Tomorrow, 13th October 2014, is an historic date in the history of midwifery, for tomorrow midwives are striking for the first time since the profession became regulated. Shock horror, women will be left unattended in labour; babies will die, just a couple of scare-mongering comments I have read in response to articles discussing the industrial action. Wrong. Midwives are ‘striking’ from 7am until 11am on Monday. The strike action may affect elective caesarean sections and routine appointments, other services i.e labour wards, birth centres and the on-call provision for homebirths will be unaffected. For the rest of the week midwives will be working to rule, in other words they will take meal breaks and finish work on time.
Well, how much of this will happen? The usual level of staffing for births will happen, as for the rest………it is unlikely that there will be an adherence to the work to rule.
Why are Midwives joining in the action? The pay review body recommended a 1% pay rise, the government decided not to take this advice. At the same time as this has happened the cost to remain registered as a midwife (or nurse) has increased by 31.6%, with a further 20% rise in the pipeline. The pensions contributions have risen from 6.8% to 9.5%. Those are just a couple of the financial reasons but for me, why would I take action*?
I’m sick, tired and fed-up with the way the maternity services rely upon ‘good will’. A joint staff-side survey in 2012 discovered that two-thirds of midwives work more than 2 hours extra each week and, of those responding, only 2.9% have recompense for the overtime. Many Trusts now operate a 12-hour shift system. Staff working these should expect to have a break, in my experience this doesn’t occur, midwives work through, constantly on their feet and making life or death decisions in frequently stressful situations. The community scenario is often equally debilitating. A community midwife can expect to work all day and then, if on call, may find herself continuing to work through to the following morning. This is not necessarily due to a homebirth happening, s/he can be called in to cover a birth unit or the labour ward. A working day approaching 24 hours is not unusual and this is totally due to ‘a lack of NHS funding and a national shortage of 2,300 midwives‘. This is why I support the action. Yes, I would enjoy a pay rise but far more than that I am calling for an increase in staffing levels. I want the maternity services to be safe for women, babies and care providers.
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.
This has been a week where the papers have been full of the crisis in the maternity services, from the shortage of midwives, to David Cameron back-tracking on his pledges, to women being so traumatised by their first birth experience that they will not be having another baby, to women having never clapped eyes before on the midwife who accompanied them through labour and birth and through to the ‘postcode lottery’ surrounding caesarean section rates and other aspects of maternity care.
Cathy Warwick, the General Secretary of the RCM (Royal College of Midwives) gave a speech at conference this week which painted a hugely demoralising, depressing and, frankly, scary picture of the state of the maternity services. Her speech was sprinkled with phrases like ‘ cracking point’, ‘ safety could be compromised’, ‘so stretched it risks safety’ and ‘bewildered’. Well Ms Warwick, you hold the key, you are the union chief so stop prevaricating and issue a few ultimations as it’s quite obvious that the gently, gently approach is not going to halt the collapse of the maternity services.
I’m finding all this quite interesting, this most public of admissions regarding the safety of the maternity services. Midwives talk to each other, especially at conferences and exhibitions and we have just had our annual conference, and currently there are rumours circulating regarding a case where a Trust is busy sanctioning staff for putting updates on a social networking site. The midwives had questioned the safety of the care they were able to provide, now they are accused of bringing the Trust into disrepute. How is it that Ms Warwick is able to shout from the rooftop that the maternity services are ‘at breaking point’ but that practising midwives are currently under scrutiny for allowing acquaintances to share in their desperation and concerns?
In The Guardian today was an article guaranteed to court fevered discussion, ‘Women have a right to a homebirth’. The authoress, Jemima Kiss, introduces the article with the suggestion that the health service should value natural births and not to allow the loss expertise in these in favour of caesareans, she has my support there. She is also quite correct in her assertion that women have the right to a homebirth, my question is ‘ Is it right that women have the right to a midwife attended homebirth in today’s cash-strapped maternity services?’ Any woman can choose to give birth at home, but NHS Trusts do not have to provide a homebirth service, apparently. It’s all nit-picking though because, if Ms B sent her partner round to my house and he told me that she was in the later stage of labour and they wanted my help, then I would have an obligation to attend and provide care ( NMC Midwives and home birth 2006).
Currently maternity services are incredibly stretched, and it’s not going to get any better. Many maternity units are desperately short of staff, Oxford being just one of them. Low-risk units are closing, Paulton in Somerset, Wycombe in Buckinghamshire and Tiverton in Devon purely because of staff shortages in the obstetric unit they are linked to. A homebirth requires 2 midwives, 2 midwives who will be needed elsewhere. If the homebirth happens at night those midwives will have already worked all that day, who will cover their work the next day? In reality how safe, how ‘on the ball’ will a midwife be when s/he has been working 24 hours? If it happens during the day who covers the work, especially if 2 midwives have already been out at another home birth the previous night? The answer is that clinics may be cancelled, pre-arranged appointments put off and any midwives who are working that day will end up very stressed and going home late. Another factor is, suppose the midwives were called out to homebirth 1 at 6pm and returned home at 2am then another woman wanting a homebirth called them out at 2.30am, it happens, and it is happening more and more frequently due to government initiatives and articles like the one in The Guardian.
I’m sounding negative about homebirth, I love homebirths but I am becoming increasingly concerned about the arrangements and staffing for their provision. Other aspects of community midwifery are really suffering due to cutbacks, childbirth preparation classes are being abbreviated, postnatal home visits are being withdrawn but a small number of women are able to command how the service functions on a 24 hour basis. I am horrified to hear me saying this but ‘ Until the maternity services have enough resources to ensure a safe provision FOR ALL then a homebirth option should be withdrawn’.
In today’s Telegraph was a piece written by Rowan Pelling who was commenting on the ‘golden hello’ to midwives who have left the profession. I feel that this article explains succintly most of the causes for midwives leaving the profession and then goes on to be realistic about what Alan Johnson is really offering – ‘He offers them a miserly £1,500 (plus up to the same amount in childcare, training days and travel) to re-engage with an even more demoralised and disaster-struck maternity service than the one they left several years earlier.’ The author is employing an Independent Midwife for the birth of her next child and suggests that the problems within the maternity services is her reason. I have no problem with this, it is her choice.
The article invites responses and the first one is from Emily, expecting her second baby in August, who says – ‘I’ve seen the midwife twice and she seems more interested in ticking boxes and moving on to the next mum than taking time to answer my concerns. The NHS has become a conveyour belt where primary care providers are only interested in treating the issue at hand. Ask anything of them and it is treated like an inconvienence.’ So, Emily is at most 18 weeks pregnant, that’s if baby is due on the 1st August, if it’s due at the end of the month she is 14 weeks, according to the NICE guidelines for Antenatal Care she should be seen prior to 12 weeks and then again at 16 weeks, so twice. Right so far then. At these sessions the midwife will have been ‘booking’ Emily, lots of asking of questions and ticking of boxes, filling in of multiple forms to book scans, have the appropriate blood tests performed, basically attempting to ensure that the pathway is laid for Emily’s progression through her pregnancy. So yes, the midwife is really ‘ticking all the boxes’ at the moment and, unfortunately Emily has it right, the midwife is moving on to the next Mum, and the next, and the next because the way the service is at the moment a midwife’s priority is to give safe care and if she has time to do anything more then wonderful, but becoming increasingly unlikely. If Emily had read Rowans article properly she would have read that one reason midwives leave is that ‘maternity services are so overstretched that a rewarding job has turned into crisis management’ so my message to Emily would be ‘ Your midwife is probably as unhappy with the care she is providing as you are with the care you are receiving. It’s not her fault’.
So the maternity services are going to have 1,000 extra midwives over the next year and by 2012 there will be a total of 4,000 more midwives for the hospital and community. Alan Johnson has said ‘midwives’ not maternity care assistants, lets just see if this is what really happens ( cynic, moi ). Good link here for the statement, plus notes to editors, from the Government News Network.
Obvously I’m really happy, ecstatic in fact but…………….Labour has promised that ‘every woman should be supported by the same midwife throughout her pregnancy’ by the end of 2009, how is this supposed to happen when only 25% of the number of midwives required to provide a ‘safe standard’ will have been recruited by then? In ‘Maternity Matters’, the 2007 publication from the DoH, 4 promises are made to women and their families, Choice of how to access maternity care; Choice of type of antenatal care; Choice of place of birth and finally Choice of postnatal care. Hang on there, rewind, ‘Choice of postnatal care – After going home, women and their partners will have a choice of how and where to access postnatal care. This will be provided either at home or in a community setting, such as a Sure Start Children’s Centre’. Well, well, so Government promised, about a year ago, that by the end of 2009 women (and their partners) can choose to have postnatal care at home. So what is this about polyclinics then and the reconfiguration of primary care where ‘polyclinics will offer access to antenatal and postnatal care’.? Confused? Well I am. Which promises should I believe? Should I, we, believe any promises?
We are back from our holiday to sunnier climes, Tenerife. Wonderful holiday, I suspect entirely due to having escaped for a week to a land where temperatures are good, atmosphere relaxed, and everyone is really friendly. Hubby and I have decided that this is now a must, a summer holiday good but awinter holiday is far more beneficial to the spirits so will have to happen every year. Interesting return to Luton Airport though. As we were approaching I commented to Hubby that the way we were coming in was unusual. Living under the flight path I am quite in tune with how the planes usually ‘stack-up’ prior to final descent, so I knew that we were using some strange manoevers. The captain called the cabin crew to the cock-pit and then came on the speakers. “Just to let you know that we are experiencing problems with one of the engines. As a result we are diverting to Gatwick where they have a longer runway and better facilities. We will be there in about 15 minutes. This is unusual but not unknown. When we have landed the ground staff will inform you about the arrangements for your to return to Luton.” The whole plane went silent for a minute and then everyone was talking. Hubby felt that he would be happier, if there was a problem with an engine, to get on the ground quickly rather than go back to Gatwick. The plane we were on only had two engines, that did concern me but Hubby assured me that it would be perfectly capable of landing with just the one. I was debating whether to phone the off-spring, just in case, but decided no as I may not have time to speak to them all (before I went up in a ball of flames) and then whoever I hadn’t spoken to would be angry. Drama queen? Perhaps, but a very logical one! As it was the most exciting thing about the landing was the welcome committee, the whole runway lined with emergency vehicles which then all raced alongside us and surrounded us when came to a standstill. Interesting experience.
Pile of post when we got home. Letter from the hospital telling me that they have put my op back a week, hope they don’t do this too often as it will really throw work into a state. As it is the whole next 2 months off-duty has been calculated allowing for the fact that I will be off, uproar will ensue if everyones off-duty has to be re-organised again. Looking on the bright side though, I would have been in hospital for eldest daughter’s birthday, now I will be at home; I’ve got more time to organise everything at home so all the holiday washing will be done and dusted and I will have recovered from all the excesses of a holiday where late nights and too much alcohol were the watch-word.
I note that the Health Commissions report on the Maternity Services was in the news, saw some news reports on that, nothing new in their findings to get me riled, basically reduced standards of care owing to a ‘shortage’ of midwives. Once more, with feeling, THERE IS NO SHORTAGE OF MIDWIVES, JUST A SHORTAGE OF POSTS FOR MIDWIVES.