Your views on MCAs at birth?

[cherrycherry16]

Hello lovely MNers!

I was just wondering how ladies who've given birth (or are set to give birth soon) feel about having a maternity care assistant present at their delivery? I've never thought it was that strange; I've been an MCA for several years and have been in on deliveries and helped with antenatal and postnatal care since I began (and I absolutely adore it btw!)
But I'll soon be starting my midwifery degree at uni and it has prompted lots of friends to say how they've always been amazed at how much responsibility and input I have already as an MCA with no training at all. Lots and lots of people have piped up with this view, and I do have to take umbridge as its really not true! I'm up to date with all my training including resuscitation and emergency procedures, and I've got lots of experience of mothers and their families who tell me they've felt really well supported by me. I had no idea so many people's minds boggled that I'd be let loose on a labour ward. MCAs aren't a band of uneducated oafs, I promise!

How do you all feel about it, or has it never been something you've really thought about?

And what of something goes wrong cherry - there should be a midwife for mother and baby.

I would have a home birth rather than use a MLU that had that level of staffing.

My point is really that I wouldn't be comfortable with a staffing decision that says you only need one midwife at a delivery. Yes, you are very able to open packets, provide support, rub down a healthy baby, etc. But what you aren't qualified to do is resuscitate my son whilst the midwife deals with my sudden PPH. Or whatever.

To me, great, have an MCA. I can see you can really add value. But have second midwife too.

How does your unit work. If a baby is delivered in poor condition does a mw ditch a labouring woman without warning to attend? It seems wrong to me, and understaffed.

I've had a homebirth where the second mw didn't make it with much to spare. But I was profoundly grateful she did.

We only have one midwife at delivery, I only ever call a second if I'm anticipating a problem or require assistance in some way, in those situations I want either a peer or a coordinator. Do you mean you are trained in neonatal resus? I find that quite scary that with no official training/background you feel you could perform those tasks. Fair enough in an emergency but not as the norm, if that's the case then you are a money saving measure and I don't think that is acceptable. Our MCA's clean rooms, do baby baths, run in theatre,make tea and toast, occasionally help with breast feeding (if they've had the training), take blood (generally in clinic), get women up to the shower and generally assist, they are worth their weight in gold. But they're not midwives and nor should they be used as such. MCA's who do more and more for less money completely erode the role of the midwife, why employ us when an MCA can do it all and we just have to be the mugs who put our PIN on the line by supervising.

As an aside, if you give birth at home unattended (at least in my area) the ambulance dispatchers always send two crew, no matter how well everyone seems. The view is that there are two patients, so need two crew.

I suppose their view is that it is different as there are mw's in adjoining rooms who can run in. But it still seems to me as treating someone who should be a great additional resource as a replacement for a mw.

Good luck with your training.

See I don't need someone to open packets for me. I can open them before baby puts in an appearance and have everything ready.

I need a qualified member of staff to give the syntometrine and concentrate on the baby so I can concentrate on mum, her blood loss and the placenta.

I'm hoping to be on a MLu and it hadn't occurred to me until now anyone apart from a midwife would attend. I'm afraid to say I wouldn't want anyone else there really. Post natal it would be ok I think

Good luck at Uni OP

Maybe OPs role would've been able to support where the midwife couldn't.

Midwives are too short staffed. We could solve this with more midwives. The MCA role is cheaper than a midwife.

cherry I was in for 5 weeks so yes I made it clear to the sister in charge I wouldn't be allowing it to happen again.
Ordinarily it probably wouldn't have bothered me, I might not even have noticed she wasn't a midwife or another clinician but being a long term patient meant I was familiar this member if staff and saw her at least 4/5 days a week so it felt really invasive of my privacy and dignity.

Plus she was really insistent that she hold my hand to support me. I really don't like people touching me so it just made the situation even worse.

Had a student MW with first baby, but asked him to leave when I got moved from birthing centre to labour ward

Never heard of a MCA until I watched OBEM the other night (not seen much of this series) but would have been happy to have one in attendance. Although second birth was just so peaceful... me, OH and MW! Lovely.

I wouldn't be happy about them replacing the second midwife. If there are problems with mum and baby who gets the real MW and who gets the CA? It's a way to cut costs and is not appropriate. Both my deliveries were 2 MW.

I only heard of a mca on one born every minute last night. . But you sound lovely.

I've never heard of an mca tbh. I had my labour augmented with the drip and had a student mw with me all of the time with various supervising mw in and out. I wouldn't want that situation again. It wasn't the fact she was a student (she was lovely) it was the dipping in and out of other un-introduced, unknown mw that wasn't very nice. If having an mca added to that I wouldn't want it.

When push came to shove so to speak a second mw was there for ds's actual delivery (good job as he came out quickly all in one go). I was in so much pain I honestly didn't have had a clue who she was and what her role was-she could have been the cleaner from where I was sat. If something went wrong obviously I would have wanted 2 mw rather than 1 and an mca. As it was the senior mw took a quick look at the carnage that was my under carriage and announced we'd need a registrar for sewing up.

It seems that no one really objects to mca as such more the absence of a second mw or more people traipsing in and out of the delivery room????

I absolutely agree that two midwives are needed if there's anything unexpected happening, one for mother and one for baby. If everything is straight forward then I am just that support to the mother whilst the midwife is busy delivering the placenta etc. One midwife can do these things alone, only one will go out to a homebirth so they do everything themselves. I know lots of people on this thread don't see it this way but from that perspective, some additional support for the mother whilst the midwife is busy is a bonus. If the situation were to develop then we could pull the emergency bell, or I could go and get one of the other midwives or a staff grade. I have the training I need to help out, and like I've said earlier I think there needs to be a basic level of training for all staff on labour ward. That's not to say I'd shove a midwife out of the way and say 'stand back, I'll handle this resuscitation of a newborn.' But I know how, I attend the training regular and I think that's better than having someone in the way who doesn't know where to begin. I must say that there was once a really dreadful (and extremely rare) situation where both mother and baby needed attention at the same time. I was able to help the midwife in charge with the baby whilst we waited for the paeds to arrive. It must only have been three mins but it seemed like forever. It was a truly dire situation but we had a good outcome, and the parents didn't complain afterwards that someone with far less training than a midwife was involved until they could step back for the paediatricians to start. I was there because of necessity, and on balance it's a bloody good thing care assistants get the training we do as a precaution because when it comes down to those situations when there is no one else someone with the basic knowledge is better than no one at all.
I might be completely wrong but it feels like a lot of the worry is to do with fear. A huge 'what if something goes wrong?' is hanging over this thread, as in 'what use is a CA when the poo hits the fan?' And I'd want the best possible medical care for me and my baby too. But things aren't escalating into dire emergencies left right and centre, I can say that with my hand on my heart. We're not silly and we don't take risks; if a lady is high risk then she'll have a staff grade on hand, and more often than not her consultant and an anaesthetist on high alert somewhere very close by. But if a woman is low risk, and her baby seems fine then we treat the situation in a very calm way. The staff are there, a very good team, on hand immediately if they are needed. But if they aren't then two midwives aren't necessary. If a woman is low risk in the community then she has one midwife. If the same woman decides 'actually, I'm going to deliver in the hospital instead,' why does she then need two midwives? The staff at my unit say labour is normal until it's not, until something happens which makes it stray from the expected. At which point we step in. If not, then we don't. I find that empowering, that it shows we understand that a woman is capable of giving birth without intervention we're just providing a place for her to do it.
Apologies to the person who thinks care assistants are eroding the role of the midwife. That's a hard thing to read (as a care assistant) and I don't feel it's true. The midwives I work with feel supported and that they're able to fully focus on the women and their babies with the extra bit of help that we provide.

Phwoar!! Somebody shut me up! Sorry, didn't realise when I started that I'd go on and on like a boring fart. Keep it coming though, and I promise to keep my responses to a minimum. Genuinely, much gratitude for everyone's honest thoughts (and to those who have wished me luck with my studies) It's not long now until I go on to do my degree, everyone's thoughts and opinions on here are extremely interesting for someone about to study midwifery, I can assure you! Xx

Only one midwife at a Home birth? Oh my god! Id love to see the HOM or risk midwife try and defend that in a coroners court!

And MCAs definitly do erode midwife numbers. I've worked in units where ive seen it happen with my own eyes. Decision has been made to reduce the number of midwives on shift but increase the number of MCAs. Also MCAs do postnatal visits in community. Not the day 1 or day 5 visits but other visits.

only one will go out to a homebirth so they do everything themselves

Two midwives for a homebirth in the UK.

that's better than having someone in the way who doesn't know where to begin

I've never heard of anyone working on a labour ward who wasn't a nurse or a midwife. It's not a case of if you weren't there the tealady would be holding hands or helping struggling newborns.

situations when there is no one else someone with the basic knowledge is better than no one at all.

Agreed, however the argument on here is that we could have midwives, but MCA are cheaper. A fully trained professional is better than someone with basic knowledge and no one at all.

Given how many women feel that midwives were not able to provide adequate care due to under staffing and this being a cost issue I think you're naive to take these concerns personally. Why train someone half way? Why not just invest and train fully? It's like a sticky plaster on the gaping wound that is maternity services.

Is it really the case that your area has one mw at a homebirth? I am

I have had two home births and both call for a second when delivery seems to be getting close.

I'm quite shocked 1 midwife is the norm where you work. There was only one midwife when my second was born and she was desperately pushing a bell for a second but it was all happening quickly. It certainly wasn't the norm.

I wouldn't want more people there than were needed. I've given birth twice and my husband provided support and midwives provided medical care.

That said there were MCAs on the post natal ward and one helped me breastfeed and another ran me a lovely bath. That was nice.

Apologies to the person who thinks care assistants are eroding the role of the midwife. That's a hard thing to read (as a care assistant) and I don't feel it's true.

But in your situation it certainly is true, you say so yourself! Instead of having two qualified midwives, they have replaced one midwife with a much cheaper MCA. It's a cost-saving decision, not a best care decision.

your area sounds a disgrace frankly if they only send one mw to a hb

your area sounds a disgrace frankly if they only send one mw to a hb

I dare say it's a lack of policy knowledge rather than the area's policy. Which kind of shows what Viva and others were saying really.

It was me who said that MCA's taking on more erodes the role of the midwife and nothing that you have said has made me reevaluate that. So you're being trained in neonatal resus? Where does it end? Being trained to 'catch' the baby, I guess you'd just need one or two midwives to run a busy delivery suite if that was the case, one to give drugs and one to monitor the CTG's centrally. Can you not see how by expanding your role to take on more midwifery jobs means midwives end up with more responsibility (believe me it'll be MY fault that you didn't resus the baby I've just delivered - after all you don't have a professional body to regulate you and as part of my code I remain responsible for all tasks I choose to delegate) but with less satisfying elements of the job?

I'm not even commenting on the one midwife for home births thing as I don't believe it's true. Maybe initially when I the first stage of labour, and I accept sometimes babies arrive quicker than anticipated so with only midwife in attendance but to actually plan not to have two midwives at delivery in the community just doesn't ring true to me. So I guess I am going to comment afterall

I do wish you luck with your training Cherry. You sound very passionate about midwifery which will take you a long way.

I suspect if you save this thread and read it in three years time your opinions may have changed. I don't mean that sarcastically or rudely, just that the next three years will get you seeing stuff from a different perspective.

Oh and another thing (haha I appear to be on a roll now) I work in a unit that routinely has only one midwife for delivery and that suits me, I like and respect pretty much all of my colleagues but I know not all of them practice in the same as me (not wrong! Just different) and unless I realy need a second pair of hands I don't want someone else in there disturbing the environment, talking loudly (have had others come in thinking they were doing me a favour yelling PUSH when all I needed was the resuscitate checking for instance in a rapid delivery) and generally doing things differently to me. I'm not saying you're doing that OP but the potential is there.

In the nicest possible way, you have only ever seen low risk births. When you have a bit more experience you will be a lot more aware of what can go wrong, and the what could have beens.

The staff at my unit say labour is normal until it's not
Well yes. And sometimes it stops being normal in a second. I have friends who had lovely low risk pregnancies and textbook births, then baby born blue with apar of 1 and mother had massive haemorrhage. No one could have predicted it, that's why we have midwives, in case it all goes wrong. To follow your logic, why bother having midwives at all, give partners a pair of gloves and a clamp and an emergency buzzer for when it looks like someone's dying?!

If I was giving birth I would prefer to have a qualified midwife than an MCA, no matter how nice she was.

Why do you think your unit is paying MCA's instead of qualified midwives? It isn't because they think they will do a better job, it is to save money. None of your colleagues are going to tell you to your face that they would much rather have a qualified colleague than you. I don't point out to my less experienced colleagues that I can do their work in half the time why would I? It would be rude and unhelpful. Doesn't mean it's not true.

the parents didn't complain afterwards that someone with far less training than a midwife was involved

Because they didn't know that you had so little training, and they didn't want to think about the fact their baby could have died. If that baby had died or suffered permanent brain damage and a midwife could have saved it, how would you have felt?

That someone hasn't died or been injured due to the working practises in your unit yet, just means it hasn't happened..... Yet. It doesn't mean it's the best way of doing things.

I'd like to think that my body is capable and my efforts are enough to deliver my own baby, with a midwife and an MCA at the end if necessary

Apart from anything, please rethink this attitude before you look after labouring women by yourself. Sometimes everything goes tits up and it isn't because a women's body is not capable or she isn't trying hard enough.