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

That’s why I said I think better expectation setting right from the offset would help with things like this. If you were told we start listening to baby’s heartbeat at 24 weeks and then fundal height and presentation from 28 and it’s for xyz reason it would probably make a lot of mums feel more comfortable

Some sad posts here. Makes me feel very sorry for my colleagues who honestly work as hard as we can under increasingly difficult circumstances. I can relate to so much of it.
And we do it because we care- very much.
A breech presentation can be missed; not just by midwives either.
The gestation is relevant; babies can turn from breech after 36 weeks (mine did).
It can be difficult on palpation and it's really not as obvious as one might think. Feeling for baby through another body isn't easy- many factors involved here.
Midwifery training is not a walk in the park- it's physically and emotionally tiring.

Thank you for the understanding and support shown here, it's appreciated.

@Sleeplessem

That’s why I said I think better expectation setting right from the offset would help with things like this. If you were told we start listening to baby’s heartbeat at 24 weeks and then fundal height and presentation from 28 and it’s for xyz reason it would probably make a lot of mums feel more comfortable

I think the move to the digital notes really doesn't help with this- the old paper notes had the main info held within and I guess were relatively easy to update the template. The notes app, even if it works, has really sparse info and then not very intuitive navigation to the digital versions of the leaflets. I don't think it even points to the food in pregnancy guidance which is probably 5% of the posts on the pregnancy forum. And another 5% are the antenatal schedule which was definitely in black and white in my old notes. I know it shouldn't be rocket science to check the NHS website first, and yet...

I'm sure many of the 'can I/should I/what about questions that get posted on here would be alleviated by a return to a paper system with maybe a bit more 'bumph' in it. The more people have to search for info the more questions they have to ask of a human- and if it's not presented in an official document they might still not trust what they find (quite rightly given the state of Dr Google) and double check anyway.

I'm not conflating this with individual posts/situations here but I do believe in general that having a guaranteed pack of basic paper info, even if it's just glorified printouts of the NHS website, would help basic patient understanding and cut some of the queries and calls made to the midwives, clearing the way for those that do need a conversation.

@Piglet89

with love and respect if you’re not medical you aren’t going to have the specific knowledge on how to interpret somethings and sometimes too much info is worrying.

As i have Said before a) give me the information
B) explain to me how I should interpret that information.

I’m an intelligent person - I think I can handle it.

How could we possibly cover all potential possibilities with every women in a 20 minute antenatal appointment- plus then documenting everything we’ve said..

You want private care on an NHS budget, it just can’t happen at present.

It would be a case (as is standard in some countries) of needing to undertake an ultrasound scan at each appointment if the expectation was for all breech babies to be detected as early as possible antenatally. As it is very easy for even the most competent and experienced practitioner to not detect a breech baby. There would also then need to be the extra time to discuss the potential implications and options with women, some of whose babies would of gone on to turn before 36 weeks. This may seem insignificant but when there are up to 20 issues to review in each 20 minute appointment slot, every minute counts. Resources in terms of expertise/training, equipment and time would have to be pulled away from other important care we have evidence actually make a significant difference to outcomes. For this to be provided by the NHS, funding sourced from tax payers would have to be increased substantially and even then there are other priorities many would feel need to be addressed first.

Tbf, I do (did) discuss findings on palpation and explain on what's normal, what we do if breech later in pregnancy etc.

At 35 weeks, I would explain findings, helped you palpate what I was feeling should you have been interested in that, I wouldn't have referred as it would've been refused. I would've seen you at 37 to confirm and refer for scan. I would have explained all this and reassured you.

Seen numerous babies confirmed as breech via scan at 37+, booked for elcs, scanned again prior to surgery and found to have turned. They just do as they please!

@1FootInTheRave you sound amazing and I wish you’d been providing my ante natal care!

I never understood the continuity idea. I saw loads of midwives. I had all my antenatal appointments at the midwives' building attached to the hospital. About 10 on duty at any time and I saw whoever was free. Then a totally different team on the labour ward.

Always seemed obvious to me that antenatal care and delivery are different specialities and we expect doctors to specialise so why not midwives? I wouldn't want the same team trying to cover all aspects of the job. Seems daft.

@DappledThings

I never understood the continuity idea. I saw loads of midwives. I had all my antenatal appointments at the midwives' building attached to the hospital. About 10 on duty at any time and I saw whoever was free. Then a totally different team on the labour ward.

Always seemed obvious to me that antenatal care and delivery are different specialities and we expect doctors to specialise so why not midwives? I wouldn't want the same team trying to cover all aspects of the job. Seems daft.

Most midwives rotate though, they don't tend to stay just in one area, they do all aspects. Continuity of care is fantastic if there are enough staff, as we don't have that it puts more pressure on an already creaking system.

That's a valid point Dappled, and one I think women aren't made aware of.

Continuity being pushed as gold standard. How lovely to know your midwife in labour. Gloss over that the midwife hasn't worked on a high risk delivery unit for a decade and would rather be anywhere but there.

The other option is you see mainly the same one antenatally and postnatally, for labour you have a delivery midwife. Proficient and skilled in that area, passionate about intrapartum care. And working as part of her shift pattern, not called in after already working a clinical day.

Not exactly a fully informed decision is it?

Peaflock, rotation varies hugely between trusts.

I always rotated frequently as I like change.

Some have been in their area of work for 15+ years!

Continuity of care is fantastic if there are enough staff
But why is it? I don't get what the advantage is meant to be. If you have complications or are in an abusive situation where extra support is important then I can see it but I don't get why it's worth trying to make these complicated plans for straightforward pregnancies.

I saw loads of midwives. They could all read my notes, I didn't need any of them to know me personally and wouldn't have wanted to be tied to just one who could be hard to get hold of when I could see anyone in a large team.

Judging from this thread, it seems like there's a big difference between England and Scotland. The care I had was fantastic, even with COVID everything seemed really calm and organised.
I had a breech baby and it was picked up really early. I was told straight away what my options were, and it was also explained to me that baby may turn at the last moment, so I could change my mind any time (I opted for a planned C section and they checked the position just before theatre, so if baby had flipped I could have still had a vaginal birth. There was also the option to attempt a natural breech birth, but I'm not that brave).
I had read horror stories on here about post natal wards but my experience was like being in a hotel, cups of tea/snacks on tap and pretty decent meals for a hospital.
I was kept informed at every stage about what was happening.

Can I ask the HCPs on here why continuity is being pushed as the norm if it doesn't bring much to the party? As I said before I didn't give a monkeys who I saw when I knew that was the structure. Although it has been nice to have the same midwife at the last few appointments we've only been working to the consultant (again, same one most of the time) notes really anyway. And the consultant appointment midwives are different again! All perfectly nice and good at informing and reassuring so if I'd not been 'sold' continuity at the start I wouldn't have known any different.

If continuity doesn't add much on the ground (and seems to be causing staffing problems even more as well as the issues mentioned upthread with specialism and preference) how do we get that looked at? Who in the system is pushing it and why?

Or is it like schools and Ofsted where they follow the fad they think the inspectorate wants to see? But of course schools aren't directly life and death enterprises...

@AngelDelight28 I think the issue most people have with postnatal is the design of them, four women and brand new babies in various states of post-birth health all sharing a hot brightly lit space, one toilet and shower, visitors everywhere (although thankfully no overnights here). You could have 1:1 care and I'd have still hated every second of it because of the layout is just not good for anyone, in my view, it's the part I'm looking forward to least.

I’m also a midwife and work constantly in fear of caring for a women needing the third emergency procedure at the same time (we have only two senior enough doctors, one of whom might be very new and/ or managing an emergency in AandE or Gynae). We used to be able to deliberately suppress the workload and risk level at night to accommodate this but now we’d never get through the work if we did that. It’s horrifically stressful and I do to an extent thrive on that (wouldn’t work nights on a high risk labour ward if I didn’t) but the balance has tipped far too far.

We also have to care for pregnant women unwell with Covid only and I feel very out of my depth doing that. At the opposite end of the risk spectrum, brand new midwives are being pressured to immediately independently care for women in our home from home birth centre where they often feel completely unsupported and alone. These were historically staffed by experienced community and core birth centre midwives who would support and develop the skills of midwives inclined to this model of care. There is now so much fear and defensiveness that I feel the concept of low risk inpatient care (and the awareness and support for elements of it that can be safely recommended to high risk women) will wither and die.

Continuity has been demonstrated to improve outcomes for women and babies, ironically in many ways that would save loads of money! Even with funding for it though you’d need to magic up the extra midwives.

I wonder why rooms are dorm like still in England?
Ds was born last year in another European country, nhs equivalent and all rooms are private. Apparently ‘dorm’ like shared roomed stopped about 30 years ago.

As a comparison they take maximum 16 mothers at a time. There were 10 midwife’s and 6 consultants on duty, that’s a normal week. Paediatricians come in daily ontop to check the babies. Standard stay 3-7 days.

@8dpwoah Yes I can see why that's not ideal. I guess I was lucky in a way, as due to COVID there were no visitors allowed and the ward was fairly quiet, only me and 1 other woman. Actually I would've felt quite isolated in a private room, so a way when I felt vulnerable it was reassuring to have other people nearby, and there was always the curtain for privacy. But I get not everyone likes that set up.

@SwayingInTime

Continuity has been demonstrated to improve outcomes for women and babies, ironically in many ways that would save loads of money! Even with funding for it though you’d need to magic up the extra midwives.

I didn't know that- so I suppose the issue is then that it's been implemented before the staffing (recruitment and retention) has been secured for it? Kind of like good idea, let's make it fit what we've got rather than bringing it in once the resources are there to do it well from the off?

@candlelightsatdawn

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

Generally interested because usually then medical body of staff, team together and say we don't like this, there's a bloody good reason usually there's some type of link to reducing costs with these "plans" !

They are the gold standard. The evidence shows (world wide research and development) that continuity of carer for mother's Dave's lives and reduces intervention. It needs lots more staff but would reduce costs in hospital as there would be more home births and less intervention in hospital births. The bottom line is to do continuity effectively you need boots on the ground and the lack of investment in midwives and midwifery for the last 30/40 years is biting us on the ass.

@Caspianberg

I wonder why rooms are dorm like still in England? Ds was born last year in another European country, nhs equivalent and all rooms are private. Apparently ‘dorm’ like shared roomed stopped about 30 years ago.

As a comparison they take maximum 16 mothers at a time. There were 10 midwife’s and 6 consultants on duty, that’s a normal week. Paediatricians come in daily ontop to check the babies. Standard stay 3-7 days.

Top quality NHS care is pie in the sky until you realise other countries are actually doing it

@SwayingInTime

Continuity has been demonstrated to improve outcomes for women and babies, ironically in many ways that would save loads of money! Even with funding for it though you’d need to magic up the extra midwives.

But what are those ways? For a straightforward pregnancy with no complications (physical, mental or social) what are the benefits of seeing the same person to take blood pressure and measure final height and talk about breastfeeding? And what are the benefits of that same person covering the different speciality of delivery?

I've heard it quoted as being the gold standard but I don't get why.

I must admit I don't see how having the same midwife would have made my SGA baby grown any bigger and avoid induction (and then consequent epidural that I insisted on with the drip) and I wouldn't have a home birth of you paid me.

I can see how it would be nice, and in difficult or traumatic circumstances that constant face and developing relationship would definitely be supportive, but I think there's more women like me that aren't bothered who's doing the care at that time as long as they are qualified, confident and not worked to the bone?

The vile comments made on social media about nursing/ medical staff is becoming outrageous, slagging off and threatening complaints left right and centre and phone calls etc not being returned is a daily occurrence in CAMHS, all the while staff having no breaks literally peeing your pants and never finishing on time. Sad to see it’s the same in midwifery