What about the midwives?
I’ve had these words bubbling away under the surface for a while now. Keen to let them out into the world but scared of the ramifications. You see, what I am about to talk about might not go down well with some people. However, I feel that the good of the sharing and the benefit of the honesty will far outweigh the potential initial controversy.
I write the following words from my heart- they are my experience, my own life. They are not the experience of every midwife, they are not reflective of how other midwives feel, they are not written to speak for anyone but myself but I hope that by sharing what I have to say, I will give the courage to others to speak up too.
So, here goes.
I am a midwife. I have been for almost 6 years now. Since starting my training almost 9 years ago, I have seen the system change. In some ways, it is for the better- I feel that women are listened to more, that their choices are respected more and that the days of ‘doctor (or midwife) knows best’ are slowly falling behind us but there is still room for a vast amount of improvement. The voices of women hurt and traumatised by the current and old ways of working are slowly being heard. Stories that haven’t been shared before, are beginning to be shared.
At first, this worried me; I didn’t think that it was good for mums-to-be to have access to the knowledge that birth could be so traumatic. I thought it was best to shut that part of life away and only talk of the positive side of birth. After all- who wants to hear that what you are about to go through is going to be horrendous, awful, scary, undignified or agonising?
I have seen many, many births over the years- some have been euphoric, almost dream-like and others have been a horrific endurance. It can, and does, happen both ways but I think that the current normal system of maternity care sets mums up for the latter experience (with a lack of continuity of care, a focus on arbitrary time limits and a lack of truly family-centred care).
So, how can we expect things to change if we don’t talk about them? If we just continue our daily lives, pretending it’s not happening?
We can’t.
That is the change these stories are beginning to bring about. Women are no longer willing to accept a one-size-fits-all model of care. They are beginning to make the choices that are right for them and their families, not what generic statistics state as being best and this is fantastic.
We have a very long way to go but I feel that we have come so far already.
So, what about the midwives? The women and men, caring for these families as they go through this monumental life transition that is pregnancy, birth and early parenthood?
We hear so often “you can’t pour from an empty cup”. I am realising more and more, just how true this is but, as a midwife, I feel this is just what you have to do. With long shifts, no breaks, no emotional support, a lack of compassion from higher tiers of management and a chronic issue of understaffing, we have no choice.
I’ll give you more of an insight- not to scaremonger or be melodramatic but to speak to the truth. This is my experience, my life, my story.
I started my midwifery training at age 20. Eager and keen to do a job I’d wanted to do for years, I’d finally plucked up the courage to follow my dreams and here I was. The university course was great- the lecturers delving into how our bodies worked, coupled with how to use that knowledge to support mums. Always with a massive emphasis on the care we provided to be led by the women themselves, for us to act as their advocates and to really listen to them. We were taught how to diligently perform each clinical skill with precision and grace. Step-by-step we were told about the ‘gold-standard’ of care. It was wonderful.
Then it was time to start our clinical placements. I was so excited and nervous at the same time. I started off in the community and then went on to work on the different wards in the hospital. The time I spent in clinical placement was not so wonderful. The ‘gold-standard’ of care was nowhere to be seen. Each clinical skill, I had been taught, was performed in a different way by almost every midwife I met. I often felt nervous every time I went to do something because I was waiting for those familiar words of “You don’t do it like that, you do it like this”- only to be told the complete opposite by the next midwife I worked with. We were supposed to work with assigned mentors- giving us continuity in our training but the reality was that we rarely worked with the same midwife twice in a placement- leaving me feeling confused, lost and alone.
Woman-centred care and listening to women seemed to go out of the window most of the time too. Often midwives would appear too afraid to do anything that was outside of the normal ‘guidelines’ (HUGE caveat there- it wasn’t all midwives but I would say it was probably the majority).
Fast-forward to when I qualified. Ah freedom- no more being watched constantly, a little bit of autonomy, I thought I could finally look after women in the way I wanted to.
No.
A 3-month stint on the postnatal ward soon knocked that new vigour out of me. I was no longer being watched, I had the freedom I had wanted but I had NO time. Postnatal ward was busy. As a student, I could give breastfeeding support, listen to mums, offer them the time they needed. As a midwife, I had to discharge mums as soon as they were ready- all so that the next mum could be transferred from the labour ward. Sometimes I physically couldn’t do that fast enough- I had to make a choice between doing the paperwork to get a family, desperate to go home, out of the door and giving essential medication to a mum or baby. Of course, the medication had to come first but that often meant that they family waiting to go home were becoming more irate and the manager on the labour ward becoming more frustrated. This was no one’s fault- it came down to a lack of bed spaces and a lack of staff.
This was also not helped by arriving on the ward and most of the time- 20 minutes into my shift- I’d be shipped off to the labour ward to work there. I was the most junior member of staff, the lowest in the pecking order, that’s just the way it was. I hadn’t been orientated there, I didn’t feel confident working there but then, neither did the other midwives working on the postnatal ward. So, I certainly don’t blame them for not wanting to go either. One of us had to go and it would always be me (or another junior midwife).
Next I went over to the private maternity ward- an eye-opening experience for a whole-host of other reasons, I won’t go into that here.
Finally, I’d had enough. I couldn’t stand not being able to give the care I wanted to, I couldn’t stand being treated like a number and not a human, I needed a change. My dream job came up as a caseload midwife (a midwife that looks after mums throughout their pregnancy, birth and postnatal period). I got the job and couldn’t wait to start. I loved it! The team of 6 midwives were just lovely, we all looked after each other, we were in it together, we were passionate about evidence-based, woman-centred care and we did our best to ensure the women we looked after got what they needed. I think this was the absolute highlight of my midwifery days.
I did that job for two years but in the end my life changed and I had to move on. We could no longer afford to live in the city centre (we were at a stage in our lives when we wanted to own our home, not be lining the pockets of a landlord), so we decided to move back to our family home in the suburbs. This meant that I could no longer be on-call (I was too far away and wouldn’t have been able to make it to the births in time). Just as I gave up that job, I also fell pregnant with a long awaited baby.
I was now working at the same hospital but on the birthing unit there. I loved this job too- the midwives worked well as a team and we really looked after each other but it still wasn’t all roses. The same patterns I had experienced as a junior midwife were arising. I’d come into work and rarely work my whole shift on the birthing unit- normally having to go and work on the labour ward. I was lucky if I got a break- my colleagues were always trying their best because they knew I was pregnant but even then I would often work 12 hours without a lunch break.
The other thing that had only worsened too, was the paperwork. Paperwork, paperwork, paperwork. There was so much of it to do. It felt endless. If a mum has a cannula- there’s a form for that. If a mum has a catheter- there’s a form for that. If a mum has a baby- there’s 3 forms for that. If a mum experiences an emergency- there’s a form for each one of those. There’s a sticker for assessing a risk of a postpartum haemorrhage. There’re a sticker for interpreting a continuous monitoring of a baby’s heartbeat. Then there’s the main notes. Then there’s the computer notes.
“If you don’t write it down, it didn’t happen” they say.
It means that if you have to go to court or to some form of investigation into an incident- if you didn’t write down what you did in the notes, then you didn’t do it.
What if I didn’t do it because I was too busy writing everything down? What if I didn’t do it because I was filling in the 10th form for the day?
Or, what if I gave exemplary care to all the mums I looked after but didn’t write any of it down?
This is the outcome of the litigious society we are becoming. So worried about getting sued or getting into trouble that we practice defensively, instead of simply just caring.
I was so happy when I went on maternity leave that I couldn’t envisage going back. I was lucky enough to have continuity of care from a lovely midwife whilst I was pregnant and then to be looked after by her two amazing colleagues when I gave birth at home. My experience of the maternity care system (from the perspective of a mother, and not a midwife) was truly wonderful. All down to the bond I had developed with my midwife, all because she listened to me and didn’t pressure me to make decisions that were considered to be a normal part of any guideline. It was resonant of my days as a caseload midwife. I consider myself very lucky and blessed to have received such a amazing care.
When I returned to work, after almost a year of maternity leave, I went back to 12 hour day and night shifts. Two every week- so, not even full time hours. I would be up in the night looking after my baby (who knew that babies don’t sleep?!), my mother-in-law would arrive to look after my daughter, I would leave my house at 6am, work for 12 hours and if I was lucky I would return home just after 9pm. It meant I didn’t see my daughter for that whole day and I missed her like mad. I was still breastfeeding, so I would feed her before I left in the early hours, then express (if I was given the time at work) and then express again when I got home. I hated that pump. It was a reminder of the time that I wasn’t spending with my daughter. It was a reminder of my absence as a mum. The next day I would nap in the afternoon- ready for my night shift. Leaving the house at 6pm and working through the night to return home in the morning. I would stay up and feed and play with my daughter and then head off to bed, leaving my daughter with my mum. I have no idea how mums manage this pattern of working without the family support that we had- with my husband and I both working shifts, there was no way a nursery would be open for those hours and I doubt a childminder would agree to arriving before 6am either.
After half a year of this (and quite frankly feeling like a broken woman), I received an email through the various tiers of management detailing that everyone working flexible hours had to write an official letter, explaining why we required those hours and if our reasons were not deemed good enough- then we would have to change our pattern to meet the needs of the service. That was the ‘straw that broke the camel’s back’. I had nothing in me anymore. I didn’t have the capacity to explain my story, I didn’t have the capacity to sit down and write that letter- so, I resigned.
I now work as a ‘bank midwife’. This essentially means that I have a ‘zero-hours’ contract with the hospital. I work when they need cover for low staffing levels or sick leave. I can control when I work, how often I work and, indeed, if I work. The level of control I have back in my life is bliss. I feel human again. I very rarely work night shifts and I stick to 8 hour shifts most of the time. This means that I am able go into work and give my all. I can really show up and be there for the women I am looking after, I can hold the space to listen to them, I have the resilience to advocate for them and I don’t go home feeling like a broken woman.
This new experience has highlighted something to me though. It has highlighted just how broken I was before, just how hard it was to give the care I wanted to give.
But this is the reality for many midwives everyday. They are often young mothers, like myself. They have their own emotional baggage already, then they come into work and go through those intense and raw emotions that come with birth- then they come back the next day and do it all again. How is it possible for a human to endure that?
Well, I guess some people are just able to.
But I also think that some people revert to being callous, a form of self-preservation- if you don’t get emotionally involved, then you can’t get hurt. Some people end up being off sick a lot- too stressed out or too weak to keep doing it week in and week out. Others leave the profession completely- caring too much to watch women and their colleagues go through the system set up to meet the archaic needs of a patriarchal society.
I know I am not alone in these feelings- in 2016 the Royal College of Midwives published this report, demonstrating why midwives leave. They state the reasons for leaving were as follows:
“not happy with staffing levels at work (62%);
not satisfied with the quality of care they were able to give (52%);
not happy with the workload (46%);
not happy with their working conditions (37%);
and not happy with the model of care they are working in (30%)”
This touches on almost all of the things I talk about here. The irony of it is- aren’t the midwives that want adequate staffing levels, want to be able to give a quality level of care and want to work in an appropriate model of care, the ones that we want to keep?
I think we have so many lessons to learn and so many changes to make. I have shared my story today in the hope of breaking the silence. Just like the women that are bravely sharing their stories of birth trauma. It’s never about scaring pregnant women into thinking that birth is traumatic. It’s about speaking the truth- if we don’t talk about it, how can we change it? How can we make it better, if we just carry on pretending that everything is ok? How can we expect a better future for the next generation, if we stay silent in fear of losing our jobs?
I won’t stand for it. I won’t stay quiet. I won’t back down.
I will use my voice. I will use my power. I will make the change.
But we will be so much stronger together. As midwives, if we come together, if we all use our voices, if we all use our power we can make the change that needs to be made.
We can stand together- with women, with mums, with dads, with children, with doctors, with psychologists, with psychiatrists, with physiotherapists, with doulas, with support workers, with antenatal teachers. We can change the system. We can make birth better.
