It's not just more midwives we need

To fix the maternity care crisis we should call on the experience and judgement of its practitioners, says one, who prefers to be anonymous

Share
Related Topics

Childbirth has been going on for a long time. You'd think we would have got the hang of it by now, but the way we are going in this country we're making it harder and harder. Before the last election the government promised to recruit an extra 3,000 midwives, but last week the National Audit Office revealed that the country is 2,300 short of this figure.

The NAO also points out that a fifth of the National Health Service maternity budget is spent on medical negligence cover. Cathy Warwick, chief executive of the Royal College of Midwives, said last week: "There are still a significant number of trusts not meeting standards of one-to-one care in labour and if there isn't a midwife in the room then it's harder to pick up problems early, intervene early and prevent problems later on."

As a midwife of more than 20 years' standing (and an apolitical one, I should add), I can only agree, and pretty well anyone in the business will support me. Much of my time is wasted trying to magic up some pillows or a thermometer. I am constantly working longer than my shift because I can't down tools and abandon my colleagues, or having to skip my meal break. And I have lost count of the number of times I have been emotionally blackmailed to scrap my day off because I know what pressure my colleagues are under. We do it because we can't help it. It's in our nature, but it isn't really good enough if we want to attract people to the profession.

The Government, advised by the RCM, is quite rightly wanting to increase "normal" births (including more home births, supervised by a midwife) and less needless and expensive surgical intervention. Yet there are countless times when expectant mothers arrange for a home birth, only to be called into the hospital because a midwife isn't available on the day.

So, by general agreement, we need more midwives, but I don't mean to whinge about the wickedness of the Government. The insurance issue needs to be addressed at the same time as the staffing levels. Hospitals are terrified of being sued, and are trying to get their insurance premiums down by reducing risk. This means that many of the midwives we do have spend too much time ticking boxes and keeping the lawyers at bay, rather than doing the job from which their profession's name derives (midwife: being "with woman").

The assumption is that by doing more observations on the mother and baby, for instance, the more likely you are to spot something amiss early. Intuitively that sounds right, but in this field there can be no certainty. Besides, you could be using a formula to look for something that only close human contact, experience and training can bring to light.

Since I started as a midwife, this "defensive" practice has gone up hugely. It's a clear case of too much time being spent on medicalising healthy women and taking valuable time away from caring for women who really need it. After a birth, midwives are so busy checking temperature and the heart and respiratory rate on perfectly healthy babies that they often don't have time for important issues such as enabling breast-feeding. The most common (and dispiriting) complaint we get from new mothers is: "I could see how frantic you were, so there didn't seem any point in staying. I thought I might as well go home."

Another issue is postnatal community care. Again, it is an admirable thing to offer, but are four visits in the first two weeks really necessary for, for example, a web-savvy mother on her third child? The mothers who need most care are the ones who are ill, through obesity, diabetes and high blood pressure, smoking and so on, or with babies which fail to thrive. Of course everybody needs monitoring, but sometimes a phone call will be more convenient and cheaper – and just as human – for all concerned. The "one size fits all" model is out of date.

We also underestimate the value of healthcare assistants. Many are trained to take blood and help breastfeed. Some midwives worry that hiring more healthcare assistants would devalue the midwives' role, but I can't agree. On the contrary, it would leave them freer to do the specialist stuff.

The real message is, as David Cameron would say, yes, we need more midwives, but we also need to let the ones we have use their judgement and discretion in a more flexible system. We need to let decisions be made not by professional bean-counters but by the professionals themselves.

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Recruitment Genius: Production Coordinator

£18000 per annum: Recruitment Genius: A Production Coordinator is required to ...

Recruitment Genius: Finance Assistant

£28000 - £30000 per annum: Recruitment Genius: A fantastic opening has arisen ...

Recruitment Genius: Web Developer

£28000 - £30000 per annum: Recruitment Genius: An exciting opportunity has ari...

Ashdown Group: Part-time Payroll Officer - Yorkshire - Professional Services

£25000 per annum: Ashdown Group: A successful professional services firm is lo...

Day In a Page

Read Next
 

The majority of sex workers enjoy their job - why should we find that surprising?

Alex Bryce
A 'match' on Tinder  

Tinder may have inadvertently hit its self-destruct button by charging older users more

Nash Riggins
Syrian conflict is the world's first 'climate change war', say scientists, but it won't be the last one

Climate change key in Syrian conflict

And it will trigger more war in future
How I outwitted the Gestapo

How I outwitted the Gestapo

My life as a Jew in wartime Berlin
The nation's favourite animal revealed

The nation's favourite animal revealed

Women like cuddly creatures whilst men like creepy-crawlies
Is this the way to get young people to vote?

Getting young people to vote

From #VOTESELFISH to Bite the Ballot
Poldark star Heida Reed: 'I don't think a single bodice gets ripped'

Poldark star Heida Reed

'I don't think a single bodice gets ripped'
The difference between America and Israel? There isn’t one

The difference between America and Israel? There isn’t one

Netanyahu knows he can get away with anything in America, says Robert Fisk
Families clubbing together to build their own affordable accommodation

Do It Yourself approach to securing a new house

Community land trusts marking a new trend for taking the initiative away from developers
Head of WWF UK: We didn’t send Cameron to the Arctic to see green ideas freeze

David Nussbaum: We didn’t send Cameron to the Arctic to see green ideas freeze

The head of WWF UK remains sanguine despite the Government’s failure to live up to its pledges on the environment
Author Kazuo Ishiguro on being inspired by shoot-outs and samurai

Author Kazuo Ishiguro on being inspired by shoot-outs and samurai

Set in a mythologised 5th-century Britain, ‘The Buried Giant’ is a strange beast
With money, corruption and drugs, this monk fears Buddhism in Thailand is a ‘poisoned fruit’

Money, corruption and drugs

The monk who fears Buddhism in Thailand is a ‘poisoned fruit’
America's first slavery museum established at Django Unchained plantation - 150 years after slavery outlawed

150 years after it was outlawed...

... America's first slavery museum is established in Louisiana
Kelly Clarkson: How I snubbed Simon Cowell and become a Grammy-winning superstar

Kelly Clarkson: How I snubbed Simon Cowell and become a Grammy-winning superstar

The first 'American Idol' winner on how she manages to remain her own woman – Jane Austen fascination and all
Tony Oursler on exploring our uneasy relationship with technology with his new show

You won't believe your eyes

Tony Oursler's new show explores our uneasy relationship with technology. He's one of a growing number of artists with that preoccupation
Ian Herbert: Peter Moores must go. He should never have been brought back to fail again

Moores must go. He should never have been brought back to fail again

The England coach leaves players to find solutions - which makes you wonder where he adds value, says Ian Herbert
War with Isis: Fears that the looming battle for Mosul will unleash 'a million refugees'

The battle for Mosul will unleash 'a million refugees'

Aid agencies prepare for vast exodus following planned Iraqi offensive against the Isis-held city, reports Patrick Cockburn