Midwifery in the NHS: my opinion

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Those who know me well will confirm that I have spent most of my 35 years as a midwife, pushing for change to improve care. Just last week I was asked for my opinion of current NHS midwifery services, for a TV programme claiming to be supporting the cause for more midwives. Whilst I haven't worked in the NHS for more than two years, I am in constant contact with midwives and student midwives throughout the UK.

So these are some of the questions I was asked, and my brief responses. I would love to know your thoughts too, via the comments box at the end of the post.

How do you feel the role of a midwife has changed from when you first went into the profession? (Staff numbers, continuity of care etc)

The work of a midwife is significantly different now, in terms of workload pressures as a result of inadequate staffing levels, medical and social complexities of women's pregnancies, increased UNNECESSARY intervention rates, service models and bureaucracy. So much has impacted on maternity services, and midwives are increasingly under pressure due to the afore mentioned, and also due to fear of recrimination. Lack of understanding of the purpose and use of clinical guidelines, and activities related to Clinical Negligence Scheme for Trusts (CNST) has added to midwifery workloads, and the fear factor.

Because of excessive workload issues, midwives have less time to spend with women, and this in itself is stressful, and demoralising. Midwives (and obstetricians) increasingly practice defensively, over treating those in their care because of fear of reprimand or litigation. It's the 'just in case' scenario.  Maternity services seem to be entirely focused on the reduction of  'risk', which has the potential to cause more harm. Over medicalisation of childbirth can lead to iatrogenic damage, and it feels as though the more maternity services focus on safety and risk, the more worried and frightened women become. Pressure to save money in the NHS is taking it's toll on maternity services, and because there are few Trust targets for maternity, the service is more likely to be bypassed. Maternity services' position within an NHS organisation's budget or profile isn't a priority, and therefore departments such as medicine and surgery frequently take precedence (in terms of resources). Women didn't seem to be as fearful of childbirth during my early years as a midwife, and whilst services weren't ideal,  in the main women believed in themselves, and their ability to birth their baby. As we have unwittingly 'done to' women, increased screening, focused on reducing risk, we have disempowered women.

What are the main concerns for midwives today?

Lack of time to do their work well, fear of recrimination (getting into trouble).

Do you think midwives today are over stretched and unable to perform their role sufficiently? Or does this depend on the hospital in which you work? 

This is addressed above. I think in the main midwives are overstretched. There are some services with exemplary models of care for women, where midwives, obstetricians and mothers feel respected, valued and able to do their work even if it is busy. We must highlight those services, learn from them, and channel energies into getting it right for all families.

Francesca and Flo 

Francesca and Flo 

And do you feel there is sufficient postnatal care in place for women? 

Postnatal care is suffering due to lack of human resources, and because of the focus on risk, areas of the service where 'risk' is deemed to be greatest (delivery suite/labour ward) takes priority. Because of increased unnecessary intervention in the antenatal and intrapartum period, postnatal wards are busier too. Bed reduction programmes in NHS organisations significantly reduced ability for women to stay until feeding is established, so women get little support to breast feed. Postnatal care in the community is reducing due to pressure on resources. This is a great pity as the lack of support potentially leads to morbidities that cost more for the NHS.

There is no resemblance to the postnatal care I delivered on postnatal wards during the first half of my career, to latterly. This is because there are more:

-Operative births

-Babies who need extra monitoring due to an issue that was potentially caused by mode of birth, or choices made.

- Excessive use of antibiotics on neonates ('just in case'), and the extra input needed from staff.

- Excessive record keeping activity and paper work, which is duplicated unnecessarily. 

Did you ever experience or see women's lives being put in danger because of a lack of resources? 

This is hard to determine. Midwives and doctors always try to do their best, and usually go way beyond the call of duty. Sometimes, however, the pressure on staffing is so great that women receive substandard support and care, usually by way of time spent with them. The potential for harm is always greater when there aren't enough midwives to care for women, at any given moment.

Could I also gain a bit more information about your career as a Midwife - how many years you were in the profession? What you liked / disliked about the role?

I worked as a midwife for more than 35 years in the NHS, and continue to work freelance, mostly on a voluntary basis. I feel immensely privileged and honoured to have been part of each woman's journey into motherhood, and to have worked with the most inspirational teams. Women, both those I cared for and worked with, never fail to amaze me with their courage, strength and determination. Whilst working in the NHS I loved most of my work as a midwife, and grossly disliked the pressure and desperation when unable to help women, and midwives.

There is so much to do. The Royal College of Midwives continue to lobby for more midwives, and a group of well respected activists are pushing for better continuity of care, amongst other things related to Maternity Services. We mustn't give up.

What do you think?

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