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Archive for the ‘Midwifery’ Category

Over the past few years there has been an escalation in the erosion of the midwifery care provided at home after birth. I have complained, wrung my hands, and generally played the prophet of doom about the impact this could have but, unfortunately, postnatal care is the easiest way for Trusts to cut staffing costs so the resources for this area have been torn away with relief by struggling maternity services. It is the area less likely to produce litigation, and the area where any successful litigation would probably decide on far smaller awards to the claimant so, in the mind of a budget holder, is the safest area to cut services back to the bone.

I was at a governance meeting a while back where the topic of community postnatal care came-up, and I was surprised to hear a consultant midwife back the reduction in care whilst supporting her approach by mentioning ‘a study in the Netherlands’ which found no difference in outcomes between those who had care at home after birth and those who didn’t. Well, I think I’ve found the study, Costs and effectiveness of community postnatal support workers, and if this was the study then she was in error using it to support the discussion as the visits by midwives were not changed, more and longer visits were provided by maternity support workers. Well, today I learned that there is to be a study conducted initially in Scotland by Sterling University into postnatal care. Am I hopeful it will be a positive thing? Not really as I’m not entirely sure that it will be woman centred. At the moment all I have to go on is the BBC report,and whilst I love ‘Auntie’ I am aware that reporting on this topic, maternity care, is not always accurate so I’m just going on their take on the information. What concerns me is that NICE have already issued their guidance on Postnatal Care, which Trusts have interpreted to mean that care is taken away from the home and provided at clinics and this study are also going to ‘develop a best practice package’… ‘which individual health authorities could then adapt to their needs’, (their needs being to cut costs). I will be interested to read their results but I’m really not going to hold my breath.

My previous musings on this topic include; Letting women and babies down? (2010); The Demise of Community Midwifery – part 2 (2010); What now? (2009); A step backwards (2008); An embarrassment (2007). When reading these offerings prior to linking it was interesting (depressing) to chart the real demise of the postnatal care provision in my area, especially my ’embarrassment’ at the care I was not providing in 2007 when we were still visiting at home. Now we ‘triage’ on the first day home and basically, if the woman answers all the questions on our pro forma correctly, she won’t get to see a midwife until Day 5, and then the likelihood is that it will be at a clinic, one of which is 12 miles away. I’m not embarrassed now, I’m ashamed.

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Dear Mr Cameron

I know that you, your government, the country, need to cut spending. I would know that because my wage packet has already been adversely affected, I accept that and don’t believe that public sector workers should be immune from ‘cuts’. Please note that I have said ‘public sector workers’, not ‘the public sector’.

I can’t comment with any degree of authority on the majority of publicly funded institutions but ask me about the maternity services and I can go on for hours, if not days, perhaps even weeks, you see I’m an NHS midwife, and have been for many years.

At this point I could make lots of self-invented comparisons between the effects of cost-savings within education, policing, parks etc., and the maternity services but they would be trite and not substantiated so, I shall just go straight to the heart of the matter, if you adversely affect the budget to the maternity services it will cost lives. Lives of Mothers and babies.

Please don’t interrupt me at this point and say ‘there will be no cuts in the NHS’ as that is plainly untrue. You seem to believe that is true but let me tell you now, cuts are being made, huge cuts are being made within the maternity services.

Back to my diatribe. The cuts. I work on the community and in an effort to reduce expenditure staffing at the weekend has been reduced by 50%. How has this been effected? Clinics have been set-up at the maternity unit and postnatal women, even those 5 days following a caesarean section, have to come to us. Inconvenient for them, especially if they have other children, and also, due to an appointment system, not practical for giving breastfeeding support. It’s also pared down to the marrow the on-call system, at a time when your government has stated that it supports a woman’s choice for homebirth. 2 midwives on-call on the Friday night who are scheduled to work Saturday and cover the clinic. They get called out all night and so are not working the Saturday, that leaves 2 midwives who are on-call for the Saturday. See where this is going? Yes, they get called mid-morning and wham, bam, no midwives. Homebirths are not the only occurence which can show how stupid, short-sighted and negligent the staffing is at weekends, wish they were but thanks to budgetary constraints community, on-call midwives are also called in to cover the consultant unit and the stand-alone birth unit. Yes, due to the cost-savings ‘bank’ staff are no longer ‘allowed’ to be used to cover absence or staffing shortfalls so on-call midwives are summoned to fill in the gaps. Yes, midwives who have already worked a full day are then called in to work all night. The truly amazing thing is that they have been called out because the hospital midwives can’t cope as it is busy so they are entering a stressful working environment when they are already tired. Do you believe that is safe?

Safety. Let’s consider some recent news items about the maternity services.

April 4th 2011 – In The Independent and also discussed in many other places ‘British maternity wards in crisis’ Infant mortality spirals at 14 NHS Trusts.  ‘The safety of maternity care in Britain’s hospitals is under the gravest threat from an over-stretched, under-resourced service which is putting mothers and babies in danger, experts have warned.’

April 4th 2011 – In News West Midlands. ’35 of 45 Infant Deaths Were Avoidable’  The babies’ deaths would have been avoidable if there had been additional staff members and also increased standards of care. The report by the West Midlands Perinatal Institute explained that the maternity service was stretched and short of staff.’

April 1st 2011 – Mail onlineMidwife shortage is causing Caesareans’

April 6th 2011 – Access Legal from Shoosmiths  ‘Patients and their babies are being put at risk due to midwife shortages’  This article discusses the tragic deaths of Mrs Ali and her baby at  Queen’s Hospital in Romford and includes – ‘similarly catastrophic errors can arise, not because midwives don’t aim to provide their patients with proper care, but because they simply lack the time and resources to be able to do so because services are overstretched and/or because they lack the appropriate training.’

What do you think Mr Cameron, are you happy with the care being provided by the maternity services? Do you really believe that they are not being adversely affected by a funding deficit? How about the rumours of over 200 midwives in Birmingham being forced to reapply for their jobs in an effort to save money by downgrading them. What do you think that will do for for retention?

At this point I will insert a quote from the Royal College of Midwives in an article discussing the perinatal deaths in the West Midlands –

‘The general impression was that the only way this could be explained was that this was an overstretched and understaffed service trying to do the best it can’ and ‘Many midwives are being pushed to reduce the amount of time they spend with women…….If midwives do not have sufficient time to assess and support women things including identification of risk factors can get missed. Women also may feel that they have an issue they want to discuss, but do not want to bother the midwife because they can see how busy they are. This is wrong and potentially disastrous.’

I sympathise with the position the government, and the country, finds themselves in now, I appreciate that savings have to be made. With regard to the maternity services though you have to be honest. Either you stand up and admit to the public that the quality of care is being adversely affected by budgetary constraints or you effectively ring-fence the budget for their maternity services and ensure that those services are not subjected to, what are in reality, ‘cuts’.

Yours sincerely

Midwife Muse

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Life as a midwife can be unpredictable but we are always aware on community when it will be busy, just a shame that we can’t be certain which days will be manic and which will just be non-stop. March was a ‘quiet’ month visit wise which was fantastic, we could catch-up with all those add-ons which are mandatory but not time sensitive, however antenatally it was busy. Oodles of pregnant women at the stage of their pregnancy when they start having 2 weekly midwife appointments, if we hadn’t got records showing that a baby boom should be expected in April/May our antenatal clinic’s would alert us to it.

I dread busy clinics, something has to suffer and what I end up minimising is the ‘chat time’. I have to fill in all the paperwork demanded for audit, stats designed by my manager, work timings by the PCT and that’s not even including the woman’s notes and inputting consultation info onto the G.P’s computer. Midwives have been warned that if we fail to submit the bureaucratic paper mountain, ‘stat’, then our pay will be delayed. To me, having the time to sit and talk to my women is often as important as completing their notes, issues we discuss then and any worries they might communicate when they are relaxed can be vital. Having to fill in forms as if they are going out of fashion (wish they would) and hustle women out of the consulting room leaves me feeling as if I am shortchanging the women and not fulfilling my role of being ‘with woman’.

The answer to reducing much of a midwife’s paperwork duplication would be for us to have notebooks or laptops, no, too expensive. Pathetic, shortsighted attitude. All our managers have Blackberry’s, even though they spend the majority of their time in a office, next to a telephone and with their ‘own’ PC in front of them, plus a secretary. Out on community we have 5 chairs in our office, 2 telephones and one PC, most days there are 6 midwives in the office and on some days there also 6 students. Community midwifery has been in existance for 70 years but it operates as if it is a new concept, an add-on which is not considered worth funding, but who does all the initial maternity bookings? Who provides the majority of antenatal and postnatal care? Who is responsible for identifying vulnerable families and liasing with social services and other agencies? Can’t speak for other areas but locally it is the community midwife, the hugely underfunded element of the maternity services where paperwork, even if it has the capability of detracting from patient care is paramount and he area where, when there is a time-saving option which could allow patient care not to be affected, it is dismissed as being too expensive!

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I know, during all the newspaper coverage regarding the state of the maternity services I have been silent. The truth, I’ve given up hoping that things will change for the better, am so disillusioned and demotivated that I cannot be bothered to rant, report or rue the erosion of a service I entered with passion in my belly and will leave with an extremely sour taste in my mouth. Fingers crossed, one year now until I retire.

In the absence of an urge to blog I have been reading The 19th Wife by David Ebershoff, food for thought in this 600+ page book about The Church of the Latter Day Saints and in particular polygamy or, as the church calls it, celestial marriage. I have many, many thoughts on this practise, I suspect tat my outlook as a female would be quite different to that of a male. However, feeling benevolent toward Joseph Smith, I will say that he hit upon an excellent way to rapidly increase the membership of his church, after all a couple are likely to only manage one child a year, and let’s not forget how high infant mortality was back then so only around 35% would reach their fifth birthday, but if a man takes several wives then the family increases at a rapid rate and the population surges. All the more faithful for the church and all the more power for a community. Brilliant wheeze. The book is one of those set in two time frames, one historical and the other contemporary, I sometimes find this a distraction and spend loads of time flicking back to see where the story had been, or who a character was, I didn’t with this one, which must be a tribute to the author for ensuring appropriate breaks in the narrative.

A few years ago I read ‘Call the Midwife’ by Jennifer Worth, very interesting, especially as my Mother was a district midwife in East London in the late 50’s, the time covered in the book, and I have patchy memories of accompanying her on the back of her bike and waiting in front rooms with a man, and sometimes other children. Then I would hear a baby crying and a red-faced, smiling mother would open the door and call the man out. Anyway, daughter bought the trilogy ‘Tales from a Midwife’ around the other day and having refreshed myself on the first part I am now reading the two new sections. Crikey, if I as a midwife or child-bearing women think things are bad now this book certainly brings us up short, the working day for midwives was long and hard, with terrible conditions but their lot was nothing in comparison to what the women and their families endured. I hear that the BBC have serialised it and that there will be 6 episodes shown sometime this year, can’t wait.

Talking of childbirth/midwifery on TV brings me to ‘One born every minute’, channel 4’s look at the realities of giving birth. This weeks was great, I hardly shouted at the telly at all. The couples shown were brilliant, the births were uplifting and the midwives a credit to the profession. I had stopped watching it last series as I found I was getting so cross with the midwives, and their love of confining women to the bed and strapping monitors on for no apparent reason, that it was increasing my despondency, full marks this week though, nearly made me feel enthusiastic.

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Midwife wanted

This email arrived in my inbox at work the other day, interesting opportunity for a midwife in the North.

Dear Manuela,

As I explained in our phone conversation earlier I have been commissioned to ghostwrite an uplifting memoir of a modern day midwife for Headline and wondered if you could help me to find a suitable case study whose story I would write on her behalf. The book is to be written in first person narrative and will be uplifting, heart-warming, touching and life-affirming – a real celebration of a modern day heroine.

Ideally the midwife in question would be from the north of England and working in a community. She would be aged between 42 and 53, would have worked as a midwife for at least 15 years and have children of her own. She needs to open, warm and a good storyteller. She will receive payment as the author of the book and will be expected to do PR to promote it. 

My publishers have asked me to come up with a shortlist of suitable midwives for this project and I would be very grateful if there was anyone you could put me in touch with. I’d also be very interested to read the press release about Lindsey Reid.

Many thanks,

Charlotte Ward

Freelance writer

I have a few queries. Why a ghost writer? How much would the midwife be paid? Why the age constraints, especially as that rules me out? Hang on, is that age discrimination ;)? Why the location in the North? Do northerners have more interesting lives and experiences than those from other parts of the UK? Then there is the gender issue, why a female midwife? Male/female, we all do the same job.

Modern day heroine. Tee hee. Read a few parenting websites and you will soon see what the Mums think of midwives, and it’s not as heroines. How exciting though for the chosen sage femme (I just love that french word for a midwife).

She will have to tread carefully though, and I suspect that her every word will be subject to much examination by her Trust. What makes me think that? Well, as an introduction to the forwarded email was an advisory – Any midwife interested in this project should contact their Trust press office to discuss the opportunity. That should be an interesting conversation!

Oh yes, Lindsay Reid is a writer, researcher and midwifery historian.

Well, any midwives reading this who would like the opportunity to become a published authoress should contact Charlotte on charlottefreelance@gmail.com

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So, the petition regarding the Maternity Services is well underway and now has nearly 1,000 signatures, here’s hoping that it works.

When you go to the petition page you can click on signatures and here people have left comments, and for this midwife they make sad reading. For years now I have felt like a voice in the wilderness, whingeing away about the maternity services, bemoaning the midwife’s lot and warning about how stretched the service is, this afternoon I read many other midwives viewpoints, and I felt unbelievably sad, I was right and I really wish I hadn’t been. The words were so familiar ‘ midwives leaving in droves’; ‘midwives need more support’, ‘women and their families suffer’, ‘we need to stop the system falling apart’ and then the succinct  ‘the service only survives on the good will of front line staff to go above and beyond, a good deal of luck and a vast amount of prayer! while management appear to work on the basis that if no complaints role in, who cares how the work load is being managed, but when they do it is the individuals who get hauled over the coals to be paraded before those who have complained to show that the matter has been dealt with. midwives need help and support. i have been qualified for nearly 10 years, and cant wait to leave the profession – i love being a midwife, i hate the politics, lack of staff, lack of support, lack of equipment and the expectation of the management that we will do what it takes to get the job done, not what we are paid to do.’

The organisers of the petition are trying to publicise it, apparently ITV Daybreak are interested but are checking with their lawyers (?) to make sure they are safe to run with it. The TV also want, understandably, to interview midwives, so far there are no midwives leaping up to appear on telly, I wonder why.

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I’ve just finished a run of working days, hell and heaven would be the words to describe them. Heaven were the weekdays, hell was the weekend.

Heaven = Visiting new Mums and babies on their first day home, listening to their birth tales, reassuring them that baby is fine, helping them out with breastfeeding and then going back on day 5 to be greeted with a smiley face and thanks for the advice and help I had given previously. Heaven is also seeing my women at antenatal clinic, listening to their woes and then making them laugh, answering their questions and giving advice. Meeting ‘old’ patients in the waiting room as they queue for babe to have his first jabs and being treated as an old friend, even hugged by some. Heaven is feeling that I must be doing/have done a ‘good’ job, that I have fulfilled my role to those womens satisfaction and/or expectations.

Hell. Hell is the weekend, working with a truly skeleton staff, unable to provide any sort of individualised care, the women are on a conveyor belt and I am an operative. Hell is arriving at the midwives clinic to discover that 2 of the 5 midwives scheduled to be working were out at a homebirth all night so are not working that day, then the phone ringing alerting the 3 remaining midwives that another homebirth is ‘brewing’. Hell is looking at the clinic list and seeing that there are 30 women attending and then reviewing the home visits to discover that 10 women need a visit. Hell is phoning those women who are expecting a home visit to explain that this is an impossibility and ‘inviting’ them in to the clinic to be responded to with ‘this isn’t my problem, it’s yours’. To attempt to reason with the shouting woman at the other end of the phone, tell her that there is a homebirth happening, that unfortunately these take priority, and that there is now only 1 midwife covering all women requiring postnatal care over an area of 400sq miles. To then be replied to, in words containing many expletives, that she is your priority, that your job is to provide her with care where she wants it and that YOU shouldn’t put a homebirth before her (where are the decision makers at times like this?). Heaven is when 1 of the midwives who has been out all night with a homebirth turns up at the clinic and works all day with you, although it must have been hell for her, sleep deprived as she was.

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