Twenty months into a pandemic, and barely a week goes by without another bleak story about the NHS being on its knees. But the latest from the Royal College of Obstetricians and Gynaecologists (RCOG) warning the NHS will be unable to deliver “the care it needs to” for women giving birth this winter if the surge in Covid cases continues, makes for stark reading.
Dr Edward Morris, president of the RCOG, says our maternity services are close to breaking point. ‘The Covid-19 pandemic is far from over and we’re becoming increasingly concerned about the immense pressures facing our maternity staff this winter if the situation continues,’ he told The Guardian this week.
Unlike in other areas of the NHS, maternity staff cannot be replaced by other medical staff ‘due to their specialist skill set,’ Dr Morris explained, and therefore protecting midwives was ‘crucial to ensure that safe maternity care can be sustained.’
So what is it like to be working as a midwife under such strained and difficult circumstances?
Lucy*, a midwife working in the south east, says that morale is at rock bottom. ‘Staff resilience is very low right now. Many of us haven’t taken holiday for two years. Our own personal stress and that of our families is tough, with things like bereavement and financial worries stemming from the pandemic. Many midwives who are working mothers have also had to juggle home schooling and the emotional well-being of their children and concerns for ageing parents too.’
As a senior manager, Lucy says she can see the wider picture from board level. ‘Our senior management team are also under pressure from the government to keep services open, including homebirths and midwife led birth centre services, to ensure women have choice. This means we have staff in two or three locations, which can leave midwives working long overtime hours and the acute hospital unit short staffed.’
The problem has also been exacerbated by NHS staff having to continue to isolate if a family member has a positive Covid test, she explains.
Sophie*, a midwife from Manchester, says: ‘Exhausted doesn’t cut it. We are in trouble as an industry and profession, that is for sure. There are not enough midwives to go round.’
Sophie points out that the government cut bursaries for midwife courses in 2017 and that four years later they are now starting to see the impact. ‘If you have midwives coming in newly trained, that helps with the staff pipeline and future staff shortages but without that new intake, we’re going to really struggle.’
The Royal College of Midwives (RCM) warned that this would leave maternity services desperately stretched at the time.
‘In England alone we remain 3,500 midwives short. This, coupled with younger midwives leaving, an ageing workforce and the loss of European Union midwives post Brexit, means the RCM has grave concerns for staffing our maternity services,’ said RCM director Jon Skewes.
Sophie says that during the start of the pandemic, many older midwives were reluctant to carry out home visits, which put more pressure on their younger colleagues and meant new mums were left short of care. Things began to get really difficult on the wards at the start of this year, she says.
‘I know colleagues who have been working for 86 hours straight,’ she says. ‘I work on a unit with a mixed antenatal and postnatal ward and a consultant led delivery suite with 10 beds. Fully staffed, we have 10 midwives and a matron. But most days, since the pandemic, we only have five or six midwives at any one time and, since Covid, we’ve been down to just four midwives per shifts. It’s unsafe and we can’t deliver the care we so want to deliver.’
The hospital Lucy works at had to temporarily close its birth services unit during the pandemic due to staff shortages. She is very aware of the impact that this could have on new and expectant mums.
‘Not being able to provide the sort of services to women are expecting or a birth in a midwifery-led unit means that all women are cared for in a medicalised environment. This means they are more likely to have intervention in labour and end up with a medically managed birth. The fact they are not able to even attempt to birth in the environment they choose impacts their mental well-being.’
Marley Hall, an independent midwife from Surrey, said she saw a huge surge of queries from expectant parents during lockdown. ‘I went from 30 to around 300 messages per week, mainly from worried parents to be that felt unable to get in touch with their maternity teams. Many were having reduced face to face appointments and felt anxious.’
Marley, who left the NHS in 2020 after 11 years, says: ‘Many women message me reporting feeling in limbo, unable to get the help they need when they've had a baby and this can lead to things like post-natal depression being missed. I assure them that the maternity services are still there 24/7 but the constant pressure the staff are under, ends up making the parents feel like their care is rushed.’
A recent NHS England report showed that one in six critically ill Covid patients were pregnant women who were unvaccinated, but with mixed messages, many women have understandably been cautious.
‘Some of the pregnant women we’ve seen with Covid have been really poorly and have had to give birth under anaesthetic,’ Sophie says. ‘We had one lady in the other week who had to go into intensive care for two weeks after giving birth.’
Sophie says that midwives are only able to offer the most basic after-care to many new mums. ‘With the chronic staff shortages, colleagues being off with Covid and the extra strain it’s put on maternity wards, we’ve not been able to provide any additional support after delivery.’
Jessica*, a midwife from the Midlands, who works across two hospitals, says the problems with maternity services are systematic and that the current crisis is not just down to Covid.
‘Maternity services have been stretched for many years now. It’s not a new thing and it’s largely down to staff retention,’ she says. ‘People are leaving midwifery in droves because the pressure, the long hours, the lack of support and the stress of the job is just too much. These problems have been brewing for a long time and until we start to look at ways we can address them, the situation is only going to get worse.’
*Names have been changed