Midwifery staffing shortage: midwives voices

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A few weeks ago I posted a blog that discussed midwifery staffing shortage. It provoked an unprecedented response from midwives in the UK highlighting some of the current challenges they face. It seemed only right to follow up on that article, especially since another news report from the Independent discussed similar themes. In my article I mentioned Nottingham as a beleaguered area with shortages. The news article focuses on midwives in Nottingham who have been willing to whistleblow on the circumstances. I am not going to discuss the professional issues and ethics around whistleblowing, but it is evident there are deep concerns and stresses out there in the workplace. My aim is to present these views without comment. The quotes below are genuine, but to protect identity and the places concerned, I have removed personal information.

The people who contacted me varied from being qualified for thirty years to those wanting to come into midwifery. Similar concerns seem to be occurring across the whole country, particularly, it appears, about the introduction of continuity of carer (CoC) schemes where there are not enough staff to enable this to happen.

One midwife said:

We have allegedly been three to three and a half thousand midwives short since I had hair. Despite this CoC has been implemented to varying degrees. The max caseload was meant to be 100 but CoC suggests 35. My degrees are in midwifery not maths but even I can work out there’s not enough of us. BR+[Birth rate plus] doesn’t take into account this new model so in creating this new model and latterly focussing on the women who are currently at higher risk we are creating inequalities. Robbing Peter to pay Paul springs to mind. And this is without factoring in the midwives over 50 or those who don’t want to be on call so are leaving. (A)

Alternatively, it is suggested it is younger midwives who don’t want to do CoC:

1- there has been ageism affect and us older midwives are now outnumbered and invisible I feel.

2- the younger midwives do not want Continuity of carer and midwives are leaving because of it or extremely reluctant to join teams

3- there are not enough staff to do CoC justice. (B)

A previous long term independent midwife, who would have provided continuity in her practice, wrote:

I’m passionate about continuity, but not in a huge system like the NHS, because midwives have needs too and not all midwives can, due to personal circumstances, or want to work in a way necessary to provide continuity. The working patterns are completely inflexible, for no good reason. In any other organisation there would be much more flexibility. The lack of imagination on this issue is bewildering….

Why can’t we make space for people to play to their strengths instead of expecting all midwives to be skilled, competent and satisfied across all areas? Nurses, doctors, lawyers all specialise-this needs to be the case in midwifery, without one specialism being viewed as better than the other, equal but different. This is a core problem inherent in the continuity agenda at present. Trying to hold to this in a pandemic is also inhuman… (C )

This experienced midwife agrees:

We have many midwives who have been told that the will need to work nights ,days and on calls in a week , in areas they are not competent in and sometimes in area and hospital they have never worked in despite a wealth of experience in there specialised areas .With no regard to midwives literally having no childcare or means of family support to accommodate these demands and extreme changes in working practices and have no option other than to leave the profession. And this will certainly have a negative impact on patient safety and quality of care , which is a very real concern for my colleagues and myself who have raised these concerns at trust level . (D)

Another indicates there is significant burn out within her area, affecting all including managers:

Burn out is rife in midwifery, I know CofC is important but the pressure over the last 18 months on all staff has been horrific… All grades of staff are exhausted including the managerial teams, Heads of Midwifery are getting the majority of this pressure with no additional support from their own organisations or the regional chief midwives. (E)

A midwife also pointed out the reality of pay and conditions:

The pay is AWFUL considering our role and responsibilities. My monthly take home pay is a little more (£50 a month ish )than it was 16 years ago my role and hours remain the same however responsibilities and demands on me have massively increased .

My experienced amazing colleagues are leaving in droves, leaving before retirement age with no job to go to, and newly qualified midwives are not staying in the job due to lack of support and demands of the job .

So sad to see (D)

In contrast a potential future student and mother states:

I’m constantly being told it’s extremely competitive, there’s so many people applying for very few places to train. A recent open day I attended for a university in a large city with two large hospitals, will expect to receive 800 applications for 60 places…Something is clearly not working as being told as a prospective student you can have all the necessary qualifications/experience yet you have a less than one on 10 chance of getting a place at university. Yet as a mother I have to spend 10 hours alone on a ward waiting for my waters to be broken as there are not enough staff. There’s clearly an appetite for the job, yet birthing people are still having negative experiences due to lack of staff. During my research into this career I can see that those “lucky” enough to qualify are leaving the profession at an alarming rate due to “burnout” from the intense working conditions. There’s so much conflicting Information. Women are often not receiving adequate care, yet people are also unable to join the profession to fill the gaps. (E)

Students are also concerned:

I’m a 3rd year student midwife, about to qualify, and pretty much every shift the midwives are saying that there isn’t enough staff and they’re (rightly so) worried that it isn’t safe. We recently had a meeting with [managers] and their response to the concern about a lack of staff was: if people would take up the bank shift we are advertising we would have more staff on shift. However, in my eyes there shouldn’t be any bank offered. There should be enough staff to cover the workload and bank shifts should only be used in cases of sickness or maybe maternity leave etc., not as a standard! (F)

Other comments talked about students being given jobs without interview, and how the closure of birth centres and centralising services has placed more pressure on midwives (and women) who are increasingly traveling longer distances for work and needing to pay for parking. The changes to induction of labour guidance is pointed out as being a potential pressure:

…this proposed NICE guideline on induction will increase pressures on the system, including midwives. Not to mention judge more women of colour, age and raised BMI- it smacks of control in a time of huge uncertainty and anxiety. (C )

I work in one of the named trusts. I’m sure what women actually want is to have their chosen unit actually open to admissions, not to wait 3 days to be induced and a midwife who is not at the point of collapse. I’m quite sure she is not bothered if she’s met her before!!!! (H)

So we are in this situation, short of midwives, those in practice under pressure. It is not new. Back in 2016 The Knitted Midwife project was to point out that we needed more midwives. Increasing university places at the time was not the solution.

As an ex-independent midwife voiced:

There are decades worth of papers on recruitment and retention, yet we still seem to treat midwives and other NHS as bodies to be moved around- blood into a haemorrhaging system- why is there so much resistance to tackling root causes? (C )

What are the solutions short and long-term? Currently, COVID-19 clearly hasn’t helped and trying to introduce major change during a pandemic may be a bit unwise. However, there is evidence some areas have been successful in introducing continuity teams. A promise of increased maternity services funding will enable recruitment of around 1000 more midwives; a help but maybe not enough if some are choosing to leave. Only time will tell if this is a major blip that we have to get through. We need to work hard to look after everyone to keep the dedicated midwives in place.

Better births promised so much better.

Dr Jenny Hall

August 2021