one particular person with you all the time. If you want that kind of special personal attention you should be paying for it, not asking for a communal service set up on decreasing tax takes to provide individualised experience. All this individualised demand is what is killing our public sector. What we need is an organised system with competent well-trained people who can pass relevant information on.

It is also indirect discrimination against mothers, and that seems to be happening throughout the world of employment.

Ever considering giving hypnobirthing classes?

Fingers crossed the new islands proofing legislation will give our board some exemption. Our nearest consultant is 14hours away.....

I really feel for you and understand. As a fellow midwife I am now working on my exit plan as we are also switching to a case loading model that will be require being on call 3-4 nights a week (after doing your daily shift and full time hours). I have children, when I’m on call they sleep over at my mums which is fine and is once a month at the moment, 3-4 times a week I might as well give my children away for how little I will then see them. It’s bad enough now leaving before they wake up and sometimes coming home after they are in bed. I understand it’s the best option for women but sadly it simply doesn’t fit with family life and I have to prioritise my family so I’ll be leaving the profession. There is only so much of yourself you can physically give.

The work needs covering at all times of day and night 7 days a week so it simply doesn't work to have people working 'office hours' midweek with no flexibility unless others are prepared to work the weekend overnights week in week out which will never be the case.
Unfortunately when in a role that requires 24 hour 7 day coverage it really requires everyone to work a fair share of the antisocial shifts or you very quickly end up with no one ever willing to work them or a level of turnover meaning the standard of work performed is unacceptably low at certain times.
To be honest the on call working sounds like bullshit and poorly thought through but too many health workers don't understand why Tuesday to Thursday 9-5 isn't compatible with the needs of the service and think they are being unfairly treated if not allowed to work those hours.

Actually I work 24 hours a day 7 nights a week thank you, I do nights, weekends, bank holidays, Christmas Day etc. what is making me leave is having to work a 12 hour day that often ends up being a 14 hour day and then having to be on call for the 12 hours afterwards. I can just about manage that when it’s once a month, 3-4 times a week and it’s impossible and it’s unsafe. Do you want a midwife who hasn’t slept in 24 hours responsible for your babies life?

I want to know how they prevent women, assigned to the yellow team, going into labour so that the yellow team Midwives can hold their "coffee morning" and the pregnant women can meet the whole team?
Have they costed in overtime pay in this latest plan ,where everyone already works full time hours, when they need cover for someone off sick? - or do they only intend to employ staff with the constitution of Olympic athletes?

Except that second question was never really put to people so they had no idea what they were asking for. Wrongdissection YES!

All this individualised demand is what is killing our pubic sector. Dangermouse completely agree.

So often the public are told that they can have whatever they like as it’s easy to say that and damn the consequences to the staff and the budgets and, importantly, to the actual safety and quality of that service. In the meantime women are quite rightly upset about the gaps in care and ridiculous ideas like this are sold to them as the answer, rather than a way to increase the gaps as all the senior midwives leave .

Most Trusts now are very reluctant to offer set shifts anymore. It isn't like the Police or Fire Service where they have a rolling rota do you can predict your shifts month in advance - most places you will get your off duty a month (maximum) in advance and most midwives will have been in the position of not knowing what they are rostered for the following week.

I have worked in a CoC model (for 4 years). It was very well run and the parameters were strict - each team member (there were 6 of us) booked 3 women a month and were the second midwife for our partner). We planned our own workloads, had monthly "meet the midwives" where families could come and meet the team ram we offered flexible care. We had a fantastic home birth rate and it was really well evaluated by women.

We were not expected to go in and cover Labour Ward when it was busy or cover Postnatal ward. We were not expected to run ful antenatal clinics and be on call that night. We would occasionally act as second on call for home births for other teams if they needed it.

It was great and a very satisfying way to work, but it was expensive for the Trust and after 4 years I was getting burnt out and needed a change.

It seems like they are trying to provide a gold standard service on a brass tack budget and will blame midwives for lack of flexibility when it doesn't work.

I truly believe that there is an ongoing, plan in place to completely undermine and destroy the profession of midwifery in the UK.

That was exactly the set up for the team I had, Maude. Now wondering if you've delivered any of my children, just because I know it's pretty rare!