Live webchat with Royal College of Midwives CEO Cathy Warwick, 13 October 1 - 2pm

[KateHMumsnet]

Today, midwives in England are due to go on strike. Midwives and thousands of other health service staff are taking action after the NHS Pay Review Body’s recommendation of a 1% pay rise for all staff in England was rejected earlier this year by the Health Secretary, Jeremy Hunt. It’s the first strike over NHS pay in more than three decades, and the first-ever strike by the Royal College of Midwives, which nevertheless has the backing of 82% of its members for industrial action.

RCM Chief Executive Cathy Warwick will be joining us for a webchat on Monday from 1 - 2pm to answer your questions about the strike, and about maternity services in general. Please do join us live on the day, or post your questions in advance on this thread.

@Angeleno

Hi Cathy,

I also completely support the strike, and thanks for coming to MN.

The few midwives I know are overworked, several of whom haven't had a proper holiday in years and now they're being denied a teensy 1% pay rise, on top of it all. It's surprising that not more midwives have quit!

My question is, apart from the 1% pay rise, what one change would you advocate to improve circumstances for midwives?

Hi

This may be a bit off the wall, but I think if our maternity services could be organised so that there was more continuity of care, this would make life better for mothers and better for midwives. I don't mean every midwife has to case load, only some midwives want this level of commitment. But if we could arrange things so that midwives saw the same woman antenatally and postnatally, I think it increases job satisfaction, reduces the number of times things have to be repeated, and even makes all the paperwork easier. So that's my first suggestion.

On a much lighter note, I just think people should be nicer to each other! Say thank you more often, and help each other out. That probably happens where you work already, but it isn't always the case. Lots of sympathy for each other I think goes a long way.

@Crumblemum

Not about the strike (which I support massively) but about care in hospitals post birth. How can it be improved. I hated staying overnight and seeing c-section women ignored when not being able to lift their babies and everyone else overstretched. If it's not a role for midwives can auxiliary staff help more?

Couldn't agree more that we need to concentrate on postnatal care. My answer to the problems that you quite rightly highlight is that more maternity units should let women's partners/mothers/friends stay overnight on the postnatal wards. This is being done in an increasing number of units, and it makes a massive difference. Women report being much happier and midwives also like it because they can concentrate on things like breastfeeding support rather than the simple tasks that partners are happy to do. It's also good because the partners don't miss out those lovely first hours of their baby's life.

People say it's hard to do because there isn't enough space, or other women will want more privacy, but all these problems have been overcome in some units, so why can't they be overcome everywhere? Every time I talk to midwives, I make this suggestion and put them in contact with places it's happening. I also agree that auxiliary staff (who we call MSWs) can be fantastic at giving this support. And many units are employing them in these roles. It's the sort of thing your maternity liaison committee could bring up if there is one in your maternity service. Good luck.

May I ask why standards of care differ so much? During both my labours, I had a lot of midwives (14 for the first and nearly that for the second - my labours were inductions so were quite long but I think I also kept getting people at the end of their shifts) and I can count on the fingers of one hand those who introduced themselves to me, and were just nice. The rest were rude, silent and in some cases shouted at me, once because I asked for a glass of water when hooked up to a monitor, and another time because I said I didn't want to eat breakfast because I felt sick (neither of us won: I did eat it but was promptly sick). I appreciate that some people may have been having a bad day or were stressed etc, but I was shocked at the poor level of care and regard these women had for me and other labouring women.

I am in favour of the strike, by the way. Despite my experiences, MWs have a difficult job to do and work for little pay and in poor conditions.

We had a really big thread last year about partners staying overnight on pn wards. Over 800 messages and I'd say 80% weren't in favour of it. Would be interesting to see how women who actually have to spend the night the other side of a thin curtain from a random bloke actually find it.

@IAmAPaleontologist

As a student midwife my heart is with the strikers today. My head sadly is in my books as we have an exam looming . It was a brave choice and I hope all goes well for those out on the picket lines today.

I am looking forward to tomorrow's RCM study day in Stockton :)

As far as midwifery service in general go, what, if anything, do you think can be done to stop having such a vast difference in services from trust to trust? All trusts have access to the same evidence bases yet practice can be wildly different. When to induce? When to use antibiotics? Eating and drinking in labour, admission CTGs, who can use the pool, how long to wait before augmentation with SROM. Just a few of the things that vary so much even within my local area. This area spans several trusts and as such there is quite a wide choice of hospital for women (sadly we do not have access to a stand alone MLU) but with all of the trusts following different guidelines it becomes very difficult for women to make an informed choice.

So glad you're coming to our study day tomorrow! Hope you enjoy it.

Yep, it's frustrating that there are so many differences. Generally, I would say it's about leadership and about midwives themselves not accepting local protocols that don't fit with national guidelines. Having said that, there will always be those that are a little ahead of the game and adapt their protocols specially in terms of admission criteria to MLUs and pools sooner than others, and I guess that's just life.

The RCM has a huge role to play in spreading changing practice. However, the problem is when trusts are not even implementing the basic evidence. I think the new CQC inspection regime may start to pick some of these issues up, and recently the RCM had success working with the CQC in identifying a maternity service that needed to up its game, as it was intervening too much with women whose pregnancies were normal. That practice has now changed. It is hard for women to make informed choices, and this is where good midwives can make all the difference.

I just wanted to add my voice to those supporting the strike and any other action the midwives take. They are unsupported, underpaid and unappreciated by the NHS (along with a lot of their staff!). The whole thing needs sorting out - not least of all the ridiculous number of hours they are expected to do (even if they were paid for them!). It's a complete disgrace.

It is degrading and extremely painful to travel 25 miles when in labour. Women in my area will travel twice that now since the consultant led unit has moved further away.

Hi Cathy,

Do you think you'll ever persuade the RCN to join you in any future action?

Thank you. It is good to know that the CQC inspections are helping to change practice. We have just had one so it will be interesting to see the full results of it.

On partners staying overnight we do have them stay. However we have all private rooms, I think a traditional ward environment would be very different.

Ambulances are not particularly smooth vehicles. Driving on country roads was extremely bumpy and VERY painful indeed.

@elliejjtiny

Completely support the strike. I have 3 questions if that's ok.

1. How common is it for a woman who is induced before their due date to experience complications (failure to progress, forceps, emcs etc) and if it's really common why isn't C-section recommended for women who need to be induced early?

2. Is it common for women in HDU to have no/occasional visitors and do you judge them when that happens?

3. If a woman is in HDU and the baby isn't ill enough to be in SCBU, who looks after the baby

Hi

OK, let's take each question in turn.

1. I don't have the stats with me, but it is relatively common for women induced before their due date to end up with forceps or caesarean delivery. However, if the induction is for a good reason, then it's all about a balance of risks. If a baby is not growing well, that baby may be safer out of the uterus, despite the risks for the mother of a more complicated delivery. The important thing is that we don't unnecessarily induce women before their due date or indeed before two weeks following their due date. So do make sure that you've been given a proper explanation about why induction is necessary.

2. The practice in HDUs varies enormously from place to place. In my experience, most HDUs associated with maternity units are pretty relaxed and it will be the exception not to have any visitors. Bit confused on the judgment bit, if I'm reading you correctly, then no woman should be judged for the choices she makes. If it was me, and I was told I could have no visitors, I'd be breaking the rules!

3. Ideally, the baby will stay with the mother and the mother will be given support in HDU to look after her baby, especially if the baby is well. Otherwise, mostly if a baby is on their own, they do go to SCBU because the staffing will be a little bit better than on the maternity ward. But it really will depend on individual maternity units. Overall, if you're reasonably well, you should argue for your baby to be kept with you if at all possible.

@Greengrow

I am presume we are also allowed to say we are against the strike if we are? I certainly agree with the right in law for people to withdraw labour but NHS workers are getting rises when those outside the state sector have not had rises and often never even get increments based on length of service. There is too much of a divide between higher pay in the state service and usually younger retirement ages and higher pensions and the private sector who are paying for it.

Yeah, absolutely it would be strange if everybody supported us! And it's good to know what people feel.

cherries why is it degrading?

[quote MayaSilver ]Do you think more needs to be done to support mothers having multiple births?

Some hospitals have been known to turn away mothers expecting twins or triplets as they don't have the facilities or staff to deal with multiple births. But surely if they can accommodate two mothers giving birth to a child each, they can give a bed to a mother having twins?[/quote]

Hi

The issue here, I think, will be more about the potential issues that can exist in a twin or triplet pregnancy. You're right, if the delivery is completely normal and the babies are healthy, there's really no reason why you can't be in any maternity service. But people anticipate the possibility of complications and so often women with multiple pregnancies do go to the more specialist units. I can't really say any more than that without detail about your case and indeed your local unit. But if in doubt, contact your Head of Midwifery and have a good chat.

@Izzy24

Hi Cathy, I've just heard Jeremy Vine state midwives earn 39,000 pa. Please set the record straight, that the vast majority of midwives will not be on a pay scale of more than 34,000 pa. (excluding London Weighting) and that only at the end of a considerable incremental progression which reflects the increasing experience and responsibility gained over years of service. I have also noticed an increasing trend of downgrading posts being advertised so that positions which would previously have been paid at Band 8 are now Band 7, former Band 7 jobs being paid at Band 6 and so on.

It is also true that many many midwives are unable to work full-time , because the job IS TOO STRESSFUL AND EXHAUSTING TO DO SO. It needn't be if the midwife/ woman ratio was appropriate to the levels of care needed but this is not the case.

Izzy24, you are bang on dead right! £21,000 is the starting salary for a midwife, and it takes 9-11 years to get to £34,000 (which will be the vast majority of midwives' final salary). Couldn't agree more about the stress and exhaustion, and we continue at the RCM to argue that we need more midwives. More than the 1,700 that the government has already got into post, we're saying they need to keep their foot on the accelerator!

I have been lucky enough to have my last baby (home vbac after a stillbirth and early failed induction leading to CS) with 121 midwives. It was brilliant.

I avoided a repeat CS which the consultant wanted to book me in for at 36 weeks, saving myself unnecessary surgery and the NHS money. The case loading made me feel very secure in my midwife and I trusted her completely. A total contrast to my previous 2 pregnancies.

Is this the future of maternity services in the uk?

I also support the strike. 1% is nothing and should be given annually in my opinion.

@Cherriesandapples

I am not a midwife but work in healthcare and have 20+ years experience. I support this strike.

My question is:-

As local hospitals are closing consultant led units and moving them further away (50 miles plus) what is the Royal College of Midwives doing to ensure that women in rural areas are able to receive maternity care.

I speak as someone with a history of preeclampsia so Midwife units are not an option.

This really depends on the number of women living in a local area who will be having more complicated pregnancies. It's really important that for these women, there is an obstetrician available 24/7. There aren't enough obstetrician to staff lots of very small obstetric units (except in places like the Scottish islands where transport is a major problem) and there isn't enough for them to do, even if there were enough of them!

So what we would argue is that transport systems for women like yourself have to be excellent. We would hope that you could have your antenatal care locally, travel comfortably to the further away unit and then be back home for postnatal care. I know this isn't ideal, but like a lot of things these days, it's a compromise. I think the good news, though, is that when I met with Simon Stevens, who is Head of NHS England, he seemed to feel that we should avoid centralising maternity services too much, and so I hope for most women their local unit will not be as far away as 50 miles. The RCM certainly always argues that maternity services should be as local as possible.

Not to mention the fact that if you take the salary and work out the hourly rate, I bet many midwives aren't even earning the minimum hourly rate! :(

Because you leave your home in the middle of the the night wearing pyjamas, are strapped down and have to endure every single bump in pain on what is a long journey!

My point is that closing the more local unit has made the situation worse for many women! That journey was essential! The consultation about where the new unit was going to be was a sham and the decision ignored the needs of rural women and put (freedom of information request) 12 women per year at risk of adverse incidents including death!

@polarpercy

But Greengrow state sector workers are also paying for their pensions and their salary, as they pay tax too. There are also far fewer jobs in the state sector that don't require a degree and therefore a higher level of debt (doctor, nurse, dentist, teacher, SENCO etc) As Izzy24 said there is often the salary figure of the very highest earners in a state field quoted when the reality is the trainees, new-starters and vast majority are on far less. I support the right to strike and hope that midwives, like so much of the public sector, finally get the thanks and recognition they deserve.

Cathy do you think this will begin rolling strikes or further action?

Very hard to say at this point. I think after this week, we're going to have to assess what we've achieved, what the impact has been (both negative and positive), and decide next steps. This will obviously be done in discussion with the other trade unions. My own feeling is that strike action and work to rule can't go on forever because there is always the law of diminishing returns, and it may be that we have to think about different tactics. Obviously we'd be interested to know what our members think too.

If I'd have been due to give birth this week, I'd feel deserted at a time of desperate need. What safeguards are in place for mothers to be this week?

Thanks for answering that Cathy! For your information maternity services are also under threat at Bonglais hospital Aberyswyth, leaving a black hole of care in mid wales. Hopefully that won't happen!

@stubbornstains

Hello Cathy, can I ask if there's any chance of staffing levels increasing?

Our local community teams seem to be constantly 1-2 members down, and have been for years. A friend who is on one of these teams is frequently in tears from stress. I've known a couple of MWs leave the profession because they just couldn't cope with it any more. I now hear that, in contrast to when I had my son 5 years ago, post natal home visits have been dropped, as the community teams just can't manage any more.

It's not fair on mothers, babies- or midwives

I'm really looking forward to the NICE guidance that will be coming out early next year on staffing levels in maternity services. I'm really hoping that it will be a lever for more staff. I do think that community teams are under terrible pressure, and we have been emphasising this in all our lobbying. Certainly the government is committed to maintaining midwifery training places, which means the supply side will be OK, but we've got to make sure the posts are available. CQC inspections are highlighting where staffing are too low, and this might help as well. The RCM will be publishing the State of Maternity Services Report again this year, which will again highlight gaps.

@Devora

Hi Cathy, good to see you on here. Other than pay (and not diminishing the importance of pay) what are the top things we should be doing to attract and retain amazing midwives?

Having enough midwives in post so that stress levels drop
Being nice to each other
Reduce bullying
Saying thank you
Being flexible
Letting midwives choose how they want to work
Having different service models (so midwives can choose their favourite)
Improving continuity of care (so that midwives get more satisfaction)
Dropping hierarchies and letting young midwives with enthusiasm develop and thrive

You're all fantastic I agree!