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

@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.

My homebirth was suspended. There was a lot of encouragement on Facebook groups for staying at home and having someone sent, however please remember that those comments are often there anyway and are said to women who live in areas where home births were discouraged prior to the pandemic.

Also on home birth groups there is a not insignificant number of people who have chosen the home birth route due to previous birth trauma. For many, free birthing did seem like a safer option for that reason. I’m not saying I agree with that conclusion. I had a hospital birth when my home birth was cancelled, but having had a very traumatic birth where a lot of things happened to make me feel unsafe (a wasp nest in the room with wasps being swatted away as the epidural was being cited and anargument with the consultant after I had been pushing for 45 minutes as she was adamant I couldn’t feel pain, being unnecessarily banned from eating in labour), I can see why people may have been willing to risk a free birth.

@Beaudalaire

I have so much admiration for midwifery staff who I think are doing the very best in untenable conditions However, there is national scandal in maternity care with 2 public enquiries into failings at different trusts and I think it’s important this isn’t glossed over as when things wrong it’s devastating, truly.

Sadly I believe this goes beyond the 2 Trusts subject to enquiries and there are many, many more. Tragedies like at Morecambe Bay and Cwm Taf only come to light when the numbers reach a high enough threshold that they raise suspicions. Before then, there will be tens of mothers and babies needlessly dying but not wholly investigated, reports to MBrace etc not submitted, internal investigations that focus only on correct documentation rather than what caused the tragedy. Before then, hundreds of “near misses”, thousands of mothers left for hours without pain relief, babies left to get cold/hypoglycaemic, families deeply upset by poor communication etc.

The trouble is though - as long as the response is more blame on individual junior staff, more paperwork to prevent litigation; the real root causes of staffing and culture remain unaddressed.

To expand on my last comment, my hospital birth during the pandemic was fantastic. It followed a great home birth and I was assisted by the home birth team in the hospital. It was basically the ethos of a home birth but in the hospital environment. It was wonderful

Of course we can appreciate individual midwives doing the best they can, but also acknowledge systemic failures and the source of the problems. The two aren’t mutually exclusive. My midwife was lovely but what I struggled with was the lack of proactivity from her - no suggestions on further pain relief once my epidural failed, no mention of moving me into another position when second stage was dragging out, in fact I wasn’t ever asked if I had an urge to push I was just told to do it 😒 it felt like the aim was to just leave me on the bed, speed up the birth as much as possible & get me out the room.

I’m 33 weeks and of course it’s scary reading this thread. But it was also scary the other day when I rang maternity assessment and the midwife told me the hospital was on divert. I have GD and will likely end up having an early induction and it’s scary to see how many women, in many different trusts, are being told they need to be induced but the hospitals just don’t have the staff to do it.

Our trust operates continuity of care. I didn’t really understand how my community midwife was able to do all booking appointments and general midwife appointments but also possibly be on call for my birth. It seems like the model is even more unrealistic that I first thought. I kind of accepted that my community midwife would not be at my birth but obviously this trust is pushing the principle and it will lead to a lot of women feeling disappointed.

I’ve actually not had continuity of care as my midwife changed at 24 weeks due to staffing levels. It doesn’t bother me and fortunately both my community midwives have been really lovely. With the GD I feel like I’ve also met half the bloody hospital staff, there’s only one member of staff who I thought was quite rude and I didn’t like. That’s from the ultrasound techs, GD staff, midwives, admin staff. I think my trust are doing really well, it’s clear they’re understaffed in all areas but I don’t feel my care has dipped. I suppose that’s the problem though isn’t it? As long as women are getting the care they need, it doesn’t matter how stretched the system is and how close to breaking point the midwives are. Midwives go into this profession to look after women at their most vulnerable and when you enter that type of work, you can’t just switch off easily.

I’m adding boxes of chocolates to the list of stuff we need and I’ll make sure I tell DH to give them to midwives on the ward and the community midwife.

@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 would also be terrified if I was pregnant and had just read this thread. But fwiw I gave birth in March 2021 when everyone was exhausted from the pandemic and had a thoroughly GOOD experience, despite it being a long labour and induction that eventually resulted in EMCS! I cannot fault the midwives and wider team for the care I received at any point. I felt safe and in good hands throughout. Yes, I was aware of the staff shortages, and occasionally had an appointment rescheduled or saw a different midwife to the one I was expecting, but never felt these staffing problems impacted on the care I was given. It was far from the ideal birth that people write about in their birth plans , because my family seem to have been incapable of giving birth vaginally for at least a century, but it was fine. The worst part was the loneliness of a long labour with no partner allowed.

I’m a midwife and I love my job, and yes we are under staffed and over stretched. I have a senior management role part time, but I also work one or two nights a week on the labour ward & I cover home birth on calls to fill the gaps. It’s the most difficult time I’ve ever known in midwifery, everyone’s tired and frustrated and nobody can see a point when it gets better. But I do know that I, and all my colleagues, are trying our best and that we don’t allow the frustrations to show to the women we care for. I genuinely love being a midwife and I am not yet considering leaving the profession - although I’d hate to work in a privatised model - and I am lucky enough to work in a unit where the Consultants are happy to be challenged and I feel we have good working relationships and all want the best for our women and babies.
So for all the expectant mums reading, not everywhere is terrible. You will get good care from people who genuinely want the best for you, and hopefully the day you meet your baby will be one of the best days of your life. And for the women who don’t have that experience, speak out. Speak to PALs, the head of midwifery or look up your local MVP. And everyone can join us in petitioning parliament and demanding the government do better - more midwives, better pay, better conditions, because the issues in maternity cannot be solved at individual trust level anymore. I refuse to be driven out of the job I love just yet, I will hang on until the bitter end, I just really hope the bitter end does not come.

Midwife here too of nearly 20 years. So sad to read these comments but can totally relate. I have never known it so bad. For those asking about training, that doesn't seem to be the problem it's the retention of staff. Midwifery has changed a lot and so have the women we care for. More high risk women, think IVF, heart problems, raised BMI. Things are great as we have become so advanced but that takes time and training and more midwives than we had previously. Lots of people expect the job to be challenging emotionally and mentally sometimes but it is also very physically demanding. I am fit and healthy but not sure how the hell I would do it up until 67! We have to frequently close' and send women to other hospitals as we don't have any staff. Those of us left are really trying and we will literally work till we drop to care for our women and babies. Anyone who is worried please try not to, there are amazing midwives out there who will look after you. Always call your hospital if you are worried about your baby and never put off going into hospital to be checked over.

[quote ThisMustBeMyDream]@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?[/quote]
I’ve been a vet for 12 years, it’s not terrible, definitely not as bad as working for the nhs in many ways. But it is similar in that you are providing medical care for patients with complex needs and unfortunately not always great outcomes (imagine being a gp, surgeon, medic, midwife, radiographer/sonographer and palliative care doctor rolled into one) with an unpredictable case load, disruptive emergencies and a lot of admin/lab reports/prescriptions to fit in around everything else. And, like the nhs, every patient comes with a worried and often emotional/impatient human being attached, many of whom behave as if they are the only client you have to think about that day. Who would want you to drop everything and deal with their emergency but tut and huff when they are kept waiting over somebody else’s. Oh and resent paying for your time, expertise and the upkeep of the expensive equipment on which you rely. And as an industry also with massive staffing shortages, unsociable hours and mythical lunch breaks….

But don’t let that put your son off. It still has its great moments, but you need a lot of resilience, time management and people skills for clinical veterinary work.

Well when university's only allow something like 30 pupils onto a training course what do they expect. Increase training places

(Oh and more of our patients are likely to bite, scratch and kick you)

More high risk women, think IVF, heart problems, raised BMI.

That’s a very good point which hadn’t occurred to me.

Of course people will say the service needs to adapt to fit the customer, but do you think maternal age has had a significant impact upon the number of women with greater needs in pregnancy? If I can ask that.

But who is going to train those students? 50% of their time is spent on placement and there are a limited number of experienced midwives for them to work alongside. We have time when we really struggle to allocate mentors to all the student out on placement, increasing training places isn't necessarily the answer.

That said, I don't know what the answer is. Definitely scrapping continuity of carer for starters, it's taking midwives away from ward based roles without really reducing the workloads on the wards/in community as each midwife cares for far fewer women. We are constantly being asked to do more with less and it isn't sustainable.

OP also asked about inductions, the change is definitely not related to staffing issues, in fact it has the opposite effect - women being induced are likely to be in hospital for longer (due to the length of the induction even if the stay afterwards is the same) so it makes staffing issues worse. But the evidence says it is safer so on we go.

How terrifying! I didn’t realise it was this bad. I remember labour ward and maternity assessment unit being overcrowded and understaffed back in 2015, so can only imagine what it’s like now.

What do the midwives on the thread feel I should do about the booking in appointment and 12-week scan, are these still offered on the NHS?

My GP practice has no midwife and none of the staff seem able to find the new phone number for the ‘health visiting team’. I had a private scan at 6.5 weeks to confirm the heartbeat etc. I feel like I shouldn’t bother the NHS midwives so do I just book the 12-week scan privately and ask for the 20-week one on the NHS? (I’m 8.5 weeks, 2nd baby, 37 yr old, want to give birth on a consultant led unit, ideally with an epidural as last baby was back to back and unusual presentation).

Or would having the 12-week scan privately (and emailing details to GP) mess things up? Do I keep hassling the GP for the contact details of the local community midwives/health visitors? Apparently the old number has changed and nobody knows the new one, unclear whether they really don’t know or if the service is overwhelmed with women trying to contact it.

It’s worrying to think there are other women with their head in the sand at later stages of pregnancy, thinking it will be all ok.

I will sign. If it were men having babies you can bet the service would be properly funded.

@fatehasredesignedmost we really do need to book you. The initial history taking, and your bmi , bp and bloods at the beginning of pregnancy are crucial to making your plan of care. It sounds like your gp are being less than helpful. Can you find your local maternity unit online and contact them directly?

I clocked that I was probably higher risk due to my age following a pretty probing conversation with the NHS midwife running our antenatal classes.

They didn’t spot my son was breech at 35 weeks; I decided to go private as our occupational health insurance covered it. My consultant spotted it in seconds as he had an ultrasound machine in his room. He was like “turning procedure or c section”; I chose the latter.

Terrifies me, frankly, to think what might have happened if I’d just stayed in the NHS system who seemingly had no idea he was breech.

we really do need to book you. The initial history taking, and your bmi , bp and bloods at the beginning of pregnancy are crucial to making your plan of care. It sounds like your gp are being less than helpful. Can you find your local maternity unit online and contact them directly?

Thanks, that’s a good idea. I wasn’t sure if the booking appointment was a thing anymore as the GPs don’t seem to know.
They’re happy enough to keep prescribing meds for HG (without ever seeing me) but seem clueless about the midwife side of things. One suggested phoning the local EPU to ask for the number but I don’t want to put pressure on already stretched services.

By local maternity unit do you mean phone the local hospital and ask switchboard for it, or any nearby maternity unit from a Google search?

But Piglet89 this is a really good example of why midwives get a bad name through no fault of their own. It doesn’t matter if your baby is breech at 35 weeks. Evidence says that ECV shouldn’t be done till 37 weeks because of the chance of baby turning back so our unit would determine at 36 weeks the position of the baby and go from there; refer for presentation scan and ECV if appropriate/consented for. We wouldn’t be checking at 35 weeks to ‘do’ something about it as if you went into labour then it would be obstetric led as a prem labour.

But if you have nobody to explain that how can you know? And when there’s no phone number or the midwives are always in clinic or on house calls how can they be available to answer?

I have never met a midwife who went into the profession to intentionally be crap or mean to people or to be dismissive and horrible. People don’t go into midwifery for that. It gets into them along the way. I spend a lot of time with people managing their practice and try to remember that as I’m going along; usually their behaviour is because of a trauma response of some kind. Obviously there’s always a few people who are just wholly unsuited to it. But I said to my friend last night we have all got a level of PTSD after the last few years and even from before that in a lot of cases and I’m not surprised people are leaving when people with 20+ years of experience don’t have any way of even earning more than £40k unless they go into people management. Because clinical experience is not valued.

As a paediatric nurse I see the shortcomings in maternity tipping over into our unit when we see many babies being admitted to our unit due to ineffective breastfeeding leading to a range of health concerns which the babies need treatment for. In the worst case scenarios we have 5 day old babies being treated in our high dependent unit because of how sick they are due to inefficient milk intake.

We’ve treated over 20 babies in the last month and most of the mothers will say that post birth they weren’t shown how to latch the baby to the breast or how to position it correctly, they weren’t told how to recognise if their baby is getting enough milk and they weren’t even watched breastfeeding their babies before they were discharged.

I know it is because of low staffing levels but it just demonstrates another way in which a lower standard of care is impacting on the mother and baby.

On continuity ... antenatal continuity of carer is quite easy to achieve as the midwife just works a set clinic day each week. Works really well for both midwives and women and as many of the advantages of COC tout better outcomes that relate to prior to birth then surely many would be achieved with just antenatal continuity? Providing continuity of carer postnatally a little more tricky to achieve as midwife might not be working on day visit required but named midwife usually able to still provide some of the care. Trying to aim for the same midwife to also care for a woman also during the birth is where it starts to become a bit unstuck for all the reasons mentioned in previous posts ....
Midwifery is an increasingly tough job but the lovely women/families we care for are what keep many of us in the job. Coming into work early and knowing will finish late plus working through your break to then have a woman (or more often then not her partner) miffed because clinic running late (simply because you’ve been trying to give everyone decent care) and the fear of litigation despite doing best in very challenging circumstances really make us consider leaving.
To reassure women pregnant at the moment, most women will still receive great care and bad outcomes such as overall stillbirth rates continue to fall year on year. For example serial growth and wellbeing scans for unborn babies at risk are now routine. If you experience a true emergency then you will be made top priority. In the meantime staff really are just trying their best and do wish care could be better too.

It's not just midwifery. I know people who work in our local mental health hospital and the staffing levels are dangerously low. There's times there is no qualified nurse rostered on, just a procepter who can't work unsupervised. They have to get nurses off other, also short-staffed wards. One of my friends often works 4-5 hours on top of her 12 hour shift to cover until they can get a bank nurse to take over. Meanwhile, some of the patients are very difficult to manage, behaviourally. They'll have more people on one to one observations (which is basically suicide watch) than they have staff.

The NHS is being eroded before our eyes, through underfunding and mismanagement at the very top level.

In my recent and not so recent experience of midwife care, the staff do their best not to let it affect patients. I had a baby last year and had an extended stay in the maternity unit due to complications, and the staff were fantastic. I don't know how HCPs do it, they are clearly drowning in their work but they still do their best to provide good patient care. I'm not surprised they're leaving in droves, they're being treated abysmally from the top.

I worked as a midwife for a year and left due to lack of support and such unsafe practice.
I've done additional public health training and love my role now. So much happier and I don't dread going into work!
Dread to think what the wards are like now.

@Iwouldlikesomecake

But Piglet89 this is a really good example of why midwives get a bad name through no fault of their own. It doesn’t matter if your baby is breech at 35 weeks. Evidence says that ECV shouldn’t be done till 37 weeks because of the chance of baby turning back so our unit would determine at 36 weeks the position of the baby and go from there; refer for presentation scan and ECV if appropriate/consented for. We wouldn’t be checking at 35 weeks to ‘do’ something about it as if you went into labour then it would be obstetric led as a prem labour.

But if you have nobody to explain that how can you know? And when there’s no phone number or the midwives are always in clinic or on house calls how can they be available to answer?

I have never met a midwife who went into the profession to intentionally be crap or mean to people or to be dismissive and horrible. People don’t go into midwifery for that. It gets into them along the way. I spend a lot of time with people managing their practice and try to remember that as I’m going along; usually their behaviour is because of a trauma response of some kind. Obviously there’s always a few people who are just wholly unsuited to it. But I said to my friend last night we have all got a level of PTSD after the last few years and even from before that in a lot of cases and I’m not surprised people are leaving when people with 20+ years of experience don’t have any way of even earning more than £40k unless they go into people management. Because clinical experience is not valued.

This.

This is a brilliant explanation, families tar midwives are crap and incompetent as they do not have the understanding of guidelines, procedures and care pathways. But like you say, if no one explains, how can people understand. I also feel like routine birth debriefing would be an excellent way for women to discuss their care and ask questions, so years later they aren’t coming to an Internet forum to say how crap the midwife was as they didn’t spot a breech at 35 weeks! The consultant didn’t spot it either, they performed an obstetric ultrasound, as they are consultants, trained in sonography, we don’t have x ray vision😩 Even my friends have told me their birth stories and I can categorically sit there and think ‘that didn’t happen that way’ as whatever they are describing is medically impossible, but that’s their understanding of the event.

But again the funds and staffing can’t stretch to a fully staff Labour ward, let alone routine birth debriefing for all women.

@66NC88 I'm sorry if it scares you but it's so important for people to know what is happening behind the scenes, if anything so expectations can be lowered. I'm not referring to a safe birth of course but if an appointment gets changed last minute, or you get seen late people need to understand why that is. The pregnancy board shows how little people know of the crisis, I lose count of the number of people complaining that they're 6 weeks pregnant and haven't heard off a midwife and only earlier this week I was arguing with another poster who was complaining about the facilities that are available on a consultant led unit. Fuck the facilities, I'd give birth on a cold floor if it meant there were enough midwives for everyone. Midwives work bloody hard, at my 16 week appointment my midwife was having to run 3 clinics all on her own as 5 members of her team were off sick. And I wouldn't even have known if she hadn't mentioned it, at no point did I feel I was rushed or anything like that but inside she must've felt bloody stressed out. Any midwives reading this: you do a fantastic job and I am so grateful to each and every one of you.