On Sunday 21 November, midwives will be holding peaceful vigils in city centres around the country as part of March with Midwives UK. Is this another group of public sector workers campaigning for greater pay and longer holidays? Unfortunately not – if the problem was that simple, a remedy would have easily been found by now. The nation’s midwives are instead taking action to preserve the women in their care and their profession from desperate and dangerous staffing shortages.
I am in my third decade working as a consultant obstetrician. In all that time, I have never seen the midwives I know and work with so demoralised, so drained and so likely to leave the profession.
We are currently facing a massive midwife shortage. The delivery suite where I work is supposed to have eight registered midwives on duty overnight but frequently has to cope with only five. This is the same in hospitals across the country.
Unlike in other parts of the health service, you can’t slow admissions or postpone operations to cope with the pressure when it comes to childbirth. No expectant mother can be told that they will have to come back another day, no one can have their surgery delayed. And this has inevitable consequences on the service we offer.
A fundamental tenant of caring for women in labour is one to one care. This means a labouring woman is cared for by a single midwife assigned to her, and her only. But at the moment midwives are often forced to divide their time between two or even three women giving birth. And here’s when it gets hard. Work on a maternity ward is demanding and requires a team effort. When there are plenty of people around to help there is a collaborative effect that makes the delivery easier. But when there is a staff shortage – say one midwife is missing from a team that usually includes eight – there isn’t just an eighth more work to do. Everyone has to work an awful lot harder to cope. And when a midwife is split between two women giving birth there is then twice as much to do and twice as much paperwork.
For new mothers this can make a huge difference in the service they are offered. For example, one to one care in labour means a woman is less likely to have a complicated birth, and leads to a reduction in interventions such as a forceps delivery. In 2015 the health department set out objectives to reduce still births, maternal deaths and neonatal brain injuries by 20 per cent in 2020 and by 50 per cent in 2030. In 2017, the 2020 target was pushed back to 2025 because these worthy aims were impossible to deliver against a backdrop of midwife shortages. Dr Bill Kirkup, who chaired the investigation into maternity failings in Morcombe Bay and East Kent, told the Health and Social Care Select Committee in 2020 that staff shortages were a significant factor in failings there and in other investigations he has been involved in.
The current state of our health service also means that post-natal care is impacted as well. After a woman has given birth, she usually goes with her baby to the post-natal ward in a hospital. At the moment she will remain there for a very short time – even if she has had a difficult birth – before being discharged home. This is because the onus is to discharge mothers quickly to make room for women currently in labour on the delivery suite. The number of maternity units in England has reduced from 180 in 2007 to 130 in 2017. And the remaining maternity units often don’t have the infrastructure in place to cope with the increased numbers. Even a decade ago women in the UK had among the shortest postnatal stays of any developed country. Following the reduction in the number of maternity units and squeeze on bed numbers, this has only gotten worse. No wonder new mothers feel neglected. And that the UK remains one of the countries with the lowest breastfeeding rates in the world.
It would seem the answer is to train more midwives. In 2014 a House of Commons committee found that England was short of 2,300 midwives. David Cameron pledged to increase midwife numbers by 3,000. More midwives were trained – but the attrition rate meant that staffing levels have remained a serious problem. From my own experience the midwives most likely to leave are the newly qualified because they just don’t get the support they need. A ‘blame culture’ in hospitals from senior managers creates an atmosphere that drives midwives away.
The need to make the lot of a midwife happier should be an urgent priority of this country. Paying more isn’t the answer – the currency midwives deal in is kindness and compassion. Instead midwives need to be allowed to care for pregnant women the way they do best. So when March with Midwives goes onto the streets next week, they are asking for the government to recognise that maternity services are broken in this country. And for a stop to the blame culture and bullying that contributes to so many highly able staff leaving the health service.
I have worked more than half my life with midwives. In doing so, I have seen humanity at its very best in these wonderful and very essential people. The government should listen to their protests next week. Because if they don’t we will continue to lose midwives – and the decline in antenatal and perinatal care will be disastrous.