To think a lot of midwives are.. just not very good?

[JackandSallySkellington]

Please hear me out.

I am SURE there are dedicated, talented, intuitive midwives out there. But AIBU to think beyond doing obs, most actually do very little in the course of labour/birth and a lot of the time seem very passive and like they just can’t be bothered?

I have had 2 babies at different hospitals. In the first delivery, the midwife ‘popped in to check on me’ now and then and simply called the doctor in to do an instrumental delivery when the pushing clock ran down. She didn’t do anything else - didn’t help me change positions, didn’t offer me a drink, didn’t give me adequate pain relief despite me asking (just kept saying ‘it’s coming…’), didn’t ask me how I was feeling in any way. Couldn’t have been less interested.

Second delivery far worse. I was admitted for induction and after a few hours found to be 4cm dilated. I laboured all night - a full 10 hours - in a cubicle on a ward and despite regular pleas that I was in labour, the midwives insisted I wasn’t. They didn’t exam me again, just offered paracetamol, and only took me to labour ward when I was vomiting and discovered to be in transition and 10cm dilated the next morning. I had really hoped for a water birth and I’m gutted my final labour was spent alone in the dark. The hospital apologised but what’s done is done.

I understand about overstretched NHS etc but my stories are not down to that - in both cases the midwives spent a lot of time milling about and chatting.

I feel like the only stories about midwives being great are when the birth was going well anyway so there wasn’t much for them to actually do.

AIBU to think a lot of midwives just aren’t really up to the job? Sure I’ll get my arse handed to me as I’m aware criticising medical staff is v controversial!

I went through three midwife shifts whilst I was in labour - the first two were amazing, so kind and reassuring. The first one even “milked me” to help speed up my labour and build up my colostrum stash. She was so dedicated and I could have cried when her shift ended.
The third one still haunts my memories- she seemed so clueless and dithered a lot. I ended up having an emergency c section at 10cm dilated and I could hear the obstetrician shouting at her in the hall about something she had missed.
My first midwife popped back to see me on the recovery ward when her next shift started. So in my experience, 33% are amazing, 33% are very good and 33% probably aren’t right for the job!

I’m a midwife and is really sad reading through the OPs experience and thread comments, in my personal and professional experience there were a very small minority of midwives (mainly in the past and very specific to certain hospitals, in London in particular) whose care and compassion could have been better. I’ll always remember the very dour faced midwife I had with one of my births, who didn’t even smile once. This was in London and I’ve never experienced another midwife or colleague like this outside of London, although there were also many amazing midwives in London too, it just seemed to be a place of extremes.
The vast majority of midwives do really care but work under tremendous pressures. Working inside the system I can understand how some of these stories come about. Particularly around induction of labour and women being believed that things are progressing or just getting to care and support they need. For the midwife caring for 9 other women/babies who all need monitoring/ drugs/care and a labour ward who have made it clear they can’t accept your lady even if you do think she is probably fast progressing, it is an impossible situation. Add in ladies who are not fast progressing but also coming to you to tell you their contractions are getting stronger. Plus the postnatal new mothers you may also be caring for who are asking for support with breastfeeding and pain relief. In addition the lady crying as she’s been waiting all day to be discharged. Is it any wonder some women end up feeling dismissed. I think some women’s frustrations with their care also come about through misunderstandings, for example many babies start labour back to back but will usually turn during labour and deliver without a problem so it isn’t usually something we’ll make a big deal of unless it does become an actual problem. Reading these forums also, the expectations some women have of community midwives can be very unrealistic and I think some people do confuse the NHS community midwife role with the role of (privately employed) midwives in other countries. I now work in the community which faces its own challenges but I don’t envy the impossible juggle of the ward midwife. Fortunately where I work is generally a very good trust (and rated as such too) and I think we are able to provide a good standard of care most of the time but it certainly is not easy due to the constant time pressures,. I do absolutely love my job and that is down to the genuinely lovely women we care for and the team I work with. I’ve just been on maternity leave and it was so nice to hear so much positive feedback about my team (and the hospital care) from other mothers at the baby groups. I speak to friends who work at other trusts who are expected to work all day and then all night without a break, in clinical areas they are not familiar with and with much higher workloads, cannot understand how they can begin to do a decent job

44k midwives. You’ve experienced 2 and wrote them all off.
Both my babies, had several midwives and couldn’t have been more proacticve. Your experience is poor but doesn’t equate to the entire cohort of midwives.

The problem is that none of that hard work excuses being unable to tell if a baby is breech - community midwife confidently claimed baby was head down - I was equally confident I could palpate their skull below my rib cage - she was breech on US shortly afterwards and breech at C section- if I'd listened to that midwife I'd had an undiagnosed breech labour.
It also doesn't excuse being rude on the phone to women calling about reduced movements- which we are told to do!

Personally I think the entire midwife model is outdated and failing. No other high risk area of medicine delegates most care to people without a medical degree and with a very variable skill set. The huge number of maternity scandals in this country are a disgrace and massive nationwide reform of maternity care is urgently needed.

I also think it should be compulsory for midwives & obstetric doctors to have to spend time with some of the children and adults who experience life long harm from maternity complications. Have you actually met any adults left severely disabled due to maternity complications? Or older women with incontinence due to pelvic floor damage? Or families whose baby died - still traumatised decades later? The lifelong consequences of poor maternity care are devastating.

I suppose it’s like any job, some people are great at their jobs and some people are shit. It just so happens when a midwife isn’t very good at their job it has a very negative impact on others (their patients).

I have had very mixed experiences giving birth and medical staff who are good at their jobs and care about their patients make a huge difference. With my second baby I panicked when I seemingly went from 2cm dilated to 10cm (No one had checked on me for hours, the call button was put out of my reach and I was completely alone, no birth partner). The midwife in charge of the ward that night screamed in my face to “shut up shut up shut up” when I cried out in pain and fear and baby was crowning. The midwife who actually delivered my son was chill and basically hands off. By the time I got to her though he was nearly out. Between them I did it all myself and out of the 3 times I’ve given birth that one was the most straightforward.

My 3rd baby, I didn’t meet a single midwife who was a dick in any way at all. And I met a lot! Loads of appointments, in and out to check baby was ok, induction ward for 2 days… they were all brilliant, as were the community midwives. Tough birth but all credit to them for being fantastic.

Thank you. - and you’ve put your finger on what I’ve been trying to say! Leaving aside the clinical competence issue, which is separate, that’s what struck me: there does seem to be a culture of ‘not caring, not being supportive or sympathetic’ almost as a badge of honour for some midwives. It’s not so much the not helping people to the loo (to take one eg) as the bossy pleasure they seemed to take in telling mothers that! It was as if they had a thought balloon over their heads which said ‘Don’t think you’re special- we see thousands of births and frankly it’s boring, so shut up and get on with it’. But it IS special to individual women.

It’s definitely a culture, and as such ought to be able to be improved.

Thanks Thea46. I’m sure there are great midwives out there too.

I agree, mine was shocking and gave me dangerous advice so I had to go to the hospital for all future appointments. She was given further training. This was 25 years ago. Post c section they all seemed pretty crap,I spent 5 days in hospital afterwards.

My last 2 labours a student midwife was with me the whole time and they were absolutely fantastic especially with my 5 month old she couldn't do enough for me and was so encouraging ( the labour was pretty quick so got intense fast) but I've had midwives that were useless aswell and wouldn't listen to me i mean its my body I know what I'm feeling better than they do !

This is kinda like complaining about an air steward on a straightforward flight.
They're not there to interfere in a natural process, they're there to manage when things go wrong.
I wonder how many of us would labour without one?

I had two births and if it was them alone being at the birth both me and the babies would have died they were clueless and useless in my opinion no more than a glorified care assistants like in a care home they know nothing .

My community one is rubbish, very old fashioned and was on holiday for half my appointments for both babies, as she’s semi retired. However the midwives in the hospital for my first baby were fantastic. We had two young woman for first half, and then after a shift change, a more ‘mumsy’ one for actual birth who was FANTASTIC. Told the doctor off for suggesting a episiotomy, coached hubby really well, was firm enough with me once I hit the ring of fire to get through it 😂 however I do think we got lucky, as once we were on the ward, the midwives there were awful. Told my husband off for lying on the floor with a blanket (it was 2am and we were in the end cubicle with no chair), both talking loudly during the whole night, lady next to me was crying for ages and they didn’t go in and check on her, amongst other things, so defo seems luck of the draw!

Wow, so her experience is invalid?
Bore off? Are we a 65 man on a local Facebook page?
Such a sad response.

My personal experience is that when you are in labour they can’t do enough for you but before and after birth they come across like they don’t give a toss.

Literally the only positive experience I had with the midwives was while I was in labour because I couldn’t be dismissed.

Although I will give the sister on the postnatal ward an honourable mention. When she came on shift and realised I’d been in a bay with 7 other women who had their babies with them and mine was in ICU she went mad and that side room magically appeared for me.

The HCAs were also amazing and got me a card when I was finally reunited with my baby.

Wow. That's very concerning.

My experience was, with a 35 weeker on the postnatal ward, that a lot of the midwives didn't know how to support with feeding (breast or otherwise) with a baby who was difficult to feed. They seemed fine with support to the mums of full time babies but avoided me and when they did give advice, I discovered afterwards that a lot of it was incorrect for a baby that early.

I’m sorry, I’m sure this has been said but as an NHS midwife myself, I am offended. We do so much more than obs. We are ensuring that during your labour, it is going the way it should be. We are responsible personally for TWO patients. I’m sorry your experience was not nice, and I appreciate there are some out there that could do with a little more compassion training(!) but the vast majority are on YOUR side.

also, to most of the comments, midwives aren’t mind readers. We go by what is in front of us. For example, if you are 2cm the likelihood is you aren’t having a baby anytime soon. Yes, things can change. People have quick labours, but it doesn’t often happen. They cannot get it right everytime.

Recently the media, the news, everyone has been so anti midwives and it feels like a witch hunt that it genuinely makes me not want to work. Everyday I do my best but a lot of people go home thinking did I do enough? Am I going to end up on ITV news because someone wasn’t happy with their care? Am I going to be sued?

also, as awful as it sounds, a lot of it is due to not being educated around midwifery and birth. What we see as ‘normal’ everyday, patients see as nearly dying. For example, a baby needing resus isnt (for the most part) resus. Its inflation breaths to help the transition into life and very common. They are very rarely in cardiac distress, but respiratory. People hear resus and think chest compressions but most of the time that’s not the case. Similarly to blood loss, people can and do lose a lot of blood - it is managed quickly and for the most part even a 1L loss is ‘normal’ and very rarely life threatening. Despite what you hear in the media.

I have a friend who retrained to be a midwife. She said the midwives on her ward in Cardiff do petty things like limit how much butter the ladies can spread in their toast (half a wee packet) for post delivery tea and toast. I found that so shocking- if they are limiting the butter to be petty to a poor soul who has just pushed out a baby, imagine how kind they are with the rest of their care

One of mine was born at 31+4 so they probably wouldn't have coped either with mine....thank goodness for NICU staff. They were superheroes. Brilliant with helping for the five weeks my youngest was in NICU. I do remember one midwife coming up to see him hours after the CS once he was all settled in the incubator so midwives do go out of their way to check even when finishing their own shift.

I imagine in a lot of cases madwives do become desensitised to the job itself and forget the fundamentals of caring and why they came into the profession in the first place.

I have had four DC. First was slow to progress labour...born eventually with the drip running at maximum. 3rd degree tear. So needed a spinal to repair that tear....

Then second birth needed gas & air and pethidine. Midwife seemed indifferent about it all. Just another woman giving birth on a shift. That's all I was.

Third was fast. Got to the ward in time to give birth ten minutes later. They were about to check my blood pressure when the midwife joked too late for all that. Then started to get the pack ready for the birth..oh look another second degree tear🙄

Fourth birth placental abruption. Midwife was calm and got me prepped for theatre after initial observations showed bleeding wasn't for slowing down..Young but professional and didn't seem particularly compassionate from memory. She did what she had to do. Just another difficult case. I still appreciated the care I did get. NICU were fantastic. Mixture of nurses and midwives caring for those families. All doing an absolutely amazing job.

Sadly that probably comes from higher up due to budget restrictions.

When I worked on the labour ward we were supposedly banned (after years of doing it) of providing toast to the partners. I get it, they're not a patient, etc. But if a baby has been born at 4am and they've been awake and supporting their partner I was offering toast. Our maternity unit was a good 15 min walk from the hospital canteen which had very limited opening hours so not easy for them to get food elsewhere..

The amount of times I was "caught" by the ward manager walking towards a room with a plate with 4 slices of toast and she'd properly shout at me! Ask if I was making toast for the partner. I'd always deny it and say my woman was just starving!

First birth I was in hospital, 40+15, the midwife with me for actual labour was brusque and dismissive and wouldn't believe me that I was in active labour and feeling the urge to push. She shouted at me for dropping something, I can't even remember what, and I thought she was an idiot.

Second birth at home, two wonderful (older) midwives who I adored so much, if they could be cloned every woman would have a good birth and feel safe and respected.

Third birth at home, first midwife (older) was wonderful, student midwife was lovely but I think I traumatised her, two very young midwives for some reason arrived half an hour before I delivered and I hated them both. One's first words to me were "stop shouting" and I looked at my husband and said "tell her to shut up or fuck off" which was likely a bit rude but hey ho.

I find this really interesting. Both my babies needed resuscitating. I also had quite a bit of blood loss with my first. I had no idea these things were so common. Thank you for sharing.

You’re welcome. I’m currently reading the newborn life support book from the resuscitation council for training for work. The amount of babies needing help transitioning to life is I think if I remember right around 15% with inflation breaths, following just stimulation with a towel. Babies needing chest compressions is around 1 in 2000.
most of the time they just need a little bit of reminding that they are needing to dispel the fluid from their lungs and they can now breathe for themselves! My beautiful boy included 😊

I can understand feeling under attack when the profession you have trained for is largely denigrated...but it is not without reason. It's probably fair to feel offended, but I think you should try not to, and, instead, actively listen to the stories to either reinforce (what I hope is) the good care you give, or give you insight into what could be improved.

There is a also a massive institutionalization problem within the medical profession as a whole, where they live in the bubble of a hospital and don't stop to think that what they see as "normal" or "well tolerated" is not what any sane person in any other walk of life would feel. THAT, I think, is the biggest problem.

And if you think people aren't going to understand the terminology you're using, such as resus, in your example, then say the technical term and then explain in Plain English what that means.