Nottingham maternity scandal: Midwives reveal their fears for the safety of mothers and babies

Exclusive: Nottingham midwives break their silence to The Independent – ‘Without a doubt, women are still at risk of harm’

Shaun Lintern
Health Correspondent
Sunday 25 July 2021 21:23
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<p>Nottingham University Hospitals Trust is facing a review of its maternity services</p>

Nottingham University Hospitals Trust is facing a review of its maternity services

A hospital facing an inquiry into scores of baby deaths on its wards still poses a danger to mothers and infants, according to midwives who work in its maternity unit.

An investigation by The Independent revealed the scale of avoidable errors at the Nottingham University Hospitals (NUH) Trust that have led to infants dying or being left brain-damaged. Ministers have since announced an independent review into cases at the trust, which is one of the largest in England.

But while the hospital concerned – the Queen’s Medical Centre in Nottingham – claims it is making significant changes and recruiting more staff, midwives have told The Independent that there are still not enough resources to help mothers give birth safely, with dangerous levels of understaffing as well as a shortage of beds and equipment.

One said they were regularly left in tears by the conditions at the hospital, which the care regulator rated inadequate in December last year.

“We’ve been banging our heads against a brick wall. I come home crying every day, saying ‘What the hell have I done?’ I have put myself through financial hardship for three years and I’ve gone into a career where, every day, I feel like I’m going into chaos.

“It’s that kind of anxiety where you think, is today the day that I’m going to be put in front of the coroner’s court because a mum or baby has died in my care?”, they added.

One midwife working in the community told The Independent: “They keep saying ‘We’ve learned our lessons, it’s not like that now’ – but it’s even worse now. It’s worse because we know about it and it’s still bad. Women are still at risk of harm. Even more so in the community.”

The hospital is facing calls for an inquiry into alleged failings in its care of mothers and babies after dozens of families raised concerns. Patient safety minister Nadine Dorries has agreed to meet with local MPs and families, while the NHS has agreed to an independent review of cases going back to 2016.

The trust is facing at least a dozen clinical negligence claims by families, and has paid out more than £91m in damages and legal costs since 2010 over incidents including 46 cases of babies left with permanent brain damage and 19 stillbirths, as well as 15 deaths involving mothers and babies.

A midwife working in the hospital’s maternity unit said one of the main issues was a lack of staff and resources.

They said: “You’re running around for a thermometer; you’re running around for a blood pressure machine. We’re sharing the same resources because there’s nothing available. There’s nothing that works.

“There’s just a bottleneck of postnatal beds. So there’s no movement, because if you can’t move people from the labour suite to the postnatal ward, you can’t take a new labourer. And then you can’t take an induction because they need to come round to the labour suite. So you’re chasing your tail constantly.”

The Independent was told that many newly qualified midwives who have been recruited to the trust have since left or gone off sick. It is also claimed by several staff that, due to staffing gaps, some have been given high-risk women to look after with little support. The Independent has previously reported on instances of high-risk women being looked after by new midwives.

One said: “I can be given a woman and she could die and it’s not even my fault. It’s the lack of support. It’s the lack of resources. It’s so scary to feel like you are going to be shot down because of no fault of your own. I wanted to support women, to empower them. I wanted to be their advocate and I can’t do any of that at NUH.

“I am planning to leave, but this has tainted my view of midwifery. Even if I go to another trust, is it going to be the same?”

The trust has previously said it is fighting to fill 70 vacancies in its midwifery staffing – a problem common to midwifery units across the country.

The Nottingham trust also runs community midwifery services, including a home birth service, but midwives said the service was regularly not running because the trust just did not have enough staff.

One community midwife was given a whole area of Nottingham to cover on her own as a newly qualified midwife, a source said, adding: “When she asked for help, they said: ‘We haven’t got any staff, you will have to make do with it.’ They’re screaming out for midwives all the time at weekends.

“Women are still at risk of harm. Even more so in the community. In the hospital, there’s always somebody to ask, or somebody to pass something to. At the weekends, for example, I’m working nine to five and I’ve been given seven or eight women. And I cannot physically go around and see all of them to give them the care that they need. I’m working three, four hours extra writing up notes.”

They said women were regularly being discharged from hospital without having breastfed, and were just given a bottle in order to free up the beds. “This is all the time,” one worker said: “They’re just giving them a bottle just to get them out.”

They added: “The community situation is so well hidden. Because the hospitals always get the headlines. The poor care is always at home when the women are more vulnerable, because they’ve got no one to complain to.”

The Independent has seen emails confirming allegations by the staff that some guidelines used by the hospital were contradictory or inadequate. In one email, the policy for identifying jaundice in newborns was described as not fit for purpose. And in an email earlier this year, staff were told to refer parents to A&E for a test before a second email reversed this and said it would be left to the professional judgement of staff.

But one midwife said: “Because we are so short-staffed it’s not the same person going in to see the baby.” They said this could affect the visual judgement being made.

One worker told The Independent that a new computer system could take four minutes to load one page, with 31 pages required to be filled in for a new booking.

In response to the concerns, the chief nurse for the trust, Michelle Rhodes, said: “We are truly sorry, and apologise from the bottom of our hearts to the families who have not received the high level of care they need and deserve.

“Improving maternity services is a top priority and we are making significant changes, including by recruiting midwives, consultant obstetricians and managers to support staff, as well as reviewing the way we respond to incidents and providing additional updated equipment and training for our teams on the monitoring of babies. We are also reviewing our clinical guidelines to ensure they are in line with best practice.

“I’m sorry that some of our staff feel like they haven’t been listened to – we hold regular open forums with our new director of midwifery, the senior team and myself, to actively encourage them to raise any concerns with us, and they can also speak to any of the leadership team at any time, or our ‘Freedom to Speak Up’ guardians.”

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