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?

I was at Brighton end of last year and they seemed to be doing this or a similar system and it worked very well imo, they were a really professional and good team. At every shift change the mw taking care of you came and introduced themselves and asked how you were doing (crucial to keep continuity imo) and though hcas often came when I rang the bell they were generally great and went off to fetch the mw if the request required it, eg when I had such bad afterpains they were as bad as labour, within 20 mins of me ringing the bell I'd been prescribed some high strength painkillers over the ibuprofen and paracetamol that did nothing.

I think the key here is excellent communication good training and very clear roles and responsibilities - seems like a good idea to me tbh.

@Blahblahblahnanana she explicitly said she wasn’t a midwife, but a nurse.

Re weight management there’s actually no evidence based guidelines on what constitutes appropriate weight gain during pregnancy. And dieting during pregnancy isn’t recommended as it may cause harm to the unborn baby.

With all due respect for midwives, I think for breastfeeding support it is more helpful to have advice from someone who has done it irrespective of their qualifications.

@myself2020 perhaps your hospital works differently then, but it’s usually midwives on the postnatal wards or she might be dual trained.

OK a thought running classes nb this is far from a perfect solution! run courses with support workers but have one section where there is an online video midwife who can answer questions but is able to do this with several groups at same time - everybody can hear each others questions & it is interactive it isn't perfect but it might be better than not having any access to midwife to ask questions

@timeforakinderworld breastfeeding support is more about having the time to sit with women and support them 1-2-1 throughout a feed.

In an ideal world there would be enough midwives and HCAs to cover all care sufficiently.

Personally I would love to volunteer as a 'mum helper'. I've no medical training whatsoever but have had 3DCs. I'd love to be able to help with the day-to-day things that there just isn't the time for by medical staff. Things such as: going getting dinners for mums - no-one should have to shuffle along the corridor in pain & embarrassment, leaving baby, then shuffle/stagger back with a tray of food whilst feeling your insides are about to fall out -, changing bed pads, sheets (I lay in my own blood for 3 days with my 1st), pass you some tissues when you just want to cry, give you a hug and tell you it'll be ok, get you a cup of tea and toast, give your baby a bottle because you've not slept properly for days and just want to sleep. Just basically do the things you're too scared to ask for because you've been shouted at before for asking for them (been on the receiving end of that too).

Midwife here.

Care in the antenatal and labour setting needs to be led by qualified trained staff.

Postnatal care is where skill mix can be more flexible. I work with some very experienced support workers and nursery nurses and honesty could not get through a shift without them. However this affects the holistic, woman centred care I give and as the trained professional I spend a good amount of time delegating and supervising the untrained care. In an ideal world I’d prefer to deliver all the care in the mother and baby dyad myself but I cannot square this within the context of the challenges the NHS faces (financial/staffing).

I also feel that it also gives others the opportunity to work and earn within this setting without embarking on lengthy and expensive training which is prohibitive to many women.

I’ve had really terrible terrible experience with maternity assistants. They were unqualified and unkind. So I think that is unacceptable.

However I do think it’s fine to have qualified breastfeeding consultants, qualified doulas etc working in the NHS to support midwives. As is often the case the devil is in the detail. If they insist on paying people £8.90/hour and work 5 random shift in a 24/7 rotation then they won’t recruit the best staff. Fixed shifts that don’t cross a child’s bedtime and paying £12/hour plus with qualified and committed paraprofessionalsis fine.

I don't understand why there can't be assistant staff/ helpers around to help with things like food and water provision for new mums - those things don't require medical training and you hear all the time that midwives are stretched and women go without - just seems like a waste of a midwife's time to deal with things like that 🤷

I think most of the antenatal class should be run by a midwife. The others things can be done by non-midwives.

@Weathergirl1 in hospital?

There are staff (not midwives) specifically employed to manage the kitchen, providing food & water to patients .

Oranges not enough. It's quite common for postnatal women to be pretty neglected in terms of non clinical care, there are staff shortages everywhere. Read other threads and you will hear about women who can't walk post c-section being expected to go and get food from a trolley outside the ward etc.

The best bf support I had was from a non clinical worker so no issues from me. Horrified by the suggestions on here that people be charged for midwifery services, that would lead to huge numbers of poor people simply not accessing the services and a huge amount of preventable stillbirth etc. Madness.

My midwife didn't do any of those things any way. She took my blood pressure, tested my wee and sent me on my way without so much as a 'how are you?'. So, yes I'd be happy to have those things delivered by a trained practitioner, they might actually get done.

@Squashpocket same for me. “hand me your urin sample”, “i need to take your blood pressure”, “fill in this form” and “make an appointment with the receptionist “ is literally all i’ve ever heard my community midwifes saying.
in the hospital it was a but better, but there is hardly any ante natal care apart from looking at stitches and the newborn health check - which is important, but its not as if all these things mentioned above actually get done!