SPECIAL REPORT
The shattering words of one woman on the maternity frontline, in this deeply disturbing report on a profession in crisis
AFEW weeks ago, the midwife-led birth centre at one of London’s largest teaching hospitals declared a temporary closure to expectant mothers. St George’s Hospital’s centre, in South London, shut for 16 days while its midwives were redeployed to the main labour ward ‘to ensure safe one-to-one care’ during a period of severe staff shortages. Similar announcements have been made across the UK with growing frequency. The reason? There aren’t enough midwives. While St George’s re-opened their birth centre, not everyone is so lucky.
In Essex, Oxfordshire and elsewhere, the closures persist. In the worst cases, entire wards have closed. And the closure of home birth services since the pandemic struck remains widespread.
So why has Britain’s stock of midwives become so dangerously diminished? The last two years have pushed a crisis that’s been a decade in the making to breaking point. The reasons are complex. Training funding for new midwives has been cut, leading to a shortage of recruits.
Yet long-term issues with the structure of maternity provision, and ever-increasing red tape, mean the numbers of experienced midwives staying are dwindling.
Add in increased absences due to Covid, and it’s no surprise the midwives still working are experiencing a barrage of stress, burnout and illness.
There has been a shortage for more than ten years, after 3,000 new midwives promised by David Cameron in 2010 failed to materialise.
But these essential health workers say it’s never been so perilously unsafe.
Last week, the Royal College of Midwives (RCM) warned that the UK is facing an ‘exodus’ of midwives, stating that after an unrelenting 18 months, staff were at breaking point, with 57 per cent of maternity staff considering quitting.
And fears are rife that should mandatory vaccination against Covid be expanded beyond care homes (government consultation closes later this month), it would herald more staffing woes, with unvaccinated midwives made to withdraw from clinical roles. While there is no official figure, it is estimated that — in line with the population — more than 80 per cent of midwives are vaccinated.
Earlier this year, the Care Quality Commission warned two in five maternity services were not performing well enough, with 41 per cent rated as ‘inadequate’ or ‘requires improvement’.
‘The RCM have been calling this out for ten years. We have been clear that the number of student midwife places shouldn’t have been reduced, that the bursaries for training shouldn’t have been removed, that we should be offering decent salaries and flexible working to retain staff,’ says Dr Mary Ross-Davie, director of professional midwifery for the RMC.
With the professionals worried, what does this crisis mean for the safety of mothers and babies?
‘It feels dangerous to give birth,’ one midwife tells me, her passion for her profession drained by what she sees each day at her large hospital trust in the north-west of England.
She says: ‘As a student, I wanted to be a midwife who empowers women, gives them choice — now I think if I finish work and haven’t lost a baby or a woman it’s a good day.’
It’s not, she says, that tragedy is a daily occurrence — but it is a constant fear as fewer staff means mistakes become more likely. She knows of at least one baby stillborn in circumstances where there was a heartbeat when labour started, but the mother was not examined within the first 15 minutes of arriving at triage, as she should have been.
What if she had been examined within that window? ‘If there was a heart rate, you wonder,’ she says.
‘The women I worry about most are the ones on the induction list. If you are being induced you are high risk.
‘We say we are going to give you tablets to start labour as we are worried about your baby, and then we will leave them [on the induction ward] for a week because there are no beds [in the labour ward].
‘The woman will say, “You told me I needed to get induced five days ago because my baby is not growing, what’s changed?”
‘But nothing has changed, we just don’t have a bed. Every day you put someone on a monitor and are waiting for there to be no heart rate.’
It has become almost routine, she says, for babies to be screened for infection and treated with antibiotics as a woman’s waters have broken and labour has not been induced fast enough to minimise infection risk.
Recently she was told to encourage a woman making slow progress after an induced labour to opt for a Csection, as they needed to free the bed. My job is to advocate for women, I should be saying absolutely not but I find myself saying, “It could be over if you want it to”. Then you feel awful, but there is someone else waiting.’
And then there is post-natal care, the first area staff are pulled from to fill gaps on the labour ward.
‘Everywhere suffers since we prioritise one-to-one care in labour,’ explains the midwife. ‘But it means staffing for post-natal care drops.
‘If I have ten women and ten babies and answer a call bell because someone wants help changing a nappy as they have had major abdominal surgery for a C-section, I want to help them. But what do I then do about the septic patient who needs me?
‘Obviously I prioritise the septic patient but the other woman then feels I’ve ignored her.
‘I’ve become the sort of midwife I never wanted to be. It’s become, “How can I make things go quicker?” rather than, “How can I give the best experience?” ’
And that’s apart from the personal toll of endless shifts without breaks.
‘We get messages on days off asking us to come in, you don’t get your breaks, I take antibiotics for UTIs [urinary tract infections] because I
‘You wait for there to be no heart rate’
‘Working there is like looking at a war zone’
can’t get to the toilet as I am so busy. I wouldn’t trust me to deliver a parcel never mind a baby because I’m so tired, hungry and thirsty.’
Midwife Cheryl Samuels runs the social media account The Holistic Midwife. She has been bombarded with reports from midwives illustrating how perilous things are.
She has set up a petition calling for urgent government investment.
‘I’ve been a qualified midwife for five years and every year has got worse, the pandemic has taken its toll,’ says Cheryl. ‘People postponed leaving and now everyone is very tired, the added pressure is the straw that broke the camel’s back.’
So bad is the situation that Clare, a former midwife, says: ‘I’ve got two children and I don’t think I’d feel safe going to have another baby.’
When she became a midwife, the 31-year-old thought it would be her career for life. Yet she quit earlier this year after just nine years.
At the end of her tether, she had four shifts — each 12-and-a-half hours long — to complete before going on maternity leave, but made it through just one before she was overwhelmed.
She says: ‘I was with a high-risk woman in labour thinking, “If she delivers and I pull the bell how many people are free to help?” I felt unsafe and I didn’t want to do it any more.’
She is still haunted by the memory of nights struggling to manage the workload on the high-risk observation ward, alone because colleagues had been moved. ‘I would text my partner at 1am, saying, “I’m going to die, I can’t do this”, and he would say, “Come home”. But I couldn’t do that, you can’t leave people who you are looking after.’
As another midwife tells me: ‘It’s like looking at a war zone. How do you keep fighting a fire that isn’t being put out?’
In July, once the hours of all fulltime and part-time midwives were combined, there were the equivalent of 21,942 full-time midwives in England, a dip by almost 300 in just two months, the fastest fall for that time period in 12 years of these changes being charted.
Midwifery vacancies doubled from
2018 to 2019, with more than half of units understaffed.
NHS maternity services received a £96 million boost this year, which included money for 1,000 more midwives and £26 million for safety training — but the RCM says there is a shortage of 2,000 midwives in England alone.
MPs on the health committee called for an immediate investment of £200-350 million to ensure the safety of mothers and babies.
Alarm bells are ringing among expectant mothers too, with women given reduced face-to-face care and, at some trusts, forced to give birth without their partners.
But surely women can now expect to be allowed the birth plan they hoped for?
Apparently not. As a clinical psychologist who is trained in perinatal mental health, Michaela Thomas knows how crucial it is pregnant women have both ‘voice and choice’. She also knows the impact when those are removed.
‘It is no coincidence post-natal depression has gone up about 45 per cent since Covid,’ she says.
Unfortunately her own experience has given her an insight into the impact that sudden changes in staffing availability can have.
Two weeks ago, her plans for a home birth were thrown into disarray by staff shortages at Milton Keynes University Hospital.
‘I planned to home birth, but didn’t plan to free birth without medical assistance,’ says Michaela.
When she rang the hospital to report she was in labour at 9.30pm, so the home birthing midwifery team had good warning to come to her, she was told to ‘call back when you need us’.
That she did, two hours later — but by then, the response was very different.
‘They said, “There is no midwife, the home birthing team has been suspended and they have been brought to the labour ward so you have to get to hospital”.
‘I went into a state of panic, started crying and everything went quickly, the doula arrived 20 minutes later and an hour later my daughter was born at home. But none of my hypnobirthing or anything like that could make me feel less abandoned.’
While Michaela can help herself thanks to her profession, she considers it paramount that the crisis in midwifery does not put the mental and physical safety of parents and babies at risk.
‘As a psychologist I know that if you are uncertain whether care is going to be provided it puts you in a state of anxiety and we know adrenaline is negative for birth, it can stall labour, or intensify it. And the risk of birth trauma goes up where women feel powerless, out of control and unsafe.’
A spokesman for Milton Keynes University Hospital said the unpredictable nature of demand for maternity services meant home birthing services could be temporarily stopped to concentrate on safe care on the labour ward.
‘We say this to every woman who books a home birth, so they know their plans may need to change to ensure they receive safe care.
‘In this case the hospital did everything possible to support this family to have a home birth, including taking extensive steps on the night... The family were
‘I went into a state of panic, I started crying’
advised to come into the hospital immediately so labour and birth could be supported. We have spoken with the family about their experience and are sorry they did not get the home birth they had planned for and for the distress this caused them.’
A Department of Health and Social Care spokesman said: ‘Midwives do an important job, made more challenging by the pandemic, and this was recognised through a 3 per cent pay increase.
‘There are more midwives working across the NHS now than at any other time in its history and we are increasing the maternity workforce further.’
Yet, sadly, women are increasingly feeling unsafe — which is just as upsetting for their carers.
‘There is no midwife that goes to work and wants to do a bad job but the only way we can improve maternity services is to increase staffing levels,’ insists Dr RossDavie of the RMC.
But as these vital nurses leave in their droves, that’s easier said than done.
For now, the midwife we spoke to in the North-West has bucked the trend, saying she doesn’t want to leave. Yet.
‘I write down every baby I deliver, I know them all, it is a lovely job,’ she says. ‘I would never want anyone to think I resent the job, I just hate that it’s got to the point where if someone wants help with a nappy change, I think, “Oh my God, please do it yourself.” It shouldn’t be like that at all.’