Childbirth in crisisDirty, over-crowded wards. Demoralised midwives forced to put form-filling before patients. And soaring birth rates… The Mail goes inside a maternity ward
At 9am in the operating theatre at London’s Elizabeth Garrett Anderson maternity unit, midwife Michelle Thorne is recording her first birth of the day: a boy weighing 8lb 10oz, born by elective Caesarean.
His mother was transferred here from a nearby private clinic (where treatment will set you back 10,000) because there they are not equipped to deal with high-risk cases and her son was in an ‘extended breech’ position.
At the clinic she left behind, the rooms are akin to a five-star hotel suite, with Molton Brown products and champagne to toast the newborn. But here, on an NHS ward, the new mother is left to recover from abdominal surgery with her hour-old son on a post-natal ward crammed with 40 other women, plus their babies, and just three midwives on ward duty.
Exemplary treatment: The EGA wing at University College Hospital offers some of the finest maternity care in the UK. But huge shortfalls in funding are threatening the quality of the services
The EGA wing at University College Hospital offers some of the finest maternity care in the UK and attracts people from all over the country to its lauded labour ward and birthing centre. But huge shortfalls in funding are threatening the quality of the services on offer.
So overstretched are maternity staff at state-funded clinics that midwives are seriously concerned about the quality of care they can offer.
The situation, says Cathy Warwick, General Secretary for the Royal College of Midwives, ‘is very close to breaking point’. Despite the best efforts of its staff, she adds, NHS London is already in crisis.
Just two months ago, an investigation by the Care Quality Commission at the Barking, Havering and Redbridge University Hospitals NHS Trust, following the death of two women in the care of its maternity services, found the trust needed to deliver ‘fundamental and wide-ranging improvements’.
A midwife elsewhere, at one of the capital’s most respected units, says: ‘You feel like shouting, “This is ridiculous”. I’m looking at these women and thinking: “I can offer you safe care, but it’s inhumane care; I can look after you without letting you die, but I can’t make it a nice experience”.’
Pregnancy-related death in this country is still relatively low; the most comprehensive recent report on maternal mortality found that in the UK between 2006 and 2008 there were 261 female deaths directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities, with infection overtaking haemorrhaging and thromboembolism as the most common direct cause.
Many of the women I’ve spoken to over the past few months have had good experiences, such as Ruth and Matt who I meet at the EGA’s birthing centre, dedicated to natural delivery.
Their midwife, Helle, sits at the edge of a low bed brimming with cushions as Ruth moves between the birthing ball and a birthing pool in her own personal suite — a service open to anyone deemed at ‘low-risk’.
But to varying degrees, horror stories involving maternity care at NHS hospitals, ranging from dirty wards and missed blood tests to aggressive or absent staff, seem to be commonplace.
Overstretched: Pregnancy-related death in this country is still relatively low… but for how long (File photo)
Debra Kroll is a community midwife in Central London, and advises the Nursing and Midwifery Council, whose responsibility it is to ensure staff are following the professional code and to take action where necessary.
She says standards are only going to get worse: ‘The biggest frustration for someone with my experience is not being able to support new midwives coming through’. If staff are unsupported, she adds ‘then care is not safe’.
In the past 20 years, the birth rate in Britain has risen by 22 per cent. At the same time there’s been a surge in the number of older women giving birth for the first time, and of women getting pregnant who are obese or have pre-existing medical conditions. This means more support is needed in pregnancy, labour and the recovery period, creating a complex workload for midwives.
I spend a morning with Debra Kroll at the James Wigg Practice in North London, where she works two days a week as a community midwife.
‘The biggest issue,’ she says, ‘is the complexity of social and medical needs. Women come to us with language barriers, social and medical problems. There are very large pockets of social deprivation, so the need for extra social services is huge.’
This means hours spent filling in forms: ‘I do a clinic from 9am-1pm; that brings at least another three or four hours of paperwork.’
There simply aren’t enough midwives on the ground, and it’s not just the South of England which is buckling. The West Midlands, Yorkshire and the Humber and the North-West are among a number of regions suffering crippling shortages.
Nationwide, more than one-third of heads of midwifery have been told to cut staffing levels; two-thirds say they haven’t enough people to cope with current pressure. During his election campaign, acknowledging pressures which left NHS staff ‘overworked’ and ‘demoralised’, David Cameron promised 3,000 extra midwives. Then he changed his mind.
The Government has decided to keep the number of midwives in training this year at the same level as last year, but from then on, there will be no plans to safeguard the number of midwives in training and no protection for the number of jobs.
Meanwhile, pensions are being reviewed, and basic terms and condition and incremental pay rises for staff across the NHS are all coming under attack.
Timebomb: In the past 20 years, the birth rate in Britain has risen by 22 per cent (file photo)
Midwife Michelle Thorne is stationed on the high-risk ward at the Elizabeth Garrett Anderson, which deals with women with conditions such as gestational diabetes, and those awaiting C-sections.
There are just four beds, so once an operation is complete, if all goes well, mum and baby are taken to the post-natal ward to recover; a large portion of Thorne’s day involves moving between wards, looking for free beds and duty midwives to whom she can hand over care of her mother and babies, before more yet paperwork.
This morning (‘a quiet one’) she struggles to find anyone to hand over care to on the post-natal ward. The first midwife she tries — one of three women already in charge of 40 babies and their mothers — tells her flatly: ‘I’ve got enough on my plate’.
There should always be one nurse on duty solely dedicated to babies on antibiotics, but today there are not enough staff, so between them they are looking after these as well as their usual share of the ward.
Meanwhile, one of the three midwives on duty is telling a woman that her baby has been diagnosed with Down’s syndrome. ‘Who’s doing the antibiotics then’ someone asks. ‘They’re sending a nurse up from downstairs, so they say.’
‘No more beds,’ notes Thorne, who qualified in 2005, after working as an intensive care nurse. What does that mean ‘If there are no beds, the pressure’s on to discharge someone.’
Later I speak to one of Thorne’s colleagues who has worked at the hospital for 20 years, and says there have been ‘many changes’ recently. For the better She frowns. ‘Gosh, no! Everything’s more difficult.’
With management faffing over protocol, excessive form-filling and not enough hands on deck, she says staff are preoccupied. The first thing that gets swept aside, ‘is looking after the women and babies’.
Aneira Thomas was the first baby to be born on the NHS on July 5, 1948. She was named after its founding father Aneurin Bevan
According to the Royal College of Midwives, there is already a shortfall of 4,700 midwives in the UK. ‘In order to replenish the number who will retire over the next decade,’ says Warwick, ‘we need to keep the same number that is coming into service now, over the next 15 years.’
But — assuming there are any jobs left — one wonders how the NHS will attract new talent into the sector. The starting wage is typically 21,176, slightly more in London, for an average 37 hours a week, though unpaid overtime is part-and-parcel of the job. Thorne does three days on, four off, with an hour’s lunch break per shift.
The real problem is that with so many other pressures on their time, looking after women — the reason most midwives are surely drawn to the profession — has become a marginal part of the job. Two years ago, as a new mother recovering from an emergency Caesarean that followed a failed induction, I was shocked by the level of care I received in hospital.
Having been induced — a common procedure when you’re overdue, even if you’re young, fit and healthy as I was — my boyfriend and I were left alone in a room for hours at a time.
This meant that in the end, after four days of being attached to a monitor, but rarely catching a glimpse of a midwife, I ended up needing an emergency C-section. At an additional cost of about 2,500 to the NHS, compared to the average 1,000 for a natural birth.
In the 16 hours I spent in hospital after surgery (I was discharged early in order to free up beds) there was no one around to help me establish breastfeeding, or even pick up my baby when she needed feeding, my boyfriend having been sent home since our daughter was born outside of ‘visiting hours’.
Repeatedly, my calls for help went unanswered. Sadly, my experience appears to be a pretty standard reflection of childbirth in Britain today.
While I had impeccable antenatal care that was so good it made up for the fact that clinics were often overrunning by several hours, post-natal care seems to be in particularly bad shape (after all, if you’re short-staffed the priority is understandably to get midwives on to the labour ward, and the obvious place to pull them from is the recovery ward).
It doesn’t help that natural delivery has never been so unpopular in Britain. The number of women having Caesareans has doubled in the past 30 years, accounting for 24.9 per cent of births in the UK in 2009. And a surge in surgical births should mean that post-natal care from a midwife becomes more important, not less.
The bottom line, says Cathy Warwick, is that Britain’s NHS midwifery service needs more staff and a more efficient way of working, one less bogged down by targets and forms, and more interested in women.
‘At the moment the system is like a big sausage machine,’ she says. ‘We used to talk about the alienated worker in the car factory, who only fitted the clutch or the gear stick and so didn’t care what happened to the car.’ This, she concludes, is what the system is making of midwives.
‘Unless something is done very soon to change things, we’ll have a real crisis on our hands.’
The Independent 2011