Midwife shortage? Hello? 28 births per midwife per year?

[Ushy]

I don't want to midwife bash because I know how hard some work but I couldn't believe it when I read that midwives are complaining that they are overworked and they want to reduce their workload to 28 babies PER YEAR from around 32 or 33!!! PER YEAR? I thought I must have misheard and they meant a month but no, a year. How come then, there is not already enough midwives for every woman to have good quality one to one care in labour and postnatally without us tax payers having to pay for more? Can someone explain?

[Haribojoe]

Interesting about the clexane/tinz at other trusts, women going home on these drugs hasn't started at our unit yet.

We have got the VTE assessment though and it has to be completed within 24 hours of admission for all women, whether antenatal, intrapartum or postnatal.

[3littlefrogs]

The period of high risk for VTE postnatally is greatest in the first 6 weeks. Proper risk assessment and follow up is so important. One of the reasons that prophylaxis is only given for 7 days is down to cost.

It has taken years of research and lobbying just to get to the point of having the risk assessment programme in place. The only reason it is happening is because now the Trusts will lose money if they don't do it.

They should be using the money they get for risk assessing to ensure that there are enough staff to do it!

[laluna]

We send all post sections home with seven days supply of clexane (dose dependant on bmi) as well as those with previous dvt.

[3littlefrogs]

There are over 30 maternal deaths a year in England due to VTE.

There are over 30,000 deaths per year in England due to hospital acquired VTE.

I know it is a pain risk assessing and thromboprophylaxing, but it will save lives.

[mintpurple]

Yea we use the VTE form too and yes lots going home on tinzaparin (we use instead of clexane). Biggest pita is the new pathology system - has instantly added probably 20-30 mins extra work if you do a few pathology requests and rH bloods etc.

[VivaLeBeaver]

Maxbear, we do a pn vte assessment on everyone. All high risk get clexane. Works out all lscs, prev vte, raised bmi if instrumental. Smokers don't increase the score.

[maxbear]

oh & to the other mw's on this thread, I'd be interested to know do you have endless women going home on clexane that wouldn't have 2 - 3 years ago (eg 36 year old, fourth time mum, smokers) or is that just where I work?

[maxbear]

yep same sort of paperwork here although we don't have to do a cjd form and a plymouth form (what on earth is that?)

I had two completely different night shifts last week one was very quiet, I stitched a woman and then did nothing but bits and bobs (and got lots of paperwork done) for the rest of the shift. 12 - 24 hours later I didn't stop all night, we had 7 community births between 4 midwives which may not sound a lot to you but with all the paperwork as well as attempting to provide one to one care, and one being a homebirth which meant two midwives went to one woman, it was a bit mad. Everyone was safe and I think most had good care but if only we could have had 3 on the first night shift and 4 on the next! (although then I wouldn't have got all of my paperwork done!)

[stoatie]

Viva - that pretty much sums up our paperwork (oh and of course the Register and NN4B on the computer.......) so sounds pretty much same amount across the country, then add into the mix all the other bits of paperwork (controlled drug register etc) - and its even worse if you have a student (said tongue in cheek) who have reams of paperwork as well which has to be completed and countersigned...........

[twotesttickles]

OP well clearly it's all down to me

When pregnant I have to spend at least one hour a day being monitored by a midwife and that lasts for the last five months of pregnancy. Sometimes it's more obviously. Plus they have to write in the 'big blue folder' a lot.

Midwifery is largely NOT about playing 'catch' in my experience. It's about keeping women alive and calm for a really long time.

[breatheslowly]

Viva - I didn't expect them to end up in my handheld notes, but I got a full copy of my hospital notes and was very surprised by the lack of detail.

[VivaLeBeaver]

Breathslowly - I can't say that all this paperwork is done at every hospital. However where I work all those forms are filed in hospital notes rather than handheld notes so the woman won't even know about them.

[breatheslowly]

Viva - your list makes interesting reading as at least some of them weren't in my notes when I got a copy of them. I was particularly surprised that the MW drew me a lovely diagram of all of my tears, but there wasn't one in my notes and the attitude (in my experience and other threads about debriefs) seems to be that if it isn't recorded it didn't happen which is quite upsetting for women and their partners who have their experiences denied.

[TheProvincialLady]

Viva that woman-feeling-fluey situation could have been me if I had been seen by an untrained HCA rather than a trained MW in my home. It is scary how quickly and how seriously ill I got, even with someone looking out for me, The GP was no use at all (refused to come out or to prescribe antibiotics on my MW request). I could have been dead. How appalling that HCAs are allowed to visit women on their own

[notsuchayummymummy]

VLB - I can't believe how much paperwork is needed and am shocked - shame we are in such a letigious society .

Thank you for doing the good job that you all do.

[VivaLeBeaver]

Oh and they've brought out a new bloods system so now when we take blood rather than filling out a paper form to send with the blood its all done electronically. So you spend twice as long doing it on the computer. Thats if you can find a computer thats free as we dont have enough.

[VivaLeBeaver]

The paperwork is terrible. I can understand the need for antenatal notes, partogram and postnatal notes but I'll try and list just some of the other forms that I can remember.

CJD risk form
VTE assessment form on every admission and postnatally
Plymouth Score form, to be filled out 2 hourly in labour
Admission summary form
Perineal repair forms to include diagram
2x lscs audit forms for audits
Form which states when staff were called/arrived for theatre cases (duplicates notes)
WHO form for all theatre cases
24 hour fluid balance chart for any instrumental delivery
epidural form to be kept filled out throughout labour (duplicates partogram)
Birthrate form
Wound assessment form
TPR charts
Meconium observation charts
Body maps for any bruises, etc

Thats pretty much it for standard sections and vaginal births. Obviously if anyone gets a bit more high risk then there's more forms.

I'd love to be able to get rid of most of these forms however they are a CNST requirement. CNST is the NHS insurance scheme. If we don't meet their standards we have to pay more in insurance. Which means we'd have less money. So even though we're wasting time filling out these forms doing this actually saves us money. I believe this was a Labour government thing.....not sure? But its got a lot worse in teh last 5 years. Paperwork has doubled in this time. .

I've spent most of the last two days not doing much as I've been given a high risk lady to look after. She hasn't needed much care at all but because she has the potential to go from needing next to no care to needing a lot of intense care very suddenly I haven't been able to look after anyone else as well. So there's someone who has now had well over 48 hours of one to one care. She probably doesnt realise that she's had one to one care and as far as she's aware someone's just popped their head round the door and checked on her every now and then. So I think sometimes people can have more care than they realise.

[Ushy]

Stoatie Exactly and I did say that was an essential. I work in litigation and I know first hand how right you are about the necessity for records BUT what about the duplication? One set of good records written once is what is needed. More than one is time wasting. (Don't get me started on the 12 billion the NHS has just wasted on its scrapped IT system....)

[stoatie]

Don't underestimate the paperwork. I had worked in the NHS as a healthcare professional/senior (ish) management position for 20 years before re-training as midwife. I thought I had seen all there was re paperwork - however the amount required by others is nothing compared to maternity. Maternity records must be kept for 25 years and may be required in legal cases. Therefore it probably goes without saying that meticulous records are required. If I am being questioned on a birth in 20+ years time - I may not recall a great deal accurately - the records will be needed (and scrutinised with a fine tooth comb). Rule 9 of Midwives Rules and Standards NMC states

"A practising midwife shall keep, as contemporaneously as is
reasonable, continuous and detailed records of observations
made, care given, and medicine and any form of pain relief
administered by her to a woman or baby"

"Your records relating to the care of women and babies
are an essential aspect of practice to aid communication
between you, the woman and others who are providing care.
They demonstrate whether you have provided an appropriate
standard of care to a woman or baby.
8 General advice on record keeping is published in Record keeping:
Guidance for nurses and midwives, which is available to download,
free of charge, from the NMC website at www.nmc-uk.org
9 All records relating to the care of the woman or baby must
be kept for 25 years. This would include work diaries if they
contain clinical information."

Trust me - keeping contemporaneous records and providing care of one labour is challenging, never mind if you have another woman in labour, and another poorly postnatal lady as well.

Similarly in an average antenatal clinic, the midwife will complete your care, write in your hand held notes, duplicate this information on the GP records (usually computerised) and in some areas, also a summary of visit/care in hospital/midwife held records.

[Ushy]

Must add one thing - not only would it be better but I reckon it would be safer!

[Ushy]

mathanxiety I agree with your comment about it being ludicrous ..and as for taking an hour to fill a form to report an incident that almost certainly arose because of lack of time..

BUT Viva Haribojoe Mintpurple and all the other midwives on this thread - suppose we said YOU design the service you deliver. I worked out you have 50 hours individual time for each woman with CURRENT staffing. Your constraints would be: one to one care in labour, high quality postnatal care, a good booking appointment, good records, other care as indicated by NICE guidance. You could shift ward 'stuff' round so that it was easily accessible and reorganise the physical environment as much as you like and you could delegate to HCAs as you wish - providing you also engage with them to get their views. Unnecessary jobs you could dump.

I bet you would come back with a blue print to develop one of the best maternity services in the world and there would not be a single mindnumbing senseless bit of paperwork in the building, no-one would be stressed and running round like headless chickens AND you wouldn't have cost tax payers a penny!

[mathanxiety]

'For example, my lovely lovely community midwife was only allowed to run one clinic a week at our GPs, which was always overbooked. All the women who could not get one of the extra "emergency overflow" appointments (which were almost always all taken up in advance as there were not enough normal appointments available so no room for actual emergencies) had to be seen at home in the rest of the week. So instead of seeing 18 women in 3 hours at the clinic one after another she would have to spend say 9 hours seeing them as she had to travel to see each of them individually.'

What does this say about the quality of management?
And the length of time to fill out a form? Ludicrous.

In my experience the US system worked well, with nurses doing the more mundane monitoring and post natal care and MWs or doctors there for the delivery and occasional checking of progress. I personally experienced only one delivery (out of five) where the hospital was really busy and my nurse wasn't there with me for about half an hour as she was called to assist in another room. It shouldn't have happened though as I was being induced. There wasn't enough time for the anesthetist to give me an epidural that time either [grrrr].

However, in the US, nobody visits you after the birth at home. You are completely on your own once you leave the hospital. You bring your baby for a checkup at two weeks and you go for your own post natal checkup at six weeks.

[breatheslowly]

That's classic Viva - filling out a form that takes an hour where if you had a free hour at the right time you probably wouldn't have needed to fill out a form.

[VivaLeBeaver]

I'm not sure who delegates the work tomthe hcas as I don't work in community. I know they have no qualifications and I know they do visits on their own. Whether individual midwives tell them can you say x and y or whether there is some other system I don't know.

I do fill out risk management forms where I think there s been a near miss and this is done frequently. I filled out four so far this month, they all take about an hour to do. So that's more time wasted. We fill out so many forms about staffing levels to patient ratio that we've been told to stop doing individual forms but to fill out one a month with a list of affected dates/shifts.

[fraktious]

Maternity care is funded at 100% things like a private room are paid by top up health insurance.

Antenatal classes there were 6 of us, dropped to 5 as 1 had her baby early. I had the option of individual prep, as does everyone in my area, which would have been 3 1 hour sessions IIRC? But that might have been partially funded, partly paid by insurance. I wanted to meet other people though!

I get the feeling I could have had more care if I'd wanted IYSWIM. I didn't get the impression that they were stretched or harassed, but when I worked with PN mothers in the UK I definitely got that vibe from the MWs I saw and the mothers said the same. No matter how good they are and how caring and attentive they currently have too much work and I do think that negatively impacts on care.