How on earth midwives?

[Sleeplessem]

How on Earth are you doing your jobs? It must be bloody gut wrenching and terrifying!

Read this today (below)…. There are no words. It’s obviously not just that area either. I’m a pregnant lady with my 2nd and it’s really easy to get frustrated by the poor care (sorry but in some instances it is quite poor from a continuity point of view and at least personally a few things are getting forgotten or left off as a result, although obviously a result of severe understaffing and over working) but you read stuff like this and it just makes me so mad, it’s just a disaster waiting to happen and then all the ‘blame’ will fall on that one midwife who’s trying their best under impossible circumstances.

Also in my area, during the last 18 months inductions have increased a huge amount (the amount they ‘allow’ you to go over has also reduced from 14 days to 10 and 7 in some places, do we think that’s partly due to the fact the trusts are trying to ensure staffing?

www.itv.com/news/meridian/2021-10-15/unsafe-staffing-levels-found-in-east-kent-maternity-inspection

@Chipsinthewoods

My personal view is that community hospital MLUs are massively underused. My local hospital releases stats every month and last month they had ONE birth there! One! I checked and it was open the entire month, no closures as far as I can tell & they update the Facebook page regularly.

To my amateur eye (and do correct me, midwives) women are deemed ‘higher risk’ at the drop of a hat, possibly because it’s a more litigious world now. It makes no sense that a woman with a BMI slightly over the limit but no other issues & previous normal births have to go to CDU, whereas a first time mum who has no idea how they labour can go to a stand-alone unit with a nearly 50% chance of being transferred.

I think previous births seem to be a much better indicator of how smoothly the next will go rather than a sparkling bill of health on paper. Of course that doesn’t mean there won’t be women with good previous births who need to be on CDU for X and Y reason, but the blanket rules seem to create a CDU bottle neck.

@Chipsinthewoods I’m going to don my tin hat here because it causes rifts amongst midwives!

Community midwives as a whole are more woman focused, they are low risk practitioners who rarely see risk because of the clientele, historically they barely went into high risk environments and had lower case loads working out of a birth centre that only accepted low risk women. This meant they could give extra care postnatally because they don’t have a queue of inductions, high risk labourers who then need 1:1 postnatal care etc.

Then you have the high risk obstetric midwife who
Is taking care of woman after woman, no sooner has a woman delivered than is she given the next lady, the notes are rushed, the woman is barely warded, the emergency bell goes and she leaves her lady to help her colleague because the doctors are in theatre, she cannulates her, reassured her husband, bleeps the paed, the midwife in charge comes in the room and tells her that her woman needs her, she rushes back, her lady has a baby, she barely has the placenta out and the midwife in charge comes back in to say she is needed for another labourer (watch the wording, women now become “labourers”) the next lady is massively high risk but she wants a pool birth, she has been put in the pool room because it’s the last room available, she can SEE it but she can’t go in it because the midwife knows if she bleeds out there is not another midwife who can help, she is trying to explain but just looks and sounds obstructive, she is tired! The woman has prepared a beautiful birth plan with her community midwife but is progressing, still asking for the pool, the midwife looks at her notes, checks her medical history, scan reports, the woman wants to push, another baby is born, midwife clamps, asks dad to cut the cord, the injection to deliver the placenta is administered, baby is screaming, midwife breaths a sigh of relief and then the woman says “I wanted a physiological 3rd stage” did you not read my birth plan? Why did you not read my birth plan? She takes to mums net or her friends “the bloody midwife didn’t even bother reading my birth plan”

The birth centre midwives are not up against this pressure, and here is where the divide comes in to play. The community midwives don’t want to work in that environment under that pressure, the Labour ward midwives think community midwives are lacking in knowledge and are fluffy!

When In fact both are excellent in their own field but fucked by expectation and failings of under funding and an unrealistic work load!

@Kidsaregrim

Wow, I think my job is high pressure, but that is another level… I take doff my tin hat to you all

‘off’

The birth centre midwives are not up against this pressure, and here is where the divide comes in to play. The community midwives don’t want to work in that environment under that pressure, the Labour ward midwives think community midwives are lacking in knowledge and are fluffy!

This further adds to my amateur suspicions that the MLU/CDU system just doesn’t really work. Would be interested to hear how the midwives on here think an ideal maternity system would run?

@Glassofshloer take it to the midwives, flexible working, realising that a midwife with two kids under 5 doing 3 12.5 hour shifts in a row means she doesn’t see her children for 4 days!

Stop making midwives work in areas they don’t want to be in, not every midwife thrives off emergency bells and resuscitation! Let community midwives be community midwives, re open low risk birth centres to take the pressure off main units, have local continuity of care!

Stop the hierarchical bullshit with doctors, respect midwives and their practice, we actually do know what we are doing! Stop admitting ladies for unnecessary inductions! More outpatient inductions so women aren't left on wards without their partners support feeling unsafe and vulnerable which we all know isn’t conducive to going into Labour!

I could go on for hours, I’ve left midwifery now but it will always be a massive part of my life, it’s all I ever wanted. Please be kind to your midwife, she/he is trying their hardest and even though it’s hard they got up in the morning and come to work with good intentions

[quote Kidsaregrim]@Glassofshloer take it to the midwives, flexible working, realising that a midwife with two kids under 5 doing 3 12.5 hour shifts in a row means she doesn’t see her children for 4 days!

Stop making midwives work in areas they don’t want to be in, not every midwife thrives off emergency bells and resuscitation! Let community midwives be community midwives, re open low risk birth centres to take the pressure off main units, have local continuity of care!

Stop the hierarchical bullshit with doctors, respect midwives and their practice, we actually do know what we are doing! Stop admitting ladies for unnecessary inductions! More outpatient inductions so women aren't left on wards without their partners support feeling unsafe and vulnerable which we all know isn’t conducive to going into Labour!

I could go on for hours, I’ve left midwifery now but it will always be a massive part of my life, it’s all I ever wanted. Please be kind to your midwife, she/he is trying their hardest and even though it’s hard they got up in the morning and come to work with good intentions[/quote]
All of this plus, we need a way to manage women’s expectations. Bring back good antenatal education sessions, we need lactation consultants on the wards present in the wards, 24/7. I don’t have an issue with partners staying overnight but they are their to help, most of them don’t help, they sleep like a lump in a chair whilst I’m changing the baby’s nappy at 2am, I’m so happy to do that for women but not when the dad is sparko in the corner, so many partners treat this place like a hotel it’s ridiculous.

Let people work where they are happy, either go fully paperless or just bring back the notes as currently we are just duplicating everything. Trust that women are sensible and can administer and manage their own medications, like they will do in 12 hours when they are discharged home.

So many typos in that I apologise! You’d think I’d be a good multitasker😂

[quote Kidsaregrim]@Chipsinthewoods I’m going to don my tin hat here because it causes rifts amongst midwives!

Community midwives as a whole are more woman focused, they are low risk practitioners who rarely see risk because of the clientele, historically they barely went into high risk environments and had lower case loads working out of a birth centre that only accepted low risk women. This meant they could give extra care postnatally because they don’t have a queue of inductions, high risk labourers who then need 1:1 postnatal care etc.

Then you have the high risk obstetric midwife who
Is taking care of woman after woman, no sooner has a woman delivered than is she given the next lady, the notes are rushed, the woman is barely warded, the emergency bell goes and she leaves her lady to help her colleague because the doctors are in theatre, she cannulates her, reassured her husband, bleeps the paed, the midwife in charge comes in the room and tells her that her woman needs her, she rushes back, her lady has a baby, she barely has the placenta out and the midwife in charge comes back in to say she is needed for another labourer (watch the wording, women now become “labourers”) the next lady is massively high risk but she wants a pool birth, she has been put in the pool room because it’s the last room available, she can SEE it but she can’t go in it because the midwife knows if she bleeds out there is not another midwife who can help, she is trying to explain but just looks and sounds obstructive, she is tired! The woman has prepared a beautiful birth plan with her community midwife but is progressing, still asking for the pool, the midwife looks at her notes, checks her medical history, scan reports, the woman wants to push, another baby is born, midwife clamps, asks dad to cut the cord, the injection to deliver the placenta is administered, baby is screaming, midwife breaths a sigh of relief and then the woman says “I wanted a physiological 3rd stage” did you not read my birth plan? Why did you not read my birth plan? She takes to mums net or her friends “the bloody midwife didn’t even bother reading my birth plan”

The birth centre midwives are not up against this pressure, and here is where the divide comes in to play. The community midwives don’t want to work in that environment under that pressure, the Labour ward midwives think community midwives are lacking in knowledge and are fluffy!

When In fact both are excellent in their own field but fucked by expectation and failings of under funding and an unrealistic work load![/quote]
This sounds so familiar I’m feeling stressed just reading it, so many shifts like this. I retired early because of health problems and no way could I ever go back or would want to.

@Kidsaregrim but do they actually take pressure off of hospitals? Like I said I follow several on FB, they usually have around half the beds that the CDUs do, yet no way do they host half the births - more like 10%. Hardly anyone seems to be able to step foot in them!

I definitely agree re outpatient induction. It took me 4 days to be induced. At the end of it I ended up sobbing in the loo, I couldn’t take yet another night on the ward with the constant noise & 3 hourly obs meaning I was getting less than 3 hours sleep a night. I asked if I could go home for a quiet nap for a couple of hours (hospital was 20 mins drive away) and if I could come back for the next set of obs. I was told if I did this they couldn’t guarantee I would still have a bed when I got back & I would go to the bottom of the CDU queue. I was taken through to the CDU in the small hours of the morning expected to do something as physical as running a marathon after 5 days of no sleep. It was horrific. It really doesn’t surprise me that so many CDU women end up in theatre - half of them are already exhausted only to have every method that could speed them up inflicted on them. It all just seems so counter productive.

@Glassofshloer they used to, before reports like “the term breech birth trial” and the “peel report” came in and scared everyone witless!

It’s a very consultant led method of care now while trying to keep the ethos of midwives which isn’t working. I’ll give you an example, low risk first time mummy gets measure using a tape measure and is measuring large for dates, the hospital guidelines state the midwife has to refer for a growth scan, growth scan performed and consultant see’s her, baby is measuring 9/10lb so the doctor books induction at 38 weeks because well who knows? (he has lost trust in a woman delivering a large baby).

Inductions starts and 3 days later and a Caesarean because baby is unhappy with being delivered early, wasn’t ready, didn’t like the drugs!
Baby is an average 7lb

This happens FREQUENTLY

One measurement has led to such an overreaction of intervention that lady has missed out on a low risk midwife led unit birth and is now traumatised, the birth centre is under utilised because we keep sending women in for unreliable scans because we don’t trust women to birth babies naturally anymore, we lose our skills as midwives!

You can’t have epidurals in stand alone birth centres, without correct antenatal care and again trust in a midwife first time mums don’t realise that birthing a baby actually HURTS and can take a long time, they don’t trust that they can do it so they choose the hospital “just in case”

[quote Glassofshloer]@mummyh2016

1. You’re not a midwife
2. The actual real midwives on the other thread agreed with me
3. You were thinking of other people during the staffing crisis when you hopped in the birth pool and had midwives clean it up after you but other people who want to do so are selfish and fuck them? Why didn’t you refuse the pool on account of the lack of resources and just ask for a small cupboard room with a bed in it?
4. You have to be the most obtuse, I’m-ok-so-what’s-the-fuss-about person I have ever spoken to on here. Stop thinking you speak for all the midwives when pushing for other people to have things withheld from them that you enjoyed yourself. goodbye[/quote]

Actually I was going off info and comments made by my community midwife, who happens to also be the same midwife I had 4 years ago. Considering she works at the trust I will be giving birth at I'll go off what she says thank you very much rather than arguing with a nobody who isn't a midwife either. Now give it a bloody rest eh.

What a coincidence she comments on the exact, rather specific topic I’ve been discussing! What are the odds…

[quote Kidsaregrim]@Chipsinthewoods I’m going to don my tin hat here because it causes rifts amongst midwives!

Community midwives as a whole are more woman focused, they are low risk practitioners who rarely see risk because of the clientele, historically they barely went into high risk environments and had lower case loads working out of a birth centre that only accepted low risk women. This meant they could give extra care postnatally because they don’t have a queue of inductions, high risk labourers who then need 1:1 postnatal care etc.

Then you have the high risk obstetric midwife who
Is taking care of woman after woman, no sooner has a woman delivered than is she given the next lady, the notes are rushed, the woman is barely warded, the emergency bell goes and she leaves her lady to help her colleague because the doctors are in theatre, she cannulates her, reassured her husband, bleeps the paed, the midwife in charge comes in the room and tells her that her woman needs her, she rushes back, her lady has a baby, she barely has the placenta out and the midwife in charge comes back in to say she is needed for another labourer (watch the wording, women now become “labourers”) the next lady is massively high risk but she wants a pool birth, she has been put in the pool room because it’s the last room available, she can SEE it but she can’t go in it because the midwife knows if she bleeds out there is not another midwife who can help, she is trying to explain but just looks and sounds obstructive, she is tired! The woman has prepared a beautiful birth plan with her community midwife but is progressing, still asking for the pool, the midwife looks at her notes, checks her medical history, scan reports, the woman wants to push, another baby is born, midwife clamps, asks dad to cut the cord, the injection to deliver the placenta is administered, baby is screaming, midwife breaths a sigh of relief and then the woman says “I wanted a physiological 3rd stage” did you not read my birth plan? Why did you not read my birth plan? She takes to mums net or her friends “the bloody midwife didn’t even bother reading my birth plan”

The birth centre midwives are not up against this pressure, and here is where the divide comes in to play. The community midwives don’t want to work in that environment under that pressure, the Labour ward midwives think community midwives are lacking in knowledge and are fluffy!

When In fact both are excellent in their own field but fucked by expectation and failings of under funding and an unrealistic work load![/quote]
Quite true, although the community midwife these days is usually working unpaid on her laptop until late into the evening, coming into work an hour before her start time (again unpaid) just to try and get through her workload. Usually working through her break too and still feels like she’s having to rush women in and out the clinic room door. The number of assessments, reviews and information required to be given per an appointment has more than tripled in the last 20 years and yet the appointment slots remain the same, an extra 5 minutes added on at some point over the 20 years if your lucky!

[quote Kidsaregrim]@Chipsinthewoods I’m going to don my tin hat here because it causes rifts amongst midwives!

Community midwives as a whole are more woman focused, they are low risk practitioners who rarely see risk because of the clientele, historically they barely went into high risk environments and had lower case loads working out of a birth centre that only accepted low risk women. This meant they could give extra care postnatally because they don’t have a queue of inductions, high risk labourers who then need 1:1 postnatal care etc.

Then you have the high risk obstetric midwife who
Is taking care of woman after woman, no sooner has a woman delivered than is she given the next lady, the notes are rushed, the woman is barely warded, the emergency bell goes and she leaves her lady to help her colleague because the doctors are in theatre, she cannulates her, reassured her husband, bleeps the paed, the midwife in charge comes in the room and tells her that her woman needs her, she rushes back, her lady has a baby, she barely has the placenta out and the midwife in charge comes back in to say she is needed for another labourer (watch the wording, women now become “labourers”) the next lady is massively high risk but she wants a pool birth, she has been put in the pool room because it’s the last room available, she can SEE it but she can’t go in it because the midwife knows if she bleeds out there is not another midwife who can help, she is trying to explain but just looks and sounds obstructive, she is tired! The woman has prepared a beautiful birth plan with her community midwife but is progressing, still asking for the pool, the midwife looks at her notes, checks her medical history, scan reports, the woman wants to push, another baby is born, midwife clamps, asks dad to cut the cord, the injection to deliver the placenta is administered, baby is screaming, midwife breaths a sigh of relief and then the woman says “I wanted a physiological 3rd stage” did you not read my birth plan? Why did you not read my birth plan? She takes to mums net or her friends “the bloody midwife didn’t even bother reading my birth plan”

The birth centre midwives are not up against this pressure, and here is where the divide comes in to play. The community midwives don’t want to work in that environment under that pressure, the Labour ward midwives think community midwives are lacking in knowledge and are fluffy!

When In fact both are excellent in their own field but fucked by expectation and failings of under funding and an unrealistic work load![/quote]
I can’t believe you weren’t doing this last night it’s so accurate! But in my trust the BC midwives are often not able to be relieved on transferring women to DS so are abandoned with an epidural they’re not up to date with or assisting at a forceps delivery with a tired doctor who won’t be then reminded to prescribe the antibiotics etc or if they stay on the birth centre are expected to deliver woman after woman and hand them over to a healthcare assistant while actually retaining responsibility for them despite having a labouring woman, sod how are they actually ever going to get discharged?

And I will be told to go to the birth centre if the women coming in through triage are more low risk than high and have to desperately attempt to dismantle all my instincts for a few hours and trust the process when the only way to practice acceptably on the other side is to constantly be able to transfer to theatre at a moment’s notice and mitigate any risk at all at all times.

Just like to say that while historically Community Midwives saw mainly "low risk" women it is very different now!

My team see a very high number of women who speak no English/book late/miss appointments constantly/have social issues such as DV or learning disabilities/high BMI/gestational diabetes etc etc all of which increase their risk during pregnancy/birth. We see women for AN care as well as the consultants- or often instead of if they don't go to the hospital! I often have women sit and tell me they have been bleeding/reduced movements/think waters have broken despite us using interpreters to explain where and how they need to be seen of these things happen. One woman ended up in ICU.

We also have to find time somewhere to liaise with social services and or mental health services, health visitors, social support services, charities to get baby equipment. We don't get protected time for this.

It is neverending, draining and definitely not low risk!!

@PinkPrawns2 would a box of chocs for the clinic office be weird at a final appointment? There’s no GP midwives so for the hospital I’m booked at it’s basically a drop in clinic doing it all. Ante natal and post natal appointments, some work with social services to make sure vulnerable mums have basic info, the building is literally heaving and there’s maybe under 10 midwives there, you can see they are rushed off their feet and the building is boiling too. Would like a tin of celebrations (or the like) be weird at like the 38 week app? Could they even take them? I know it’s not much, but sometimes chocolate helps lol x

A box of chocolates would be very welcome! We get forgotten in Community, so any gift or even a card is a lovely morale boost 🙂

When I had my DS (not recently) my labour progressed very quickly - for much of the time (admittedly not a long period between arriving and birth) we were on our own. I knew I was ready to push and DH went into the corridor to find someone. The HCP wasn't a mw and said you can't push now the midwife is not here!! ...as if I had any choice in the matter. Ds was born very quickly and with the cord round his neck . I can't remember at what point the mw did arrive. That was 12 years ago im sure things are a lot worse now.

We also have to revalidate every 3 years and any cards, comments feedback help us to do this so if you do see good work please write a comment, email, feedback card, anything that HCP can use is lovely and really helpful 😊

I love looking through my cards

Since I qualified the ‘risk level’ has gone up massively and that’s not because we are arbitrarily deeming people to be ‘higher risk’ for no reason. DV, mental health, social needs, isolation, learning difficulties, language barriers, coexisting medical conditions- when I started probably 50% of our clients had a ‘risk factor’ but now it’s more like 90%. If we miss something we are vilified. If we fail to refer to social services or support mental health or notice a risk factor for DVT or pre-eclampsia or prem birth then the consequences could be huge. Then consider you might see 40 women a week (or more) in an average community week.

It’s a lot of people to potentially ‘miss’ something for when you get 30 mins with each woman (and we are lucky as I know a lot of trusts get less time).

We get 15 mins in community gp clinics @Iwouldlikesomecake . Our bookings are supposed to be done in 1hr 15! Just not possible at all! 2 hours is the fastest I can do the most straightforward ones.
It took 4 hours for a booking this afternoon. Started at 1.45, allocated 1hr and 15. But the woman was on the phone for an hour and 20 as there was a lot of social issues and mental health issues. I was very thorough, but conscious of my next booking. Luckily my next booking didn't answer, because the paperwork was just monstrous. FIlling in all handheld notes thoroughly, the blood forms, hospital paperwork - with all the duplication invovled in that, organising her scan, her 16 week appt (trying to get through to the GP surgery to book it!!!), referrals for various medical complications, mental health referrals... in between getting calls from the mental health midwife about one of my other ladies with significant problems. I then had to deal with that. Also fielding calls to another lady who needed follow up from her bloods - dealing with 2 other midwives errors (no surprise given the workloads we are under!). I only finished this at 5.40, when I had to dash to get the kids before wraparound closed. I'm on call for homebirths tonight (more likely the hospital calling me in to plug staffing gaps!). Tomorrow I've got another full day, in which I also have to ring social care in 3 separate authorises, and complete the safeguarding paperwork from my booking as I couldn't fit that in on top of everything else.
More and more is being asked of us, and no extra time is ever given. It is endless. I'm exhausted. I'd still rather this, than hospital midwifery though. Which is telling I suspect....

I see East Kent have been mentioned. The care given under this trust is shocking. I went private to avoid it and I would recommend anyone else living here to do the same. If you can afford it, it is worth every penny of the £5k. Literally could be a life or death choice.

The 1 hr 15 is to book the woman plus paperwork BTW. Impossible.