We’re in the middle of a baby boom and the NHS is fraying at the seams – yet still the media appears to enjoy giving midwives a good kicking. Here, Yano’s Secret Midwife reveals the pressures facing those whose sole aim is to help make delivering a baby into the world a safe and memorable experience
We keep hearing there aren’t enough midwives, without anyone asking why so many of us are leaving the profession. In fact, there are enough midwives. That is to say, there are enough trained midwives – more than 41,000 in the UK. But the Nursing & Midwifery Council estimates that only 35,305 are practising. Which means there are nearly 6,000 midwives who could be working. The current shortage was this week estimated at 5,000.
I’m in my 13th year of midwifery and I’ve noticed that, above all, working conditions are strangulating. There’s endless red tape and paperwork, and a constant threat of litigation. Every move and decision has to be documented and accounted for. This stops midwives doing the job they were trained to do – support women and families. I’m not here to moan or garner sympathy. But it might help people understand the pressures we’re under by explaining how the job has changed for the shrinking number of midwives left or those who do seek to enter the profession.
Midwife Helen* from Derby says: ‘There are social conditions that make the job more difficult. A growing number of obese women and older mums put more pressure on the system.’ This is because they are not ‘normal, low-risk’ pregnancies.
Child protection is one of the biggest challenges to midwives. Some families need support, others need monitoring, and midwives are responsible for making that assessment during the initial appointment at the beginning of pregnancy. In the wake of the Baby P case in 2007, more families are being referred to Social Services.
There is extreme pressure to get it right, says midwife Anna* from Middlesbrough. ‘Refer unnecessarily and it alienates the family from care. Miss a case of neglect and it can be detrimental, as in the case of Victoria Climbié in 2000. The referral process is antiquated – they still use faxes! It’s certainly not the most efficient way to do things.’
There has also been an influx of non-English-speaking women into the UK, and it is often left to midwives to source interpreters. Not being able to speak English can have an adverse outcome for women and their babies, because they don’t access services as quickly. ‘They’re also far more time-consuming, as every consultation takes twice as long,’ says midwife Vicky* from London. ‘Interpreters are trained professionals but they don’t have medical training, so things can get lost in translation.’
Perhaps the most damning fact is that there is plenty of interest in midwifery courses – up to 30 applicants per place at some universities – yet the drop-out rate is up to 50 per cent. That shows how disillusioned student midwives will become before they’ve even completed their training. It doesn’t help, either, that The Royal College of Midwives says midwives are getting older. In England, between 2002 and 2011, the proportion of midwives aged 45 or over jumped from a third to a half. The number of midwives still working at the age of 65 or above jumped from 13 to 122. This suggests that the problem is only going to worsen.
So what are the options for pregnant women who are worried about their care? If you go private, you will pay for nice surroundings but may need to be transferred to an NHS hospital if you or baby requires more intricate treatment. And there are legal issues around independent midwives, as they are not obliged to have indemnity insurance (most don’t because it’s expensive). An independent midwife can only practise at a client’s home, so if transfer is required for a hospital birth the independent will take on more of a supporting role.
What can be done? In very simple terms, the government needs to make the job attractive again. There has been no inflation-related pay rise for the past four years. There isn’t much movement in the employment structure – it’s hard to get a promotion because if higher-band midwives leave, their work is redistributed. And many hospital trusts are downgrading midwives’ ‘bandings’ in management restructures forced on them by financial cuts.
The system needs midwives who have abandoned or lost their jobs to come back. They are trained and in many cases want to work, if the conditions are right.
‘It’s too risky to work at the moment,’ says non-practising midwife Karen*. ‘I’ve always worked in London but the rising number of births and falling number of midwives is a recipe for disaster.’ What would make her return? ‘Inflation-linked pay rises and better staffing structures so midwives are midwives and clerical staff do the clerical jobs. But most of all, more midwives, so I wouldn’t feel vulnerable on a 12-hour shift.’
The birth rate is rising, and there has to be a better patient-to-midwife ratio, or there will be more abnormal deliveries, more pressure on the system and more litigation. And, to put it bluntly, more dead or compromised mums and babies.
All of the midwives I spoke to cared deeply about giving mums and families the best possible care. Not a single midwife complained about the caring, compassionate side of the job. ‘Last week I was at a difficult birth where both mum and baby were in danger,’ says Vicky. ‘With my knowledge and experience and the help of my obstetric colleagues a healthy baby was born, and mum was delighted with the care she received. That’s why I do the job.’
*Names have been changed