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?
SPONSORED FEATURES
iJobs Job Widget
iJobs General

Guru Careers: Copywriter / Direct Response Copywriter

£20k plus sales linked bonus. : Guru Careers: We are seeking a Copywriter to j...

Recruitment Genius: Accounting Technician

£17000 - £18000 per annum: Recruitment Genius: A fantastic opportunity has bec...

Guru Careers: 3D Creative Designer

Up to £26k DOE: Guru Careers: A Junior / Mid-Level 3D Creative Designer is nee...

Recruitment Genius: Ecommerce Website Digital Marketing Manager - Fashion / Retail

£40000 - £60000 per annum: Recruitment Genius: You'll be joining a truly talen...

Day In a Page

Read Next
Jeremy Corbyn greeted by supporters in at a Labour leadership rally Camden, North London  

Labour leadership contest: Hard-left caricatures of Jeremy Corbyn are not fair or right

Richard Burgon
Edward Heath, pictured at his Albany flat in 1965, the year he became leader of the Conservative Party  

Edward Heath 'child sex abuse' allegation: Rumours always swirled about his sexuality - I’m sure that’s all they were

John Campbell
Turkey-Kurdish conflict: Obama's deal with Ankara is a betrayal of Syrian Kurds and may not even weaken Isis

US betrayal of old ally brings limited reward

Since the accord, the Turks have only waged war on Kurds while no US bomber has used Incirlik airbase, says Patrick Cockburn
VIPs gather for opening of second Suez Canal - but doubts linger over security

'A gift from Egypt to the rest of the world'

VIPs gather for opening of second Suez Canal - but is it really needed?
Jeremy Corbyn dresses abysmally. That's a great thing because it's genuine

Jeremy Corbyn dresses abysmally. That's a great thing because it's genuine

Fashion editor, Alexander Fury, applauds a man who clearly has more important things on his mind
The male menopause and intimations of mortality

Aches, pains and an inkling of mortality

So the male menopause is real, they say, but what would the Victorians, 'old' at 30, think of that, asks DJ Taylor
Man Booker Prize 2015: Anna Smaill - How can I possibly be on the list with these writers I have idolised?

'How can I possibly be on the list with these writers I have idolised?'

Man Booker Prize nominee Anna Smaill on the rise of Kiwi lit
Bettany Hughes interview: The historian on how Socrates would have solved Greece's problems

Bettany Hughes interview

The historian on how Socrates would have solved Greece's problems
Art of the state: Pyongyang propaganda posters to be exhibited in China

Art of the state

Pyongyang propaganda posters to be exhibited in China
Mildreds and Vanilla Black have given vegetarian food a makeover in new cookbooks

Vegetarian food gets a makeover

Long-time vegetarian Holly Williams tries to recreate some of the inventive recipes in Mildreds and Vanilla Black's new cookbooks
The haunting of Shirley Jackson: Was the gothic author's life really as bleak as her fiction?

The haunting of Shirley Jackson

Was the gothic author's life really as bleak as her fiction?
Bill Granger recipes: Heading off on holiday? Try out our chef's seaside-inspired dishes...

Bill Granger's seaside-inspired recipes

These dishes are so easy to make, our chef is almost embarrassed to call them recipes
Ashes 2015: Tourists are limp, leaderless and distinctly UnAustralian

Tourists are limp, leaderless and distinctly UnAustralian

A woefully out-of-form Michael Clarke embodies his team's fragile Ashes campaign, says Michael Calvin
Blairites be warned, this could be the moment Labour turns into Syriza

Andrew Grice: Inside Westminster

Blairites be warned, this could be the moment Labour turns into Syriza
HMS Victory: The mystery of Britain's worst naval disaster is finally solved - 271 years later

The mystery of Britain's worst naval disaster is finally solved - 271 years later

Exclusive: David Keys reveals the research that finally explains why HMS Victory went down with the loss of 1,100 lives
Survivors of the Nagasaki atomic bomb attack: Japan must not abandon its post-war pacifism

'I saw people so injured you couldn't tell if they were dead or alive'

Nagasaki survivors on why Japan must not abandon its post-war pacifism
Jon Stewart: The voice of Democrats who felt Obama had failed to deliver on his 'Yes We Can' slogan, and the voter he tried hardest to keep onside

The voter Obama tried hardest to keep onside

Outgoing The Daily Show host, Jon Stewart, became the voice of Democrats who felt the President had failed to deliver on his ‘Yes We Can’ slogan. Tim Walker charts the ups and downs of their 10-year relationship on screen