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Midwifery staffing shortage: midwives voices
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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

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Elsie Gayle 10 August 2021 at 14:18

“Midwifery Conversations” was birthed at the SAID Business School, University of Oxford under the NHS Health Accelerator Programme. It has supported numerous aspiring and non-practising and practising midwives to enhance all round care and Clinical outcomes.
Sadly the ‘authoritative voice’ declines to acknowledge (to date) both the root causes and remedies which will ensure a quality and safe workforce; despite current challenges.

[email protected]

Elsie Gayle 10 August 2021 at 14:19

Please see my entry above.

Carole Smith 12 August 2021 at 10:19

The demands on the midwife are increasing. The conditions in which midwives are expected to practice are decreasing – increase in client numbers, being unable to give women choice in their care due to ‘policy’ or ‘guidelines’. Midwives feeling under valued, not only due to pay but due to ‘bullying’ tactics used by managers. Shift systems which give no consideration for the midwife’s life/work balance. There is so much wrong with the ‘system’, but yet again the square peg will fit into the round hole and if as an individual midwife you can’t force yourself into that space you have to leave. Again that is an issue with the ‘system’ – midwives are not a disposable commodity. On top of all of that midwives frequently work 12 hours without a drink, let alone food, for a woman in our care there would be an outcry (and rightly so) if we let her go that long with out food and drink.. It is not surprising that midwives are leaving.

Joanne Walters 12 August 2021 at 14:25

I have been in a Continuity team now for over 2 years and nothing is getting better…….. more teams have been created and everyone is on their knees!!! The sickness is worse than ever and staff shortages are beyond ridiculous and unsafe.

We have tried a couple of different ways of working but it just doesn’t work!!! We have asked……. in fact begged for things to change before there are no staff left.

Our Midwifery unit is now closed ro births and home births have been suspended because all of the Continuity teams are now having to work in the obstetric unit – so much for continuiry there!!!

Management tell us they can’t change the model we are working to……….. but now it suits them we can!!!!

There is no thought for midwives work-life balance within the Continuity model and my husband is getting fed up with my work pattern as much as I am. I rarely have 2 days off together so never feel like I have been off as my day off is spent catching up on household chores etc. I’m sure there are.many others feeling the same.

What is it going to take to realise that this is not working????
How.many more midwives will leave the profession due to this model??

Sad times ahead for many 😢

Anne Gledhill-Myhill 15 August 2021 at 08:38

I could have written all those comments myself. I absolutely love midwifery but at 56 with 3 children still in school I am very concerned that I can’t be either the parent or the midwife I want to be.

Isabella Smart 16 August 2021 at 13:12

I am writing from Aotearoa/NZ. I trained as a midwife in Nottingham. The situation is so similar here with drastic shortages of midwives in the public health system and, sadly, in the self-employed midwifery system, too. We have a system where self-employed midwives are the majority and they claim payment from the Ministry of Health for delivering care to women from their own private practices. This started on the 1990s when continuity of career was the ideal. What had happened over the last 30 years is that due to underfunding and women’s expectations the a large proportion of self- employed midwives find their working lives unsustainable. They are on-call 24/7 for the women under their care and are expected to ‘live midwifery’ really to the exclusion of all else. They are often exhausted & afraid. So the maternity system is breaking down & in crisis here. Employed midwives like me ( I manage the largest community team in the country) are overwhelmed as we have to take on the care of women when their self-employed midwife ‘hands over care’ because she is too tired or it’s too complicated for her or she just doesn’t want to provide care any more. My health board is 47 midwives short- we do 7500 births a year in the poorest area of the country with a large % of very complex care situations. The attrition rate is huge for students and staff and our sickness rates are high. The theory of continuity of carer researched by academics abs promoted as the ideal is good on paper but it seems to be highly exploitative of women as midwives as it assumes we have no lives and will give up our health for poor pay and conditions because women need us. It guilt trips us about not providing ‘the best’ in a rigid system which is not designed to enable it. I feel so sorry for women who hope for an ideal pregnancy experience but cannot find anyone to care for them. I currently have over 150 women with no named midwife and I am providing a patchwork of care to make sure they have midwifery care in their pregnancy. It is heartbreaking as I cannot allocate a midwife to women for whom this is a unique life event as I don’t have them available. I feel so sorry for my Nottingham midwifery sisters and I hope it somehow gets better for them. We at least have government intervention to improve funding in the offing. So I have hope here in the South Pacific that things will improve. Kia kaha.

Nick JM 28 November 2021 at 22:35

My wife is a midwife and my daughter (21 this year) wants to follow in her footsteps, despite the poor pay and worsening conditions of employment, not to mention the substantial debt of £9k a year fees plus the cost of subsistence and accommodation for the 3 year degree course. Given the shortage of midwives, you would think it would make sense to train more and avoid having to try to recruit from oversees (harder for midwives than nurses). You would also think the Govt. and its university education ministers would understand that. However, it seems not.

For my daughter, the first hurdle was getting high enough A’ level grades; she needed three Bs (seems excessively high to me) but only managed BBC, and was not offered a place at any of her selected universities. She was however, informed that if she did a year on another health related degree course at a particular university, she would be assured a place on next year’s intake by that route. So despite the additional expense (another year’s fees and maintenance), she decided to do exactly that. A little while into the course, however, she was informed that the numbers on the midwifery degree were being cut by more than half and that she now was very unlikely to be offered a place, due to the higher graded students that were applying for next year.

So she’s now left with the choice of abandoning her current course and applying (and then moving) to a different University (still no guarantee of being offered a place), or applying for a different course that her A’ level grades will get her onto, and abandoning midwifery altogether. And she’s not the only one in this predicament.

This is not only immensely frustrating for her and for us, but inexplicably short-sighted and detrimental to women, the new born and UK society as a whole.

My questions are:

Why, when we have an acute shortage of midwives, are we discouraging, even preventing, those who are prepared to work hard and pay a small fortune to train as midwives from entering the profession?

Does the Govt. secretly not want people to enter the profession? Is there an agenda here that I don’t understand?

Why are universities such as the ones my daughter applied to requiring such high grades? And why is the one she has started at, and was hoping to be accepted at for a midwifery degree course place next year, slashing its intake, at a time of shortage?

Isn’t the Dept. for Education and Universities Minster interested in helping address the midwifery crisis? And what is the RCM as the professional body doing to help?

Personally, I think the Govt. should be paying for, or at the very least subsidising midwifery training (as used to be the case) and creating more, not fewer, university places. Whatever the reasons (anyone – please let me know what they are), it seems clear to me our university system is failing our nation, failing the profession and compounding a crisis that it should be helping to solve.

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