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Midwives at our three main hospitals are throwing their support behind ‘March With Midwives’, a peaceful vigil to bring attention to a national problem.
March With Midwives is a group of midwives and supporters across the UK who are organising events up and down the country to bring attention to the fact that “2021 has seen maternity services become critically unsafe for staff and users”, according to their manifesto.
One midwife, who works at one of our local hospitals and has more than 20 years experience, but wanted to remain anonymous, is organising a vigil in Torbay to support the group.
Jane* explained that March With Midwives all began with a number of doulas (women who support women in labour but usually without official obstetric training) coming into maternity suites and witnessing how overworked maternity staff were.
She said: “What happens to women in labour has knock-on effects to others in the family, and there are hierarchy and bullying behaviours within the system that are making midwives leave the service in their droves. Student midwives are coming in to see entrenched behaviours that perpetuate the situation.”
A recent Royal College of Midwives report said that for every 30 newly qualified midwives, 29 are leaving the job, meaning the NHS gains just one extra midwife for every 30 trained.
Jane went on: “Covid added another layer. Managers who work 9-5 are the ones organising the shift patterns with what feels like little consideration to staff’s personal needs and instructing PPE use with lack of understanding the challenges it may present, which leads to discord within the service and leading to midwives being worn out and going off sick.”
Jane* told of situations where mothers-to-be are being scared into taking procedures or paths they didn’t plan for, only to be found that there isn’t the staff to perform them. She explained: “I remember one woman who was planning not to be induced and to labour at home. A doctor has frightened her into thinking she was risking her baby’s health by not being induced so she came in, nervous, and was told to go home because there wasn’t the bed or staff to induce her.
“So she was in the same situation she started in, but now she’s anxious and scared and not sure what the right course of action was.”
Far from a small group of people trying to cause trouble, the network of vigils to be held across the country has the backing of the Royal College of Midwives and has a concentration on education during the process of pregnancy and birth.
“We want grandparents and men involved too”, Jane* said, “and we want to empower women through their pregnancy. Currently we pay lip service to it by creating a birth plan with them, but as soon as anything deviates from expected, midwives are constrained by ‘guidelines’ and women are disenfranchised during the actual birth.
“Because of staffing levels, we end up constantly fire-fighting on a shift and never catching up with ourselves.
“We went into midwifery to look after women and we’re not, and that is heart-breaking and soul destroying. We should be starting from a position of kindness and compassion.”
If you would like to support the midwives and their group, the vigil will be held on Sunday, 21 November, at Torquay sea front, at the end of the pier, at 2pm.
*Not her real name
Jane* wrote a day in the life of a midwife in order to give people a glimpse into the role of these highly trained medical professionals.
A 12hr shift starts either 7.30am or 7.30pm. The shift ends at either 8.00am or 8.00pm. The overlap is for handover, we all know we have to start promptly to enable those exhausted staff to go home, but that rarely happens.
The morning staff arrive in varying states, some enthusiastic as they have suitable rest or a few days off. Others bleary eyed having worked a long, stressful shift the day before having not slept too well worrying about what they may have forgotten, or how did the woman they cared for yesterday get on. Some may be tired as they are still breast feeding their own baby and have been up endless times to an unsettled child.
Some may be looking after poorly family members or an elderly parent. Yes, these amazing, strong and courageous women have a life outside of their job and as they try to leave it at the door, somehow all of the staff who have worked the night are relieved to see them but know the transition they are going through.
The night staff look exhausted and whoever is relieving them knows that they may be going home to their beds with bells ringing in their ears or worrying they had forgotten something, concerns about a baby or mother, did they do everything right.
Some of those getting ready to go home may have rising anxiety that they need to get away on time so their partners/husbands may leave for work or they might make them late for work or worse still he will need to leave the kids before you get home. Then there’s the traffic to consider, the school run and did they remember to get the PE kit out? Some of those night staff may be worrying that their elderly or ill mum/relative will be waiting for them; to assist them getting up, fed, dressed.
Some may even have some training to go to and they know they won’t be going home to their beds until lunch time. Some have 10 minute drives after a long night shift but then have the school run and some have a 40 minute drive but pray they can stay awake long enough to get home.
The day staff coming in try to gauge the atmosphere and pray that the shift is going to be ok, enough staff, no massively challenging cases which can leave them feeling scared and vulnerable, are they working with staff they get on well with, or are they even going to stay where they have been allocated to work.
Sometimes hearts rise, it’s looking like it’s going to be a good shift, and sometimes hearts fall, this shift is going to be a challenge. On occasions they may arrive with dread as they know they have a meeting over an incident and are full of fear or maybe they left their poorly child at home and feel guilty.
There is this unspoken knowing whether you are coming or going there is always something else going on for everyone and with the best intentions everyone tries to rally around and support each other the best they can. Day staff reassuring the night staff they will sort out x, y and z. Night staff apologising if they have forgotten anything and wishing them a really good shift. The transition has happened and each individual new pathway begins for all.
The day staff get down to allocating staff to women, reviewing prioritising care needs and planning (as best they can) the day ahead. As one mask shrinks and the other begins to grow the staff start about their business. The night staff face their next task before they are able to get to their beds. Some will be back later that night and so are desperate to get to bed and get enough sleep. Others are relieved that they won’t be back that night and are looking forward to that prospect, though they know it’s a double-edged sword as tomorrow will be the day they feel jet lagged and exhausted due to the mixing of days and nights.
The buzzers start soon into the shift and the drug round commences. The conflict begins. Is someone able to answer that buzzer, has someone gone to the other woman who has been waiting for help for ages? Women are waiting for pain relief, what to do and who to go to first is a constant quandary.
Then someone shouts that there is a doctor on the phone wanting to talk to a midwife, the woman in the side room waters have broken and then the partners start pressing the door buzzer to come in and see their loved ones and those loved ones are so desperate to see each other.
The push and pull feeling can be overwhelming but with a big deep breath and conflab with the team, the plan that was made in handover has changed. The woman is assessed, the drug round complete and the partners let in. The woman needs to go to the delivery suite and a midwife has to take her. That will leave the ward vulnerable as it will be a staff member down and the delivery suite can not look after her unless someone stays until relief can be organised.
Off the midwife and the woman go and the other one left goes to the ward manager and asks for help. On a good day for her that is easy to do however on a busy day and back-to-back meetings this can be a challenge. Another transitional exchange happens depending on if the support is available or not. What happens will affect the atmosphere and the work pressures for the day staff. If it is supportive then a satisfied staff member can continue on with her work knowing she is supported. If the answer is not then anxiety and fear rise’s and challenging few hours are anticipated.
Bells, buzzers, boobs, pain, concerns, reassurance, education, checks, written notes, Dr’s changing plans of care, antenatal checks, postnatal checks, discharges, safeguarding, jaundice baby requiring a blood test, feeding concerns, observations, escalations, interruptions, happy mum’s, crying mum’s, helpful partners, stressed partners, concerned relatives, baby’s in special care, new admissions, computer work, phone calls, drug orders, equipment checks to name but a few of the tasks ahead of the shift.
In amongst this is self-care, drinking enough fluids, needing a wee, will we get a lunch break, need to express breast milk and fleeting thoughts of those who share your life at home are OK.
Meanwhile the night staff have driven through tiredness and arrived home, for some they are relieved because they can fall into bed, for others that is not possible. Breast feeding, school runs, tidying, dog walking, relatives cares and appointments need to be done before their bed will invite them in. Some know they are back that night and are hoping that if they can get into bed by 10am they will get four hours sleep before they need to get up for the school run, cook tea, help with homework, tidy and get ready to repeat the night before.
Some staff can sleep because the night was OK, others are restless because they have much on their mind. Then the dreaded need for a wee which can end the sleep required to prepare for the night shift ahead. The school could ring, the carer could call, the parcel arrives that needs signing for and brilliant, fantastic they’ve decided to dig up the road. Dogs barking, cars hooting and daylight interrupting their snoozing, which adds to worries about the pending night to come. Sleep has left for the rest of the day. For others, it’s straight into bed with a full deep eight hours of rest and sleep but for some reason it still doesn’t feel enough. A fleeting thought for those on the day shift as it always seems more crowded for them with so many staff about.
The day is passing for those on the day shift and the workload building. For some of those staff they know they are being judged for finding it a struggle and comments being made at why she is not coping. Some staff have eaten and some have forgotten and for some they just haven’t had time. The happy couple leaving and thanking you for care then back to the woman in total despair. Delivery suite call and ask if you can assess someone. Considering the request with a deflated heart knowing they are asking because they have no room or no midwife. Sometimes you can say yes and sometimes it is no and depending on the answer will influence their opinion of you.
Escalating your concerns is something expected but as you go to do so the husband of the woman being induced comes to find you to say that she cannot cope anymore. You know in your head the delivery suite is busy and pray and hope that you are able to support and reassure her enough to cope a bit better for a while longer.
You run a bath, guide some breathing techniques, reassuring with observations and a quick listen to the baby’s heartbeat, all is well and reassuringly you explain you will be back to see how they are in a bit. It’s important to let the delivery suite know that there is a potential labouring woman coming their way to which they agree if we can have back the recently delivered woman, we sent up earlier. They will call us when they have been able to clear the room and then she can go to the delivery suite.
Handover is short as both parties are busy and there is an assumption that the woman coming to the ward is known to staff because she came from the ward. The midwife who took her up arrives 30 minutes later with the woman saying she still has her computer work to complete. You know this is going to take even longer for her because of the constant interruptions but you are glad of the extra body. Periodically checking the woman in the bath is doing ok, encouraging her to hydrate and listening to the baby’s heart rate, all seems well.
More interruptions and buzzers galore when a staff member arrives looking quite cross. But she is upset because something has happened and she feels so bad. You listen, support and give her a hug, make her a cuppa and encourage her to speak to someone who can support her better.
You hate to leave her but buzzers are buzzing. Someone is cross because they wanted pain relief over an hour ago and the lady waiting to be discharged is packed and ready to go even though you haven’t even completed the paperwork. Your stomach rumbles reminding you that you still have not eaten and it is 5pm.
Half of you is delighted as you know you're nearing the end of your shift, the other half worrying because you have so much more to do before the night staff arrive.
A fleeting thought of how their sleep has gone and then a concern that you may be leaving them to a lot of work left undone.
The staff working the night shift ahead begin to awake and prepare for the unexpected. For some they are not working so only had a quick nap earlier and now it is 5pm they are feeling tired and worn out. Probably worrying if they can make it until 9pm and then hopefully sleep until the morning or will they fall asleep for a few hours then go back into ‘night mode’.
Those coming back prepare for their shift which includes feeding kids, seeing elderly relatives or even a shopping list. Food is cooked and time spent with the family and then the mental preparation for the shift ahead. How was their day, did they manage ok, have they discharged some woman and pray things are a lot calmer? Where will they be for the forthcoming shift, they are allocated to work on the ward but anything can change.
On goes the mask in the shape of a uniform, big deep breaths and positive thoughts, big cuddles from kids or a wag from the dog, maybe a relief the carers not called. Goodbyes all said and, into the car, off for the shift, reassuringly repeating all will be ok.
The transition begins as you arrive on the ward. The day staff look tired or chirpy and that can set the mood. ‘Thank goodness you have arrived’ is often a greeting when really, all we want to hear is ‘it’s been fine you are going to have a great night’. As we take our coats off and watch the staff rushing about, trying to finish their jobs we greet each other hopefully encouraging a fine night.
Then a partner runs out and shouts ‘She wants to push’ and the only one available to go is you and you know nothing about her. Entering the bathroom, it is very clear things are advancing quickly in her labour, calmly you reassure her and tell her to breathe through the urges. You ask someone to contact the delivery suite and tell them you are on your way and ask the husband to fetch a wheelchair from near the door.
You help the woman out of the bath who is really struggling to stop following her urges to push. She is quickly dried and wrapped in a sheet, put in the chair and rushed to the delivery suite and the only person to care for her is you.
Encouraging her to breathe and pant between contractions you ask her some questions, what’s her name, how many weeks, why was she being induced, is there anything important we need to know about. Her poor partner is answering some of the questions as best they know how but they are looking concerned. I know what they are thinking ‘will we make it to the delivery suite?’ Trying our hardest to look really calm, reassuring them we will get there in time. Panting and breathing we enter a room where the woman shouts out ‘I want a fucking epidural now’. Calmly spoken we say, ‘let’s assess the situation and would you like gas and air whilst you decide what is best’. There is not much time to assess because the baby is coming and with a good few pushes the baby is born. A hearty cry and relief all round, then tears of joy break through the event. Wow, that was a great start to the shift.
After the placenta and calmness resumes’ the family are given some alone, ‘golden hour’ time.
Speaking with the coordinator as what is expected to happen next, is greeted with an expression and acknowledgement that what is about to be said is not going too great. ‘Can you quickly do your paperwork and handover to midwife B, you are really needed on the ward as the workload is high’.
Disappointed for the woman who has only just birthed, another midwife to meet in her special event and the pressure of not being able to complete care. What a journey for them, what fragmented care. The notes are finished as quickly as possible and then into the room to say goodbye, well done and what a pleasure it was to help them in this magical moment.
Back to the ward and now not fitting in as the handover completed and the chosen work dished out. Disappointingly you know you are not caring for those you know but for the one who has been buzzing all day. That poor woman needs lots of support and a smiling midwife, not a disappointed one.
The day staff have left and you briefly think ‘I bet they are just sitting down to eat, watch TV or crawl into bed’. The night begins and the buzzers commence.
These poor women sharing a bay, how can they get any sleep? One woman’s baby is crying a lot and the mother is worried that she is not doing things right, she is concerned she is disturbing others and her baby is hungry.
She is exhausted from her labour before her, which ended in an emergency caesarean after a long, long labour. Guidelines say keep mums and baby’s together but your heart knows this woman needs sleep. You offer to support more feeding and she is falling asleep; this is not safe and you suggest that maybe some cuddles from the midwife to allow her to sleep, that may help. The woman agrees and you take the baby with you, before you are at the door you hear her snore.
The other women are now not disturbed by her restless baby but from her evident exhaustion. This pattern continues throughout the night with the other women on the ward who are also really struggling. Then disturbances from staff because of observations, antibiotics, babies needing to go to special care, new admissions, other women’s buzzers, phones ringing, doors banging and babies crying.
How can anyone get enough sleep here?
Breaks are organised and staggered we go. Whilst resting some shouting is heard outside. A familiar sound of a woman in labour who is in need of assistance. No break can be had now and out to investigate what is unfolding.
A woman is screaming and crying, a partner looking scared, relief is seen as the approach from staff looks helpful. “Explain to me what is happening” the midwife asks kindly. The partner declares they are being sent home, as she is only 1cm dilated but cannot even get in the car. The midwife suggests “let’s go back inside, settle you in a room and see what can be done as there is no way you can go home”, so now we have a new plan instead.
In to a side room for some privacy and quick discussion about preceding events and plans. A waterbirth with aromatherapy oils was what was wanted but she never expected it to be this intense. Some quick reassurance and breathing techniques shown, the woman calms down and copes a bit better. Directing her partner to do the same thing and into the shower on all fours will be amazing relief for the intense pain on her back and please feel free to use the aromatherapy oils.
A quick call to the delivery suite to explain the situation and, as there are no rooms or midwives, a request is made for the woman to stay with us for now. With break now on hold and the other staff working through the observations, answering buzzers, helping with breastfeeding, supporting and caring for our new arrival is given. She is coping much better and seems very relaxed, being here is obviously meeting her needs and alleviating her fears.
Refreshments are offered and observations complete, notes reviewed and completed. Several check-ins later, a familiar sound of involuntary pushing urges emerge from the woman. “How are you guys doing?” “I want to push; this baby is coming.”
Amazing! So unexpected but it is amazing what a bit of trust, relaxation and breathing can have on the progress of labour. All is well, the baby’s heart rate is good. There is no time to transfer to the delivery suite so lots of towels are grabbed instead. As the head is emerging, a staff member says, equipment is checked and we are ready for the pending event. In a very small space, the baby is born and tears of elation are filled in the room. All is well and the woman is helped to the bed and once all the checks are performed to ensure all is well the couple are left to welcome their new arrival and shock of the rapid arrival.
We discussed how that could have been a different story of being born in a car or at home but we all agreed and were reassured by how great the team work was. More notes, more computer work and uniform changes and the rest of the buzzers to be answered.
A quick look at the clock and as we see the sun rising and relief is gathering as we know the staff will be preparing for their shift ahead. Lots of activity starts to erupt to ensure all the final checks and jobs are complete.
The night staff think about the staff coming in and the staff on their way into work are praying for a good day ahead. There are rumbles and grumbles of some of the night’s events, everyone has an opinion on what should or should not have been done. Most of us are glad everyone is OK and our thoughts are now moving towards what is the next phase of the day. Will the handover be quick? How will the staff feel? I hope that all is well at home and can’t wait for my bed!
Some days you arrive and there is more than enough staff and no women to care for. We all recognise the feast and the famine of our work and know this is part of the course. And on the day, you think you have a moment to breathe, catch up reading your emails, then be reminded of e-learning. There is no real rest as there is always something to do, just like being at home really!
The lack of respect for each other’s roles is exacerbated by tiredness, exhaustion, home life concerns, support women against medical advice, the art of midwifery, experience, knowledge, support, work load, personality clashes, power roles, guidelines, protocols, expectations, different opinions, hierarchy, ego’s, outsiders, compassion, burnout, public, Covid, health of the nation, personal health, mental wellbeing but one of the biggest concerns is that you are frowned upon or seen as weak if you do not have the resilience to cope. Kindness has been replaced by expectation.
The trauma of a very much-loved job is unbearable. The fear of failing or making a mistake is draining. The conflicts of opinion can make the difference between fitting in and being isolated. There is bullying and cliques but most of those are not bad people, they are trying to get through the shift the best way they can. They do not wake up thinking ‘today I am going to be mean’ but their behaviour is influenced by so many variables.
Honestly, this job can be the BEST job in the world or the WORST. Being a midwife means ‘Being with Woman’…..today there is less time for being with women and more fire fighting or ticking boxes to evidence we have been with women. The irony is heartbreaking.
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