Midwifery staffing crisis

[Madwife123]

For those of you who are not aware there is currently a huge midwifery staffing crisis in the U.K.

We are losing staff faster than we can train them and almost half of midwives currently in practice are looking for ways out. Sadly myself included.

This means pregnant women are simply not getting the care they deserve. We are desperately trying to fix this and are calling on the government to help tackle this issue before services become completely unsafe.

Please have a look on Facebook for a group called March with Midwives U.K.

Don’t think I’m allowed to post the link sorry. There is a vigil planned which would be great if we can get as many people to join as possible. Or if not then it helps sharing your story of poor care you’ve received, delays in appointments etc. any adverse outcome you have had so we can evidence the effect this is having on women.

Please help us make maternity services safer!

I have heard it from the Head of midwives at the hospital where dd was born. It was also said regularly by the Director of Midwifery and the Director of Womens' and Childrens' Services at a large SW London Teaching hospital when I was a member of their Maternity Services Liaison Committee in the late 90s. And golly they didn't like being challenged on the point.

If staffing is so much worse now than in the late 90s can a midwife tell me why the midwives were complaining so bitterly in about 95/96 or was it political and there was a Conservative government if so, I don't recall staffing being any better in 1998 when dd was born.

@RosesAndHellebores A few years back universities were asking for ABB. The requirements are high! In response to your comments about midwives referring to doctors and ‘not knowing’. The very likelihood is that they do know the answer but we have a very tight remit and anything outside of that we are not allowed to advise on.

In terms of scanning everyone in labour. Who is doing that? Where are the staff? Not all midwives are trained to scan and the doctors are busy enough! A nuchal cord wouldn’t be detected on a portable ultrasound as they are not that clear so that means traipsing labouring women down to the ultrasound department and praying they don’t give birth in the corridor on route. Plus a nuchal cord does not cause any complication in the vast majority of cases so then all the intervention would have in fact been unnecessary.

@RosesAndHellebores Yes staffing is now worse than the 90s. Maternity has always been short staffed but things are now on a whole new level having had the ‘perfect storm’ of brexit and a pandemic. This has led to a mass exodus of staff.

Roses - The population has grown since 95/96, and I’m not sure the midwife numbers have grown to match.

In addition, due to advances in medicine, there are now more complex births to women who have medical issues and more births to older women. Some of these will be dealt with under consultant care, but some (who have some minor risk factors - like me) would mainly be under midwives.

There is more that can be done now than previously - but this in itself brings problems of implementation. Your suggestion of initial scan on arrival to maternity unit sounds good - but the resource implications can be quite large. You would need 24hr US scanning capability (possibly more than just 1 trained person at a time to cope with the volume) on a rota. Is this going to give enough benefit to justify the cost?

Who is calling for the continuity of care thing? I couldn’t have given a shiny shit if the midwives delivering my baby were the midwives I’d seen for antenatal appointments - I’m glad they weren’t because they were doing two completely different jobs. As for continuity of care in labour, it went on for more than 12 hours so I had no expectation of it being the same person all the way through. As it was I had a new midwife come in 5 minutes before I needed to push, who I hadn’t ever seen before. It was fine, she was caring and competent as the previous ones had been, so why would this be a negative thing?

Is there really a demand for this from patients or is it just something that’s been thought up as a misguided ‘solution’ to something.

@Madwife123 a well managed unit would put a proper ultrasound scanner in the labour ward and staff it. The savings from unnecessary labours and emergency care would more than pay for it. Notwithstanding unnecessary birth injuries which arise from said births. Oh how I lived my prolapsed bladder and now incompetent anal sphincter. Put right privately because the NHS didn't want to know.

My first born was posterior. He had the cord wrapped round his neck. The third time the twisty midwife blamed the dip in heart rate on a faulty belt my dh opened the door and belted to get a Dr immediately. The baby was being strangled by the cord - he was too far out for a section. They had to cut the cord whilst he was in the birth canal. It could have been catastrophic. He spent the first night in SCBU and examined by more drs than hot dinners on Xmas Day. They clearly had the wind up as evidenced by a very senior manager visiting me to ask if I was satisfied with my care - disingenuous or what?

Only when the Dr arrived were the words posterior mentioned. The midwives had spent much of the previous 12 hours having a laugh about how I'd cope with labour bearing in mind how much fuss I was making as the cervix effaced.

The standards were no better with more staff; there were just more of them poking their noses in and being inappropriate. The minute the senior midwife appeared the emergency button was hit and the room filled with people.

My two subsequent births were much better. Consultant led and properly managed with as little interaction with madwives as possible.

@RosesAndHellebores I’m sorry you are wrong. Paying a full time sonographer 24/7 and using valuable space on a labour ward to have that massive proper ultrasound machine would absolutely not pay for itself.

Only 3% of babies are breech at term. Finding a nuchal cord would not change the management of labour as it rarely causes an issue. It’s the length and stretch of the cord that has more bearing and that cannot be determined on scan.

@RobinPenguins Evidence has shown it to be safer and women have reportedly asked for this model of care. The issue is we don’t have the staff to do it correctly but have implemented it anyway to the detriment of the service.

@RobinPenguins Evidence has shown it to be safer and women have reportedly asked for this model of care. The issue is we don’t have the staff to do it correctly but have implemented it anyway to the detriment of the service.

Thanks, that’s interesting, it’s just not something that it ever occurred to me to be bothered about. From what you’ve said, it’s definitely not the right time to be introducing the model now!

@RobinPenguins I suspect the questions were loaded to ensure women answered the way they wanted as I’ve never met anyone who actually cared that ‘their’ midwife was present in labour and some of them wouldn’t want them there as didn’t have a good relationship with them. I mean realistically it’s impossible to guarantee your midwife will deliver the baby anyway, what if you’re in labour for 18 hours etc. You are going to have multiple midwives caring for you. Does it really matter if one of them is ‘yours’? I think not.

@RobinPenguins

Who is calling for the continuity of care thing? I couldn’t have given a shiny shit if the midwives delivering my baby were the midwives I’d seen for antenatal appointments - I’m glad they weren’t because they were doing two completely different jobs. As for continuity of care in labour, it went on for more than 12 hours so I had no expectation of it being the same person all the way through. As it was I had a new midwife come in 5 minutes before I needed to push, who I hadn’t ever seen before. It was fine, she was caring and competent as the previous ones had been, so why would this be a negative thing?

Is there really a demand for this from patients or is it just something that’s been thought up as a misguided ‘solution’ to something.

Misguided solution.

So the govt a few years ago asked BAroness Cumberledge to do a review into maternity services. I suspect she had an agenda. Yes, women were asked if they’d like to see the same midwife throughout. Of course a significant number said yes.

Only problem was they were saying yes without all the information about how that might affect midwives, how to make it work properly and not burn the staff out you need a massive increase in staffing which we don’t have.

So now we have the gold standard of the Better Births review and Trusts have been told they have to have x percentage of women on a continuity pathway by various dates or the trust has to answer why. So we’re now on a runaway train of implementing this regardless of whether it’s working or not. The writing is on the wall but we carry on. To be honest it was on the wall before…..team midwifery was a thing in the 80s (?) and didn’t work….continuity is the same thing rebranded. Various older midwives said been there, done that, didn’t work last time, won’t work this time and we’re told off for being negative.

Another issue is some midwives love labour ward, hate community and vice versa. Some love post natal ward. Now everyone has to do everything regardless of whether they like that area or not. So even without the burnout people are leaving.

And I agree that the stats have shown continuity to be safer/better results but if you dig down into the stats that’s more down to having the same midwife for all of their antenatal care…..which of course is going to be better and safer than a different person at every appt. the results aren’t as significant for having that same midwife in labour.

So all trusts needed to do was sort out their community teams a bit better. 🤷‍♀️

[quote Madwife123]@RobinPenguins I suspect the questions were loaded to ensure women answered the way they wanted as I’ve never met anyone who actually cared that ‘their’ midwife was present in labour and some of them wouldn’t want them there as didn’t have a good relationship with them. I mean realistically it’s impossible to guarantee your midwife will deliver the baby anyway, what if you’re in labour for 18 hours etc. You are going to have multiple midwives caring for you. Does it really matter if one of them is ‘yours’? I think not.[/quote]
I've had 2 hospital births and 2 home births. The hospital births I saw an array of different midwives and didn't have continuity during labour due to shift changes. That wasn't an issue to me because you just sort of expect it to be the case.

The two home births I had I saw the same community midwife throughout both pregnancies and she delivered both babies 3 years apart. This really was as near perfect as you can get it but I suppose it would have been an issue if I didn't like her (she was lovely).

It was also only a perfect outcome because I was experienced at childbirth by this point and had very quick labour and deliveries both times with zero complications before, during or after.

@CovidCorvid The ironic thing is at my trust antenatal continuity, the bit that actually matters, is now worse due to trying to improve labour continuity. I’m forever having another midwife cover my antenatal clinic as I’ve been called out. Previously I would have seen my own women myself.

I probably should add that wasn't a recent anecdote. My youngest 'baby' is 15 now.

Interesting points you have focused on there @Madwife123. I'd like to review all the data before I agree that I'm wrong. You have said nothing about rectifying unnecessary birth injuries, sometimes decades later.

I shall certainly be advising my dd to have elective sections privately when the time comes. And yes I'll pay for them. The system stank 25 years ago and still stinks. If it served men it would be organised very differently.

Your "own" women? Did you buy them at the sales or something? What a reductive expression. I take it you meant your allocated caseload?

@OvaHere That sounds lovely. I agree continuity is easier with low risk multips (not first baby) having a home birth. Not everyone fits into that category however and they all need equal care provision.

There was a wonderful service called one2one midwives a few years back. They offered full continuity and had a high home birth rate, brilliant proven outcomes etc. They didn’t charge the patient but billed the NHS for the care that they would have been providing if the woman wasn’t being cared for by them. They went bankrupt as it was impossible to provide that level on service on what the the NHS was willing to pay. That’s a team full of midwives who actually signed up to work in this way and chose it and they had a far far less patients than the NHS have and they still couldn’t achieve it. How can the NHS?

@RosesAndHellebores Of course I don’t own women. I’m quickly typing and referring to the women that are allocated to me. As in I am their named midwife which you are well aware of.

It's a shame that women can't take the NHS contribution to birth and put it towards private one-one care. I'd have been happy to top up if I'd had low risk pregnancies.

Yes, but language is a very important part of communication and to type the phrase you must also think it to a degree. It's concerning and something that's wrong at the heart of many NHS stakeholder relationships.

[quote Madwife123]@OvaHere That sounds lovely. I agree continuity is easier with low risk multips (not first baby) having a home birth. Not everyone fits into that category however and they all need equal care provision.

There was a wonderful service called one2one midwives a few years back. They offered full continuity and had a high home birth rate, brilliant proven outcomes etc. They didn’t charge the patient but billed the NHS for the care that they would have been providing if the woman wasn’t being cared for by them. They went bankrupt as it was impossible to provide that level on service on what the the NHS was willing to pay. That’s a team full of midwives who actually signed up to work in this way and chose it and they had a far far less patients than the NHS have and they still couldn’t achieve it. How can the NHS?[/quote]
That's interesting. I hadn't heard of it. Sounds like a great scheme but I can understand why it it didn't work due to funding. Such a shame.

@RosesAndHellebores I completely agree if the service served men it would be different! And sadly there is not a lot of research into birth injuries years later so it’s impossible to comment. I’ve often raised the point that midwives are not informed of this and don’t work in this area so you could be doing perineal repairs for years and not actually be aware that x percentage of them break down at a later point so wouldn’t know that your practice needs improving etc.

ELCS isn’t the miracle answer however and leads to many injuries down the line also. Each to their own however.

@RosesAndHellebores This is something the campaign is asking for. Personal maternity budgets that follow the patient.

I didn’t type that I own women. I said my own women. I also earlier said about women having a midwife that is theirs in labour. I also don’t think women own the midwife but I am chatting and using language that is commonly used to explain a caseloads for system that not everyone has knowledge of.

I understand that outcomes for planned caesareans performed by a trusted obstetrician are rather different from outcomes for ELCS performed after exhausting labour's by locum senior registrars.

@RosesAndHellebores A caesarean performed in labour by a registrar would be an emergency caesarean not an elective. But yes the outcomes are different for emergency and elective caesarean. It’s just not the miracle cure as adverse outcomes do occur with ELCS also. I personally think we give women the information on the stats and let them choose. They are the one taking the risks so they can decide which risks they are most open to taking. Either way birth carries risk it’s impossible to remove it altogether but women should be able to make their own decision regarding their own body.