Save Liverpool Women’s Hospital campaign have called a national meeting on Sat 5^th October to discuss the crisis in maternity in the NHS and how we can oppose the Tory government agenda for maternity. Tickets can be obtained here

Dr Rebecca Smyth, Senior Lecturer in Midwifery explains to Lesley Mahmood of Save liverpool Women’s Hospital Campaign

 I worry about the current situation of midwifery as well as the future. Having a shortage of 3,500 midwives without doubt impacts on the care midwives can give women. Poor and inadequate care due to the shortage of midwives leads to poor outcomes for women and their babies as shown in the recent MBRRACE-UK Perinatal Confidential Enquiry (2017). The report outlines how heavy workload and staff capacity issues can affect care provided, leading to delays in transfer to hospital, plans for induction of labour being postponed and difficulty in providing some elements of advanced life support when a baby requires resuscitation after being born. The report’s stark findings attribute some babies dying to staffing issues, including paediatric shortages, lack of hospital beds and high clinical activity.     

What changes have you seen in the last few years?

A consequence of poor staffing leads to midwives being overworked, which then results in midwives leaving the profession, either mid-career or retiring early. Midwifery was always a job for life, a vocation. However, so many midwives are at breaking point, I see my colleagues leaving the profession much earlier than they previously had and the reason they give is plain and simple; they are overworked, exhausted and feel dissatisfied with the quality of care they give. It is both sad and worrying; this was never the case in the NHS.

What concerns do you have about the current government agenda for Maternity?

Better Births, in particular Personal Budgets really worry me. The personal budget will be given to women for them to ‘buy’ care, care that is already provided in the NHS free of charge, so buying is not necessary, unless you are a government that wants to bring in payment / privatisation of healthcare. The budget would then be useful in opening the way to full-scale charging, and we know the poorest of society are in the most need of health care, often needing additional investigations and treatments linked with their poor health status.  

How can the shortage of midwives be overcome?

 The easy answer is train more midwives and as a consequence midwifery teaching departments at universities are being strongly encouraged to take more students. However, at present there are not enough clinical midwifery mentors, clinical placements, educational institutions or educators to facilitate this. Resources are lacking too, booking classrooms for a cohort of 75 students in many universities is impossible, meaning classes are split into two, therefore doubling the number of lecturers required. So it is not an easy fix.

As way of dealing with the lack of clinical mentors (caused by understaffing as well as increase in student numbers) the Nursing and Midwifery Council has revised the national standards and now the traditional Mentoring model has been replaced with a new Coaching model. So instead of student midwives having their own personalised mentor they now share this person with two other students. The rhetoric is that it encourages students to support each other and shares the responsibility of practice learning among the whole team. Or put it another way dumbs down clinical mentorship. Midwives learn to be midwives in the clinical area, the teaching in the clinical area is fundamental; if this goes, lives will be lost.    

Why come to the national maternity meeting in Liverpool on 5^th October?

 The problems with the maternity services feel so overwhelming this is a chance to come together. On a day-to-day basis as a midwifery educator, I am reminded of the crisis we are in. I visit the clinical area to see my students and feel for the staff, you can often see the overcrowding of a labour ward, the noise of unanswered buzzes, the midwife grabbing a long needed bite to eat at the desk and others charging from one room to another. I know many midwives who have worked in this environment for many years and they have my upmost respect. Yet at times in the press, they are treated like uncaring incompetent beings. They cannot win. 

I myself feel completely overworked, I have a large group of personal students, which is an oxymoron really as you never get to know them on a personal level, you just fire fight with them in the hope their journey to becoming a midwife is successful, rewarding and enjoyable, just as mine was.

The nub of it all is the shortage of midwives, clinical and educators. Yet midwives say to me, there are easier jobs. The job was never easy, but we had enough staff to look after the women and our students. Enough staff to forge friendships, get to know each other in the quiet times, so when things got tough you knew your work colleague, she was your friend, and you all mucked in together. Working relationships, sharing the burden of a busy shift is a priceless component to good care. But without good staffing levels and a real acknowledgement by the government nothing will change.

Midwives I know are amazing people and we all know how privileged we are. Supporting a woman through pregnancy and particularly birth is an honour. At the last SLWH rally a woman came up to me. I had delivered her grandson. He’s now 24. You can’t beat that can you J    

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This article was first published in Health Campaigns Together

Images with the srtists permission from from The Birth Project and Cyrano Denn