This entry is an attempt to explain what I mean, and what my responsibilies are when I’m ‘on-call’. It has come about because of a New Zealand midwife (she is also much more, and really puts me to shame) who was asking what being ‘on-call’ entails for me. This expanation is not intended to encompass the whole of the UK, or even just England, our Trust has 2 maternity units within it, and each one operates a marginally different system. Every area will operate a different system based upon the way it’s services are configured.
First, an explanation of ho we are organised. In our Trust we have two different entities, hospital based and community midwives. As the names imply one group works solely within the hospital, whilst the other covers all the work within the community. A community midwife is associated with one, or more, G.P practices. Her primary responsibility is toward all pregnant women and all new Mums and babies registered with that surgery. When a woman finds she is pregnant she contacts the relevant midwife to arrange a ‘booking’ appointment, within her own home. During her pregnancy she will then attend her G.P’s surgery for antenatal care with her ‘named’ midwife. Generally, in our area, the community midwives do not accompany the woman into hospital, their responsibility is for homebirth. There are areas where midwives work in both scenarios, however their caseloads are ideally about 35 women, at present my caseload is 160 women, and this is by no means a large caseload!
Today I am on a 24 hour on-call. Generally this will be scheduled approximately once a week, or 4 times over a 4 week period. The 24 o/c is divided into two 12 hour allocations, today I was 1st daytime and 2nd night. For me this means that from 8.30 am until 8.30 pm I am the midwife who would be called first to any homebirth. On-calls are allocated for working days so today I have had a normal working day from 8.30 until 5 and I am rostered to work a normal day tomorrow. At present there are 18 women due, over the next 3 weeks, to have their babies at home, I could be called to any one of them. I would also be called to any BBA’s, born before arrival. In these cases the paramedics have usually arrived first and baby is either born, or it is obviously too late to consider a safe transfer to the hospital. I would also be asked to contact any postnatal Mum who had phoned up and required attendance by a midwife. Our hospital midwives are now also implementing their own on-call system to cover staffing problems within the unit however, if the unit is very busy they will call in the o/c community midwife.
So, it is now after 20.30 hours, I can relax, slightly. I will not relax properly as I was called to a homebirth lady this afternoon who thought she was in labour. When I visited she definitely wasn’t in active labour but who knows what might happen overnight. Now though I’m 2nd, so I will only be called as the birth approaches or if it is imminent and I am the closer midwife, which I am in this case.
Ultimately, when on-call, I could be called to any one of the 3,000 women booked to have their baby at the local maternity unit in one year. Geographically my responsibility is an area of about 25 miles by 20, mainly rural.
There are times when we offer to go on-call for our ‘own’ women. I have offered this for one of my women whose baby is due over the next 5 weeks. In these cases I give them my mobile number and tell them to try phoning me when they think they are in labour. If I answer, I will come. If I don’t they will have to contact the hospital for the official o/c. When we offer this we don’t get paid if we attend and we are not officially on-duty.
Hope that this explains what being on-call means for this community midwife. Oh, nearly forgot, we are paid extra when o/c. It’s about £9 for a weekday, and about £14 at the weekend or Bank Holidays. No, not hourly, for the whole 24 hours.
A link to another New Zealand midwife who is setting up on-line midwifery forums. She welcomes midwives from any country.