Surprise! Government cuts are putting women’s health, women’s bodies and their babies at risk. A recent study called Support Overdue, brought out by NCT and the National Federation of Women’s Institutes, found that ‘dangerously low staffing levels mean that half of women experience at least one red flag event during childbirth’. We’re not talking matadors here - a red flag event might mean waiting over half an hour for pain relief during labour, being left alone during labour, waiting too long to wash or have stitches after labour, even a delay in medication.
A red flag event is not in itself dangerous, but it can signal that something dangerous could develop; it leads to women feeling that they’ve been abandoned, that they’re not important, that they’re on their own.
Let us be clear: this isn’t the NHS’ fault. The National Health Service is, like all services, vulnerable to circumstances beyond its control. The government has cut funding to maternity services, while demanding more of the staff left behind; midwives are seeing a great increase in complex births; we’re experiencing a baby boom [there were just over 100,000 more babies born in 2015 than there were in 2001]; shift patterns are moving towards 12-hour stints; and the country is still short of 3,500 full-time midwives. As Louise Silverton, the Director of Midwifery at the Royal College of Midwives, put it to me this week, ‘The simple message is there aren’t enough midwives. But the key thing is, there aren’t enough midwifery jobs. And that’s because the money in England that pays for maternity care isn’t enough. The government is expecting us to provide more and more… But there’s no more money and no more time to do that.’
I spoke to lots of women for this article - mothers, midwives, policy advisers - and the thing that came up again, and again was that midwives are doing their best. They’re doing an amazing job, in fact. But they’re having to do so under unbelievable conditions; 12 hours shifts without a wee, looking after several women at once, exhausted, frustrated and demoralised. As one midwife, who wished to remain anonymous, told me, ‘Not a single day goes by in my workplace when we are fully staffed. On some wards, it’s become the norm to run the place on skeletal staff. Midwives are moved from their usual wards and areas of expertise, to try and help other wards that are less staffed. The harder everybody works, the more tired we become. It has become acceptable on some wards not to have a single break in a 12 ½ hour shift… On-call community midwives are frequently called in to help overnight…affecting the community teams the next day.’
In this sort of climate, it’s no wonder women report feeling ‘like cattle’. It’s little surprise that mothers are worried. And, as anyone who understands how muscles, orifices and stretching works, the more anxious you are during labour, the more likely you are to experience problems. Sometimes, serious problems. I spoke to a woman in Bristol who, during the birth of her second child, had to be taken across the city to a birth centre during labour because the hospital she was booked into didn’t have space for them, then had to be taken back to the hospital in an ambulance during established labour (the active stage of the process when everything is in full swing) because of problems with the baby, and then be driven across the city again just four hours after the baby had come out had to go back to the birth centre, in their own car, because her bed was needed. ‘The midwife I spoke to said they’d had a couple of emergency cases come in when I was there and that’s why it had all just gone to hell, really. They just didn’t have the staff in to cope with it’, she tells me over the phone. ‘When I told my midwife I was submitting a letter of complaint she gave me all the information I needed of who to write to and how. She told me that it’s “really useful for mums to do this because they don’t really listen when midwives say stuff”. I thought it was interesting that the midwives themselves are looking for support from mothers.’
The second thing that came out of these interviews was the serious lack of staff, time and resources for post-natal care. Because - surprise! - pushing the baby out is only the start of it. A woman in Birmingham, who delivered her baby in the very same hospital where she herself was born, told me that after a fairly tricky labour, she was left on a ward, alone, at night, with a hungry newborn and just a ring binder containing information on how to breastfeed: ‘because I was on the ward with all the C-section mothers, who couldn’t get up, the midwives were run off their feet’, she told me. ‘My husband had to go home so I was left all alone, at night, on a ward, with my tiny baby, in the dark. She hadn’t eaten anything yet so I asked the midwife to show me what to do. She turned on the lamp, got a ring binder that had instructions on how to breastfeed and then left to attend to someone else. There should have been enough people on the ward for her to have been able to stay with me and show me. But instead, they were all running around trying to help everyone at once.’
This came up again and again - overworked midwives without the time to show a new mother how to breastfeed, how to change a nappy, how to bathe their baby. As Louise Silverton puts it, ‘If you’re really busy in labour ward for three or four days, you’re then going to be really busy in postnatal care straight afterwards. Obviously, you can’t control the number of women who are giving birth - you can’t put them on a waiting list.’ And so, the overstretching continues into postnatal care. ‘I wanted to be a midwife to be with women, and to support them throughout pregnancy, childbirth and in the postnatal period,” one midwife told me. “It’s extremely frustrating to not be able to give the level of care you want to provide; the care that they deserve. It’s more than frustrating, it’s heartbreaking… Postnatal care is just as important, as women are hugely vulnerable and need all the support they can get in this period. Midwives play a central role in promoting the emotional wellbeing of women and their newborns, but how can we do this on just two or three home visits?’
The government is also, wait for it, cutting the funding used for children’s centres, breastfeeding cafes and classes, and community midwife centres. As one mother, who had a homebirth in Oxford told me, ‘In Oxford, the funding for children’s centres is getting massively slashed. Florence Park Children’s Centre, which is literally two streets away from where I live, is where the community midwife team is based. Now, I’m not sure where they’ll go if the centre is closed. One of the things that made a massive difference to me was having that [children’s centre] locally.’
It is also the case that most of the very serious problems occur after the baby has actually been born. As Elizabeth Duff, the Senior Policy Adviser at the National Childbirth Trust put it, ‘When we look at NHS budgets around 8 per cent is allocated to postnatal care yet 80 per cent of maternal deaths happen at this time...We do feel there is a mismatch… The postnatal ward is legendary for being chaotic, understaffed and really pretty unpleasant for women.’
So, why are things so stretched? Why are we 3,500 midwives down? Why aren’t there the resources we need? One simple answer is funding. According to figures from the Royal College of Midwives last year, maternity services are seeing cuts to their budgets, despite the high birth rate and more complex births. Almost a fifth (18.8%) of Heads Of Midwifery said their budget had decreased in the last year, compared to 14.6% in 2015. This is at a time when 93.2% surveyed said their unit is dealing with more complex cases than last year. ‘There’s absolutely no doubt that more resources are needed throughout the NHS and particularly in maternity care because the consequences of a shortfall in quality care are so awful and can affect a family for the rest of their lives,’ says Elizabeth Duff. ‘Not that I want to compare it to other forms of care because, of course, everybody needs high-quality care.’
Then there is the matter of training. It’s not there is a lack of people who want to be midwives - large numbers of women and men enroll onto midwifery courses every year. But the government has taken the somewhat wild decision to take away midwife’s training bursaries. That’s right - we no longer financially support those brilliant people who want to go into one of the most important, most difficult and most exhausting health services there is. ‘This is not a very timely decision from the government at all,’ says NCT’s Elizabeth Duff with remarkable understatement. ‘Nurses and midwives are different kinds of students because they have to work in the service to learn about hands-on midwifery, so they’re not in a position to take on a part-time job in a shop or a bar. The bursary was an absolute lifeline for many of them to simply get through the course and cover their costs. Quite a few women go into midwifery after having children, or another career, and it can be prohibitive to get a second student loan.’ Or, as one midwife put it to me a little more bluntly, ‘I wouldn’t have been able to apply for a midwifery position if a bursary wasn’t available to me, even with a part time job I simply couldn’t afford it.’ And, as we know, a health service works at its best when the staff demographic reflects that of the community it serves. Without funding, we will lose brilliant staff who simply can’t afford to train.
Talking of staff, the Support Overdue report found that ‘midwives feel more over-worked and under-resourced than the average clinical NHS member of staff. Midwives are so over-worked that a clear majority (63%) do not have enough time to use the toilet during their working hours and most (57%) report that they have to neglect some tasks because there is too much for them to do. Almost half (48%) say they feel stressed every day or most days due to workload, staff shortages, not having enough time to do their jobs, and missing their breaks. This compounds the recruitment and retention problems facing the workforce.’ No shit. The report also mentions that ‘while the full implications of the result of the EU referendum are still not yet clear, the decision to leave the EU has the potential to further harm efforts to recruit and retain adequate staff numbers across the entire NHS’. Great.
But perhaps one of the most obvious problems with maternity services in the NHS at the moment is continuity of care. Midwives simply don’t have the time, the schedule or the ability to see a woman through her pregnancy, labour and post-natal care like they want to. ‘We feel that there are things that need to be and could be done in the system without much more in the way of resources. Making systems that offer more continuity can actually mean midwives can do more with the time that they’ve got’, says Elizabeth Duff from NCT. ‘If they know the woman they’re looking after and have been with them all the way through the pregnancy then they don’t need to read more notes each time, make themselves known each time, spend a lot of time helping the mother become relaxed and reassured each time, because they already know each other. It also makes it more likely that their medical history will not be lost - the midwife will always know, for instance, that this woman has gestational diabetes or has previously lost a child, or had a stillbirth’. This, says Silverton, could be achieved if the government and NHS managers actually listened to midwives when they told them what they needed. ‘If you let midwives sort it out’, she says, ‘then they probably could sort it out’.
I asked one young midwife what she would say to Jeremy Hunt, if she had the chance. Her answer was simple and telling: ‘We are not his enemy, he needs to work with us, and listen to us’.
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This article originally appeared on The Debrief.