Posts Tagged ‘Maternity Services’

Recruit 5000 more NHS midwives in England

Responsible department: Department of Health

More babies were born in England in 2010 than in any year since 1972, whilst births to women aged 30 or older were at their highest since 1946. The NHS is desperately short of midwives, and the shortage affects every region of England. We need urgent action from the Government, including a target to recruit the equivalent of 5000 more full-time midwives. Care for women but especially babies at the very start of life should be shielded from the cuts.

This is an e petition to H M Government. I would have worded it differently, but there again I am a simple being who would just go to the heart of the problem. The whole world, literally, interprets the current staffing issue within the maternity services as being down to a shortage of  trained midwives but that isn’t the situation, there are plenty of us. The issue is the employment of midwives, and the crux of the matter is funding. The Trusts are having to budget so harshly that coal-face staff numbers are being trimmed to below the quick, and not just midwives, other professionals as well. We do need to recruit more midwives but to do this we need to improve the funding, be shielded from the cuts yes, but also improve the monies available to the maternity services, not for paper-shuffling exercises but to employ more midwives.

Anyway, here’s the link, it can’t do any harm so please sign  the e petition here.


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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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March For the Alternative

This Saturday, 26th of March.

The RCM says –

This is a major chance for us to show our opposition to cuts to healthcare services for women and the newborn. Please join us and bring your colleagues, friends, families and supporters in your community. 

We hear from the TUC that over 60,000 people are planning to attend.  This will be the largest demonstration for many years.  It is important that midwives are seen and heard with other public sector workers.

I’m going. Anyone else?

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I’m about to write an assignment centred around the perspectives of childbearing women, and I could really do with some input from the ‘other side of the fence’. I know what I believe is important, and the area where I think the maternity services should focus but I would really appreciate an honest snap-shot of ‘consumer’ opinion. Where it says ‘Other’ then I hope that voters express themselves and perhaps explain why they rate one aspect more highly than another. If it doesn’t have enough space, or anyone has loads to say then please leave a comment.

It doesn’t matter when, where or if you had a baby. It would be useful though if you could identify your gender in the spare box as then I can identify if perspectives are affected by this. 

Thank you for your time.

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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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Midwife Muse’s roll call of causative factors so far –

  • PCT’s for with-holding government monies
  • Groups who place the majority of their emphasis on THE BIRTH, and lobby accordingly, putting antenatal and postnatal care on the back burner
  • Trusts for employing too many managers

Fittingly the midwives come last, that’s the usual position we appear to occupy in any planning, so why alter the status quo? Why are we to blame then? Well we will do what we always do when change is foist upon us, we will grumble, get stressed, some of us will even rant, in private but ultimately we will comply. When I used to work in the unit the obstetricians, generally the registrars, would keep coming out with jokes which were always based upon how bolshie midwives are, ‘What’s the difference between a rottweiler and a midwife? A rottweiler eventually lets go.’ That may be true in the one-on-one clinical situation, when we are being an individual woman’s advocate, but as a group, when change is being imposed, our contracts being re-written or some other attack on our ability to provide the care we KNOW that we should provide we capitulate and fail to work together to resist or modify the changes.

My crystal ball is showing me that once again we will moan and have a brief, vaguely supportive interaction with our union, incidentally that won’t get us anywhere (prediction), a couple of us will leave, another couple will retire, half of us will apply for other jobs, perhaps midwifery related but the majority of us will just end up going along with a change we are intensely unhappy with.

Midwives are their own worse enemies. We are already working above our capacities, both within the maternity units and in the community but we don’t ‘work to rule’, we can’t, but we should. The managers are not ignorant of the ridiculous workload and the number of extra, unpaid hours the staff put in, in fact I do believe that the managers join in sometimes, so we are all colluding in the farce which will allow these changes to go through, these changes which will definitely affect the coal-face midwives, the women and babies.

For a profession whose members are portrayed as fierce we are badly misrepresented, we are actually shrinking violets.

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Previously in ‘The Demise of Community Midwifery :-

The PCT’s, in some areas, are with holding the government monies which were supposedly ring-fenced for the improvement of the maternity services. The result is that the maternity care providers, the hospital trusts, have increased consultant availability, improved facilities and employed (in some cases) more midwives in line with recommendations but the promised monies have not been forthcoming from the PCT’s, so they are now having to make cut-backs.

Next on my list of ‘those responsible’ are the ‘user’ and ‘interest’ groups. Within maternity care the focus, their focus, is on the birth itself. Fair enough, that is what is most important, a healthy baby and Mum. Childbirth is not an isolated event though, there are 40 weeks leading up to the birth of a healthy baby, the antenatal period. Traditionally this care is provided in a variety of ways but, within the NHS, the majority of care options will involve a midwife to a greater or lesser extent. G.P’s may also be involved, if the G.P is registered as providing maternity care s/he will receive extra funding from the PCT for each of his pregnant women, regardless of how much input s/he actually has and, surprise, surprise, the PCT’s are still paying G.P’s this.

Back to the interested parties and why I point a finger at them. They lobby, they lobby for women’s choice. Women’s choice in where they give birth. Nothing against this, in theory, but everything against it when it appears that they place more emphasis on this than on antenatal and postnatal care and so this is where the money and focus is. Wonderful for a woman to give birth in a friendly, tastefully decorated, home-from-home room, littered with birthing balls, fully equiped with a birthing-pool and aromatherapy diffusers. Is it still wonderful though if, after the birth of her choice to a healthy baby, baby fails to thrive, develops jaundice and is, eventually, readmitted to hospital for IV fluids and phototherapy? This happens now, how much more often will this happen when community midwives no longer visit? G.P’s will see an increase in visits by, or to, newborns and their Mothers. Why the Mothers? Well, wounds become infected. Presently a midwife will visit, suspect an infection, take a swab and then phone the G.P to request that a prescription be issued for antibiotics. The infection will be caught early and the wound will, in most cases, heal well. If an infection is not treated promptly then it will ‘break down’ leading to a longer healing period or a readmission to hospital for re-suturing. I’m not even going to discuss the effect that reduced domiciliary visits will have on breastfeeding rates, all at a time when WHO are emphasing the importance of community support. Much is written about the detection of postnatal depression, as a community midwife I may suspect that a woman is likely to suffer PND, but serious PND generally shows after I have finished visiting. My role in this is to ensure that women know where to access help and to not  be ashamed, as many women are, of admitting that she is suffering from depression. Then there is an illness which does present whilst community midwives are visiting, puerperal psychosis, yes, it is rare but when a woman does begin to suffer from it early detection is beneficial as this illness can have tragic outcomes, as recognised in Why Mothers Die.

The essence of my argument with the ‘interest’ groups, who concentrate so single-mindedly on the ‘birth day experience, is ‘what point an ecstatic birth if, as the result of poor follow-up care, the mother and/or baby are unnecessarily ill, or die?’ It is wonderful that there are groups out there who apply pressure to government and care providers to improve care within the maternity services. Come on though, widen your focus from the glamour, headline catching time of birth and acknowledge the importance of good care before and after birth

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So now, yet another, organisation that wants to decide how the maternity services should be run, The Fatherhood Institute. Apparently we (midwives) don’t do enough to include the fathers in antenatal and postnatal care. We don’t ask questions if a father fails to show for the ante natal appointment and they feel that Fathers should be allowed to stay overnight with their partner and baby on postnatal wards. I’m sure that they are a lovely, caring organisation who are full of wonderful ideas but have they lost touch with reality, do they not read or listen to the media? At a time when the maternity services are struggling to cope with an increase in the birth rate, when units are closing and women are being turned away due to a shortage of beds we are expected to find somewhere for the partners to sleep, wash, pee and poo, I suppose we will have to feed them as well.

Why don’t the majority of fathers attend antenatal appointments? Could it be a question of finances I wonder? Pregnant women have a right to paid time off for all midwife/G.P/hospital appointments, and antenatal classes, their partners don’t.

I especially liked their accusation that “those (partners) that show no interest are not challenged” by us. Yep, I hold my hands up and admit to this, and the question I would ask is ‘what right have I got to challenge the way a couple manage their relationship/responsibilities?’ I can advise a partner, if I see him, that his baby’s mother needs support and help, but “challenge” him? Could be rather counter-productive and may result in me not being allowed back.

All a bit tree-hugging really.

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Just when I was contemplating how long it had been without a rant the Telegraph published this article ‘The case for Caesarian Section’. I read the article by Julia Llewellyn Smith with my usual interest as to how someone was about to justify an elective C- section for ‘social’ reasons. Ms Smith starts off by quoting a study by the Birth Trauma Association citing this as showing that fewer women die following an elective (pre-planned) caesarian than during an emergency section or vaginal birth. She helpfully puts a link in, but unfortunately it is to an article, also in the Telegraph, reporting on the study, not giving the details of it’s methods. I can’t comment on the findings, all I will say is that it doesn’t discuss morbidity or the outcomes for the baby.

The authoress then continues with her own experiences, which are bad. Filthy ward, insufficient attention, but then I’m lost as she describes how she wants a section second time around and then continues with problems but I can’t understand whether these are with her second baby or with her first, It isn’t really that important as this just shouldn’t have been her experience but she does say “I wanted my second birth to be conducted by well-rested professionals, to have the energy to defend myself on the ward, to have some control during a process which – thanks to the NHS’s shortcomings – has become the most distressing experience of too many women’s lives”. Did she go privately? Basically it makes no difference within the NHS, whether you have an elective or emergency section, you still end up on the same ward and wherever you have your operation you will still be “dressed in Nora Batty-style surgical stockings, attached to several drips and a catheter, with suppositories administered every few hours for the pain”. I shall dismiss the tale of the friend who laboured on the geriatric ward as elaboration since I regard this as extremely unlikely, not least because that would have entailed a midwife being on the ward with her.

Those are my issues with the article out of the way and, on the whole, I wasn’t too upset by it as it was telling her experience in a maternity service which I will admit is struggling. Then I read the comments and one comment in particular really got me riled. It was from Mark and goes like this:-

“….to have the energy to defend myself on the ward….” says it all about NHS hospitals, staff and processes.

These stories are not unusual. I have heard several similar ones. To go through childbirth in an NHS hospital must be an appalling experience. How anyone can think that this treatment of women is reasonable is completely beyond me. We know it happens, but the NHS staff seem oblivious. No wonder mothers end up with depression and post-traumatic stress.

And it’s not just childbirth where we are let down. The behaviour of some medical staff is unbelievable – rude, arrogant, off-hand. Many do not even seem to know that much about medical matters, and they all seem hidebound by “process” in any case. What’s the point of training to be a doctor if all your actions are pre-determined by “Trust Policy”?

“Overworked” is no excuse – most of the “overwork” adds nothing to patient care, and the staff should have the knowledge and guts to realise this and change the system. Too lily-livered and thinking of their pensions, I guess.

All the NHS cares about is computers, and filling in forms, and administration, so that if someone complains they can produce this worthless twaddle that no-one uses or reads to help the patient. (Although many secondary users have access to it for their “research”, without your knowledge or consent). The intention seems to be that hundreds of thousands of NHS workers can have access to your medical file, so clearly privacy is regarded as not important for the patient either.

But what I find most frightening about the NHS medical system is that no-one is prepared to admit that things could be doen better, or that people make mistakes.

And this whole cra**y, p*ss-poor system costs us a fortune. Also we are not allowed to leave this system, we are issued with an NHS number whether we like it or not, forced to contribute, and then the NHS thinks it owns your body and can do with it what it likes – apparently harvesting your organs without your explicit consent is now considered reasonable.

How can all these highly paid professors of medical ethics that lurk in the teaching hospitals and universities think any of this is even remotely reasonable?

No other 1st world hospitals are like ours, they don’t waste so much time on paperwork, they don’t treat patients so discourteously, doctors expect to doctor, and nurses expect to nurse, i.e. they spend 99% of their time with the patients, not with the computer (aka a fancy filing system).

I want to spend some time with this man. I would like him to spend some time working on the wards etc. and see what the staff are up against. Oblivious are we? We should have the knowledge and guts to change the system. No one is prepared to admit that things could be done better. Does he think that we enjoy all the paperwork, especially when patients, quite rightly, are ringing buzzers, clamouring for discharge papers, and people in strange audit/bed-state/IT offices are phoning demanding numbers of this and that, the woman in bed 3 needs help with breastfeeding and labour ward are doing another caesarian section so they want a midwife there NOW?

That takes me very neatly back to the case for and against caesarian sections from the service providers perspective. How are they positive? Well, as long as nature doesn’t beat the surgeon to it, they are allocated a time slot and adequate and appropriate staff can be arranged.  How about the negative? They are 3 times as expensive as vaginal births. They are staff intensive, normal birth = 2 midwives at any one time, perhaps an anaesthetist (epidural); assisted birth = 1 midwife, 1 obstetrician, 1 paediatrician, probably an anaesthetist; caesarian section = 1 runner, 1 scrub nurse/midwife, 1 midwife, 1 ODA, 1 anaesthetist, 2 surgeons and perhaps a paediatrician. Following the operation the woman requires close observation on a recovery ward and then a high level of nursing care on the postnatal ward. She will be unable to get out of bed for several hours so requires more assistance caring for personal needs and those of the baby and women who have undergone a section often require more help with breastfeeding, mainly positioning the baby. They will stay in hospital longer than a woman who has had a vaginal birth and the baby is at higher risk of requiring treatment for breathing problems. Does that answer the question of why NICE would like to see the section rate go down? Does it also help to explain why the service is struggling to cope?



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The King’s Fund report looking into the safety of the maternity services has come out, this is just a shortened version, but I found it quite illuminating when you read between the lines. I loved how it started as this really sums the situation up –

Giving birth in England remains safe in spite of neglect by senior managers and pressures on staff, according to a major new report.

Well if those who hold the purse strings, and ultimately decide staffing levels are not responsible for the service being safe, who is it down to? They have answered it by highlighting the pressures on staff. The pressures are there due to the neglect by senior managers. However, I don’t believe that they should carry all the blame, the DoH and Government are just as much, if not more, responsible. It is they who keep throwing initiatives out, promising the public this level of care, that access to services but at the same time the budgets are not increased sufficiently for the facilities and staff to be provided, in fact monies are effectively cut by the Trusts in an effort to stay within the Government decided budget. The report actually states that the ‘boards that oversee NHS Trusts have insufficient focus on maternity services’ and I believe that this is true, as long as mortality and morbidity remain low they are not prodded into taking action but the report does ‘call the the Trusts into action’ as it goes on to advise that ‘we could do better for mothers and their babies’.

I have blogged so much about the hand-to-mouth provision of care within the service. The obstetricians and midwives struggle to ensure that the service is ‘safe’ and on the whole we do well but women do not only want a service that is safe, they want the service that government, books and the media has lead them to expect. It is this that causes the majority of moans we read about on a regular basis, difficulty seeing a midwife when they want to, not only when it is scheduled; lack of attention from staff when they are in labour, on the wards or back home. Not enough help with breastfeeding, having to wait for painkillers and worse. On labour ward it would be lovely to provide one-to-one care but if there are more women than midwives that can never happen and attention will always be paramount for the high-risk cases. On the ward the problem is that if the ward is half full of women who have just had a major operation, C-Section, the staff are going to be more concerned about their post-operative recovery, that is a safety issue, the others demands on their attention, though hugely important, are not life-threatening.

So lets hear it for the staff on the ground because although they are under resourced they are still providing a safe service.


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