I am a midwife and a mum of two. I wanted to write an account from a midwife's point of view in support of the Better Postnatal Care campaign. Not to make excuses, but because midwives know how much those early days count and we want to see improvements too.
It has been about five years since I worked on a postnatal ward; since then I have worked in antenatal services. I know that the trust I work for is not alone in its determination to improve postnatal care, and I know that changes have been made for the better, but I fear that the difficulties I experienced as a midwife remain. One issue being that of staffing levels.
A shift would quite often start with lower than recommended staff numbers. Then, during the shift, it wasn’t unusual to get a call from the Delivery Unit asking for a member of staff to move there because they were short-staffed too. I worked on a 28-bed ward; the ideal number of staff was five midwives and two healthcare support workers, but frequently there were only three midwives and one support worker for 28 mums and about 28 babies. With so few staff to patients it is incredibly hard to deliver the care that is needed.
There are medical ward rounds, observations rounds and drug rounds. There are new admissions from the delivery unit and women to discharge home. On a standard postnatal ward in a hospital obstetric unit (so not in a midwife-led unit or birthing centre) there are also mums with various complications. There must be frequent observations for mums back from high dependency care; hourly blood pressures for women with pre-eclampsia; blood sugar monitoring for babies and mums; bilirubin measurements for babies with jaundice; emotional support for mums with babies in NICU; IV drug administrations; and scoring of babies who are withdrawing from maternal opiates.
There are also time-consuming cases involving social services. Then there are the stacks of paperwork. All these supersede the basic emotional and practical support new mums need, want and deserve. Building a relationship with a mother and her family is pivotal in providing the care they need, but to do this time is needed - a precious commodity that is rarely available during a shift.
Midwives get through most shifts with no more than a toilet break. ('Eating' means scoffing chocolates left by patients or a snack eaten in secret behind the desk.) If you forget to bring a bottle of water, the chances of getting a drink are slim. They told us not to drink at the midwives' station because it looked unprofessional. Leaving a shift on time is a rarity. Stress levels are high. Retaining newly qualified staff is a huge problem because they just don’t receive the support they need.
The pressure on beds is considerable. I remember being told to discharge a new mother against my better judgement; she had given birth the previous day and was medically fit for discharge, as was the baby, but she clearly needed support with breastfeeding. I was told to discharge her because the bed was needed to clear a space on the delivery unit; she would have to try to get the support she needed from the (overstretched) community midwifery services. I was disgusted and ashamed. Midwives are autonomous practitioners, which means we are accountable for our own actions. Every decision we make we must be able to justify, but our autonomy is squeezed by pressures on services.
So often I would feel physically and mentally exhausted. I would go home wondering if it was my fault. Were my time management skills lacking? Maybe I just wasn't up to the job? Had I let the team down? Had I let the women and their families down? At the end of some shifts staff would go home in tears. Tempers flared in sheer frustration.
Many reports over the years have recognised postnatal care among other areas of maternity as needing major improvement. More recently reports have also recognised the need for better working conditions too. The Royal College of Midwives found in a survey that 48% felt stressed at work every day or most days with over half of respondents worried about making a mistake because they are exhausted and 62% said they were dehydrated at work because they didn’t have time to drink water.
We all (NHS leaders, midwives, women and families) want the same outcome. How can we get there? How can we offer an excellent standard of care and create a good work-life balance for staff? The quality of postnatal care, staff well-being and staffing levels are all intrinsically linked. I don't think you can have one of these without the others.
To put it simply we need more midwives, highly trained maternity support staff and good clerical staff before we can start to attempt to implement a better maternity service. We need change, and we need it now.