‘At The End Of Every Shift, I Wonder Whether I Can Push On’: The Reality Of Being An NHS Midwife

For the 600,000 women a year who have their baby on an NHS ward, it’s the most intense day of their lives. Leah Hazard, a midwife for six years, reveals what it’s like to be the person responsible for guiding them through it...

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by Leah Hazard |

I thought I knew what fear was before I became a midwife, but I was wrong. Sure, I was prey to all the usual common- or-garden variety fears – of what others thought (particularly acute growing up as the chunky, bespectacled daughter of two academics), of never finding my place in the world (still working on that one, having changed careers numerous times), and that old favourite, fear of death (which I viewed up close through a diamorphine-fogged lens during childbirth). But real fear – the kind that sends a jolt of adrenaline to every cell and synapse in your body, the kind

that makes you think you’re going to bring up your breakfast and soil your scrubs all at once – that kind of fear only became vividly real to me once I had become a midwife.

You know, the job where you get to cuddle newborn babies and hold ladies’ hands all day, and cycle down cobbled lanes in your cloak and cap? Yeah, that one.

It was stupid o’clock in the morning and I’d been looking after a labouring woman since the start of my shift. In the final stages, her baby’s steady, reassuring heartbeat began to stutter, then drop, and then almost stop. I pulled the emergency buzzer and the usual suspects piled into the room – the labour ward sister, an auxiliary, the obstetric registrar and a paediatrician. The mother was told to push her ‘tired’ baby out, but her pushes were tired too, and while the baby remained tantalisingly close, its heartbeat was spiralling lower and lower. Now, for the first time, I wondered whether this baby would die before we even saw its face.

The faces I usually looked to for reassurance were as ashen as my own when the baby finally slid out, dusky and limp, to be whisked over to the Resuscitaire machine for oxygen from a tiny mask, and chest compressions on delicate ribs. An eternity seemed to pass before I heard a feeble cry, and glimpsed a little foot blooming from purple to pink.

That visceral fear is just one of so many sensations I’ve discovered during my time as a midwife. There is the hilarity of my colleagues’ filthy, foul-mouthed, sleep- deprived humour; the crushing exhaustion of the third night-shift out of four; the exhilaration of knowing that, in collaboration with a highly skilled team of other midwives and medics, I have saved a life; and the searing pain of telling a woman that her baby has died – an empathic ache of sorrow and horror that never gets easier to bear. When most people think of midwives, they think only of joy – and yes, there is the delight of welcoming a baby into the world – but our role and our experiences are so much more complex (and sometimes, so much more troubling) than that.

When I decided to train as a midwife six years ago – having worked as a doula (or birth coach) for six years before that – I anticipated a varied and challenging job, but I could never have anticipated the true breadth of the role. I certainly didn’t anticipate coaching 14- and 15-year-olds through their first labour pains as they gave birth to their own little humans. I didn’t expect the number of traumatised asylum seekers who’d end up in my care, bearing deep emotional and physical wounds from faraway war zones. I didn’t anticipate palpating (feeling with my hands) the tiny tummies of anorexics or the vast abdomens of the morbidly obese, and I definitely didn’t expect the phone call in which I talked a woman through what I thought were the throes of advanced labour, only to find that all she really needed was a giant poo.

The truth is that midwifery in today’s NHS is nothing like I imagined, and it’s nothing like you think. Current representations of midwives in the media do little to improve the accuracy of public perception. While Call The Midwife makes admirable attempts to tackle topical issues, it’s hard for me to reconcile its nostalgic glow with the harsh reality I face every day. One Born Every Minute purports to be a fly-on-the-wall documentary, but at its heart it’s entertainment – highly edited for ‘the best bits’ of labour and birth. One would be forgiven for thinking, based on these two programmes, that midwives are endlessly good-natured souls, uncomplainingly catching the odd baby in-between supersized mugs of tea and the odd pithy moral platitude.

Writing my memoir has been my attempt to dispel those myths, and to paint a more realistic picture of my profession. We’re not all good-natured, for one thing – we have the same prejudices and preconceptions as the rest of the world, and I’ve witnessed countless tea-room tirades against any number of ‘soft’ targets, including women who conceive accidentally, women who spend their life savings on fertility treatment, breastfeeders who just can’t get the knack, ‘greedy’ refugees... the list goes on.

But I’ve also seen midwives bending over backwards to help these women: nursing their broken bodies, listening to their tales of desperation, holding them in an unbreakable bubble of care. And they do this work at the expense of their own health, sacrificing their time, energy, well-being and, quite often, personal relationships in the name of helping others.

We do this for disproportionately poor reward, and the system in which we work is dangerously under-resourced and under- funded. I work in a large urban hospital and, like so many units up and down the country, we get through each shift by the skin of our collective teeth. Managers told us in a meeting not long ago that ‘there’s no money in the pot’, and don’t we know it – we’re almost permanently short-staffed and there’s a constant scramble to find empty beds for those who need them. There’s no ‘give’ in the system, and this pressure takes a far-reaching toll on those who use it and work within it.

I’d like to say that patient safety isn’t compromised on those increasingly common days when women in labour form a queue out the doors of triage, or that I’ve never thought of the precarious bed state when deciding whether to admit a woman or send her home, but I can’t. And this perpetual pressure, combined with the hypervigilance required to ensure that every woman is safe at every given moment takes an emotional toll. There’s only so hard a woman – or a midwife – can push, and at the end of every shift, I wonder whether I can push on.

We must not take midwifery or the NHS for granted. On more days than you might like to believe, the system and its staff are close to collapse. Many of my senior colleagues have taken early retirement in the last few years and, with the withdrawal of the student bursary in much of the UK, there’s scant hope of replacing them in adequate numbers. My book is a love letter to the women I care for and work with, but it’s also a battle cry. My voice is just one of many; we ask only that you stop and listen, so that our story can continue.

Leah’s memoir, ‘Hard Pushed’, is out on 2 May.

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