Last week I received a message on social media from a newly-qualified midwife. “I’ve just had a panic attack and left work in the middle of my shift,” she told me. “The staffing has been dangerous for months. I’m tired of pretending that it’s normal.”
The staffing has been dangerous for months. Not just the odd day here or there, not just a few weeks, but months.
I wrote back to the midwife and expressed my concern; I asked her if she was safe, and whether she could share her emotional load with a trusted family member or friend. My fingers typed these words automatically, a reflex of rote comfort. The truth is that since I wrote a memoir of my own midwifery career in 2019 my phone has bleeped and pinged with cries for help on an almost daily basis. I seem to have become a kind of unwitting agony aunt for colleagues who, unheard by a government that views maternity as a kind of quirky sidebar to the “real” NHS, are desperate for someone, anyone, to hear their stories.
The messages I receive are disturbingly similar: there are not enough midwives to care safely for wards full of women and babies. Staff are crying in toilets, sluices and car parks, tired of apologising for a woefully under-resourced service, tired of 12-hour shifts with no breaks, tired of emergency buzzers haunting their dreams and imagined haemorrhages waking them in a cold sweat. Just tired. The emotional and physical toll is universal. The problems within the system are endemic.
On 30 March the independent midwife Donna Ockenden published her review of nearly twenty years of maternity failings at the Shrewsbury and Telford Hospital NHS Trust. Poor care contributed to or caused the deaths of 201 babies and nine women, and the permanent injury and trauma of many more. The report describes an environment in which staffing was inadequate, bullying and toxic relationships were rife, medical staff were stretched thinly across gargantuan workloads, and families’ concerns were dismissed and ignored with shockingly callous arrogance. The events covered by the Ockenden Review have been described as the biggest scandal in the history of the NHS. What the public may not realise, though, is that the true scandal is even bigger. The failings are everywhere, and they’re ongoing. Most of them just haven’t been exposed yet.
Nine years of midwifery have thickened my skin. I can, and often do, cope with blood, pain, chaos and tragedy. However, as I read the case studies and staff testimonies in Ockenden’s report, I had to stop and catch my breath every few lines. The circumstances Ockenden describes — the missed breaks, the unsafe staffing ratios, the constant worry that things will go horribly wrong in spite of the very best efforts made to make them go right — hold up a mirror to my own career.
I know many, many midwives across the UK have had the same reaction. They have read this catalogue of catastrophe while thinking, “That could be me. That could be here. That is here.”
After the shock and sorrow comes the anger. As a profession, we have been raising the alarm for years. We have been speaking out, campaigning, marching — anything we can do to catch the fickle eye of a government that seems hellbent on dismantling the NHS and determined to ignore that tricky little women’s business of maternity for as long as possible. I tried to do my bit by writing a book about the desperate challenges facing our profession. It sold well. I did the “circuit”. Nothing changed.
I hoped that perhaps the pandemic would highlight the very best of midwifery, how we’ve risked our lives to protect birthing families from a terrifying disease, but the Health Secretary Sajid Javid’s paltry promise to provide a boost of £127m for maternity — less than half the sum recommended by the Health and Social Care Select Committee in 2021 — shows how little our efforts mean to those in power. So, with hoarse voices, we shout louder. With broken backs, we push harder. Still, nothing changes.
At what cost? Obviously, the greatest toll is counted in human lives: those of the mothers and babies from Shrewsbury and Telford who should be alive today. Ockenden has suggested that to prevent more tragedies like these staffing levels should be reviewed and improved as a matter of urgent concern. This overhaul will be no mean feat. Midwifery has a dire rate of retention — only one graduate midwife staying in the role for every 30 who are trained — as well as a mass exodus of experienced midwives who no longer wish to work in a system that causes demonstrable harm. A 2021 survey from the Royal College of Midwives showed that over half of midwives were considering leaving their job, and 57 per cent of those planned to do so in the coming year.
Where, then, does this leave maternity services? For meaningful change to come the government needs to realise that birth isn’t just a sideshow, and midwifery isn’t just nice ladies smiling and holding other nice ladies’ hands. Birth is where we all begin and, as such, midwives lay the foundation for a lifetime of public health. Those who control NHS budgets must get wise to these facts, and soon. If they wait too long, there will still be hands to hold, but no one left to hold them.