Earlier this month a health correspondent from The Independent contacted me via Twitter to ask me if I would be willing to comment on this article, written the day before.
The piece quoted the words of a very honest and courageous midwife, and I applaud her. I don’t usually like commentaries which could potential cause fear amongst women who use our maternity services…and I am always wary of journalists, for this very reason. However this article is very accurate, and I am sure 80% of midwives would agree with what is written.
I wrote about these issues here.
The RCM are continuously campaigning for more midwives, and although NHS England have published a staffing strategy placing onus on Trusts to ensure safe standards in terms of capacity and capability http://www.england.nhs.uk/2013/11/19/staff-guidance/, there aren’t enough midwives to fill posts. Support staff are crucial, as often midwives are doing non midwifery tasks, but often organisations can’t afford them either. We are constantly reminded that there are increased pressures within maternity services due to an increasing birth rate and complexities of those using the service, but external and internal reviews of NHS organisations and departments, and risk management agendas (including processes relating to CNST) are adding to the strain through increased bureaucracy and fear.
It seems some midwives possess professional resilience to pressure and adversity in the workplace, managing to stay positive and motivated despite the increasing demands placed upon them (Hunter and Warren 2013). . One of the themes from this study findings was ‘building resilience’, where participants demonstrated the development of strategies to help themselves and others to cope. So where do student midwives and midwives get the support from, to help them to cope on a daily basis? Do they know whom these ‘resilient midwives’ are, to help them to build coping mechanism for preservation? Sometimes sharing a crisis moment with a work colleague or supervisor of midwives does the trick, and support is there and continues. But there are times when practitioners fail to share feelings for many reasons, including time, confidentiality, and confidence.
I had specific colleagues that I turned to in stressful times or moments of crisis, and I knew the things I could do to help me re-focus and keep things in perspective. In the early 1990s I had read Caroline Flint’s book, ‘Sensitive Midwifery’ (Flint 1991), and I loved and used the suggestions Caroline gave to midwives on self-care. I think they helped me.
I have written a short piece in February’s edition of Practising Midwife, about how social media and online resources can help practitioners to stay in touch with like minded individuals and to glean tips to try to stay positive at work. And later this month I have written a @wemidwives chat to share ideas with nurses, midwives and students. Join in if you can!
In the meantime, these were my suggestions to the journalist, about how we can try to help midwives and improve maternity care:
The Government needs to hear and act in terms of resourcing increased midwife numbers. The problem will not go away. Choice, continuity of care and carer and the sustainability of independent midwifery are all crucial issues that need urgent attention, BUT WE NEED MORE MIDWIVES.
For maternity services, there needs to be a shift of focus on wellbeing instead of illness, and kindness and compassion instead of punitive culture where fear and blame prevails. The latter adds extra burden on an already pressured service. Although midwives are leaving due to increased stress at work, there are many who can’t, and they need to be valued and cared for.
We need an invigorated focus on reducing unnecessary medical intervention during childbirth, mainly because there is emerging evidence that the consequences are potentially catastrophic.
What are your thoughts?
Flint C (1991) Sensitive Midwifery Butterworth-Heinemann Ltd London
The tust I work at have currently responded positively to low staffing levels and offered over time for the past couple of months. Although I do not know if this is in the short term and recruitment always appears to be ongoing, but it’s certainly made a difference.
Retention is an issue and something I speak to cohort friends about. I wonder if some people do become midwives for the “romance” of the job, as people often say to me “I would love to be a midwife your jobs amazing”. yes it can be amazing, but truthfully the reality of the job is long hours, physically and mentally draining and requires a great deal of stamina, dedication and self motivation.
When staffing levels are correct this makes my job pleasurable and I feel a sense of achievement and therefore valued. When the staff to women ratio is accurate it enables staff to provide actual clinical care, but most importantly time to chat to women, as they so rightly deserve. As a consequence I leave a shift feeling I’ve achieved my possible best.
When staffing is low it creates that sinking feeling and I know my stress levels will increase. This inevitably impacts upon the time I can spend with each woman and I believe my own health and well being suffers too.
I think as midwives we do a valiant job of trying to smile through it all and at the same time look out for our colleagues. Most days there’s a hug from someone to tell you your doing ok and to stay positive, we are each other’s scaffolding. We have to remember to look after each other as this creates a positive working environment, even during these difficult and adverse times!
Hi Lesley it’s so reassuring to hear that your Trust has responded to pressures and increased staffing levels. Thanks for your brilliant comment; I totally agree with and love the phrase- we have to be each other’s scaffolding. Hope you are going to join in the wemidwives chat on 21st! Sheena x
Totally agree about the need to reduce unnecessary medical intervention during childbirth. But disappointed with the reference you cite – pure speculation.
There is evidence for lack of benefit from some interventions. e.g. CS for twins,(twin birth trial) oxytocin to accelerate labour, routine amniotomy, cord traction etc.
But in some areas recent evidence is tending to support interventions that in the past might have been regarded as meddlesome, e.g. induction near term.
I’m sure you don’t intend this Sheena, but blanket opposition to all interventions, will harm the profession.
Many thanks for reading and taking time to comment…
Firstly the paper I sited was referred to as emerging evidence, which I believe is different to speculation.
Also, I didn’t allude to blanket opposition to interventions, I would never do that. Apart from seeing life saving procedures throughout my career, both my daughters NEEDED medical intervention and it enabled them to have healthy and happy babies.
I am interested in your comment about supporting evidence for induction near term? Can you share it with me please?
Forgive me Sheena. Comment came over a bit aggressive.
re IOL. It looks like in many scenarios IOL doesn’t increase CS rates, may even reduce them. I blogged about the latest paper here. http://ripe-tomato.org/2013/08/24/induction-increases-caesareans/
The other source is all the Cochrane reviews of IOL for post term, term PROM etc. etc. which each show a non-significant trend towards reduced CS!
Not a problem Jim…
I will take time to peruse the papers and your post, and respond. Until then just want to mention that CS isn’t the only measure when considering IOL, and now we have others to consider with epigenetics etc, which are rapidly gaining momentum.
Great to debate!
How about the Birthplace study Jim- shows in medicalised environment (ou) interventions were much higher which increases cost and causes harm also reduces women’s satisfaction of birth experience. Sheena has a right to point out the harm physically and psychologically we have caused over the years to women and also without making a difference to our stillbirth rates or neonatal outcomes. How many women over the years of medicalisation have we used CEFM on and either using it as a baby minder or just concentrating on watching the trace and not caring for the woman while she is prevented from getting into good positions for her to deal with the physiological process of birth? We have been hindering rather than helping! Sheena is just pointing out the tip of the iceberg as far as I can see!
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