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Posts Tagged ‘Midwife’

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.

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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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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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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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There has been a lot in the news recently about a scottish midwife, Anne Duffy who resigned from her job and is now claiming constructive dismissal by her employers. I’ve been interested in the outcome as the decision, it seems to me, will come down to interpretation of the NMC rules.

As yet a decision hasn’t been reached concerning Anne Duffy’s case, so why am I writing about it now?  Well, in the news today was a report about a couple whose baby sadly died as a result of no midwife going out to their home for the birth and the fact that a settlement has been agreed with the Trust.

In Scotland Anne Duffy was the midwife in charge of the maternity unit, which meant that she was the most experienced available midwife, when a call came in that a seriously ill, pregnant woman needed air lifting from an island to the hospital. After a discussion with other staff members she went off in the helicopter, when her actions were discovered she was disciplined and as a result she resigned. Report here.

So, on the one hand we have a case where a midwife attended and was disciplined as a result and  on the other hand, we have a case where a hospital failed to provide a midwife, a baby died, and the Trust have, I assume, admitted fault and made a settlement with the parents.

There are differences here, in one a midwife failed to follow hospital procedure, but fulfilled the professional requirement to provide care, and as a result was disciplined and in the other a hospital failed to provide care and have admitted fault. Can anyone else see the double standard here?

The Huddersfield baby death does bring up the homebirth and midwife staffing issue again though. There must be more to this though as there was already another homebirth underway, there was only one on-call midwife and she was already at the other homebirth so why didn’t the parents come into the hospital?

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Christmas Day for a midwife

 

7.30am, woke up, not because of excited children but due to my alarm beeping loudly, yes, just like an ordinary working day. Three-quarters of an hour later and I was quietly closing the front door so that I didn’t disturb a sleeping Hubby and, crunching across the icy snow and getting into the car. 

8.30 am and I unlocked the office door. Instead of the usual 4 or 5 midwives in our office there were just two, just 2 with half a dozen mince pies, a tin of chocolates and a box of luxury biscuits. Unfortunately we have no tea or coffee making facilities and the cafe isn’t open at weekends or bank holidays, so the biscuits were left unopened, the mince pies stayed in their container but each of us took a handful of chocs to enjoy whilst driving around. 

Busy day in store. Usually we try to leave Christmas Day free of ‘routine’ visits and only do visits for those who have been discharged from hospital the day before, but the backlog of visits from the couple of  days when the road conditions made some visits too dangerous or impossible meant that we each had 5 visits on the books before we found out about the new discharges. No one wants to be in hospital on Christmas Day so there are always quite a few discharges, and today was no different, so by the time the phone call from the mothership was over I potentially had 11 visits. My colleague and I had a chocolate and then brainstormed, prioritise, that would be the solution. A few phone calls later and 3 women had told me that they didn’t want to see a midwife on Christmas Day and assured me that all was well with them and baby. 

9.30am, I picked up the entonox cylinders and left the office. The main roads are virtually ice and snow free, however the side roads are full of icy, rutted snow and black ice, that was what I encountered arriving at my first visit. Having negotiated the slope and the corners I found a safe place to park, away from any other vehicles and not obstructing anyone’s driveway. As I stood getting my scales and bag out of the boot a BMW started coming toward me, lovely, new 6 series saloon  with an elderly, distinguished looking gentleman behind the wheel. Just as he drew level his car lost traction, there was much wheel-spinning and no forward motion so he ceased trying and proceeded to lower the window nearest to me. He may have looked distinguished, but his language was straight from the gutter . The gist of his discourse was that his driving difficulties were due to him having to drive past my car; that if I didn’t move then he would probably end up bashing my car; that I should drive out of the side road and onto the main road. I wished him a happy Christmas, apologised for having to work and inconvenience him, returned my scales and bag to my boot and drove out of ‘his’ housing estate and parked on the main road. Then I was truly pathetic and had a quick cry. He had difficulty driving up the road, I wish I could see him again and explain to him how much more difficult it was to negotiate 200 yards of rutted, icy snow carrying scales and a heavy bag. Good start to the day. 

My next visit was to the home of the woman’s parents, as arranged, however she was running late so I was asked to ‘return in an hour or so, but not over 2 hours as they would be having christmas dinner then’. For the rest of the day everyone was in, and welcoming, and after 30 miles and 8 visits I pulled onto my drive.

4.30pm  and I’m home. Hubby had cooked the turkey and was just putting the beef in to roast, we are having a christmas ‘buffet’ tomorrow. I phoned all the family and heard how their day had gone, prepared one of the puddings for tomorrow and with ‘The Gruffalo’ recording in the background settled down to baked beans on toast. Who needs turkey and all the trimmings?

Christmas day for a midwife is much the same as any other, the roads may be quieter but there are still breastfeeding issues to try and resolve, newborn screening to undertake and babies to weigh. Unfortunately I’m on call until 8.30am so no relaxation….yet, but tomorrow, whilst everyone else has a year to wait until next Christmas, this midwife will be enjoying her’s with all her family.

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