AIBU to think that NHS maternity care is only sustainable with these kind of changes?

[Dragonflyby]

I've been asked to take part in a focus group looking at potential changes to maternity care, where more things that are currently done by midwives will be done instead by maternity support workers or other trained non-midwives. So things like breastfeeding support, antenatal classes, smoking cessation/weight management advice; the non-clinical stuff, basically.

I've got some mixed feelings about it - on the one hand I know there's a staffing/financial crisis in the NHS and there have got to be changes and finding new ways of working, on the other hand, I wonder how midwives will feel about their roles being pared down like that, and whether it's what women actually want.

So is it reasonable to delegate more of midwives' current duties to trained laypeople? Has it worked/failed already with MSWs, and with nursing and HCAs? Or do they just need a lot more midwives instead?

@Midwifes aren’t currently doing any of these things though?

I don’t understand what you mean. Midwifes do all of the things the OP posted.

Also things like providing refreshments, changing beds, emptying catheters ect takes the midwife away from providing 1-2-1 care to women in labour as the midwife will have more than one woman to care for. These things of course are not beneath the midwife, we just have so much to do, so often the non essential things may be left as there’s other priorities to deal with.*

I don't see changing a catheter as non essential to be honest, or checking blood saturated sheets to be honest, and it's sad if you do- the former is actually extremely dangerous if it overfills (I would have done it myself but I couldn't reach), and the latter they would have spotted earlier that I was losing too much blood (as well as it being degrading and distressing). For context, I know they are overworked and understaffed, but when you are on a recovery ward (no one in labour here, they are in a completely different part of the hospital so I doubt they're running between every few minutes); and you can hear them in the office opposite having a good old natter then you know, says a lot about priorities. A midwife also missed something that turned out to be very obvious to the other midwife at shift change which nearly killed me and my baby, so even this 1 to 1 care was lacking. Maybe I am jaded because of all of this, but honestly, these aren't non essential mum being fussy type things.

So anything that can be done to help should be looked into.

Personally the following should be cut from NHS budgets:

smoking cessation/weight management advice

For two reasons -

1. It should come from Public Health England and
2. Smoking cessation and weight management do not work for women who are already pregnant.

I wish I had a link handy but I’m out with the buggy already.

Finally, if you think NHS England services are woeful you should see Scotland’s and NI’s.

There’s fuck all. So if to maintain the services they need to be done by “lay” people and it’s non clinical (and in the case of feeding support done by a lay person who has studied bfing and can spend time with mums unlike stretches midwives) then I’m all for it.

I've been asked to take part in a focus group looking at potential changes to maternity care, where more things that are currently done by midwives will be done instead by maternity support workers or other trained non-midwives. So things like breastfeeding support, antenatal classes, smoking cessation/weight management advice; the non-clinical stuff, basically

To clarify. Currently maternity support workers do both the basic clinical things (take blood pressure/take bloods/empty catheters ect) provide breastfeeding support, and do non clinical things such as change beds/provide refreshments. In the hospital environment. In some community settings maternity support workers also do some of the antenatal checks such as weighing baby, the heal prick test ect.

Antenatal classes are usually midwife led.

Smoking cessation is a service outside of midwifery.

Weight management is usually referring the woman to a weight loss program.

Breastfeeding support - mixture of peer support workers/midwives and maternity support workers.

**
Firstly; being asked to bring a passport with me to my first booking in appt. (a good thing, IMO!)
**

I don't think NHS should be used as an extension of the border force. Many vulnerable women, including asylum seekers, already miss out on essential antenatal care because of lack of information and language barriers, and heightening their fears will certainly not improve the outcomes of their pregnancy.

I don't see changing a catheter as non essential to be honest, or checking blood saturated sheets to be honest, and it's sad if you do- the former is actually extremely dangerous if it overfills

I said that often the non essential things may be left due to other priorities, I didn’t say that an overflowing catheter or blood soaked sheets were none essential, blood soaked pads/sheets should trigger the midwife to check the woman’s blood loss and to rule out a postpartum haemorrhage for example, and overflowing catheters is a bug bear of mine they should be emptied before they start to overflow. I’m sorry that you had a poor experience, I was trying to highlight that sometimes things like changing a bed are left due to the workload.

I think it's a good idea.

What would help is if post labour there was lots of people about to help with picking baby up, taking ladies to the loo helping with feeding mum and baby etc etc.

Then we wouldn't have men staying on the wards all night upsetting other women and women like me who have non attentive husband's struggling on there own.

Women need more support, it doesn't always need to be from a midwife. After my DS was taken into NICU a HCA gave me a hug and a cup of tea and changed my sheets and it meant the world to me. Something a midwife doesn't have time for.

Sounds like a good idea! There’s no reason why people can’t be trained in those things without having the three year midwife qualification. I do think antenatal classes should be ran by a midwife however.

I’m surprised when I see people complain that they didn’t have the same midwife throughout their pregnancy to ‘build a relationship’ though, how feasible would that actually be to enforce for everyone? They’re only human and aren’t at work 24/7, plus they have annual leave to take and sick days and you can go into labour at any time. I’ve seen a different midwife at each appointment so far (twenty weeks atm) and didn’t expect anything different to that, and it’s been fine as they’ve had access to my notes. And I fully expect when I give birth I’ll have new midwives I’ve never met before, probably changing partway through as shifts change. Seems so bizarre anyone would expect one or two continuous midwives to hold their hand throughout. Wonder where that attitude comes from.

@Sandybval I agree with you.

Midwives in my hospital regularly tell people “it’s not their job” to help them wash after delivery, so get a completely different stranger in to do intimate care. Midwives DO think basic care is beneath them.

Plus the student saying MCA’a should do all the non essential things. If there’s one MCA on a word of 20+ women, as there is in my hospital, it makes them very busy having to do every single patients “non essential” care and all the regular observations and all the breastfeeding support. They also have to do post natal checks to assist the midwives, discharge patients, baby observations, baby bloods, mums bloods and have to clean all the beds/rooms after patients have being discharged as well as cleaning all the equipment. It’s a tough and very exhausting role, yet they're paid the least of everybody on the ward.

@Zebraaa yes the support worker role is a demanding role and should be paid accordingly to the workload. Ideally the role should be paid more, and perhaps different pay scales so the more advanced things are done by a more senior grade.

I actually said that we need more midwife support workers one support worker on shift isn’t enough, and ideally a team of breastfeeding support workers. The only problem is sometimes the wards can be quiet/or women may choose not to breastfeed so the breastfeeding team would have no work to do, and if we moved to a more specialised breastfeeding support role it would no doubt cause controversy as women may feel pressured to breastfeed.

So it comes down again to money and needing more midwives and midwife support staff.

I think something needs to change as nobody is doing a lot of the essential care jobs. I was a bit shocked how much care was ‘missing’ when I gave birth, compared with the very good nursing care patients receive in my own unit (I’m a nurse).

I remember a few decades ago we nurses were tasked with doing everything for patients and maintaining the ward environment. As well as keeping sick patients alive we would have to clean equipment, constant bed changes, clean the sluice, empty the dishwasher! The tasks were just endless and definitely all did not need a nurse to do.

Thankfully now there are support staff to do most / all non clinical jobs. Having said that I would be reluctant to delegate all personal care to assistants. I think having time to observe and talk to patients allows a registered skilled practitioner to pick up on sometimes subtle signs of deterioration or distress. I also think breastfeeding support requires specialist training and a breastfeeding consultant lead. We need to outsource work without losing important elements.

Midwives in my hospital regularly tell people “it’s not their job” to help them wash after delivery, so get a completely different stranger in to do intimate care. Midwives DO think basic care is beneath them.

To be fair, in other areas of the hospital it’s HCAs who help with washing too, midwives are highly trained professionals, I doubt it’s that they think it’s beneath them, more that their role has them using their skills and knowledge for more complex tasks than giving someone a bed bath which can be done by a support worker. Makes no financial sense to pay a midwife on band 6 to wash someone for 15 mins when you could be paying a HCA on band 2 or 3 to do the same.

In some places, you'll find that actually, the MSW workers are better trained and qualified to offer that support than the midwives, depending on the trust.

@IheartNiles I agree that some of the essential care jobs are sometimes not prioritised for example helping the woman to get out of bed to wash after she’s given birth. I think some of it is due to the fact that most women are well, and able to get out of bed to shower, so the expectation is that they can wash themselves. However they could be in bed for a few hours due to needing to rest/feed baby ect so a quick bed bath as a basic care need to help them freshen up would help meet this.

I’m very conscious that often women are left in bed before they can shower, so always offer a quick freshen up whilst they’re in bed. I also agree this is also a good opportunity to speak to women and pick up on anything clinical that might be going on.

Also I think some of the basic nursing skills aren’t taught during our training such as bed baths (we pick it up whilst on placement), this is something I think the NMC are changing as they’ve introduced placements on other wards.

@JemimaPuddlePeacock so you’ve been in labour for god knows how many hours, a midwife helps you deliver vaginally and then they send someone else in to wash your swollen damaged vagina? I don’t think that’s very kind to the patient.

@JemimaPuddlePeacock no bed baths are given on the ward, this is post delivery labour ward only.

@Blahblahblahnanana all i ever got from midwifes is:
antenatal:

• blood pressure measurements (doesn’t need a midwife)
• handing me a questionnaire to fill in (doesn’t need a midwife)

delivery

• actual labour (does definitely need a midwife)

after birth

• two check up (needs midwife) in hospital

antenatal classes: only offered by nct
weight management: not offered at all
breastfeeding “support” : offered on paper by health visitor, practically not offered at all
support in hospital with washing etc: not offered at all (i stayed 3 days due to complications)
handing out painkillers: nurse

Why would it be unkind to the patient @Zebraaa? You don’t have to be a midwife to be gentle and careful.

What on earth would be unkind about that Zebraaa? I’m not following. If you’re on a maternity ward you’re acutely aware there are other women in labour too, why would you expect a skilled midwife to stay with you to wash you when they need to be assisting other births?

@Zebraaa

@Zebraaa
JemimaPuddlePeacock so you’ve been in labour for god knows how many hours, a midwife helps you deliver vaginally and then they send someone else in to wash your swollen damaged vagina? I don’t think that’s very kind to the patient

Why would another healthcare profession trained in the job be an unkind thing to do? Bath baths are generally given to women who can’t get out of bed, well women are encouraged to get up when they’re ready and shower. If you have stitches the midwife will clean the area before suturing and change the pads and sheets, you’ll then be encouraged to have a shower when you feel ready.

@myself2020

Yes, blood pressure readings can be done by another trainer healthcare professional, however they help build up the bigger clinical picture and can be an indication of pre eclampsia.

The nurse in hospital if you were on the labour ward would be a midwife.

Breastfeeding support is a known issue it’s something that the NHS needs to address, women don’t get the right support and get lots of conflicting information.

Re the washing/bathing if you were bed bound you should have received some help.

To be fair I didn't expect a bath, just when I kept saying my pad is saturated (not just my maternity pad but the big square one on the bed) and I feel very unwell (I also haemorrhaged during birth) and the answer is one of those whose job it is (MCA) will be along soon, same with the catheter I think that's appealing to be honest. The woman opposite me was in agony so I have her some paracetamol, honestly, for any other op would people be expected to go without rounds and lie in agony? It's not the individual midwives fault and I understand that, but it's honestly appauling.

Appealing is meant to be appauling haha

Anyway, in my opinion everyone does a hard job in challenging conditions, both the staff and the mother's; anything that can be done to make it better for both parties has got to be worth a go :) I understand it's not individual midwives and I don't want it to seem like I am bashing them (except some werent great), but the overall system which isn't fair to anyone.