Midwifery in the NHS: my opinion

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Those who know me well will confirm that I have spent most of my 35 years as a midwife, pushing for change to improve care. Just last week I was asked for my opinion of current NHS midwifery services, for a TV programme claiming to be supporting the cause for more midwives. Whilst I haven’t worked in the NHS for more than two years, I am in constant contact with midwives in the Trust where I worked for all my career, and with midwives and student midwives throughout the UK.
So these are some of the questions I was asked, and my brief responses. I would love to know your thoughts too, via the comments box at the end of the post.
How do you feel the role of a midwife has changed from when you first went into the profession? (Staff numbers, continuity of care etc)
The work of a midwife is significantly different now, in terms of workload pressures as a result of inadequate staffing levels, medical and social complexities of women’s pregnancies, increased UNNECESSARY intervention rates, service models and bureaucracy. So much has impacted on maternity services, and midwives are increasingly under pressure due to the afore mentioned, and also due to fear of recrimination. Lack of understanding of the purpose and use of clinical guidelines, and activities related to Clinical Negligence Scheme for Trusts (CNST) has added to midwifery workloads, and the fear factor.
Because of excessive workload issues, midwives have less time to spend with women, and this in itself is stressful, and demoralising. Midwives (and obstetricians) increasingly practice defensively, over treating those in their care because of fear of recrimination or litigation. It’s the ‘just in case‘ scenario.
Maternity services feel to be entirely focused on the reduction of  ‘risk’, which has the potential to cause more harm. Over medicalisation of childbirth can lead to iatrogenic damage, and it seems the more maternity services focus on safety and risk the more worried and frightened women become.
Pressure to save money in the NHS is taking it’s toll on maternity services, and because there are few Trust targets for maternity, the service is more likely to be bypassed. Maternity services’ position within an NHS organisation’s budget or profile isn’t a priority, and therefore departments such as medicine and surgery frequently take precedence (in terms of resources).
Women didn’t seem to be as fearful of childbirth during my early years as a midwife, and whilst services weren’t ideal, (i.e. we had moved from home birth to hospital birth for all women without any evidence to suggest we should!) in the main women believed in themselves, and their ability to birth their baby. As we have ‘done to’ women, increased screening, focused on reducing risk, we have increasingly disempowered women.
What are the main concerns for midwives today?
Lack of time to do their work well, fear of recrimination (getting into trouble).
Do you think midwives today are over stretched and unable to perform their role sufficiently? Or does this depend on the hospital in which you work? 
This is addressed above. I think in the main midwives are overstretched. There are some services with exemplary models of care for women, where midwives, obstetricians and mothers feel respected, valued and able to do their work even if it is busy. We must highlight those services and channel energies into getting it right for all families.
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And do you feel there is sufficient postnatal care in place for women? 
Postnatal care is suffering due to lack of human resources, and because of the focus on risk, areas of the service where ‘risk’ is deemed to be greatest (delivery suite/labour ward) takes priority. Because of increased unnecessary intervention in the antenatal and intrapartum period, postnatal wards are busier too. Bed reduction programmes in NHS organisations significantly reduced ability for women to stay until feeding is established, so women get little support to breast feed. Postnatal care in the community is reducing due to pressure on resources. This is a great pity as the lack of support potentially leads to morbidities that cost more for the NHS.
There is no resemblance to the postnatal care I delivered on postnatal wards during the first half of my career, to latterly. This is because there are more:
-Operative births
-Babies who need extra monitoring due to an issue that was potentially caused by mode of birth, or choices made.
– Excessive use of antibiotics on neonates (‘just in case’), and the extra input needed from staff.
– Excessive record keeping activity and paper work
Did you ever experience or see women’s lives being put in danger because of a lack of resources? 
This is hard to determine. Midwives and doctors always try to do their best, and usually go way beyond the call of duty. Sometimes, however, the pressure on staffing is so great that women receive substandard support and care, usually by way of time spent with them. The potential for harm is always greater when there aren’t enough midwives to care for women, at any given moment.
Could I also gain a bit more information about your career as a Midwife – how many years you were in the profession? What you liked / disliked about the role?
I worked as a midwife for more than 35 years in the NHS, and continue to work freelance, mostly on a voluntary basis. I feel immensely privileged and honoured to have been part of each woman’s journey into motherhood, and to have worked with the most inspirational teams. Women, both those I cared for and worked with, never fail to amaze me with their courage, strength and determination. Whilst working in the NHS I loved most of my work as a midwife, and grossly disliked the pressure and desperation when unable to help women, and midwives.
There is so much to do. The Royal College of Midwives continue to lobby for more midwives, and a group of well respected activists are pushing for better continuity of care, amongst other things related to Maternity Services. We mustn’t give up.
What do you think?
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82 comments on “Midwifery in the NHS: my opinion

  1. Very very well said Sheena. I couldn’t agree more. It feels like the focus is on the paperwork, and the CNST targets and trying to ensure ‘safety’ – forgetting to care for, and about, the woman at the centre of it all. Or that’s my opinion anyway.

  2. I don’t work in the NHS any more because I couldn’t cope with the pressures you have outlined here. I still work with parents and I love the work that I do, but i am a lost resource -my skills are not being used. I have a huge amount of respect for the midwives who stay and continue to give their all but I hear a lot of sadness and frustration from friends still working in the NHS.

    • It’s sad Dot, as there are so many like you. But I believe we can change if we keep trying, and support the new midwives to be strong. I am totally bowled over the calibre of students and new midwives. Thanks for your comment 🙂

  3. Thank you Sheena, I agree with just about everything you’ve said. I am a very disillusioned midwife and so frustrated with the way the NHS is run nowadays. I’ve never known the NHS to be as bad as it is now and sadly I feel it’s unsustainable and something is going to give in the system..

    You are completely correct about the pressure, but it’s also about not being valued, it often feels that your just a number and the only thing that’s valued is the fact you turn up to work because of the staff constraints. If you are off with illness, then having the manager of the day ringing to find out when your back which as far as I’m concerned is a form of bullying and harassment and bang out of order. I’m sick to death of the politics too and other than peer support there isn’t anywhere else to turn to. The NHS chews you up then spits you out and by the time you retire you haven’t got anything else to give.

    I love being a midwife, but hate not having the time to care for women as I’d like as I’m sure most midwives feel. I have began my own business with the aim of leaving the NHS as soon as I can as I can’t stand it anymore. There’s got to be more to life then facing the day-to-day struggle and stress that working in the NHS results in and which a lot of the times makes me feel ill and exhausted. I for one, hasn’t got the energy to keep fighting, my health has to come first and I can’t wait until I can leave once and for all.

    • I feel desperately sad when I read your email (sorry I don’t know your name), and I can fully understand your reasons and urgency to leave. The managers you speak about are almost surely feeling as desperate as you, and that’s why they react to sickness as you described.

      I have known different times, and I think it will improve if we keep trying. There are high calibre midwives entering the profession, and I for one will be helping them to change. There are also hundreds of women having fabulous care..and it’s crucial that we share ideas and expertise.
      Thanks SO much for commenting. You sound like a caring and dedicated midwife, and it will be such a great pity to loose you. Wishing you lots of luck in your new business!

      Sheena x

  4. Very well said Sheena! I would like to see a ‘pressure group’ where everyone who is involved in maternity services is represented and where the woman and the family are at the center rather than a specific profession. If we always keep our eye on why we do what we do, to give a woman and her family the best possible start in her role as a mother, we might be able to make the changes that are needed. We DO need more midwives and we DO need to change the culture of fear in maternity. I feel everyone need to be ‘on board’ and work together! x

  5. As the husband of a midwife I get to listen to all the trials and tribulations of a midwife and I can recognize all of the problems you highlight in your blog.
    Also as an operations manager of 20 years I can also say that the NHS waste an awful lot of money on ‘bank’ staffing because of poor rostering of midwives. That money could easily be spent on additional midwives which would give women greater continuity of care.

    • Hi Paul,
      I agree with your comment about bank staff costs. I think maternity staffing is hard to plan for due to the unpredictable nature of admissions…but it always seems to feel like there is a shortage of midwives. Thanks so much for taking time to respond, and I hope your wife is OK!

  6. I am currently doing my training and wondering what the hell I am doing! I am so disillusioned by all of the excessive paperwork and du standard care I see being given (and am expected to participate in) that I feel like just throwing in the towel! I still have a burning desire to work for women, helping them to empower themselves, but I just can’t see how that’s a possibility in today’s NHS maternity services.

    • Oh dear! I am so sorry to hear your distress. So sorry. It would be advisable to chat to your course leader about your feelings asap, although you probably have. Whatever you decide, I sincerely wish you lots of good wishes. Choose well. Sheena x

  7. You have hit the nail on the head here Sheena
    I too wish I could leave the nhs but would lose too much from my pension & also the right to retire at 55
    So I’m stuck for a few more years.
    Midwives are leaving in large numbers & experienced midwives are hard to recruit.
    Saying that its difficult to recruit any midwives at present!!
    It doesn’t help facts that middle managers don’t support their staff & senior managers are denying there are problems with staffing.

    • Hi Patricia, it’s such a pity you want to leave our fabulous NHS. I know there are so many others like you. I understand midwives are leaving, which is a travesty. Recently I have been overwhelmed by the calibre and commitment of student midwives, and newly qualified midwives. They are bright, energetic and determined to make change…I just want to support them as much as I can, to do so. Middle managers and senior managers are all under enormous pressure too. It’s hard for all, but we just have to look after each other. Managers need that too! Thanks so much for commenting. Keep up the good work! Sheena x

      • Hi Sheena
        I’m not writing much on here for fear of reprisals
        Things are no better than they were last year
        Management like to cover up problems so they don’t exist

      • Sorry you are fearful, but I understand why. I hope things improve for you, try and get some positive support if you can. Managers often feel the same pressure as you, and are caught in the middle. They need support too! Thank you so much for your comment….let me know if I can help 🙂

  8. I actually cried reading this. What you describe brings back all the emotion I felt over over 8 yrs ago when I finally, after 16 years, left the NHS & became an Independent Midwife. Both women & midwives need so much courage for birth to be as it should & can be.

    • Thanks for an insightful article. I feel on top of everything you have high lighted I would add that in my experience things took a nose dive when team midwifery was whole heartedly endorsed! This was as a response of the Cumberledge report and the very things it was supposed to give to women control contiuity and choice were never delivered. No continuity of care, misunderstanding of the use of protocols and midwives are no longer “with women” . I left the NHS 8 years ago disillusioned with teams and lack of continuity and have had a thriving career as an Independent MW. I qualified in 1986 and am still as passionate about women and their amazing abilities to give birth as ever. If I had stayed in the NHS I would be burnt out and dissillusioned for me the answer is to give each midwife a caseload of women and then listen to them , give them a voice instead of telling them what they are or are not ALLOWED TO DO! Love Jo Watson.

      • Thanks for your comment Jo. Interestingly, I LOVED team midwifery, and in our unit it has developed and lead to an amazing staffing model for birth centres. It’s one of the examples of good practice I mention in my post. Would love to tell you some of the other advantages…hopefully face to face (I would love a chat and a culpa!) Glad you are enjoying your work now…Sheena xx

  9. Hi there Sheena

    These are very honest and heartfelt answers. I’m only beginning my journey as a qualified midwife (having only done a year I’m experiencing the other end at the minute with new arrival due any day 🙂 now).

    I was very lucky as a student midwife to be placed in one of the few midwifery lead units in Northern Ireland that still had a number of core staff (most areas are staffed by rotation….which I think has it benefits but also many disadvantages if not balanced by core staff) who were passionate about empowering women and making their birth experience as natural and normal as it should be. On a side note I’m incredibly honoured to have some of these women on call (even though retired) for my upcoming birth **eek! Back to the point….Had I not had a placement here and worked alongside these ladies I would have thought it completely normal for women to be induced before term have membranes ruptured in early labour and to only birth on their backs on a bed…..because these things make work load more controlled and time restraints more possible……never mind the fact that it usually ended up with instrumental deliveries and trips to theatre. Letting birth happen the way our bodies intended doesn’t seem to be the way to play it..

    I agree with what you say about midwives feeling the pressure from guidelines, bureaucracy and the fear of recrimination. These things take away from being able to be with woman to react to her unique experience and to fulfil her needs. Yes it is vital to provide best care and have high standards but birth is a life experience not an illness and should be responded to in a way which is suited to the individual and her experiences and her family situation. This simply doesn’t happen because of rigid guidelines and the other big issue of lack of staff.

    Not only is lack of staff an issue but I think the mix of staff and lack of overlap of experienced midwives working with new/junior midwives. Because of cost,new midwives are not being hired until other midwives retire and are gone, we junior midwives are missing out on the mentoring opportunity that those with years of experience have to offer. The excuse being once you’re qualified you should be able to go into whatever situation and follow the guidelines and protocol……but guidelines and protocol simply doesn’t cut it-women deserve more than this.

    Midwifery and birth is something I feel very passionately about but unfortunately it feels like you are continually meeting a brick wall to be able to do what is best for the woman and her baby in providing a normal individual birth. I know in my recent antenatal experience as a woman, I had to fight hard and put up with discouraging attitudes to try and get the normal birth experience that should be available to all woman and that my husband thought best for us and our birth.

    I could babble on but really I just wanted to say that I agree with what you have said and I think you put it very clearly and objectively. I hope I’m still practising in 35 years and still have that passion to do right by women and their births!

    Thanks Sheena for being an inspiration. X

    • Hi Jill, thank you for such an interesting and detailed response. You have captured so much more, and I am interested in what you say. I agree with the benefit of working in midwifery led units…they are the catalyst for change, and it’s desperately sad if midwives never have the chance to experience birth facilitated in such an environment. It’s important that we continue to speak about the constraints, and to acknowledge where services are good to help shift the current situation. It sounds like you DO have the commitment to continue to serve mothers and families Jill, and I am sure you’ll be encouraging others in 35 years time!
      Thank you so much again for your time…Sheena x

  10. Hi there Sheena

    These are very honest and heartfelt answers. I’m only beginning my journey as a qualified midwife (having only done a year I’m experiencing the other end at the minute with new arrival due any day now).

    I was very lucky as a student midwife to be placed in one of the few midwifery lead units in Northern Ireland that still had a number of core staff (most areas are staffed by rotation….which I think has it benefits but also many disadvantages if not balanced by core staff) who were passionate about empowering women and making their birth experience as natural and normal as it should be. On a side note I’m incredibly honoured to have some of these women on call (even though retired) for my upcoming birth **eek! Back to the point….Had I not had a placement here and worked alongside these ladies I would have thought it completely normal for women to be induced before term have membranes ruptured in early labour and to only birth on their backs on a bed…..because these things make work load more controlled and time restraints more possible……never mind the fact that it usually ended up with instrumental deliveries and trips to theatre. Letting birth happen the way our bodies intended doesn’t seem to be the way to play it..

    I agree with what you say about midwives feeling the pressure from guidelines, bureaucracy and the fear of recrimination. These things take away from being able to be with woman to react to her unique experience and to fulfil her needs. Yes it is vital to provide best care and have high standards but birth is a life experience not an illness and should be responded to in a way which is suited to the individual and her experiences and her family situation. This simply doesn’t happen because of rigid guidelines and the other big issue of lack of staff.

    Not only is lack of staff an issue but I think the mix of staff and lack of overlap of experienced midwives working with new/junior midwives. Because of cost,new midwives are not being hired until other midwives retire and are gone, we junior midwives are missing out on the mentoring opportunity that those with years of experience have to offer. The excuse being once you’re qualified you should be able to go into whatever situation and follow the guidelines and protocol……but guidelines and protocol simply doesn’t cut it-women deserve more than this.

    Midwifery and birth is something I feel very passionately about but unfortunately it feels like you are continually meeting a brick wall to be able to do what is best for the woman and her baby in providing a normal individual birth. I know in my recent antenatal experience as a woman, I had to fight hard and put up with discouraging attitudes to try and get the normal birth experience that should be available to all woman and that my husband thought best for us and our birth.

    I could babble on but really I just wanted to say that I agree with what you have said and I think you put it very clearly and objectively. I hope I’m still practising in 35 years and still have that passion to do right by women and their births!

    Thanks Sheena for being inspiring x

  11. You could be describing a midwife’s position in Australia where I currently work. I also totally love being a midwife and working across the spectrum of care. I have been a midwife for many years and currently feel more like an office worker with a bit of surgical care on the side. When I spend 3/4 of my day attending to paperwork and maybe 1/4 if I’m lucky actually providing hands on care for the woman and babies I have to wonder why I work in a hospital. I know it can be different because I have spent 15 years working as a lead maternity carer in NZ providing continuity. One of the most frustrating issues is that midwives mostly don’t have a voice – in fact they almost seem invisible. The roller coaster of medicalisation seems unstoppable here and although there must be pockets of hope somewhere I am afraid for birth and even the future of humanity. I am a stubborn sort and will keep fighting on but there is a price to be paid in terms of employment and my health.

    • Oh dear Linda; I hope you are not feeling too worn out. I am pleased to hear you are a stubborn sort, and that you’ll continue to press ahead (I try not to use the word fight!) I feel your frustrations, and I understand there are more issues in Aus due to private practice. Good luck in your quest, but most of all, look after yourself.
      Thank you very much indeed for taking time to comment…there are so many saying the same thing.
      Sheena x

  12. I’m a second time round 2nd year student midwife, after deferring first time as I hated what I was being taught whilst out on placement, and how, at the bigger trust of the 2 my training are taking place in.

    As you correctly state, everything now seems to be focussed on the management of perceived risks, rather than the actual scenario that is occurring at that moment in time, which makes it incredibly hard as a student, as everything we seem to be doing is ‘umming and ‘ahing over which interventions we stick into a woman’s AP/IP care ‘just incase’ something happens, and god forbid we don’t write a essay within her notes every 5 mins to cover our own backs, thus meaning I (and many other students and midwives) feel as though I spend more time documenting and filling in charts and forms thank I do actually being “with woman”.

    I also feel that, as mentioned by someone above with regards to the managers – if they are under so much stress as you are guessing (I agree with you) then some of the pressures need removing from them – I always thought the point of having a Band 7 / co-ordinator was that there was someone on the ward with a wealth of experience and knowledge that members of the team can turn to for advice / information / help. In the 2 trusts I am working in, this mainly doesn’t seem to be the case – it’s almost like an inconvenice to them if anyone tries to make use of their expertise, thus potentially putting women at risk, when there are pressing issues such as off-duty to attend to. Many staff aren’t getting their appraisals when they should be, and everyone feels disheartened at the conditions in which they have to work, feeling undervalued, unappreciated and completely demoralised.

    I think it’s a massive shame – whenever I tell anyone that I am training, their automatic response is “oh how lovely, that must be the most rewarding job in the world” – er well no actually it isn’t often, as, the more I learn, the more I see, that we are not able to do what we should be doing, looking after women, giving them information to make choices to receive the care that best suits them, as we’re all too flippin’ petrified of someone going against the grain and suing us in 20 years time for a decision that they made. The number of times I have seen midwives provide women with select information to get the result THEY want, rather than giving information for the woman to make her own informed choice, is beyond me.

    I actually want to work as a community midwife, it’s what I wanted before I started my training, and I know for sure now that this is where my heart lies, but I’m worried at the apparent lack of trust in CMW’s by hospital core staff to make make appropriate decisions, and the wider effects this has on midwives and teams within the community.

    I just hope that there are some huge changes over the next few years to pull back what midwives to best, rather than being glorified data collectors.

    Thank you for everything you, and everyone else, is doing, to try and make some positive changes to midwifery care for the future x

    • Hello Marie,
      Phew. You really got that off your chest. You sound frustrated with the way services are delivered, and the thing is, it’s now up to all of us to make those huge changes you mention. I really think they’re not so huge, and sometimes if we just focus on the small things we CAN change, we feel more positive. Think I will write a post with some tips?

      We need you Marie. It sounds like you have lots of passion and love being a midwife really. Find some positive support to help you continue to push for change. There will be others like you who want to make it better.

      Thank you SO much for sharing your feelings and experiences. I appreciate it. Sheena x

  13. I’m a first year student midwife, I joined the profession to make a difference in the care in which women receive. However since being on placements I have discovered that antenatally the care midwives give is paramount to the care which they later receive. Many a time have I seen women come in to hospital in labour without completed notes or discussed birthplan, in some cases medical history and obstetric history missing, I am not blaming midwives, but feel that time pressures and massive caseloads, limited staffing to cover huge areas are clearly impacting on care.
    On another note, it is clear from my perspective that midwives are too short in supply, how can you have 13 labour rooms, potentially with 13 labouring women, plus antenatal admissions to be seen with only 5 midwives on shift, constantly closing units and choice of birthplace for women in order to staff the high risk units and taking staff for postnatal wards also to cover low staff levels. From my experience the only time women are able to obtain true one to one care during labour is if they have a student. Postnatal care is abysmal, again too many to see, not enough time or staff, many women are re-admitted due to infection or medical instances missed. Babies also re-admitted due to feeding issues. The practice seems to have become get them home quick, and then when they come back they go to another ward to be someone else’s problem. This is not how I want to practice. I just hope that things will change, or I can see more students like myself disheartened by the profession and lack of support in trusts, that will eventually lead to a further loss to the private sector or abroad. My opinions here are my own but I also am aware that I probably speak for many students and midwives that may feel pressured into silence.

    • Hi Keri, I think you speak for most midwives and student midwives really. Everything you mention here, I completely agree with, and I have witnessed the same for many years. It’s so hard. Have you spoken to a Supervisor of Midwives, or shared your thoughts with a positive role model? The thing is…we need you to help change the things you highlight here, but you need support and care to do it. We can’t give up!
      Keep in touch with me, sheenabyrom@mac.com
      Sheena x

      • Kerri, I am hoping to apply to study midwifery in a few years time. I am worried that what I have seen and read on here (and elsewhere) will impact my learning and getting the right support whilst on placement, with mentors. How do you feel your first year is going? I suppose that explains one reason why so many universities know have clinical skills labs set up on campus, which I think is a fantastic idea as it gives you exactly that, the skills and knowledge you need before going out into the work place.
        One of my friends recently had another child. She said that the main midwife – who in this hospital was a male, which I thought was wonderful – was so stressed and panicked because, as you said, there were a lot of women in labour & not enough staff to support, that the student midwife had to step in & take the reins during her delivery. She was thankful the student was there as she was very calm and helped my friend through her delivery amazingly.
        I hope your studies are going well, all the best – Yasmine 🙂

  14. Your article seems to have hit the nail right on the head. As a peer supporter and a doula, what I see is, sadly, exactly what you are describing. Despite this, I am still absolutely determined to become a midwife, delusional as that may sound. I do sometimes wonder though if things have now got to such a point that the only way is up? Do you feel that the fact that midwifery does seem to be in the papers so much at the moment, precisely because of the issues you’ve described, means that we are nearing the bottom of the dip and improvements are imminent, or is this a slightly “rose tinted spectacles” sort of outlook?

    • Good an ya Carolina! That’s what the NHS needs…courage and commitment! Maybe we are at a turning point. I am positive things can change, if we continue to talk about the issues, and to offer solutions too, and share good practice.
      Thanks for your comment, and keep the rose tinted spectacles on!
      Sheena x

  15. I absolutley agree with everything you have mentioned. If only everyone could see this, then maternity services would be so much better, giving women and babies the care that they deserve! I am a final year student midwife and am feeling these pressures already, but I’ll plod on in hope that things will change one day.

    • Thanks for commenting….we need you plod on with vigour! You are the future, and you CAN help to change things. There are some fabulous, positive services and I believe if we shared good practice and learnt more from each other how to manage the hurdles…things could be so much better. Onwards and upwards I say!
      Good luck with all, and keep positive
      Sheena x

  16. Totally agree with all that Sheena has said above. Litigation, paperwork, CNST, birth being perceived as technological and medical are all issues responsible for taking the midwife away from being with the woman and coaching her through the physiological birth process. Birth is an extraordinary experience and it is a privilege to be an observer of that. It is easy to not see and feel the love and joy when your head is in the paperwork!

  17. I wholeheartly agree with your comments. The high levels of stress, bullying and harassment must addressed. How can we care for women when we can’t care for each other. We have lost our way as the majority of care is fragmented and many midwives have not known the pleasure and joy of caring for women during their pregnancy and the excitement that builds as she comes towards her due date and delivery. Keep up the good work Sheena!

    • Hi there, hope you are managing to get support if these negative situations are affecting you 😦 It’s crucial that we find a solution together and to help maternity services be the nurturing environment it should be.
      Thanks so much for your comment, and for taking time to read and respond. Stay strong!
      Sheena x

  18. Could not have been said more succinctly! I have fond memories of you Sheena! Very well said. I left after just two short years, and found it very stressful once qualified. And here was I just the other day thinking about returning!!
    Julie M
    x

    • Hello Julie, lovely to hear from you! I am sorry to put you off coming back to our amazing profession…never my way or intention to be negative; here I outline constraints to acknowledge what they are. However, there are SO many positives, and areas where great services are provided (East Lancs is one!)…despite these issues. We have to try to keep changing! Hope you are OK…much love Sheena x

  19. So honest and so sad.

    I’m not a midwife but a Mom of two beautiful girls delivered with the help of NHS midwives. My first birth was difficult and long, each of the Midwives that helped me through it were brilliant no doubt about it but it was clear they were stretched and under pressure. For my second pregnancy I hired an Independent Midwife, I knew I was going to have to give birth in hospital due to a previous PPH, but after a difficult time previously I needed the trusting relationship I built with my IM through my pregnancy and her 100% support and focus during my labour. It worked brilliantly and both my IM and NHS midwife were wonderful throughout the birth, working together, I felt totally at ease with my IM there whilst my NHS midwife was busy elsewhere. I went on to have a great water birth with no complications, I’m still thrilled to have enjoyed such a great birth experience – to both Midwives I’m eternally grateful.

    I sincerely hope that one day Midwives will have the opportunity to give women the level of care they strive for as standard, wishing you all the very best in your mission for change.

    • HI Laura,
      Sorry I missed your comment, not sure why? Thank you for telling me about the births of your two daughters. I was heartened to hear that you had a positive experience with your IM, but sad that NHS midwives sometimes can’t give the care they want to.
      Thank you for your support..and for taking time to comment.
      Sheena 🙂

  20. Well said sheena,
    As a student midwife myself I believe we can make a change if we keep on trying! Care should be our main concern rather than reems of sometimes unessary documentation. I want the time to spend caring with my women as that is why most of us enter this profession! It’s rather upsetting the amount of women who feel the need to employ doulas as they feel midwives are no longer able to be their support and coach! I feel I am privileged as a student as I have the time to support women, I just hope that by the time I am qualified things will have changed for the better! Xxx

    • Hi Lauren, I agree with all your comments, and thank you for taking time to respond. We have to keep trying to make a difference, and it may take a long time! Keep strong and stay positive. We need you! And there are still many positive things happening. Sheena 🙂

  21. Have read through all the comments on this page and your replies Sheena! Can relate to most of them! I have worked through many of the frustrations named above and have decided that change can happen by a positive outlook, an encouraging and supportive environment whilst caring for women and their families and caring for each other. It has taken me a long time to learn this simple law of life! I have seen many positive changes in all areas of my life since and the ‘ripple effect’ is continuing!! The art of possibility can simply be a reality!

    • Hi Allison,

      So good to hear from you! I am absolutely inspired to hear that you have moved into a positive space, and that it’s influencing your working life in a goos way. It’s definitely the only way. Upward spiral! And now we just need to tweak the service, and continue to lobby for more midwives, and less bureaucracy! Thanks again…keep strong…Sheena x

  22. Having trained in Ireland and recently started working with the NHS as a newly qualified midwife I can’t believe the extra paerload over here for the sake of CNST and then theres the unbelievable staffing levels. Having trained in major city hospital with over 9,000 births and moving to a trust with just over 4,000 I thought things would only be better,but how wrong I was. As newly qualified and new NHS employee I feel so unsupported, staffing levels are chaotic and dangerously unsafe here. Been able to get a break makes it a good day and many a shift I’ve come home starving having had no break or even a cuppa of tea, not to mention stressed and even fearful that I’ve missed something because it’s been so busy and understaffed. I feel I’ve no time to spend with the patients as I constantly filling out paperwork , but If I miss something I’m quickly told off for doing it wrong.I’d read so much good things about midwifery in the UK and how it’s more community based and how we have more autonomy and I had wanted to stay a year and get much needed experience, but I’m not sure if I could stick it.I love been a midwife and been able to empower and support women through such an amazing journey but I feel my skills are wasted due unnecessary restraints and protocols. I’ve learned sometimes the grass isn’t always greener on the other-side and it’s better to the devil you know than the devil you don’t.

  23. Pingback: It’s 2014. Time to listen, and hear what midwives say | SHEENA BYROM

  24. I’ve not long left the conventional NHS system, and as apprehensive as I was about this, I’m sad to say it is the best decision I’ve ever made. I’m finally able to offer women not just safe care, but good care; care that sees them as individuals and honours their personal journey in to parenthood. It was so very rarely that I would glimpse even a small amount of this basic ‘right’ for women: a known midwife who could offer them sensitive, individualised care in a un-hurried, caring way.

    I felt so broken and battered by my years in the NHS, and by all accounts it wasn’t as many as some. I felt every day that I was letting someone down, somewhere. Most often it was the women, but there was often that conflict suggesting that if you chose to give ‘extra’ time (or ? just good care) to women, you were somehow putting pressure on your colleagues and failing to be a ‘team player’. I constantly felt as if my loyalty and my priority was the institution I was working for- for my colleagues, for the daily logistics of running the service, and for ensuring that all of the associated admin work was correct for stat collection and audit purposes. I so often felt as though the women and families under my care- so deserving of my time, my energy, and my passion for a job I feel I was born to do, were, unfortunately, not always my first priority.

    Had I not found the career I have now, I feel very strongly that I would have become too disillusioned to continue in the NHS, at least at the organisation I was at previously. However, it is also heartening to hear of pioneering organisations who are paving the way to innovative, compassionate, mutually beneficial care, for women and for caregivers. I can only hope that a service which still cares for the majority of birthing mothers in this country begins to review their services, and consider stripping out the politics and the drudgery of risk-based care to focus on what really matters: women, families, and midwives providing comprehensive, skilled, compassionate, sensitive care.

    • Thank you Kelly for such a distressing yet sensitive response to my blog post. It is incredibly sad and unacceptable that you and many others feel this way, and it makes me more determined to try to influence change. I am involved with several strategic groups and the RCM who are keen to learn from messages like yours, and to use current evidence such as Birthplace and the National Audit Office report to improve the way maternity care is delivered in UK. Please keep in touch, because you may be able to help too. Thanks again, really appreciate your time….Sheena x

  25. I completely agree with everything you have said. I am a second year student midwife, just entering the profession, and already I am seeing and experiencing so many things which make me feel sad. Whether it’s unnecessary interventions or women simply not recieveing the quality and standard of care they both need and deserve, not because the midwives caring for them don’t want to deliver it, quite the opposite, simply because of constraints placed upon them due to insufficient staffing levels or resources. Quite often it’s the little things, which over stretched staff do not have time to do, that make all the difference. But unfortunately it’s those little things which are all too often the first things to fall by the wayside. Instead of caring for women and being “with woman”, we are caught up in too much bureaucracy and, as you mentioned, (often) unnecessary ‘defensive practice’.

    • Hi Amanda,
      It’s true.. small things that matter. Try not to be too disheartened, as whilst my post is ringing true to many, I am positive that things can and will improve if we keep trying. We have never had better evidence, and there are some amazing services out there that changed due to like minded colleagues making small steps.
      As a student you can separate good from bad, and learn from both..keep your eyes open for positive role models, and stick to them like glue. There are so many amazing, kind and dedicated midwives—and remember they need support too, so don’t forget to tell them if you appreciate their practice!

      You have chosen a very special, unique and highly privileged career..and you are lucky. Keep strong and focused, and remember to smile! Lovely to be in touch, and thanks for commenting, Sheena x

  26. Hi Sheena, I’m a newly qualified midwife who is about to start my first post this Monday and although I am very excited about starting my career and I am also completely terrified for the exact reasons that you stated in your blog. I have already worked one bank shift (my first and last one!) and the experience almost put me right off the profession altogether! I just hope that the working environment in my new trust will be much more supportive and understanding that yes I am fully qualified now but I have never actually had to do this job completely unsupervised before and WILL need to ask constant questions and for advice for several weeks before I start to feel comfortable and confident in my own practice. The pressures put on our services and staff by higher management are shocking and unrealistic and it our poor women and families that suffer for it x

    • Hello Heather,
      I am so sorry if my post has worried you. There is truth in my opinion, BUT try to remain excited and positive, and seek out the right support from the beginning. Sometimes the person who will give you the most help and guidance isn’t apparent immediately; just keep observing. It’s also worth pointing out that the managers are under as much pressure as midwives delivering the service. It’s hard at all levels really. See http://nhsvoices.nhsconfed.org/2013/03/27/maternity-services-need-to-take-stock-of-the-francis-report-too-says-sheena-byrom/

      There is much that is good though Heather, and most of my career I spent smiling and happy-it’s the best job ever. There are some amazing maternity services, and we just need to share ideas and evidence, and push for change. You are our future, and once you’ve settled you can make little changes that will make a big difference. Keep in touch, and good luck ☺ Sheena x

      • Thank you for your kind words Sheena. My concerns have not stemmed from your blog post however, I have had these concerns for some time. Looking forward to getting stuck in and (hopefully!) prove to myself that I CAN do it!

  27. Wholeheartedly agree with all your comments Sheena and very well put. I have to admire your relentless desire to keep on truckin’ in the face of adversity.
    I recently took flexi retirement at 55 after 28 full time years as a midwife, partly to pursue a second career in Bowen Technique (I am not ‘allowed’ to use it in my midwifery role) which has been my partial get out of jail card! Sadly that is how I feel about the NHS now. Even sadder is the fact that I work in a small birth centre in a beautiful rural part of the UK where the staffing is half what it was 5 years ago and most days we barely manage to cover the routine antenatal/postnatal workload, stressed out at the prospect of how we will deliver intrapartum care should a labouring woman present!
    I do count myself lucky that I trained in an era when I could learn from plenty of senior midwives who had the skills and art of midwifery that you cannot learn from books. The ‘boss’ came round the wards every day and wouldn’t have known what strategic planning was. We still had co-op cards at AN clinic and the Aberdeen Kardex system was the extent of written word in the wards. Paperwork in labour consisted of ‘the partogram’ and not a great deal more.
    This time was by no means perfect, but being ‘with woman’ was definitely at the heart of it. Lawyers and accountants now dictate the terms which is why we are ‘risk assessed’ to distraction and staffing levels have been at breaking point in most of the country for what seems like forever. While it is lovely to be able to perform perineal suturing and newborn neonatal examinations, these role extensions (as they were once seen) also add to the pressure of our daily workloads.
    Having said all of this, I do still relish guiding students in learning the ‘art’ of midwifery, having faith in the natural process of childbirth and supporting parents in the early days of the journey that is parenthood.

    Good luck to all who still have their careers ahead of them.

    • Thank you Shona, for commenting and sharing your thoughts. It seems we are all saying the same things, and this is evidence that it’s time for change. We can’t keep doing the same-there is no improvement, only potential harm. With your expertise and philosophy, it would be brilliant if you could keep your eye on ways to help guide the future of our services, we need you!
      Thanks again, and keep in touch…Sheena x

  28. Dear Sheena, what an interesting read. I am hoping to train as a midwife starting in Sep 2015, I have applied once before and was rejected based on lack of experience. I have now spent a few years getting experience and taking on some additional training where possible. This post interests me as I am so passionate about the holistic care that pregnant women and new mothers deserve, but disappointed to hear the bureaucracy involved. I had my daughter overseas (India) and can’t tell you what a wonderful and caring experience it was. I wish every mother could experience what I did. Your article has not put me off though :). If anything, I feel more determined than ever to get stuck in and try to make a difference. It’s clearly needed now more than ever. Thank you for sharing your experience and thoughts.

    • Thank you for your comment Amy, and so good that you had a positive birth experience in India. Good luck with your application to become a midwife…and well done for staying positive! It makes such a difference. Sheena 🙂

  29. What a shame it is that nowadays we are judged on our abilites as midwives by different measures. Women judge us to be a good or bad midwife by how kind, caring, patient and knowledgeable we are (as always) whilst management judge us on the auditable numbers….whether we did observations at the correct time (far too often these days), whether you signed your name here or there, whether certain pieces of paper have been taken out of the notes and given to a woman rather than just pointed out to them. Red tape is killing midwifery skills. We can no longer relieve a womans worries by explaining why something is happening and that it will pass, she must be referred on and fussed over and small thing made into big issues, JUST IN CASE!
    Everyone seems to have forgotten what NORMAL looks and feels like.

    • Hi Catherine, I know your frustrations. I don’t think women judge us, (we are women remember, my daughter has recently had a baby) they just want and deserve sensitive compassionate care. Try to find a positive role model who you admire and trust (this really helped me), and support each other to find solutions to improve things.
      I really appreciate you commenting here, because these concerns are real and need attention. There are areas of excellent practice where normal physiological childbirth is very real, and we are trying to find a way to share ideas and strategies to others.
      Keep strong, and remember you ARE making a difference. Much respect, Sheena 🙂

  30. Midwife for many years.
    Totally agree with what you have put. The staff shortages and need to rob peter to pay paul on the wards is ridiculous. On one shift I personally got moved SIX times back and forth. I ended up with 12 postnatal woman all screaming for discharge and labourers and deliveries aswell!! You cant spend any time with woman anymore, everything feels rushed.
    Now everything is computerised to ‘make things easier’ but it has tripled the workload and half the time systems aren’t working. More time is spent sat in an office filling out the computer while the woman sit in thier beds waiting to see the whites of eyes!! Anyone in a uniform will do!! Its such a shame.
    Shame on the government for closing down all the smaller birthing units that took the overflow from big ones as now the conveyer belt of fast ‘care’ is not what midwives spend time, energy and effort for years becoming a midwife wants to do.

    • Oh Dawn, you have so much pressure! You probably already know this…try to make time to speak to a supervisor of midwives who you trust, and explain how you feel. I remember issues like this being escalated and I was pleased, as it gave me evidence to push for more staff. I agree amalgamations of small maternity units is potentially detrimental to all, especially as we know at least 50% could give birth in midwifery led settings.

      Sheena 🙂

  31. Hello Sheena,
    In 2012, I started work in a hospital and although I was terrified, I was amazingly supported by lots of experienced midwives. I left 7 months later because I got a job in my home town where I wouldn’t have to travel. Now I am at the end of my preceptorship year, I have had a good chance to reflect. Six months in, I suffered terrible depression which, I think led from an unhealthy period of stress. Luckily, I have an amazing family, but work stress came from feeling unsupported, unguided in my goals, lack of structured appraisal and generally feeling I was failing women. I just could not give them the time and care that I wanted to. At the start of most shifts (on the ward) it would become apparent when work was allocated that there was far more than you could get round efficiently and it was a question of which one of your ladies you would upset because they had had to wait. This is simply soul destroying.

    All that said, after hitting rock bottom, I bounced back, determined that I would never feel this way again and started reading lots of positive and inspirational books. How to achieve, be successful and cope with work stressors. This has enabled me to become stronger, put things into context, and become more efficient at work. And most importantly, become happier. When you’re happy, the women notice and they feel at ease and are happier too! I had not realised how inefficient I had been, simply by being negative and ground down. I have now made positive comments boxes for work – so we can recognise good work (and there is loads and loads of it) of colleagues which I will make into a inspirational scrap book at the end of the year.

    I guess what I have concluded is that because the NHS is generally consumed by saving money and making cuts, they crack whips and tighen belts and sometimes miss a fundamental part of effective and efficient working – investing in how to get the most from staff, positive feedback, incentives and promoting team spirit. I think managers are also ground down and under incredible pressure – I feel sorry for them. But it means that they are stressed, unapproachable and junior staff do not go to them for advice or with concerns. I am so sad that after only 2 weeks my friend, a newly qualified midwife said she cried and cried during her first week, was left to ‘drown’ and has already applied for another job in neonatal nursing.

    Where I work, there is a culture of being a ‘martyr’, as I see it. People never ever leave work on time and often stay hours after their shift ended (filling paperwork, which could be handed over), sometimes night staff help the day staff if they’re short. Many hours are done unpaid as time owing is not allowed. I think this leads to feelings of being undervalued, and eventually, when people are burnt out, they go off sick. Leading to understaffing, and so the cycle begins again. Unfortunately, staff are not respected.

    The only way people can cope is to be negative, moan and groan – which seems to wipe out any brilliant work being done.

    I am one tiny drop in the ocean, but I’m trying to change things by working how I think is right, I try to avoid at all costs being negative and moaning. I try to lead by example by being positive, enthusiastic and smiling! I’m going to try to organise some social event so we can become a stronger supportive team, too.

    We have many, many brilliant midwives where I work – they don’t know how good they are because managers never tell them! We all want the same thing – quality, compassionate care for women. And let’s face it, we can all cope with having busy days, if only we are supported and feel strong mentally.

    Maybe, just maybe, we can change a few things from bottom up, instead of waiting for those who don’t work on the wards to change.

    Here is a helpful link on why positive feedback is so important.
    https://morethanaminute.com/how-to-give-your-employees-the-positive-feedback-they-want-and-need

    I know things can change, they have to. Good luck.

    • Oh Claire, your message is so encouraging and uplifting. I would love to share this with others (perhaps you’d like to write a post for my blog?), to influence change. I totally agree with you, positive meaningful feedback is powerful, and can shift negative cultures and improve care. Thank you so much for the excellent link, so useful. I also fully commend your thoughts on changing from the bottom up; instead of waiting for ‘them’ (usually managers) to influence change…do small things within your team, and watch it mushroom.

      I am so proud of you for your positive outlook-it is doubly amazing as you have come from a difficult please. Well done you. Keep in touch Sheena x

  32. Only being new to the nhs as a
    Midwife for two years I have nothing to compare the care too. However I feel that maybe the women themselves have also changed not many truely believe they can birth their baby themselves and most expect some form of intervention. I tend to try and spend most of my time with the women and frantically write my notes at the same time, I truely believe that if you have a good relationship there’s no need to worry about missing a name at the bottom of the page as that rapport with women is more important. What’s hard to remember is ultimately the nhs is a business and as a friend of mine says if they ran the nhs as well as centre parks it’s be fantastic and cost effective!! Ha

    • Well done Frankie, for trying to focus on what really matters, even though it’s hard.
      Women may find it difficult to trust their bodies to give birth, because we (HCPs) have, over several decades, led them to think they can’t. It’s so sad. But let’s keep trying to influence change, and supporting and encouraging women to feel confident that they can do it! With midwives like you, who take time to be there (when writing notes too!), I think we’ll succeed.
      Thanks so much for commenting, Sheena 🙂

  33. I totally agree with the points you raise. I am only glad that I am at the end of my career and not starting out. I have loved my job up to around the last five years but find that it is becoming a constant battle to keep women on a low risk care pathway. Interventions by young inexperienced Doctors is a major risk issue and unfortunately today’s midwives lack experience of normal midwifery without technology therefore often go along with the obstetricians viewpoint instead of working with woman and striving for normality until being proved that is not possible. I know no one is indispensable but I worry about what kind of service will be provided when old dinosaurs like me retire!

  34. Pingback: We are NOT using the evidence: it’s time to change | SHEENA BYROM

  35. I so agree with the comments however I am thoroughly enjoying my job at the moment. I retired 3 yrs ago after many years of midwifery in a birth centre and community, but I took my retirement as I was sick of the bureaucracy, politics and penny pinching that was going on, leading to my being ultra tired, after endless extra shifts and on calls leaving me feeling tired and sick. Since retiring I joined the bank workforce, now I work the shifts That suit me, I work in lots of different environments, I feel able to practise my skills as a midwife without being burdened with the politics of it all, my colleagues tell me constantly that I look younger, healthier and happier and More importantly I feel valued. Being a midwife is who I am not just a job and now I love it, needless to say I haven’t been out of work since my retirement.

  36. How on earth do you manage to care for 2 labouring women and antenatal admissions ? (see post regarding 5 midwives on shift, and 13 labouring women and antenatal admissions to be seen). My unit is indeed very lucky, we have 9 labour rooms, and separate antenatal/postnatal ward. We have 4 midwives plus a labour coordinator, and 3 midwives for antenatal/postnatal ward 29 beds. We mainly have one labouring woman each plus a labour assessment patient or a pn patient when it’s busy. How can you auscultate every 15 minutes, support a woman, monitor a ctg with a high risk woman, severe preeclampsia, or cardiomyopathy, or hellp, or twins, when you have a second labourer with variable decelerations in the second stage so you have to be with her in the room ? this is not safe practice surely… How do you physically do this ?? seriously, what do you do ? woman one, low risk 5 cms, needs auscultation of fh every 15 minutes. Woman 2, high risk, twins, OR preeclampsia, in the second stage, How do you give care to both at once ? :*(

    Anonymouse midwife of 13 years, caremaker, rcm health and safety rep.

  37. Very well said Sheena. I am a Nqm and have seen the one size fits all care that is provided in some areas. I am passionate about preserving normal birth and empowering women to have the birth they choose. It is disheartening at times but makes me want to be part of a bigger change that is sorely needed.

  38. Hi Sheena
    Your answers are spot on, and sadly reflect the reality of nursing too, indeed change the words midwifery to A & E nursing and the situation is identical…never mind NICU too! These are the 2 areas I spent 6 years if my 10 year nursing career working within the NHS, and sadly for all the reasons you outlined I became terribly burnt out…as with so many before me and I suspect many more to follow…that I can never go back to the NHS. But I am heartened than people such as your self continue fighting xx

  39. One of the biggest changes I have noticed recently as a community midwife is the impact cuts in other social and healthcare services and the are having on our role. The social and mental health problems now not prevented because of cuts in these services have significantly increased our workload. This coupled with the expectation that we as midwives along with teachers and other core professionals despite little expertise or resources available to us to deal with such issues should now be held responsible for the ill effects these social and mental health problems can have when they occur has made the job immensely more stressful and made me seriously look at leaving the profession as soon as I am able to. Despite the fact that I still absolutely love my core work as a midwife and will miss this very much.

  40. I love being a midwife………that sense of offer to motherhood can not be compared with anything else……that sense motivates your inner ethical goodness and keep you going…..however paperwork has increased dramatically as well as the fear of litigation as mentioned above. Every time I turn my back to a woman to write notes I feel guilty that I am neglecting her and every time I do not use my clinical time wisely to write notes I feel guilty to my professionalism, my employer , the NMC and the woman as well. As every colleague, I would like simpler high quality documentation and more time with the mothers.

  41. Shenna, nail on the head as you might say! Describes maternity services in most trusts I can only assume. Certainly the trust I’m training in. I would have loved to have trained in the environment you did, I guess we student midwives become accustomed to this way if working as we know no different.
    It will reassure you to know that behind all the contraband, red tape and monitoring are student midwives and midwives with only one thing (or two ) concerning them … The woman and her baby (fathers too).
    Students training now are finding ways of trying to overcome the current climate and still give the woman the care and birth she wants. Don’t get me wrong , it’s hard… Hard work to be with women, reassure them that everything Drs and obstetricians are telling them is ok and support them so they have less anxiety over labour and birth. It takes a certain type of person who can overcome everything maternity services stand for currently and still give women the best care and experience possible.
    Women should always remember their midwive positively… That’s my main aim Shenna. If I can do this, then I know I’m doing well 🙂

  42. Sometimes its feel like for the sake of cost efficiency and nhs targets maternity support workers are also beginning to take from the role of the midwife. In some trusts they almost solely manage smoking cessation, healthy living, parentcraft and breastfeeding support. Midwives are getting less time with women to build trusting relationships and instead being “with paperwork” instead, and student midwives lack the confidence with skills such as breastfeeding support as it is palmed off out of the necessity to complete more clerical tasks.
    All of the support workers in my trust are wonderful and couldn’t do enough. But in the long term if there role continues to expand how will it affect fully trained midwife care?

  43. As a student midwife sometimes you can see how the increasing focus on academics can affect the future midwives that are coming from universities. We are being raised and taught in a culture where ticking boxes and paper exercises means more to lecturers then making sure that students are practically equipped to deal with everything that will come there way. As long as a student can write essays, reference them, and quote research from memory that seems to be enough for them.
    For example at the university that I attend the module that focuses on teaching research skills (i.e. learning about research methods, critiquing research etc.) is 40 “credits”, whereas the module that focuses on actual midwifery skills and practice is only 20.

    As well as this the increasing role of the maternity support worker will have some affect also. In many trusts in this area the MSW’s now deal with smoking cessation, smoking support, healthy living, parent craft and breastfeeding support. The contact that midwives is having is being reduced in favor of paper tasks and the fear of failing audits without considering the impact that this is having on the midwife/woman relationship. How can midwives have confidence in their skills, knowledge and relationships that are the foundation of good maternity care if their role is being chopped up and redistributed in the name of efficiency and cost effectiveness.

    Anyway that was a little bit of rant but we’re all entitled every now and again 🙂

  44. I agree wholeheartedly with your comments, however, I would also like to add that midwives who are no longer dual trained have had a massive impact on services provided. Sadly when some mothers and mothers to be, need medical intervention, midwives aren’t able to provide nursing care. I have on 2 occasions in my career in the NHS heard direct entry midwives state “I’m not a nurse, why should I have to give nursing care”

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