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

Can someone more educated explain to me about Continuity plans and why most midwifes are against them

The continuity model in theory is a wonderful model of care, considered the gold standard.
You are cared for by a small team of 4-6 midwives, with one named midwife providing the majority of your care during your pregnancy, birth and the postnatal period. You know them and they get to know you over the best part of a year.
The evidence base shows significantly better outcomes: lower rates of maternal deaths, less stillbirths, earlier identification and better support for perinatal mental health, less nnu admissions, better breastfeeding rates, less assisted deliveries and better birth experiences. The list goes on. It is without doubt the ideal model of care for birthing women and people.

Unfortunately making the shift to continuity in the current climate is completely unviable. The staffing levels required to maintain a continuity team are far more than the traditional model of care (community midwives and hospital midwives). The midwives need to be available to do day shifts, night shifts, and on calls, not everyone has availability for those hours, think single mums, those with health issues or caring responsibilities. Midwives who are used to providing low risk care are suddenly expected to know the job of a midwife in a high risk unit. Midwives who are used to providing high risk and complex hospital based care as part of a team with immediate access to medical staff, are suddenly expected to know the role of the community midwife working alone in a community clinic, with all the health promotion, referral processes, policies and paperwork which the job entails. Our specialist roles and interests we have channelled our careers towards and honed our skills in, are no longer enough as we are expected to be Jack of all trades and therefore master of none. There is so much to know and keep up to date on, and it is incredibly difficult nigh on impossible to have excellent skills, knowledge and experience in all aspects of care. We are accountable practitioners, if you make a mistake you and you alone will be held responsible. You could lose your pin, your registration and your livelihood. If you make a mistake, you have to live with the consequence of that mistake, which could potentially be the death or life changing injury of a woman or baby in your care.

Where I work in community there are 3 midwives, including one of us who is currently on long term sick . We booked 290 women in the last year. To casehold them would be impossible.

@BanginChoons

Can someone more educated explain to me about Continuity plans and why most midwifes are against them

The continuity model in theory is a wonderful model of care, considered the gold standard.
You are cared for by a small team of 4-6 midwives, with one named midwife providing the majority of your care during your pregnancy, birth and the postnatal period. You know them and they get to know you over the best part of a year.
The evidence base shows significantly better outcomes: lower rates of maternal deaths, less stillbirths, earlier identification and better support for perinatal mental health, less nnu admissions, better breastfeeding rates, less assisted deliveries and better birth experiences. The list goes on. It is without doubt the ideal model of care for birthing women and people.

Unfortunately making the shift to continuity in the current climate is completely unviable. The staffing levels required to maintain a continuity team are far more than the traditional model of care (community midwives and hospital midwives). The midwives need to be available to do day shifts, night shifts, and on calls, not everyone has availability for those hours, think single mums, those with health issues or caring responsibilities. Midwives who are used to providing low risk care are suddenly expected to know the job of a midwife in a high risk unit. Midwives who are used to providing high risk and complex hospital based care as part of a team with immediate access to medical staff, are suddenly expected to know the role of the community midwife working alone in a community clinic, with all the health promotion, referral processes, policies and paperwork which the job entails. Our specialist roles and interests we have channelled our careers towards and honed our skills in, are no longer enough as we are expected to be Jack of all trades and therefore master of none. There is so much to know and keep up to date on, and it is incredibly difficult nigh on impossible to have excellent skills, knowledge and experience in all aspects of care. We are accountable practitioners, if you make a mistake you and you alone will be held responsible. You could lose your pin, your registration and your livelihood. If you make a mistake, you have to live with the consequence of that mistake, which could potentially be the death or life changing injury of a woman or baby in your care.

Where I work in community there are 3 midwives, including one of us who is currently on long term sick . We booked 290 women in the last year. To casehold them would be impossible.

Excellent explanation of a completely unworkable system! Unfortunately midwives are quickly becoming obstetric nurses, the women are more high risk than ever. Due to the true wonders of IVF and modern medicine, women are medically of a much high risk category than they may have been 40-50 years ago and these are the women that need the continuity and one to one level of care that at present just cannot be given. At present most shifts feel like your just merely surviving and praying that in five years time you don’t receive the dreaded phone call to say you’ve been called to discuss a case and you need to look back on your notes and write a statement. Documentation takes up so much of our time as it’s all we can rely on, maternity notes are kept for 25 years, you could be ask to look at notes from 8 years ago and explain why you did this or what you didn’t do that. It’s a fear culture and it’s so anxiety inducing, I love my job and on the good days it’s amazing but the bad days are truly worse than bad, most of us silently file them away and go back the next day. I’m sorry for everyone that hasn’t received the care they deserve, it’s just shit!

@Sleeplessem

Any Midlands midwives on this thread?

I'm not a midwife, but I am based in the Worcester area, work with women postnatally, and know midwives in the area. Where are you?

@Wannakisstheteacher

The induction limit decrease is not a minute before time. Babies have died because their Mothers were left until 42 weeks. In Germany you are induced at 40 weeks. It’s safer. Why would anyone want to risk it?

It's typical in Germany to induce around 40 + 10. That was when I was induced with my dc3, and the hospital would have been happy for me to go another day or two (that won't necessarily be the same in every case - they'll scan and look at the placenta, for example, to see if it looks as if it's deteriorating).

Slight derail, but it's the same in adult nursing. I can't even describe what went on during my last shift, the care I was forced to give was well below my standard, it was unacceptable and dangerous. I did report my concerns but was ignored and spoken down to.

Not sure I can do this anymore been an NHS nurse for years and am senior. At this point I don't even care about my pension, we are all on our knees and my mental health is awful.

I’m Birmingham @Somethingsnappy xx

@Rupertpenrysmistress

Slight derail, but it's the same in adult nursing. I can't even describe what went on during my last shift, the care I was forced to give was well below my standard, it was unacceptable and dangerous. I did report my concerns but was ignored and spoken down to.

Not sure I can do this anymore been an NHS nurse for years and am senior. At this point I don't even care about my pension, we are all on our knees and my mental health is awful.

@Rupertpenrysmistress I think I read on some other thread or an article I can’t remember but it was from a nurse or midwife saying there were terrified going into work as the thought of ‘is this the day I kill someone’ was just constantly on their minds due to hideous underfunding, baffling policies, increasing case loads and dangerous understaffing. That burden mentally, carrying those legitimate thoughts day in day out. You all deserve so much more than a doorstep clap x

I’m so glad I read this thread. I’m disgusted it’s really this bad though.
I’m not far off graduating as a vet and wished I’d done midwifery instead.. it seems the grass is always greener.

Pressed send too soon!

By that, I mean I viewed it (midwifery rather than veterinary) as the better option and it very definitely isn’t . I’m so scared of the blame culture that I don’t think I’ll ever practise as a vet.
I don’t have any children yet so I was ignorant to how bad things are.

With regards to continuity, some good answers of explanation earlier. I'll add a few more points about it.
So the model we have been asked to work in is, no more than 8 midwives per continuity team (8 midwives, not 8 WTE). They have only written the plan for full time staff (part time like me - who make up over 35% of the workforce have had no actual plan given) which is that you will do 3 community days per week, where you do you normal work, booking ladies, antenatal checks, postnatal care, accompanying women to clinic appts etc, then one day where you are on call from 8am-8pm for your women from your team who go in to labour. You plan a light workload for the day, so you can rearrange should you be called in to the hospital. You will also do one 8pm-8am on call night each week where you are on call for women as per above description. This on call period is done from home, so you can sleep but may be called out. The issue with this 12 hour on call period is that if you are not called out (which on my basic maths with the figures supplied from my trust you will be called out on average 1 in 3 - but let's be realistic, you are probably likely to be called out because of understaffed, sickness, workload etc so maybe 1 in 2. The times where you are not called out, or called out part way through the night - you will owe those hours back!!!
I can not believe they are trying to push this model through. For a start it is lip service to continuity, 8 midwives on a team... what is the liklihood of you knowing the midwife? Slim. Midwives can not work in a model where they are owing hours every month! Imagine owing 24-36 hours per month, being told you need to work those back in the next months period.
There is so much wrong with this model for both midwives and women.
I'm a part time, single mother midwife. I can't work in that model. I work on community because I can get childcare to cover those hours. I can not work in a continuity model. So they will lose a midwife of 14 years experience, and me and my children might lose our home.

@NameChangeADHD my son (he's only young!) is interested in being a vet. I've never heard anything bad about working as a vet before. What is it like?

That continuity model sounds awful, in theory great but never in reality. I cannot believe you have to owe hours with no call out, so you have to act as if you might get called out. I had no idea. Also does not sound particularly safe from a lone worker perspective.

In my area we just keep opening extra beds in unsuitable areas due to having more patients than beds, the model for staffing this area is just to move staff from wards already short, apparently that's safe. I just feel every day something awful is going to happen the nurse will then be blamed. There are no plans to improve the NHS we are just running it until it stops.

@ThisMustBeMyDream

With regards to continuity, some good answers of explanation earlier. I'll add a few more points about it. So the model we have been asked to work in is, no more than 8 midwives per continuity team (8 midwives, not 8 WTE). They have only written the plan for full time staff (part time like me - who make up over 35% of the workforce have had no actual plan given) which is that you will do 3 community days per week, where you do you normal work, booking ladies, antenatal checks, postnatal care, accompanying women to clinic appts etc, then one day where you are on call from 8am-8pm for your women from your team who go in to labour. You plan a light workload for the day, so you can rearrange should you be called in to the hospital. You will also do one 8pm-8am on call night each week where you are on call for women as per above description. This on call period is done from home, so you can sleep but may be called out. The issue with this 12 hour on call period is that if you are not called out (which on my basic maths with the figures supplied from my trust you will be called out on average 1 in 3 - but let's be realistic, you are probably likely to be called out because of understaffed, sickness, workload etc so maybe 1 in 2. The times where you are not called out, or called out part way through the night - you will owe those hours back!!! I can not believe they are trying to push this model through. For a start it is lip service to continuity, 8 midwives on a team... what is the liklihood of you knowing the midwife? Slim. Midwives can not work in a model where they are owing hours every month! Imagine owing 24-36 hours per month, being told you need to work those back in the next months period. There is so much wrong with this model for both midwives and women. I'm a part time, single mother midwife. I can't work in that model. I work on community because I can get childcare to cover those hours. I can not work in a continuity model. So they will lose a midwife of 14 years experience, and me and my children might lose our home.

When I was a community midwife, staffing was so crap I was doing a late on call (4pm-8pm) and a night on call 8-8 a week. On top of my 37.5 hours I was already working, if I wasn’t called I still couldn’t arrange anything on those evenings/nights as I had to be available to be called at anytime. I was paid £2.10 per hour for the on call periods and this was 16 hours on top of my 37.5 working week. If I got called the pay was good but if you couldn’t work the next day, you would owe those hours back!

I also HATED being a community midwife all I ever heard was ‘my midwife never gets back to me’, I’d try and reply between visits, clinics and on calls but with a caseload of 150 it just wasn’t always possible to reply immediately. Also, at every single appointment I’d tell women tlplease do not call me or text if it’s urgent eg reduced movements, bleeding please call the hospital. But every single day I’d turn my phone on and I’d have texts and answerphone messages saying ‘I’m bleeding what should I do’. ‘I’ve not felt my baby move for two days what do I do’. I never wanted to turn my phone off as I was worried what I’d turn it back on to find. CoC would be my worst nightmare, I want to be able to go to work and switch off after my shift.

I think you need to be mindful of the extent to which this thread is seriously going to stress out and worry women who are about to give birth. I am 35 weeks and reading this has caused me uncessary stress. I wasn't expecting things to be fantastic given Covid but this thread seems to suggest that I am guaranteed substandard care. Thanks a million @Sleeplessem !

@Annonmidwife I may have a reputation on mn for "nhs bashing" but I actually am not I am fully supportive of the nhs and it's staff - I used to be one

It's the cuts, underfunding and BAD staff (who are notoriously difficult to get rid of and are a major drain on funds and resources) that I am against.

This is the tories TRYING to get people to turn against nhs/staff and be open to privatisation DO NOT LET THEM

If there were ENOUGH midwives (and other staff of course) being trained and employed and SUPPORTED in their roles then they would of course be able to support mothers better.

It's insane how bad it is at the moment.

Several of my former colleagues are still working in nhs inc a midwife and it's just horrendous what's going on and what's being expected of staff!

Mh is usually the main "Cinderella" and forgotten service but gynae and obs is always a close second too - and surprise surprise it's the one with women patients!

Posting quickly for now will add more later

@66NC88 please do feel worried. I do feel that transparency is completely necessary right now. We need to be shouting from the rooftops that the service is not adequate at present, to keep the families safe. Please don’t feel that your care will be substandard, the majority of my colleagues go above and beyond and take such pride what they do and would be mortified to think any woman was expecting substandard care as a given. We just need more support, more money invested and more safe working conditions and unless we shout about it, nothing will happen.

Birth is an amazing experience, I never let my women know the chaos that could be going on outside their room so I hope you receive the same standard of care💕

Please do not* why a typo!!

Please DO NOT feel worried @66NC88

I agree with @Annonmidwife that midwives need to be heard. It is not safe and it is not fair on women or the midwives. Also yes the Tories are dismantling the NHS

Aside from the NHS being on its knees, I assume that qualified midwife numbers are lower since they introduced university fees?

It was my life dream to be a midwife, but I went for a health related course at Uni instead as I wanted to have other choices. Never used it though, got married and had babies.

Now to go back to Uni is £10k a year, and shift work with long hours which I could never work around my family especially when I was a single mum

Today is pregnancy and infant loss Remembrance Day

Now hopefully for the most part these issues cause nothing but inconvenience, but without wishing to be overly dramatic as someone who has experienced mc and a tricky pregnancy and birth with dd I worry that these issues may cause problems for other mothers and babies

More women, less midwives... what could possibly go wrong?!

Well quite!

@yippyyippy thanks this govt don't care!

My midwife kept me and my baby alive until we could get to theatre for an emergency caesarean.

I will never ever ever be able to express how much I love that woman.

It's horrifying to read what midwives are going through.

@66NC88

I think you need to be mindful of the extent to which this thread is seriously going to stress out and worry women who are about to give birth. I am 35 weeks and reading this has caused me uncessary stress. I wasn't expecting things to be fantastic given Covid but this thread seems to suggest that I am guaranteed substandard care. Thanks a million *@Sleeplessem* !

I’m 34 weeks too, you’re not the only one worried. You’ve made it 35 weeks into pregnancy surely you’ve realised that midwives are stretched beyond belief and it’s literally been In the news. What’s been Overwhelmingly obvious is not the inevitability of ‘substandard’ care as you put it but how much the midwives are trying their best to care for mums in really trying circumstances.

Plus with all due respect you’re responsible for what you click and read. This is the lived experience of midwives, they deserve to be heard too.

@Annonmidwife

I’ve name changed for this!

I’m a midwife, I’m 28 and I started training in 2012 and let me tell you, it’s bad. The staffing is horrendous, we were down 4 midwives last week per shift. When articles like this are published, local news stations post them, the comments are vile. Utterly vile. You just have to come on mumsnet and venture over to the pregnancy section to see the degrading comments people make about their midwives, some women don’t realise that they are one of thousands and thousands currently pregnant within these trusts, they instantly turn to social media as they haven’t had a routine call back. Probably because the midwife that was meant to call has been called into the unit to make up the staffing numbers, probably without a break, a drink or a wee in 12 hours! There’s no respect for staff and it’s a bleak place to be currently, I don’t know how it will get better, I don’t see it getting better. My trust suspended home births for safety reasons, I’m so pro choice and I love empowering women and supporting them to birth their babies however they choose, but 80% of the comments were women encouraging each other to free birth, or encouraging each other to ‘just stay at home as we have to send someone’.. yeah, an ambulance, probably driven by a paramedic that’s never been to a birth before. No one goes to work wanting to cause harm, but the harm that can be caused is catastrophic and the psychological effect on the staff immense. This is just the tip of the iceberg and I could rant on all day, but I promise we are trying.

This is just a ramble but it’s nice to get off my chest and it’s lovely to know that some appreciate us.

Yes. We do appreciate yourselves. I will never EVER forget the midwife who, after 50 hours in labour and I was absolutely shattered - on the way up with my baby to the ward gave me a kiss on the cheek and said I had done really well.

16 years later she is healthy, well and a wonderful young woman.

I will never forget, and I am so sorry yourselves as a profession are going through this.

It is horrible. It is not right. You need a massive pay rise.

www.change.org/p/sajidjavid-support-urgent-government-investment-into-maternity-services-to-solve-the-staffing-crisis?recruiter=false&utm_source=share_petition&utm_medium=facebook&utm_campaign=psf_combo_share_initial&utm_term=psf_combo_share_initial&recruited_by_id=24703d20-18b7-11ec-8510-3bfc9f2be5e2&utm_content=fht-30710057-en-gb%3A6

Can we please all sign and share this petition.

I've been seeing articles about this for years. It's bloody scary. I can't imagine the amount of stress that the midwives feel going into that situation each day. Equally as a pregnant woman myself, I'm scared.

I've been weighing up the idea of getting a doula for assistance with my birth, it's a long way off yet. There are lots and lots of midwives who say they left because of the stress of not having time to care for patients as they needed- too little time and too much need. Not sure how it works in practice but it's a horrible situation all round.