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

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?
Exactly. And if someone else had received poorer care because a system had been stretched so I saw the same midwife each time when I really couldn't care less who I saw makes no sense.

Wouldn't a two-tier system be more sensible so 8dpwoah and me and the probably thousands of other woman unmoved by continuity see a team and then those who need more 1-2-1 support be moved into that other level? Would mean fewer midwives needing to be stretched across these continuity teams and those who want to develop those relationships can specialise in continuity care.

We’re talking about massive numbers to see the effects, less intervention and less premature births are the clearest cut effects I remember off the top of my head. I have no explanation for the mechanism for either. TBH, it seems to be the best way to keep pregnancy and labour as boring and straightforward as you describe, which is always the aim if possible!

However, I can see that continuity for high risk women could be even more beneficial and I think we do that really well in specialist clinics. We also focus continuity programs in areas of deprivation where the effects are really immediate and obvious (prenatal vitamin uptake, smoking cessation, appointment attendance) and with women needing extra support for other reasons. There’s also greater chance of disclosure of domestic abuse and mental health problems. But then I completely take your point of how it can be difficult for mainly antenatal midwives to come on to delivery suite where we change the guidelines and move the equipment weekly. I worried about this a lot but to be honest staffing on the continuity teams has meant I have seen it happen once!

Picking up growth restriction used to be suggested as a benefit of continuity all the time but we now have the Saving Babies Lives to implement evidence based care in that area. I think so much has changed (especially induction rates) since the big documents recommending continuity that we need to go back to the drawing board to some extent.

I had my baby a few years ago whilst CoC was in its early stages at my local Trust, not in time for it to affect me but I saw it from the other side as part of my job at the time.

I always thought it was a bit of an odd one given there were never enough staff then. Clearly you need a full compliment of staff to make it workable. Lots of murmurs at the time about how it would make the job unworkable for many midwives who would then leave.

I can genuinely see the benefits for women with complex histories, previous losses, deprived situations. But it would have made no difference to me. All I cared about was safe and competent care and that’s what I got. And to be honest I didn’t feel comfortable with my community midwife and would not have wanted her at my birth.

Do you think ditching (or targeting provision, I like that idea!) the obsession in some trusts with continuity, at least until the staffing is in place to do it well, would help with retention rates or is it more than that that's driving people out? At the minute I don't think midwifery has the negative public perception that teaching has which is what knackers retention in schools (teacher bashing during Covid) but if this was one big thing that would help with the staffing levels and funding issues to a point, would it be worth campaigning for as it's a very specific thing? Or is it just a drop in the ocean of problems?

Although I get it would be very hard to argue against an evidence base that shows that, done well, it's a really good model. The crux of it seems to be that you can't do it well unless you've got great staffing levels (and if you've got great staffing levels, surely 'normal' care would be better anyway negating the impact of continuity?)

I am a midwife of 25 years. In our trust we have a team of midwives who deal with more complex social cases, those with previous traumatic deliveries or ptsd, mental health issues etc. These women have the same midwife for antenatal, labour (if free obviously but another from the team if not) and they visit them on the postnatal ward. Their discharge is directed to this specific team too.

It is quite a new thing (a couple of years) but it is wonderful and sounds like the compromise a couple of pp's suggested.

We always used to have continuity in a way as community midwives did so much more care. We physically had no triage department 20 years ago so community midwives were fielding all those questions and problems and suggesting attending the hospital if needed. I am not saying this was a good thing necessarily! You also had domino birth where you were assessed at home and just came in for the birth with your community midwife.

So much has changed and we quite rightly have higher standards for outcomes. Our triage now has women queuing and waiting for hours and using scan beds as extra trolleys at night and rotating the women around the beds from the waiting room to be seen when we finally get a doctor. I hardly ever see anyone in spontaneous labour and the c/s rare is over 1/3. If this is what is needed to keep driving down the SB rate I am all for it and choose this environment to work in but it is a different world in a very short space of time.

Obviously we always had high standards, just we have been explicitly challenged as a healthcare sector to reduce stillbirth rates dramatically and implementing the interventions to achieve this has changed the nature of what we do a lot.

It really isn’t generally an issue providing antenatal continuity and in my experience does enable more effective care, particularly within the very limited time available to provide care. This is the way most community teams have operated for years, a midwife is allocated a GP surgery and runs a clinic for all the women from that surgery with the clinic being covered by other members of the team when she is on leave/sick etc. The woman is given a contact number for the community team and also an advice line number so she can always contact a midwife if needed. Postnatal care is undertaken by the named midwife for a woman if she is on duty and not doing her clinic that day but otherwise by another midwife from the team. It is really lovely visiting families you’ve cared for antenatally. The warm welcome given by parents you have cared for since their first booking appointment and their joy and pride as they introduce you to their new arrival is one of the most wonderful aspects of the job.
I can imagine it would be nice to also have the same midwife care for women during their birth but this is where the huge logistical difficulties arise and usually also results in there then less opportunity to provide the antenatal and postnatal continuity and for how much benefit??

I completely agree that by tying ourselves in knots trying to provide labour care continuity we risk losing that practical and achievable continuity that everyone’s been just getting in with for ever that you describe.

@SwayingInTime I hardly ever see anyone in spontaneous labour and the c/s rare is over 1/3

I find this really surprising! Perhaps this is part of the reason for the staffing issues now? So much more intervention. Have still birth rates for low risk women really reduced that much?

I had a quick look and can see that still birth rates have been declining but I haven’t found anything that differentiates based on known risk levels of a pregnancy.

As I mentioned earlier on in the thread. I had my baby at home, all very straightforward. I am grateful that I could make choices that just allowed me and my body to just get on with things. Baby was born at 40+8.

With the home birth team I saw the same midwife for all my antenatal visits, until the last couple as I was seen more often towards the end and then had a different midwife for delivery. Though the benefit of the home birth team was that I felt confident that whichever midwife attended my birth would have views which aligned with mine. A hands off approach, birthing in water, delayed chord clamping, immediate skin to skin etc were things that were standard and didn’t have to be asked for in that environment.

If I wasn’t in the environment where I had confidence that the views of the midwifery team would align with my own then I think true continuity of care would have been really important to me. Having a midwife that I had built up trust with and who knew my preferences in advance would have made me feel more at ease.

The reason midwives don’t want to do continuity is because a lot of us don’t want to do intrapartum care and even more don’t want to do on calls.

Also a lot of ‘core staff’ loathe the idea of working in community. There is a real art to decent ante and postnatal care and it’s sadly forgotten about a lot of the time.

We aren’t allowed to just ‘not do it’ though because the government have mandated that we HAVE to have it for a high percentage of women so there’s no option.

I used to get fantastic antenatal and postnatal continuity with my clinic women and that just wouldn’t be doable with how things are now.

As an aside for the people who think that ‘it doesn’t take much to collate info’ well our trust looks after many thousands of women a year. My job deals with a lot of data. I was off sick yesterday and my only option is to catch up today. We are always chasing our tails making sure that we have the data the Trust needs as well as what NHS England wants. As well as dealing with clinical work too. If I had to collate outcomes for a new thing like ‘all 36 week women’ then that would be like 7000+ women… :/

@Offredismysister I wish you were my midwife when I was stitched up with no pain relief.

I have given birth twice, the first time was scary and horrible I wasn’t listened to, I was ignored, and when I begged for pain relief I wasn’t given any. I was told I wasn’t it Labour. It took me nearly 10 years to have another baby. I then gave birth in a midwife led unit (during the pandemic) and it was a very different experience. It was lovely and calm, and everyone was so kind, I wasn’t sneered at, I wasn’t shouted at, I wasn’t embarrassed or told off.

There’s a lot of criticism from managers at the moment about being ‘core’ anywhere to the extent of reorganisation to make it increasingly impossible. It’s really difficult to be good at all the different bits of midwifery though!

@hellywelly3

Do you think the situation could be improved by having dedicated training schools for nurses and midwives rather than the university route currently on offer? I did a access to nursing and midwifery course to enable me to apply to university to become a midwife. About 1/2 the people on my course couldn’t get a place at university including me. The universities don’t have enough places.

Yes, I very much think this should be brought back.

I have never understood the whole degree aspect of it.

I think there's a lot of different ways of working and set ups that would arguably be better for women and for the midwives themselves, but unfortunately all pie in the sky whilst staffing is short- bit of a chicken and egg scenario I suppose.

@yourestandingonmyneck the level of responsibility, critical thinking, decision making, diagnosis and treatment nurses/midwives now do compared to X amount of years ago is significant enough to justify wanting them to be degree educated. Some of the criticism includes misdiagnosis/missing things- the solution is not to reduce the level of qualification.
We need to firstly stop nurses/midwives paying fees and reintroduce the bursary. We then need to increase capacity within HEAs to allow students to study. This needs to be done along with practice placements to ensure high quality practice experiences (this counts for half the degree qualification).
It’s a long term not short term solution. Nursing is on its knees and midwifery is worse. It needs serious investment in the education and work environments which this government is failing again and again to do.

Retired midwife, I do not think I would work as a midwife now, it was such a rewarding job. This post makes me so sad, it was the best job in the world.

I’m a midwife of 13years. Just home from a long day with no break.. again. Was shouted out twice on the phone by a patient as needed to delay her induction of labour due to staffing mainly. Not uncommon for this to happen either, the abuse part.
I’ve ran round like a blue arse fly co-ordinating a level 3 labour ward 4 midwives short. Was the same on Tuesday aswell. And the week before.
I love my Job, I really really do. But something has to give. This is shite.

I agree that abuse is never excusable, and that people shouldn't be rude, but it's understandable that people get frustrated when induction is delayed. Your end you know rationally it's because everyone is running around doing several jobs at once whilst not touching the ground; to the woman at home waiting for the biggest day of her life and the bundle of emotions that comes with it to keep having the goalposts moved at an already apprehensive time doesn't seem overly wild that emotions run high. It's crap for staff, crap for women and in some cases bloody dangerous to boot. Something has to give, will probably be a slow take over by private companies.

@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" !

Work life balance mainly. In theory it’s lovely for the woman. But the midwife will have to do more overnight on calls, not be able to make plans, have to go into the hospital with potentially high risk women when they’re not used to providing this sort of care.

You need higher numbers of midwives to provide it as it’s labour/staff intensive. But there isn’t the extra staff. So when the coc midwife has been at work all day, then gets called to the hospital all night. She can’t also work the following day, so calls in to the team as unavailable. They’re then down a midwife for the day, have to share her workload out between them. So stress and pressure. Most days.

@50sock yes I absolutely know it’s frustrating having the biggest day of your life delayed, I know that. I’ve experienced it all myself aswell, doesn’t excuse abuse at all. I had the polar opposite from another person who was apologetic to me that it was so busy. When you are abused every single day for things completely out of your control when you are as kind and compassionate as possible, yeah kind of irritating to be polite.

@Glassofshloer

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.

That was me @mummyh2016

Interestingly you negated to mention that many midwives on my thread not only agreed with me, but said better facilities would actually save money in the long run.

You also negated to mention that you didn’t give birth on a cold floor, you had a lovely MLU experience despite going to great lengths to argue this shouldn’t be available to other people to ‘save money’.

All very well saying you’d do X, Y and Z when you actually did the total opposite!

And why did I say it shouldn't be available to high risk women due to cost? Because the only way these facilities you want so bloody much would fit in consultant led units would mean the rooms would need to be larger, so would mean less rooms or bigger hospitals to be built. We know it's a pie in the sky dream for new hospitals to be built for the sole purpose that a woman in labour gets a double bed so shall we go with less rooms? When midwives are bloody struggling as they are? Great idea. If I recall correctly I said it would be great if you did have those facilities but it isn't a realistic aim to have. I gave birth to my DD in 2017 when as far as I am aware there was no midwifery crisis going on - or if there was I didn't know about it. I am expecting my care this time to be nowhere like it was back then, not because midwives don't give a shit but because they are so thinly stretched. So yes I would labour on a cold floor if it meant there were enough midwives for everyone as after all, more midwives mean less mistakes will be made and more lives would be saved. Excuse me for thinking in a time where there are issues as big as this I don't think you wanting a double bed is a priority.

[quote Mummyme87]@50sock yes I absolutely know it’s frustrating having the biggest day of your life delayed, I know that. I’ve experienced it all myself aswell, doesn’t excuse abuse at all. I had the polar opposite from another person who was apologetic to me that it was so busy. When you are abused every single day for things completely out of your control when you are as kind and compassionate as possible, yeah kind of irritating to be polite.[/quote]
Yes hence I mentioned at the start of my post that it was unacceptable, just understandable that they are frustrated. What a sad state of affairs it is.