A Midwife’s Muse

This was in The Daily Mail today and I reproduce it in full. It is a terrible indictment on how our maternity services are being failed by those who hold the purse strings and make the decisions about how the public’s money is spent.

Anyone who reads my blog will recognise many of the concerns I repeatedly rant about. The delerate low-staffing, the midwives having to complete paperwork which could easily be one by more appropriate persons, leaving the midwives free to do the job they have trained for. The lack of support for newly qualified midwives and the expectation that staff will work longer hours, not have meal breaks and then still have to suffer abuse from patients and their relatives.

What did I find especially sad, but something that I have heard myself say? “Would I recommend midwifery as a career? I’m really not sure.”

Frantic mothers without pain relief, sick babies in unqualified care: The disturbing diary of a modern midwife

By Adele Waters

Earlier this month, the Royal College of Midwives warned the Government that problems in Britain’s delivery wards were reaching a crisis point as staffing levels were not keeping pace with our increasing birth rate.

Here, newly-qualified midwife Sarah Cameron, 35, who works in a busy London maternity unit, shares her work diary with ADELE WATERS.

SHIFT 1

Several staff have rung in sick so there are just three of us on duty – another midwife, a support worker and me. I end up with 15 women to look after – as a new girl it should only be four or five and even when I’m up to speed it should only be eight or ten.

Breastfeeding support is given a fairly low priority – there just isn’t the time. It’s all I can do to keep up with answering the buzzers.

I realise even pain relief gets missed out sometimes and women buzz their bedside alarms saying that they’re in pain and should have had painkillers over an hour ago.

First-time mums ask if they can have a baby bath demonstration and I explain that I don’t have time but I’ll ask the healthcareassistant if she can do it later. I know it’s very unlikely she’ll be able to. Mums often go home without being shown how to bath their babies or how to make a bottle up. In fact during my three-year training, I’ve never seen anyone shown how to make a bottle up.

I also have some ‘extra care’ babies to look after – those that aren’t ill enough to be on the special care unit but who still require more regular monitoring than others. I’m not qualified to do this so spend a lot of the time asking the other midwife for advice.

One of the main duties of looking after extra care babies is to calculate the feed requirements. If you get this wrong it can be serious – too much milk will wear a weak baby out, too little milk and they won’t gain weight.

I was worried that I’d make the wrong choice. The other midwife is very helpful but I feel sorry for her as she has 18 women to look after, two of whom are in early labour.

There is no way that good care can be given to women when you’re looking after that many.

SHIFT 2

Today I was asked to work an extra shift on the labour ward – normally I’m looking after pre and post natal women. I was feeling very nervous. I thought back to when I was a first year student – just three years ago – when I was left to support a woman in labour on my own.

The senior midwife overseeing me had another woman to look after and she came running into the room just as I was catching the baby.

I had been terrified but calm and the new mum told me I’d make a great midwife. I’d come into midwifery late – I was married, in my 30s and had given up my job as an administrator to retrain – so comments like that helped confirm I’d made the right decision.

I am looking after a lady who is in labour – my first time as a qualified midwife. I spend the rest of the shift in a room with her and her husband, encouraging and supporting her. I’m lucky – the other midwives have all got two women each.

Research shows that the more one-to-one care a woman receives in labour, the greater her chances of a normal birth. If you keep having to run out of the room to care for someone else, the woman is less likely to cope and more likely want an epidural.

This increases the chance of a forceps delivery or even a Caesarean section.

But my lady hasn’t needed any intervention or drugs. She’s coped with emotional support, back rubs and a warm bath. She wasn’t overemotional, just got on with it. I do think that having me there helped.

SHIFT 3

Back to my ward for a 7am start to find it full – 40 women, about 20 babies and five midwives, including me. We’re told to get as many women discharged as possible to free up beds. However we won’t shove people out if we don’t think they’re ready.

If we can’t free up any beds, it means that the women who are booked to be coming in for inductions of labour this afternoon won’t be able to.

One of the antenatal ladies that I’m looking after needs an important ultrasound scan to check how her placenta is functioning. Even at 9am the scan room can’t offer me a space. The lady decides to go home without the scan and gives me verbal abuse.

I know it’s frustrating for her, but I struggle to understand why someone won’t wait to find out whether their baby is well or not. She has very high blood pressure and her baby is not moving as much as normal, so the baby might need delivering early.

I explain this and attempt to get her to stay, but even though this is a much wanted IVF pregnancy, she leaves anyway.

Dealing with aggression is part of this job. I’ve seen women being verbally aggressive to other midwives in situations like this.

I’m worried. I constantly feel, ‘this isn’t right, women deserve better’. Sometimes, this just feels like a production line, and I wouldn’t want to give birth where I work.

I am married and have a son of my own, now aged nine – if I have another baby I know it’ll be lucky that one of my midwife friends will come in with me and deliver the baby.

It seems horrific that the only way to guarantee you get good care is to have a friend who’s a midwife.

SHIFT 4

This is the worst shift so far. There are three midwives for 40 women. I have nine women to care for; one has been quite poorly. She lost a lot of blood after a Cesarean section and ended up in the high dependency unit. She still needs a lot of regular – and time-consuming – observations.

My other postnatal women are given pain relief then I abandon them for the rest of the morning as I need to look after my poorly lady and those yet to give birth.

It’s lunchtime before I get back to see them: they’re not happy – I wouldn’t be, either. I quickly start doing postnatal checks so I can start some discharges – which includes 30 minutes’ worth of paperwork per person.

Nothing at college prepares you for the fact that you will be run ragged. I get home at 4pm exhausted.

I realise that I haven’t had anything to eat or drink or been to the loo since 6.30am – that’s 91/2 hours without stopping; I sometimes feel like a marathon runner without the training or the glory.

When asked about the vital qualities of a midwife, I always say you have to care genuinely about the women you’re working with, have good communication skills and you must to be able to cope well under pressure. But perhaps the key thing is strong bladder control!

SHIFT 5

One of my women really needs to go to the labour ward – but it’s full. I struggle to give this lady the support she needs as I’ve got four other women to look after.

There’s nothing I can do apart from give her paracetamol (commonly used in early labour) and advise her to have a bath to relax and ease the pain.

Too busy to even stay and help, I leave her partner supporting her and see the anxiety in their faces. We’ve all heard the horror stories about women delivering on an antenatal ward without a midwife there and, when the staffing levels are so low, I can see just how this happens.

I just don’t understand why – when the units are so short staffed – they just don’t employ more midwives.

I’ve been told that the hospital can’t afford to cover all the shifts with the permanently employed midwives, and relies on temporary staff like me to make up the shortfall. This is fine if people agree to come in, but it does go wrong.

I had several calls over the weekend when I was off from the unit desperately begging me to come into work as they were very short staffed. However I had my son to look after. And why don’t they employ me on a permanent contract instead of once a week, and then last-minute shifts? It’s very frustrating for me – and means a poor service for the women.

I think about how much I – and all my family – have sacrificed for me to become a midwife and yet I can’t even get a permanent job, even though my skills are clearly needed.

During those three years of studying I’ve missed out on things with my son such as school sports days, because I couldn’t miss lectures.

It’s also been a huge financial sacrifice. I went from earning £25,000 a year as an administrator to living off my husband’s wage.

We had no holidays, bought no clothes. We had to pay £200 a month for child care. I didn’t get a bursary because it’s means tested and my husband earns £35,000 a year – deemed too high. So all our savings are gone.

Today I discovered that during the first quarter of 2008, there were over 80 ‘Near Miss Incidents’ reported at my hospital, citing staff shortages as the reason. That’s over three times as many as the year before.

Near miss incidents don’t necessarily mean that anyone was harmed, but that they could have been. These figures are purely for the maternity department; that’s nearly one a day!

SHIFT 6

Today the shortage of beds means we have a bed block situation at the hospital.

There are no empty beds so inductions are being cancelled. Women get very worried; they’ve normally been told by their midwife or even by the consultant that the baby needs delivering.

Some women are getting induced for medical reasons (such as the baby is not moving or growing sufficiently) and have been told it would be safer to have the baby early.

Other women are getting induced as they’re now ten days overdue, and will have been told that at ten days over the placenta starts to deteriorate and it’s safer to have baby delivered.

I worry that one day by the time we get round to inducing a woman we won’t find a foetal heartbeat as the baby will have died.

SHIFT 7

MY first actual delivery! I’m on the labour ward and there are six midwives including myself and we all get allocated one woman. We are well staffed because the ward is unusually quiet today, with only half the rooms full.

The lady I’ve been allocated hasn’t arrived yet but is en route in an ambulance. She’s 38 weeks’ pregnant and woke up with severe abdominal pains. As she arrives, the paramedic gives me a hand-over.

Suddenly the woman gives a big grunt and I peep under the sheet to see a baby’s head between the woman’s legs – rapidly followed by the rest of the baby!

I don’t know who in the room is the most shocked – it’s certainly a memorable first delivery.

SHIFT 8

Back on the labour ward. There are seven women in labour all requiring a lot of support – they either have epidurals in place or want them. But there are just five midwives, including the shift co-ordinator.

Women with an epidural require one-to-one support from a midwife, because they are more at risk of their blood pressure falling, fainting or of having a reaction to the drugs.

The baby can also react to the drugs so its heart needs to be continuously monitored.

There is no way these women are going to get that – which means four are going to have to go without an epidural. The thought of having to look after a woman in labour wanting pain relief and having to tell her she can’t have it fills me with dread.

I get allocated a woman to care for and go and introduce myself – she’s screaming for an epidural. Luckily it’s been decided that she’s the last woman who can have one so I get this arranged for her as soon as possible.

Later, there’s a newborn baby that’s not breathing. I run to the room to find someone else is resuscitating the baby and, happily, they do so successfully. It’s an incredible relief. I’ve seen a neonatal death after an unsuccessful resuscitation and it’s horrific.

By the end of the shift I’m a nervous wreck and leave vowing never to work another shift on the labour ward. Unbelievably, I’m more stressed now than I was when I was a student.

The problem with only working the odd shift is that I’m not getting the experience I need to consolidate my skills and become competent.

It may suit the hospitals to have lots of part-time staff as then they have more cover for sickness and holidays, but I don’t think the managers have considered how hard it is to gain your confidence when you’re getting so little experience.

Equally, after a year I’ll go up a pay band which means I’ll be in a more senior role but I’ll only have done about 48 shifts before getting there – which is like getting a promotion after only nine weeks of full time work – it’s madness.

SHIFT 9

Two of the large bays are being ‘deep cleaned’. I’m not 100 per cent sure what a deep clean involves but there’s a lot of people in overalls and some strange, loud hissing, sucking noises coming from the bays for the rest of the shift.

Overall I think that the wards on maternity are kept very clean and cleanliness is never really an issue that people complain about.

Sometimes women come in with their own cleaning products because they’ve been warned about the dirt, but I never see anyone using them.

I’m at the midwives’ station reading through some notes when a man approaches me – he’s the husband of a woman who wants to go home. He very aggressively asks me when I’ll have completed the paperwork for his wife.

I tell him it should be around 20 minutes as long as none of my other women require me for anything in the meantime.

He’s not happy. He says: ‘It needs to be quicker than that, we’ve got an appointment to get to and need to leave now.’

Sometimes I feel people treat me like a servant. I think people are so used to living in a consumer orientated, fast service environment that they expect to get that in hospital as well – that they can click their fingers and get something.

Later on when I’m discharging another lady it’s a different story. She’s in her 30s. It’s her first baby and she and her husband seem overwhelmed at the thought of going home with their baby so I spend ten minutes chatting to them.

They seem more positive when they leave. The thing that makes them stand out for me is they way they couldn’t thank me enough as they left.

But sadly they are not the majority. Of course women deserve the best care when they give birth – that’s what we have been trained to provide – but due to staffing levels this is often not possible.

When I started this job I knew it was the right thing to do – I knew I was going to love being a midwife. But now, would I recommend midwifery as a career? I’m really not sure.

• We have changed Sarah’s name to protect her identity.