To think maternity is in a real mess?

[AgeingMillennial]

I had my last baby in 2023 and that was bad enough (no continuity of care, cattle on a conveyor belt feeling when I was induced, piss poor midwifery care in labour), but it seems to be even worse now.

Beautiful birth units that sit empty and half closed because hardly anyone is allowed in them. Chaotic hospital labour wards with no available rooms. Decisions made according to what would be easier for staff or their logistics. Everything ‘on the clock’, with heavy and constant interventions because midwives seem barely skilled past taking obs and fetching the anaesthetist when hours of labouring like a wild animal caught in a trap gets too much.

Despite our terrifyingly high c section rate and the vast majority of women giving birth in medicalised hospital wards, birth here still isn’t safe. We have some of the poorest outcomes in Europe.

Is it time to admit our medicalised, intervention heavy, risk averse approach isn’t actually working? Is it time to relax the guidelines a bit and focus more on a holistic, flexible approach? I don’t know what the answer is but it feels like the system is on the verge of collapse.

I had two wonderful experiences on the NHS giving birth

so i don’t think I’m your market

Isn’t it just the state of the NHS in general at the moment? It’s all at breaking point.

i have returned to midwifery after a five year break and it is worse than ever. You are wrong to say that all midwives do is obs and fetch anaesthetists though. Women and their babies are more high risk than ever before and we have never been so poorly staffed. It is standard to be 1 midwife to 10 patients on the ward and for each of those ten patients to have babies. Women are actively choosing to have elective sections and we have had a huge influx of refugees. We are caring for complex, non English speaking women with a host of medical issues. Alongside babies that are poorly too, whole living in fear that we are one error away from losing our pin or being involved in a serious adverse outcome. I wouldn’t advise anybody to go into midwifery.

it is also too easy to blame the system. Many women don’t want natural home births, they want c/sections. That coupled with a sedentary and unwell population, from across the globe, is a recipe for disaster.

I had a terrible birth in 2012 and a slightly better one in 2016 (two different hospitals.). Luckily my children are healthy so I’m grateful.

I think it’s important to consider what women actually want. I chose a caesaren for both my births with no medical reason and had a fantastic experience and super easy recovery. A lot of my friends did the same. So I don’t think a very high caesarean rate is necessarily terrifying. If I had had a natural birth I would have wanted an early epidural.

im glad that the days of removing pain relief and intervention from women and telling that them that you’ve empowered them are going/have gone.

of course there is the other side of the coin and women who want minimal intervention should be supported in that regard where safe to do so.

What makes it difficult is that a straightforward birth is a retrospective diagnosis.

Yes. From both sides of the birthing ball, yes.

I had two disastrous deliveries of my own DC. Negligence, dangerous practice, and a basic lack of decent human compassion.

I wouldn't go back to midwifery either, yet. I'm hoping I might one day but I can't at the moment. It's too dangerous to practice safely with attrition as it is and I'm honestly too fucked up from the loss of my first baby and two others very very sick and near death for all of us

You are completely correct. Many women chose to have c/s now and thus is their right. Hospitals do fail in many ways but women are empowered now to say what they want.

In one way you can argue they’ve lost faith in their own bodies to birth, but many women would rather have an elective c/s than a traumatic delivery that leaves them with vaginal injuries. Let’s also not sugar coat things, childbirth was once the leading cause of death in women. There is no golden age of childbirth. I say this as a mother too!

When I had my babies (2006, 2008, 2011, 2013, 2014) the staff were all amazing but in my later births there were not enough of them. Although that worked out well with ds3 because I waited all day to be induced and he ended up coming on his own that evening.

Does the NHS have the money for a holistic flexible approach?

It would be cheaper wouldn’t it?

In terms of pounds and pence, yes, an emergency C-section -with no post op complications- cost per day alone is x3-4 that of a VBAC or first vaginal delivery.

Now there's some more-or-less style number crunching you could do about adding in the cost of maternity medical negligence litigation and also the loss to the economy of mothers with massive post partum health issues and long recovery from birth trauma, and also caring for children left disabled by poor maternal care in the perinatal period.

There's a huge amount of evidence out there that our poor maternity care costs a lot at delivery and much more postnatally and beyond, not just to the NHS but more widely.

Good midwifery care is the safest and cheapest way to improve birth outcomes and save money. But it takes investment which has been non-existent for years and years.

To offer a holistic flexible approach safely surely there would need to be more staff?

https://www.bps.org.uk/news/counting-cost-birth-trauma

This is an interesting article. This is PTSD alone.

There's additional costs to the NHS for NICU stays, HDU for poorly mums, on going care costs...loss of working time for caring for poorly babies and physical health issues like scarring, prolapse, hernia, physio for diastasis recti etc....

I agree.

Forcing women into births they don't want because their choice of a c-section might not be considered 'holistic' is hardly ideal either.

Education, choice and safety are the most important things.

I think midwifery training is inadequate now. It took me 5 years to qualify because you had to be a qualified nurse with a year's post qualification experience before you could do midwifery. Just after I qualified the midwifery training was extended to 18 months. That was back in the 70s. There are far more high risk pregnancies and co- morbidities these days and a three year training isn't enough. Not to mention more technology. I read so many horror stories on here, mostly about lack of care and staff shortages. I am ashamed of how bad things have got.

Not long before I had my kids, there was less choice, according to friends? As in no CS allowed unless you were actually judged to need one, so no maternal choice, less chance of a water birth being available, more pushed to do everything naturally and bf. Going back to the eighties when my parents' generation gave birth, touching without consent/forced episiotomies etc were normal.
I only know a handful of people who had kids both before I did, and since, who could accurately say whether they believe it's better or worse, as not many people I know had massive gaps between their babies. And obviously they're speaking subjectively about their own experiences, but from what they say, it's better now than it was.

Despite our terrifyingly high c section rate and the vast majority of women giving birth in medicalised hospital wards, birth here still isn’t safe

You do realise that it’s getting to the point where the majority of C sections will be elective due to being a choice of the woman up front from the get go. Many women are now demanding it from the outset. So I don’t think the ‘terrifyingly high’ rate is going down, it will likely only go up as more women will probably join this group.

Is it time to relax the guidelines a bit

Exactly what guidelines are you referring to as this could mean anything?

My friend has been on the waiting list for an “urgent” hysterectomy for 18 months. She was told in the summer it would likely be November 2026.

She called two weeks ago for an update and was told that because the nearest maternity unit has closed, her surgeon is now fully booked with caesareans for the next x months and her op will be summer 2027 at the earliest.

My local maternity hospital has closed too - the nearest one is a 35 min drive away.

I don’t understand why it’s maternity units that are closing. How many women and babies need to die before this is reviewed? And why is it always always women’s health that is deprioritised??

Absolutely agree. Midwives are incredibly skilled, I had wonderful ones with both of mine, 1 to 1 care throughout, with my first I think they saved both mine and babies lives through their quick thinking.

But the nhs as a whole is getting harder and harder to work within (im in paeds). Higher expectations on less resources, it feels like a lot of time is spent fire fighting rather than providing the personalised care we got into our jobs for.

It’s terrifying working in it at the moment. The role of a midwife is being eroded. Women are considered high risk if they haven’t felt their baby move while they’re sleeping, if their waters have a pink tinge or if they contract more than 4 times in 10 minutes. I speak to so many women desperate for midwife-led care but we turn them into patients strapped to beds.

Obstetric advocacy for midwives is pretty quiet too, which is devastating in itself. All my obstetric colleagues are horrified by the section rates and the amount of gynae complications and placenta accreteas they’re now seeing. So why aren’t they shouting about the situation? Instead we’re adding more and more section lists and closing birth centres. It’s madness.

Outcomes for babies are better in midwife led care settings. Obstetric led care directly correlates with increased perinatal adverse outcomes. Obstetric care correlates with increased perineal trauma, haemorrhage and psychological trauma. And women are celebrating their elective caesareans as they now have choice, but that choice causes harm. We’re yet to see results from longitudinal studies comparing health outcomes in people born by elective caesareans with those born vaginally, but early results all point towards it being a public health problem on a massive scale.

How?

A high rate isn't terrifying as long as

• we have the resources to safely support electives it whilst not compromising the ability to provide emergency c sections
• women are making it as a positive well informed choice as the best option for them and their baby, rather than out of fear that they won't be safe in other options
• they aren't pushed on women for convenience - a friend of mine was telling me that in private deliveries c sections are often pushed for the convenience of the staff (done within working hours) rather than because they are the best option for mum and baby

But equally there should be the option. My 2nd was predicted to be an 11lb'er at full term. I asked if I could have an elective c section due to her size, and DD1 getting stuck at 'only' 9lbs. My consultant said 'you are a sturdy women having a sturdy baby' and ushered me out the door. In the end she came early at a much more reasonable 8lbs.

I agree with your title, but not you opening post.

The issue is lack of funding.
Lack of midwives, not lack of skills amongst the midwives that are working.

But it is not particularly new. There was no midwife available when I gave birth to my dc3 25 years ago - in the delivery suite, in the hospital. I suspect it has probably got worse, but it was bad back then.

You are spot on. It can all be traced back to Ockenden and the wave of “improvements”, probably heading towards 1,000 of them now. That were never evaluated. So the unintended consequences have not been captured and understood.

Why they keep asking Ockenden to improve things is beyond me. Yes there were issues previously, but nothing comparable to the damage done to the system as a result of overloading the system with unrealistic levels of expectations. What other areas of health care are so over monitored and risk assessed as maternity care…to the point where outcomes are actually worse as a result?!

Of course resources are an issue. The estate is completely wrong - under and over utilised space. The workforce is not aligned with new operating models. We’ve doubled c-sections yet the obstetric workforce needed to do them has only grown by 3% in 10 years.

You can’t blame hospitals. You can’t blame staff. When most Trusts have failed their CQC inspections. It’s so clear that this is a whole system issue. Families suffer, but so do staff. And they live in fear.

I’m not a midwife but the damage done by deskilling them is destroying the profession.

The doctors are under incredible pressure running an undeliverable schedule of planned c sections and clinics in the day, then killing themeselves with emergency care at night. It’s not sustainable.

I have had experience myself as parent voice and know staff who work in maternity and we all know exactly what has caused this. Ockenden and the tidal wave of improvements and changes that have actually made things more unsafe and unpleasant for everyone.

Yes to all of this. You have hit the nail on the head. The Amos and Ockenden reviews just don’t get into these root causes and without doing so, will never address the issues.

We also need to be honest about what we can afford. If we want to treat 80% of women as higher risk then we need three times the workforce to manage the increased workload safely and sustainably. We have to ask ourselves if this is actually necessary? Will outcomes be better?

People need to listen to those in the thick of it. They know what is going wrong but they can’t speak out. Younger staff don’t always understand because they haven’t seen the before and have a different reality now

The doctors are scared to speak out. They also see unsafe practice among midwives who are being deskilled. More experienced midwives are scared to speak out