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

This Twitter thread basically sums up the passion for continuity:

threadreaderapp.com/thread/1449347530592964610.html

@mummyh2016 of course there was a midwifery crisis going on in 2017, have you read all of these posts? The crux of it is that you’ve had a good experience thanks Jack, and now you’re lecturing to everyone else how there’s no money for theirs.

Something tells me if you were actually forced to give birth on the floor of a hospital broom cupboard (a cold and hard one no less) you wouldn’t be showing as much bravado as you are now.

There is no reason for me not to want more money to go on maternity services (yes, even us women who are high risk because of childhood illness that was random and no fault of our own!) when billions are spent on dodgy contracts and pointless endeavours like HS2.

That doesn’t mean I don’t also want it spent on the NHS in general but given my bad experience of course I’m going to comment more on this one area?

You’re absolutely obsessed with making out I’m a diva who wants to be brought to the hospital in a limousine and a champagne meal for bloody 2 afterwards. All I want is what so many other women have had (including you), good facilities to give birth in to make the experience better, more likely to succeed without costly theatre time, and less likely to result in PND etc.

How selfish of me when money should be going on… well, what? HS2? Matt Hancock’s mates? A Rule Britannia ship?

The midwifery crisis has been going on for a very long time, staffing and facilities have been poor for many many years, worsening over time. Brexit and covid have pushed it over the edge

As part of baby loss awareness week I have been campaigning for funding for 2-3k more midwives and for there to be a safe mechanism for staff to admit when things go wrong so lessons can be learned.

I also want to see continuity of carer which is proven to reduce baby loss because of outside life factors such as smoking, DV and deprivation. Impossible on the current staffing numbers.

Midwives are fab. I was grateful for mine when all went well AND when it didn't.

Like I said my midwife was lovely, but I could tell under a lot of pressure. I don’t judge her on that because it’s completely out of her hands. If there’s a petition somewhere I would be happy to sign it.

[quote SwayingInTime]This Twitter thread basically sums up the passion for continuity:

threadreaderapp.com/thread/1449347530592964610.html[/quote]
Thanks for the link- but I just don't recognise myself as a service user in what she's saying. Maybe I'm the outlier 😬 I want to be able to ring up for my induction next week and know for sure that I can go that day and not be sat round waiting any more than I have to, I don't need it to be the same person/team to make me feel safe. Actually being there and having staff that are enabled to crack on and be comfortable in their work is what matters to me.

As it happens I've already had a few indications that as it's now 'just' a post-dates induction there's every chance I'll get bumped and a month ago it was me that was going for a 37 week medical need one (things changed!) So the thought of that is making me really anxious. Far more than having an unfamiliar face coaching me through pushing again...

I agree with @8dpwoah again! I can see that in cases where there is any additional support needed it would be good but for lots of is it is trying to create a service that just isn't necessary.

Humans have 3 core emotional needs according to John Heron. The 1st need is to love & be loved - to have someone care about you. The 2nd need is to understand & be understood and the 3rd need is to choose & be chosen. None of these needs are satisfied in fragmented care

1. I do not need or want any kind of loving relationship with my midwives. Polite and friendly yes. I don't want anything beyond that.
2. Understood and to understand. Yep, totally. Makes no odds to this if I saw 1 midwife or 20
3. Chosen and to chose. Chosen? Nope, don't need to be chosen by a medical professional. Chose? To an extent but within clear guidance and again it makes no difference who is doing the guiding.

Any of the midwives on this thread happy to give me some advice about my up coming birth? Not medical advice per se, but on how not to be part of the patient problem (ie the ones who you feel are just having a pop at you) but simultaneously having my birth wishes respected? I can’t lie to you, I’m quite frightened, especially as this time I will be birthing alone.

My first labour was an induction that i felt coerced into, not by midwives they were actually very intent on listening to my feelings but by consultants. Yes there was waiting but that’s not what scares me, it was things like I had v bad anxiety and my birth plan was scoffed at until I mentioned that a v snr midwife wrote it and then they all took it seriously. I don’t have that this time. I was told a few fibs, now looking back i know aren’t true but probably didn’t come from a place of laziness but simply from the midwife looking after me being rushed off her feet and needing to have me in birth and out as quickly as possible. The fibs Im referring to are the water birth being broken (it wasn’t someone used it before me, and I wasn’t on monitors nor had the drip i could have used it an OB told me that on arrival) not being ‘allowed’ delayed cord clamping or golden hour. But I didn’t leave traumatised and for the fibs told them midwife looking after me was a sweet girl and spoke to me with dignity and respect, unlike another OB who was brought in to check some spotting, he spoke to me and the midwife like shit off his shoe.
My real big worry is post natal, specifically night shift staff. Day shift were rushed off their feet but tried their best to help with feeding. Night shift weren’t and on numerous instances despite me begging refused to help me and actually laughed in my face when I was struggling, this was mainly support workers tbf but the one midwife I saw also wouldn’t help me. My baby was meant to be having blood sugars monitored too so it was quite dangerous. I sustained awful nipple trauma and was discharged without any meaning of feeding being established and it was the start of pnd for me.

This isn’t me bashing btw, because a midwife on discharge picked up that I was struggling so sent me to the MLU so they could help me, and bless them, they spent hours but they were also pretty disgusted with how I was treated on post natal.

Do any of the midwives have advice for me about how to ensure history doesn’t repeat but I’m also not being part of the problem?

I thought bringing some chocs in when I go in, not as a bribe of course ha, but just as a thanks in advance sort of thing. I don’t know call me naive but what’s really really shocked me from this thread and what I never knew was that narcissistic yes men career climbers and toxic management was so profound in the nhs. It’s really sad to read.

I’d be interested to know if anyone has done any studies on the impact of understaffing post natal wards on the number of babies readmitted with feeding issues. We had a baby in a smallish hospital on a quiet weekend morning, we had amazing support and help to feed - baby thrived and put weight on almost straight away. My Dsis at the same hospital, busy weekday, rushed out the door, tiny baby, tongue tie. Back in within 36 hours of discharge. I know it’s not a representative sample, but I definitely think those first 24hours make a big difference to how parents get on at home. They need to focus on the bigger picture than just having the bare minimum midwives to get babies out. Unfortunately the nhs doesn’t seem to work like that

Do any of the midwives have advice for me about how to ensure history doesn’t repeat but I’m also not being part of the problem?

Don't shout or be abusive, but beyond that don't feel that your wishes, wants and needs are a problem. The sad reality is that I have many friends who have been dismissed, not listened to or had questionable advice given to them during pregnancy, all of them were only treated with respect and what they were saying taken on board when they went through PALS and had some fscetime with someone up higher.

@50sock

Do any of the midwives have advice for me about how to ensure history doesn’t repeat but I’m also not being part of the problem?

Don't shout or be abusive, but beyond that don't feel that your wishes, wants and needs are a problem. The sad reality is that I have many friends who have been dismissed, not listened to or had questionable advice given to them during pregnancy, all of them were only treated with respect and what they were saying taken on board when they went through PALS and had some fscetime with someone up higher.

Isn’t PALS sort of an after the fact thug though, I mean so it doesn’t happen in the first place. That feeling of holding a screaming baby, screaming with hunger and having no means to feed them, begging those around you for help and them laughing in your face. I wouldn’t wish it on anyone, it took me a long time to get over

@Sleeplessem

With regards to feeding, can you find out if your hospital is BFI accredited, if so call the infant feeding specialist lead and have a conversation with her now, let her know your experience and ask for her support. She will be able to come and see you on the ward and ensure history does not repeat itself. Colostrum harvesting could help you avoid formula in a baby that isn’t feeding effectively.

With regard to the golden hour, why was this not facilitated? No one has the right to take your baby away and if they do ask for him/her back, suturing and other medical procedures are not an excuse to take a newborn from its mum. Just refuse to let your baby go.

If a doctor is asking to perform a procedure or asking you to do something that does not feel right ask why! What is the benefit and risk of having it, how will it change the outcome, is it necessary or just because it satisfies their curiosity.

If at any point you feel like you are not being treated with respect or dignity ask to speak to the midwife in charge, you can do this whether you are in the antenatal ward, Labour ward, postnatal ward.

I know of a lady who had such an horrific experience with the night staff on the postnatal ward she called the director of midwifery from her bed. Please be assured that most midwives are aware of bad midwives practice and we don’t want to work alongside them, no good caring midwife wants that in a colleague.

If a HCA is rude to you please escalate to a midwife so it can be addressed, everyone in maternity is busy, but again it does not give anyone the right to make you feel the way you did.

Good luck with your birth, I hope it is a positive and empowering experience for you!

I don’t know about others, but I had a horribly difficult time with feeding DD1 at the beginning (and, fortunately, excellent support so we got there eventually but it took many weeks).

When I had DD2 it was much easier because I knew what it was supposed to be like. No problems at all. I hope you find the same thing OP.

Isn’t PALS sort of an after the fact thug though, I mean so it doesn’t happen in the first place. That feeling of holding a screaming baby, screaming with hunger and having no means to feed them, begging those around you for help and them laughing in your face. I wouldn’t wish it on anyone, it took me a long time to get over

Nope, they aren't just for complaints after the fact, but can help facilitate conversations and support that you need along the way.

I feel so sorry for midwives and nurses right now.
2 of my midwife friends, both in their 50s and very experienced, have just quit.
My DS is a student nurse, meant to be supernumerary but working his socks off on 12.5 hour unpaid shifts. Meanwhile the hospital I work for throws money at "inititives" like they will solve everything.
I have another friend who has just quit her Band 6 role and moved to the "Transformation" team, no one has a clue what they do, but they closed a ward to accommodate them.

@Chipsinthewoods

One of the problems with postnatal is that most staff don’t want to work there, believe it or not midwives find breastfeeding support and basic parenting advice dull (very sad isn’t it). Then there is the added pressure of beds, imagine you have a 30 bedded ward and it’s full which happens often. The consultants now have the dilemma with what they do with women who are waiting. They don’t want to start a high risk induction knowing they haven’t got a bed for them afterwards, they don’t want to do 4 elective caesareans if there is no postnatal bed for them. So the pressure starts to build, the antenatal ward becomes bed blocked, the Labour ward will take priority with labourers, they will then put pressure on the postnatal ward to discharge discharge discharge. The people who will get discharged first are the ones there for feeding issues, coerced into giving formula so they can go home quicker, made to feel like shit along the way. Promises of the community midwife coming out to help, a list of breastfeeding support numbers, but no actual help which ends up with babies not feeding when home, developing jaundice, being put on feeding plans for excessive weight loss and trauma for the parents who feel like they have failed

@Kidsaregrim thank you! Really informative reply. Yes the hospital is part of the BFI and they do have an infant feeding team (wasn’t signposted too with my first so I had no clue) but they are AMAZING, the lead is an IBLBC and so so lovely, she made time for me until my daughter was well past 1 (unfortunately that was the legacy of my first night on the mat ward). I didn’t know they could come up to the ward? I was planning to ask if I could be discharged ASAP, or maybe go to another ward (there are 2, one I stayed on recently due to they thought I was in prem labour but was appendicitis and the staff there were v v different but I think that’s the ward for babies that need ‘extra’ help. )

I did tell the night midwife that no one would help me feeding and she did say well it’s your responsibility and it made me feel like I was too stupid to get it right and I was the problem, but I was only asking for latch support.

The doctor was just really rude with how he spoke to me, i was trying my best to do hypnobirthing so to avoid words like pain and my husband asked him v nicely if he could try and support that and he told me flat out that I was ridiculous. He was also incredibly rough with an internal exam, massive contrast to the midwives.

There was no reason given, just we need to weigh her and clean her up now and you can have a shower. I was told a fib about the cord clamping and a physiological 3rd stage that you aren’t ‘allowed it’ due to induction. It felt like BS at the time but I didn’t think I could question it.

@50sock

Isn’t PALS sort of an after the fact thug though, I mean so it doesn’t happen in the first place. That feeling of holding a screaming baby, screaming with hunger and having no means to feed them, begging those around you for help and them laughing in your face. I wouldn’t wish it on anyone, it took me a long time to get over

Nope, they aren't just for complaints after the fact, but can help facilitate conversations and support that you need along the way.

@50sock I had no idea! Thanks for the info! Might sound silly but how do I go about doing that? X

[quote Glassofshloer]@mummyh2016 of course there was a midwifery crisis going on in 2017, have you read all of these posts? The crux of it is that you’ve had a good experience thanks Jack, and now you’re lecturing to everyone else how there’s no money for theirs.

Something tells me if you were actually forced to give birth on the floor of a hospital broom cupboard (a cold and hard one no less) you wouldn’t be showing as much bravado as you are now.

There is no reason for me not to want more money to go on maternity services (yes, even us women who are high risk because of childhood illness that was random and no fault of our own!) when billions are spent on dodgy contracts and pointless endeavours like HS2.

That doesn’t mean I don’t also want it spent on the NHS in general but given my bad experience of course I’m going to comment more on this one area?

You’re absolutely obsessed with making out I’m a diva who wants to be brought to the hospital in a limousine and a champagne meal for bloody 2 afterwards. All I want is what so many other women have had (including you), good facilities to give birth in to make the experience better, more likely to succeed without costly theatre time, and less likely to result in PND etc.

How selfish of me when money should be going on… well, what? HS2? Matt Hancock’s mates? A Rule Britannia ship?[/quote]
What has our argument on another thread got to do with the midwifery crisis? If I was a midwife reading on here utterly broken to find that there is someone still arguing about not having access to a birth pool or a fucking double bed it would push me over the edge. If there is any money free then it needs to be spent on midwives. I don't get why this is so hard for you to understand. The fancy facilities you crave won't mean a jot if there are no midwives there to deliver babies. It's not a case of I'm alright so fuck everyone else. It's everyone else I'm bloody well thinking of.

No baby needs to be cleaned, just dried and fresh towels, baby needs to be on you keeping warm and having that golden hour, please just say “no thank you, I’m not ready for a shower”

Induction can be a reason to not have delayed cord clamping as some of the drugs given can increase the risk of bleeding because the uterus does sometimes not contract effectively once baby is born, however you can have a mix of physiological and managed. If you start to bleed have the drugs, this is the whole point of having a trusted midwife you can develop a personalised plan of care with and this is where continuity of care comes into its own, a midwife empowers her woman and the mutual trust is formed throughout pregnancy. If I looked after you from booking I would know your fears, your personality and the reason why you are asking questions and be ready to reassure in a way you understand.
As a Labour ward midwife who has never met you that trust has to be built when you are vulnerable, scared and in pain, your adrenaline and fight or flight will be kicking in and it’s her responsibility to manage that effectively and quickly, not every midwife can do that, then throw in that you might be her 3rd delivery of that day or night, she is tired, hasn’t eaten since the day before, needs a wee, has a doctor barking at her and she feels so demoralised, I can understand that unconscious eye roll or the sigh of complete sadness.

This is the reality, damned if we do and damned if we don’t, and that’s why we are leaving because it’s impossible 😢

@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

I agree the workload pressure tends to be horrendous for midwives working on the ward as they can often be looking after 16-20 patients if you include the babies. Most of whom these days will need extra care for one reason or another plus all the work involved with admissions and discharges. The other issue with hospital midwifery is if you have children of your own then you have to be lucky enough to have someone to care for them outside of the hours offered my nurseries/childminders. Even if you have a partner who perhaps only works 9-5 and so can accommodate that, then you still have to pay for a full time place at nursery unless your again lucky enough that your employer will let you work set days of the week. I’ve never come across a midwife say they find the work on the ward boring. So much of our work is high pressure/responsibility it is actually really nice to do the parentcraft/feeding side of things when we get the opportunity. Anyway most of that is done by the maternity care assistants these days and thank goodness for them as much as not sure how we’d manage without them. More than a few midwives (and nurses) have given up their jobs to work as much lower paid HCAs/MCAs. I think people would be surprised how common this actually is!

@Kidsaregrim that’s pretty much what I mean, i know now they are fibs probably for an easy life, quickening things up on the delivery suite. I’m hoping this time I can be on the MLU, the staff there are v different.

The maternity ward though really really worries me as I can imagine the situation has only got worse in the last 2 years

@Kidsaregrim really informative posts.

We moved house between dc1 and 2. Had our 2nd in a midwife unit. It was in one of those old fashioned, green floored community hospitals - no en suite rooms and a bit draughty, but had a pool and bouncey balls and stuff. It was staffed by lovely, experienced community midwives - they said they averaged 1-2 births per day alongside post/antenatal appointments. They would also admit post natal women for feeding support and post c-section as soon as you were fit to travel in a car from the city hospital. The downside to birthing there was the waiting time and bumpy ambulance journey if there were complications, but being transferred there for post birth support from the city hospital was a good compromise for many women. This was 8 years ago. There are constant rumours about it being closed down. I feel really blessed that we had this option and the midwives working in this sort of unit seem to be more post natal care/feeding focussed. I guess having this choice available to women in the community adds to the pressure on midwife/woman ratios in the bigger hospitals though. When maternity services are under such pressure, you can see why centralising services is logical, but it also reduces choice and presumably makes bed pressure and postnatal experiences worse.

Scary. I think I'd recommend having a baby in the winter. So many choose to have babies in the spring and summer. One of my DCs was born in late December, and there was only one other baby born in that large hospital on that day. That was a long time ago, but there was a big difference between December and the summer.