This Sunday’s episode of Call The Midwife (BBC1 8pm) will chart new territory as the sisters of Nonnatus House tackle female genital mutilation in 1960’s Poplar.
The BBC One drama will take a sympathetic look at the plight of Nadifa, a mother-to-be from Somaliland, who has undergone the procedure and is struggling with the after-effects.
Heidi Thomas, creator and writer of the series, told Woman’s Hour she had wanted for some time to explore the issue: “I have been interested in FGM for some time and it did seem to me that if we waited until 1962, the Somali community were beginning to settle and establish a foothold in the East End.”
An estimated 200 million girls have undergone FGM worldwide. The procedure involves the partial or total removal of the female genitals for non-medical reasons. UK hospitals now treat one FGM survivor every hour.
In 1962, the Somali community were beginning to settle and establish a foothold in the East End. Photograph: BBC/Neal Street Productions
Nimco Ali, anti-FGM campaigner and co-founder of Daughters of Eve, advised the programme makers on the episode. It’s loosely based on the experiences of her close relatives who moved from Somaliland (an independent state north of Somalia) in the 1960s.
Ali, who underwent FGM at just seven years old says that while the episode’s approach may “ruffle some feathers”, she was impressed with the “immense level of knowledge” the writers showed. .
“[It’s about] setting yourself in the mindset that it was set in the 1960s – this was the language that they used,” she told the Guardian. “There is that authentic thread that runs from the realities of 1960s to the privileges and the work that’s waiting for us [as anti-FGM activists] in 2017.”
Ali hopes that viewers won’t feel overwhelmed by the trauma that FGM brings, but that they will feel heartened to act and support anti-FGM causes.
“If you look at the statistics around FGM they look massive, and there’s no way to come at it, but it’s one girl in one generation. It’s about breaking the cycle.”
“I’m hoping that… a lot of my sisters will see that they can have these conversations. That a midwife might not necessarily be of this culture but they understand and as women they can appreciate their experiences from a Somali perspective.”
The findings of a new NCT report, which revealed that tens of thousands of women were having to seek help at accident and emergency (A&E) departments or with their GP because they cannot reach a midwife, do not come as a surprise to Hannah Harvey.
Harvey has been a midwife for five years. She says that while she and her colleagues care deeply about the women they look after, a nationwide shortage of midwives and government cutbacks to training bursaries mean they often struggle to provide the necessary support to new mums. According to the report by the NCT (pdf) and National Federation of Women’s Institutes, 36% of women who were not able to see a midwife as often as they required postnatally said that it caused them a great deal of concern while almost a third (31%) said that it resulted in a delay of a health problem (for them or their baby) being diagnosed and treated. The Royal College of Midwives (RCM) estimates England has a shortfall of 3,500 midwives.
“It’s really difficult,” says Harvey, who works in West Sussex. “Of course [as midwives] we want to provide round-the-clock care, to spend two or three hours with a new mum teaching her how to breastfeed, and offering the other support she needs, but there’s just not the capacity to do it. We’ve got to look at other ways of helping people.”
It was this challenge, alongside spotting a review that found high numbers of pregnant women use the internet to search for advice, that prompted Harvey to take matters into her own hands. In July 2016, she launched Ask the Midwife, an app that enables mums-to-be to contact midwives for advice.
“I [wanted to] create something where users could ask questions and get a fast response from a midwife, instead of using Google or parenting forums, where you’re not getting professional advice,” says Harvey.
“I saw it as a way of helping the women, [somewhere] they could go and access advice and the extra care they needed and they wanted. It’s also a platform to alleviate the pressure on the NHS and the midwives working in the community and the hospitals, who don’t have the time to spend with people who might want a bit more help with their newborn baby.”
Harvey initially used £10,000 of her own savings and raised £50,000 from friends and family to help develop and launch Ask the Midwife on iOS last year. Eight months after starting the business, the app has 4,000 users across the UK, and a network of 45 registered midwives. Harvey initially found the midwives by advertising for consultant positions, even receiving 500 applications in three days. Each midwife gets paid 25% commission per question or chat they answer. Many of the midwives still work for the NHS but use Ask the Midwife to earn extra money. Harvey estimates that 15-20% of conversations need to be escalated to an in-person consultation.
For the expectant mothers, there’s a small charge (from 99p) to ask a question, increasing to £19.99 a month for support during the nine months of pregnancy and up to 12 weeks postnatally. This includes unlimited use of the “ask” and live chat services, with responses from a registered midwife promised within an hour. Midwives are available seven days a week, 14 hours a day, with plans to make it a 24-hour service in the near future.
“We get a lot of early pregnancy questions, after someone goes to their GP but before they have their first midwife appointment at eight to 10 weeks. And then, postnatally, we get a lot of breastfeeding and feeding questions. If you’ve never had a newborn baby before, you don’t know what is normal.”
Digital technology is rising in popularity among expectant mothers. According to the NCT’s study, 34% of women are choosing to use an app to support their pregnancy – two thirds (65%) used apps to track milestones, such as when the baby kicked or to track contractions, and a third (32%) used digital technology to access information about diet, lifestyle or health issues. Popular apps include BabyBump, What to Expect (from the authors of What to Expect when you’re Expecting), and My Pregnancy Today, although the majority available have been developed in the US.
Jacque Gerrard, the RCM’s director for England says such digital technology can be useful, as long as the advice is backed up by evidence-based information and carries a health warning. “Women have access to mobile phones, the internet and they want instant answers, so I think [such digital technology] is a positive step,” she says. “But what I would say is it has to be used with caution. Sometimes women do need access to a midwife or a doctor and that’s got to be the first point of contact. The NHS does provide access to a midwife 24/7, 365 days of the year, no matter where you are in the country.” The RCM is itself currently developing a hub for pregnant women, including a live help function.
Harvey is in talk with NHS trusts who are considering piloting her service in their areas, and says she’d eventually like to be able to offer the service for free – although finding funding will be the first priority; she’s currently plotting an investment round with angel investors. There are also plans to expand into other countries once the market is established in the UK.
But it’s been a learning curve for the midwife, who still juggles working night shifts with developing the business. “It’s completely different to my NHS work,” she says. “I’ve never been an entrepreneur, but the fact that I’m getting that feedback from people saying this is something they want is keeping me going and giving me that drive and determination to make sure it succeeds.” Harvey says the feedback so far has been very positive and the app recently won best parenting app and best educational app at the Mumii Family awards.
“[Entrepreneurship] has been the best experience I’ve had,” she says. “I was at a baby show in London recently and somebody said she’d used my app in early pregnancy and it was the best money she’d ever spent. She had been really worried she was losing her baby, her GP hadn’t reassured her and she didn’t know where to go. She had a 10-minute chat with one of the midwives and felt really reassured. Then she realised I was the one she’d spoken to and she burst into tears, giving me a hug. That for me felt like the icing on the cake – this is why I’m doing it, this is why I’ve put all the hard work in.”
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Tens of thousands of new mothers a year are seeking help at an A&E unit or GP surgery because they cannot reach a midwife to ask them for advice, a new study has found.
Mothers worried about a problem with their own or their baby’s health are adding to the strain on family doctors, emergency departments and walk-in centres because of midwife shortages and because they have “nowhere else to go”, says the parenting charity the NCT – which undertook the research.
“It’s completely unacceptable that new mums have to get themselves to already fit-to-burst A&E departments,” said Elizabeth Duff, the NCT’s senior policy adviser. “The first weeks are challenging enough for parents without the added stress of waiting around for hours in casualty with their babies.”
The NCT estimates that around 37,000 women every year in England and Wales resort to accessing these services because NHS care in the six weeks after a baby’s birth is so “patchy”.
The NCT’s findings are contained in a survey it conducted alongside the National Federation of Women’s Institutes of 2,500 women who gave birth between 2014 and mid-2016. While women were mostly positive about their experiences, postnatal care emerged as a major concern, including not seeing a midwife as often as they would like soon after their delivery.
Overall, 18% said they did not have the access they wanted to a midwife. Of those, 29% – around 37,000 of the 700,000 women a year who give birth in England and Wales – said they went to a GP, A&E or walk-in centre instead.
Their main concerns were their baby not feeding properly (64%), their own emotional or mental wellbeing (50%), the healing of stitches or sutures (35%) and the healing of the scar from a caesarean section (18%).
“If the NHS provided better postnatal support, new parents would not be adding to the pressure on overburdened A&E departments and GP surgeries,” Duff said.
Almost 37,000 women went to a GP, A&E or a walk-in centre because they didn’t have access to a midwife between 2014 and mid-2016. Photograph: Lynne Cameron/PA
It was worrying that the same proportion of women who could not see a midwife as often as they wanted to postnatally had not improved since the NCT carried out a previous survey four years ago, Duff said. A&E staff and GPs do their best to help women in such circumstances but are not properly trained to help with problems such as those that concerned new mothers typically present with, she added.
One woman told the NCT how she felt obliged to go to her local A&E after her midwife did not come out and see her at home when her legs and feet became swollen, even though they were potential signs of deep vein thrombosis, which her own mother had suffered from after giving birth to her. Another said she had gone to A&E when she and her baby son were discharged too quickly after his birth even though he was not breastfeeding and he soon became dehydrated.
Cathy Warwick, chief executive of the Royal College of Midwives, criticised the NHS’s failure to allocate proper resources to postnatal care as a short-term policy that stored up more problems and longer-term costs.
“Underfunding and under-resourcing postnatal care not only puts pressure on other parts of the NHS, it also fails mothers and babies who may not be getting the care, support and advice they need,” she said. “I am hearing increasing reports of babies requiring readmission to hospital because of lack of breastfeeding support.
“It is also widely acknowledged how critical it is to have early detection of women who are suffering from mental health problems postnatally. Early intervention can prevent very serious problems for the mother as well as separation of mother and baby.”
A series of reports in recent years into weaknesses in postnatal care led to NHS England’s maternity care taskforce and Better Births report last year recommending improvements, including that women can contact a midwife in the weeks after the birth. However, Warwick warned that pressure on hospital maternity units and serious shortages of midwives meant that some midwives are being taken away from home visits to help out there.
NHS England declined to respond directly to the findings, but insisted that it was making progress on implementing the recommendations contained in Better Births.
“It is safer than ever to give birth in this country and the vast majority of mothers report that they received great NHS care,” a spokesman said.
“We are now working to implement the recommendations made by Better Births across the NHS including providing better postnatal care and access to a small team of midwives for continuity throughout the pregnancy, birth and postnatally, ensuring all women receive the best possible care.”
Case study
When Leigh Jerzeyszek, 33, gave birth to her first son, Charlie, last October, the baby didn’t take to breastfeeding at first.
“I’m a new mum, I’d never breastfed before, so I didn’t know what was happening and what was normal,” she said. “He was just very, very gentle, so I thought, this is easy.”
She asked the nurses for some help with breastfeeding, but didn’t receive help before being discharged, the day after giving birth. “For three days, Charlie had barely anything to drink, and every time I tried to breastfeed him he was distressed, like I was trying to poison him,” Jerzeyszek said.
Leigh Jerzyszek and Charlie. Photograph: Leigh Jerzyszek
“I thought, this can’t be right … he’s going to dehydrate if I don’t give him something, so I tried him with formula. He couldn’t latch to my breast, and he couldn’t latch to the normal teat of a bottle, either.”
Unlike many of the mothers in the NCT study, Jerzeyszek did have a visit from a midwife the day after being discharged, and the following day a healthcare visitor, who said she should tickle Charlie to make him try to eat. But it wasn’t until three days after she left the hospital, and becoming increasingly anxious about Charlie’s inability to feed, that she saw an infant feeding specialist.
“As soon as she saw him, she said, ‘get him to A&E, because that’s not a normal cry’,” said Jerzeyszek. “It was really whimpery, just no energy. She looked at his tummy and it was quite sunken. We went back to the hospital in a panic. No one in A&E could feed him.”
Charlie was tested for meningitis and sepsis, and was given lumbar punctures.
Jerzeyszek was exhausted, awash with postnatal hormones and terrified. “I went into the toilet and cried,” she said. “I hadn’t slept, this tiny, innocent little baby’s not feeding, it’s just really surreal.”
Charlie spent three nights in hospital being fed on a tube, as an ear, nose and throat specialist and eventually a speech therapist tried to work out why he wouldn’t feed. He ended up needing special teats until he was four months old.
“I was discharged too soon … they just basically didn’t check that Charlie was feeding properly,” Jerzeyszek said. Although she received frequent visits, “they just didn’t identify the problem … I would have thought as an experienced care professional, rather than thinking he doesn’t want it or he’s lazy, he actually couldn’t feed”.
She remains angry at the impact it had on her family in their very first week. “I think because at the time it’s all a whirlwind … you just deal with it,” Jerzeyszek said.
“But now that he’s settled, sometimes I get upset about it. There was a lot of trauma to him that could have been prevented if they’d only checked [his feeding] in the first place.”
A chronic shortage of midwives across the UK means women in labour are left feeling unsafe and frightened or as if they are being treated “like cattle” or “on a conveyor belt”, a new report has found.
In a study of 2,500 women who have given birth since 2014, half were found to have experienced at least one “red flag” event such as not getting timely access to pain relief due to insufficient staffing levels.
The research conducted by the National Childbirth Trust (NCT) and the National Federation of Women’s Institutes (NFWI) found that since a similar report four years ago there has been “scant progress” in women’s experiences of giving birth under the NHS.
A red flag problem is defined by the National Institute for Health and Care Excellence (Nice) as a “warning sign that something may be wrong with midwifery staffing”.
Problems include delays of up to an hour or more in washing or suturing, medication doses being missed, delays of 30 minutes or more in getting pain relief, or when one midwife is not able to provide continuous one-to-one care and support to a woman during established labour.
The report found 17% of women did not get such one-to-one care from midwives, while more than a third who required or received pain relief experienced a delay of 30 minutes or more. Some even reported suffering post-traumatic stress as a result of the way they were treated while giving birth.
Health experts said the findings should serve as a warning to the government that staffing levels are at crisis point. Elizabeth Duff, a senior policy adviser at the NCT, said: “Our research has exposed a crisis in maternity care. No woman should have to suffer a red flag event when bringing a baby into the world. Severe staffing shortages must be acted on so that every family receives an acceptable level of care.”
The study found that 89% of women saw between one and six midwives during their pregnancy with most seeing between one and four. While 88% of women had never met any of the midwives who looked after them during their birth, just over half of those said it did not make a difference to them, mainly due to the professionalism of the midwives caring for them. But 12% said this made them feel alone and vulnerable and 6% said it made them feel unsafe.
Some women wrote about feeling like cattle or a machine, while others reported that a negative birth experience had had a lasting impact on them. One said: “I received a very ‘robotic’ care. It wasn’t very personal and I felt like just another person on the conveyor belt.”
Another said: “I wasn’t treated as a human. I was just a product on a conveyor belt. I was not respected and my birth has left me suffering post-traumatic stress disorder.”
One pointed to staffing issues, saying: “My chosen hospital ward and adjoining birth centre were extremely busy, or so I kept being told on the phone, which resulted in me having an unplanned home birth.”
Another new mother expressed her disappointment at being unable to have the labour she wanted because of “staffing issues”. She said: “There was no room for me on the delivery ward. I ended up giving birth in the antenatal ward, which meant I couldn’t get either a water birth or an epidural.”
Once women had given birth, almost one in five (18%) said they had not seen a midwife as often as they needed, with 36% saying this had caused them great concern. More than a third of women said the diagnosis of a health problem had been delayed due to lack of postnatal care.
Marylyn Haines Evans, the chair of public affairs at the NFWI, said: “The findings from this report show that chronic midwife shortages, an estimated 3,500 in England alone, continue to undermine the delivery of high-quality care for women and their families.”
Louise Silverton, the director for midwifery at the Royal College of Midwives, said the report should be a “red flag event for this government”. She said: “The fact that half of women have experienced a red flag event is hugely worrying. It is a sign of services under too much pressure, with too few resources and not enough staff.”
A midwife in Jérémie, Grand’Anse, one of the worst-hit towns in Haiti during Hurricane Matthew, has told how she delivered six babies, two boys and four girls, in a blackout during the night of the storm.
Marie-Lyrette Casimir, a midwife at St Antoine hospital, worked by flashlight as the fiercest Caribbean storm in almost a decade ripped though the south-west tip of the country, killing more than 500 people and causing widespread devastation.
Casimir, who was trapped in the hospital with her patients for hours after the storm, due to rising floodwater, said: “During the deliveries, the mothers were saying: ‘Miss Casimir, please save us. You’re going to save us.’ I was worried a lot, but I tried to calm them down, to be reassuring. I said to them: ‘Even in this desperate situation, you have to play your role, in the interests of the baby.’”
In a town where 80% of the buildings have reportedly been destroyed, St Antoine’s maternity unit, housed in one of three buildings that make up the hospital, emerged relatively unscathed. One of the hospital’s adjacent buildings was flattened by winds of up to 145mph, the other suffered extensive damage.
Casimir, who works for the United Nations Population Fund (UNFPA), described how windows were shattered and doors wrenched off their hinges during the storm and, amid fears the building itself would collapse, mothers were screaming and crying. There were two nurses in the ward that night, but she was the only midwife, she told the Guardian.
“I was very sad and worried … At first, the wind wasn’t very strong but the hurricane became really strong around midnight.”
When a power cut plunged the hospital into total darkness, she carried on using a rechargeable lamp and a flashlight, she said. “I was afraid, there was a lot of noise and I was worried I could be injured. But I had to stay – my work was to help women give life.”
Casimir, 46, said that by dawn the floodwater in the hospital had reached her knees. At one point she had to raise the bed in the delivery room, which was becoming contaminated with floodwater.
But her fears that falling debris or, worse, the collapse of the building, could risk all their lives, went unrealised. “I’m very proud of what I achieved that night. There were no deaths. The deliveries went well and none of the babies needed to go to paediatric care. Everything was great.”
Casimir’s story emerged after an assessment by the UNFPA and Haiti’s ministry of women’s affairs revealed the scale of devastation in Grand’Anse and Nippes, two of the country’s hardest-hit departments. It found most of the population affected were living in appalling conditions, with 176,000 in temporary shelters. Almost 100% of crops were destroyed in what is one of this impoverished country’s most fertile areas.
Up to 1.4 million people, 40% of them children, are in need of humanitarian assistance, according to a report (pdf) by the Office for the Coordination of Humanitarian Affairs (Ocha), with 806,000 people being at what it described as at “extreme-impact level” of food security (near-famine conditions), mainly in Grand’Anse and Sud. A further million people were at a “very high” or “high” level, it said.
Marie-Lyrette Casimir, a midwife at St Antoine hospital. Photograph: Courtesy UNFPA
Maternal health facilities were badly hit, particularly St Antoine and the City Med hospital in Beaumont. All seven of the main health facilities in the area were flooded and remain without power, water, equipment and short of staff. The directorate of civil protection of the Haitian government has reported 11 of the 33 hospitals in Grand’Anse, Nippes and Sud were damaged.
Along with the unmet basic needs of food and shelter for thousands, an estimated 13,650 women – among the most affected people – are due to give birth in the next three months, according to Ocha.
Vavita Leblanc, reproductive health programme manager of UNFPA in Haiti, said the agency has sent two teams of six midwives into the affected areas.
“In Grand’Anse, we found none of the health facilities have power [or] water, and all are flooded,” said Leblanc. “They have problems with medical supplies. Human resources have also been affected as nurses and doctors are facing their own problems, with their houses and with food.”
Leblanc said the devastation caused by the hurricane would severely affect the country’s maternal mortality rate – it is already the worst in the Americas but had been falling due to more hospital births.
“People will now stay in their communities to give birth,” said Leblanc. “It will set us back a decade.”
Two-thirds of babies in Haiti are delivered without qualified help. The country’s maternal mortality rate stands at 359 per 100,000 births in 2105. Cuba has a maternal mortality rate of 39 per 100,000.
Amid warnings by aid agencies of the risk of a fresh cholera outbreak, the storm also damaged most of the cholera treatment centres of Grand’Anse, according to the Ocha report. The country’s cholera epidemic began in 2010, when UN peacekeepers unwittingly introduced the disease shortly after a devastating 7.0 magnitude earthquake. The disease, previously unknown in the country, went on to kill more than 9,000 people.
This week, a UN official said he was concerned the scale of the cholera outbreak may be under-reported because remote areas are cut off. He also warned that protests, by desperate people angry about the slow pace and uneven distribution of aid, were impeding progress.
A spokesman for the World Food Programme’s Haiti operation told the Guardian it had so far managed to get food assistance to just 10% of the 800,000 estimated to urgently need it. “Initially, the response took time,” the WFP spokesman said. “We started distributing on 8 October and so far, 80,000 people have received assistance.”
He said the damage to infrastructure and roads delayed trucks going to the peninsula until 7 October, four days after the hurricane. It is now sending out between two and four trucks a day to the hardest-hit areas, as well as helicopters, he said. They plan to use boats to get out to the coastal areas.
There have been a few security issues, he said, but they represent a small proportion of the response. “People are really suffering, they are desperate and hungry, but we expect safe passage so that we can get to the communities that need it.”
To support the government-led response, the humanitarian community in Haiti launched an appeal for $ 120m, only $ 15.1m of which, according to the latest Ocha report, has been raised.
Paul Brockman, MSF head of mission in Haiti, speaking from Baradères, around 50km from Jérémie, said that while cholera is not as bad as they feared, significant risks remain. Brockman said: “There is a great need for shelter and drinkable water everywhere. Cholera could be a very substantial risk. It’s important to remember, that, as a small country, Haiti was very affected by the rain in the hurricane, even in the areas where the wind did not devastate – and with cholera still present everywhere, it increases the risk when treatment centres [have been] flooded.
“In every coastal area we’ve been in, there has been partial or total destruction of the cholera treatment centres.”
‘Patient A was admitted to Airedale General Hospital on the 19 February and delivered her baby during the night shift of the early hrs of the twenty February.
‘The registrant was her allocated midwife.
‘It is said that the registrant was rude in her carry out, that she inappropriately asked Patient A to quit using ache relief and that she had the patient in the lithotomy position, which is when the mother’s legs are positioned in stirrups without having providing any proper explanation or acquiring any consent.
‘As a consequence of that complaint the matter was investigated by Ms Sarah Bennett – investigating supervisor of midwives.
‘Ms Bennett interviewed the registrant about the incident and the registrant denied that she had advised the patient to stop using her ache relief.
‘She did admit that on event she would occasionally say to mothers that she may well have to give them a tiny reduce in buy to motivate them to push more difficult.’
Matthews also claimed she had obtained proper consent just before putting the patient into the lithotomy place, the panel heard.
Following the complaint, she was placed on a supervised programme of practise at St James’ Hospital, Leeds, when it is explained she failed to demonstrate competence as a midwife.
On June six 2012, she failed to react when a patient who had recently given birth started hemorrhaging, the panel heard.
‘When that occurs it requires fast response to minimise the blood reduction to the mom,’ stated Mr Unwin.
‘The registrant showed no indication that she was concerned about the risk of blood loss.’
On a second supervised shift on 27 June of the exact same year, Matthews failed to make proper records for a young, initial time mother for two hours, it is stated.
She was suspended from the hospital and practise as a midwife following an interview on three July 2012.
Matthews faces a series of charges relating to alleged misconduct and lack of competence at the NMC tribunal in central London which she has chosen not to attend.
If the panel find the allegations towards the nurse proved, she could encounter a period of suspension or becoming struck off the register.
Matthews competent as a nurse in 1987 and later on qualified as a midwife in 2002.
At my subsequent appointment with a hospital medical doctor, I raised the situation of the non-anaesthetist – “are you really telling me there’s a possibility there will not be any person to administer an epidural?” – and waited for her reassuring response.
“Oh,” she mentioned. “The problem’s not with the anaesthetists. It will probably be the case that there will not be a midwife close to.”
HUH? Come yet again? No midwife?
“Yeah, specially if you give birth in the wee small hrs of the morning, or at the weekend, there may not be any midwives to assist you.”
Forgive me if I’m becoming stupid, but aren’t midwives the only men and women that can actually supply infants? If there are not any around, what am I supposed to do? I can hardly say to my unborn boy, ‘hang on in there, darling, can you just wait until Monday morning previous 10am so there are loads of employees about to help’.
Knowing my luck I will go into labour on a Sunday morning at 4am, right when the hospital is at its most understaffed.
Immediate ideas of lying in hospital corridors becoming unattended to, in agony, filled my thoughts. Significantly, I asked, am I going to be left alone in a hospital corridor till a midwife turns up?
“Properly, in situations the place there are not enough midwives, we generally wait right up until the female is 8cm dilated, then assign a midwife,” she said, all matter of fact.
The cervix only requirements to go to 10cm before dilation is total. So I’m waiting in a corridor, in discomfort, with out a midwife, and with out an epidural, for probably hours and hours – days, even – ahead of the really ultimate phases of birth, when someone finally comes along who’ve I have in no way met ahead of, and delivers the infant?
The doctor just smiled and shrugged this situation off. But she gave me no convincing cause to feel otherwise. My birth previously sounds like a nightmare and it truly is nonetheless two months away.
But it appears I am not the only one particular. Nowadays, hospital chiefs have been accused of “burying their heads in the sand” in excess of midwife shortages.
Figures recommend that a quarter of NHS Trusts had not assessed their workforce wants for at least four many years. Eighty per cent of the 99 trusts responding to a Freedom of Info request by BBC Radio 4′s Woman’s Hour even now had vacancies in funded midwife positions.
This is despite births in England increasing by a quarter in the previous decade.
How is it, in this day and age, in the 21st century, in the West, the midwives shortage is acceptable? It is not. It is appalling.
And how dare hospital physicians place the worry of God into me so early on into my pregnancy? Like I say, I’ve been pretty relaxed about most items so far. But this will take the biscuit.
Dr Dan Poulter, responding to the midwives shortage story right now, said the NHS is a “protected location to give birth, with ladies reporting large ranges of believe in and self-confidence in workers”.
Properly I misplaced all self-assurance in this certain hospital and its workers. It might be ‘normal’, even boring, to them that births are not constantly as you picture them – with personnel shortages an daily truth of existence. To them, I am just an additional statistic. But to me, this is my initial little one. I want to make sure I get basic, normal care.
Needless to say, I transferred hospitals and am now at University University London Hospital a teaching institution that already appears a million miles ahead of the one I came from.
When I raised the problem of no anaesthetists or midwives at UCLH, a physician merely laughed. “No, you don’t want to fret about that here.” Phew.
But how can a single hospital be so different in support to another that is only a handful of miles down the road? 1000′s of ladies threat receiving inadequate therapy due to the fact they never know there are other alternatives out there. So, girls, when the time comes – feel free to store close to.
And as for the Government? We need yet another 4,800 midwives in England, in accordance to the Royal University of Midwives. Which is not a huge quantity, in the grand scheme of items. And yet a lack of midwives is a recipe for significant disaster. The females of Britain deserve better.
Are you pregnant? What type of support have you had from your NHS hospital? Are you worried about the midwives shortage? Have you been advised to put together for underneath-staffed labour wards? Join the debate on Twitter @louisapeacock and @teleWonderWomen
Burton, who has just been named Midwife Of The Yr by Johnson’s Child awards, admits it can be difficult when the wards are complete. “With the birth fee increasing, we have our genuinely, genuinely hectic intervals and it can be tough at times,” she says. “You give ladies the 1-to-a single care they require and deserve, but when you have received a big maternity unit, you try out to make it not like a conveyor belt.”
The picture of a conveyor belt is a terrifying 1, epecially when midwives are doing work twelve.five hour shifts, as Burton does 3 occasions a week. “You’re lucky if you get a lunch break,” she says. “It’s just so manic there’s no 1 to alleviate you or there’s girls you can not depart. If you get your lunch at five o clock in the evening you are lucky.”
twelve hour days
Her day sounds much more like how I imagined an investment banker’s to be, not a healthcare professional’s, but it is common for a component-time midwife. She tells me about one particular certain shift the place she delivered 4 infants back to back. It meant getting there for the labour, placenta, weighing the baby and then filling in the paperwork. “I was totally exhausted. I didn’t want to see yet another little one once more,” she laughs.
She after even had to birth a child in a lift at the hospital. She says: “I had one particular exactly where we had been expecting a lady in and her husband banged on the door and mentioned, my wife’s waters have just gone. She’s standing by the lift, like, I’m sorry it is coming. I delivered the infant, fundamentally caught it as it came out. I wrapped the child in dad’s jumper and place the mum in a wheelchair.”
With stories like these, it is no wonder Burton is often exhausted, but how does she do it day-in day-out, and make sure that she nonetheless gives the greatest care she can to her individuals? “I need to admit, with the birth price rising, it does get busy,” she says. “Sometimes it’s really emotionally tough. It tests your strengths and emotions as effectively. I really do not believe any individual can turn off entirely. You find out to deal with it but you are not like a robot. You nevertheless have empathy.”
Caroline Burton with Louise carrying her little one Zachary
One particular of her most challenging deliveries was for a girl named Louise who gave birth to a stillborn daughter, Scarlett. “It was extremely challenging because naturally she’d regrettably died inside and you really do not often know what you’re dealing with,” she says. “The baby looked completely perfect when she came out – but it can be very… you really don’t want to break down in front of them when they’re striving to remain sturdy.
“The girls and husbands seem at you like a pillar of support. If you break down, it is not going to help them but I must admit there is been a handful of instances I’ve received in the automobile to go home and just burst into tears.”
Pillars of help?
Burton supported Louise throughout the stillbirth, and then by way of her second pregnancy. She won the ‘Midwife of the Year’ award for assisting Louise by means of her 2nd birth to a healthier son, in which she even changed her shifts to come in and assist with the complex Caesarean pregnancy.
It sounds more like a scene from Phone The Midwife than reality, and Burton agrees that degree of help is no longer the norm. “We really don’t tend to remain in touch with everybody but most of us, if there is a person in this situation and she lives close by to me, we do keep in touch.
“Nowadays you have to be quite careful with Facebook and social media to keep your specialist and your private life separate. We shouldn’t really do it but I gave her my mobile mobile phone quantity since I knew she wasn’t going to go off and promote it on the black marketplace. She needed to mobile phone me up and allow off steam.”
Specialist guidelines mean that midwifes can’t be like their 1920s predecessors, no matter how tough they try out. The barriers of packed maternity wards and the prolonged hrs include to that issue, and Burton thinks midwives need to have far more assist.
“We need a lot more nurses, health visitors, medical doctors and items like that simply because the population is getting so large,” she says. “I know there’s people out there who want to do the job but it’s getting them to do the paperwork, get educated and maintaining them.”
Midwives v. Rottweilers
Recent headlines suggest that it is getting hard to persuade midwifes to remain, or even enter into the market. Midwifery appears to have two contrasting pictures – one particular of the warm, glory days of the past, and a darker modern day one particular.
Burton agrees that folks usually don’t see midwifes in the greatest light. “People presume we’re these stocky matron kinds,” she says. “Someone when said, ‘what’s the distinction among a midwife and a rottweiler?’ A rottweiler does not put on nail varnish.’ Nowadays I feel it’s modifying. Midwives are perceived a lot much more as normal human beings rather than this scary girl.”
Midwifes no longer put on uniforms – alternatively they dress in a function polo shirt and informal wear. Burton says it indicates people are much more relaxed close to them, and stresses that the United kingdom technique is much much more personable than a US one, where ladies do not get the exact same degree of personal care. She says: “We’re extremely significantly led by the females now. They have their birth strategies and we do what we can to adhere to that. It’s not as surgical or sterile.”
Call The Midwife nurses
It sounds like Burton and the other midwifes are making every energy to cope with challenging situations, to try out and give sufferers the assistance they deserve. It is not very Get in touch with The Midwife, but it isn’t the terrifying picture frequently presented in the media.
In reality, Burton tells me it is a great deal more like the BBC Television series than I considered. When she was a neighborhood midwife in Kent, she did pay a visit to her individuals on a bike – only it was a motorbike. She says: “I could get close to rapidly, get via the visitors and it would result in a handful of looks when I’d flip up at the door in complete leathers and say, ‘I’m your community midwife’.”
It’s not the typical picture I pictured, but it is undoubtedly greater than the idea of a conveyor belt and “robot” midwives instantly delivering infants for twelve hours a day. From the sounds of it, the Uk could do with a lot much more midwives to ease the strain on maternity wards and so too very good ones, like Burton, can foster the next generation.
As a midwife, I want to give mothers and their babies a greater possibility. There is so considerably for them to search forward to, but there is much to worry about as well. Like mothers anywhere, they are anxious about caring for their little one with out significantly income and how a new addition to the loved ones may affect their lives.
That’s why my colleagues and I don’t just provide infants. We perform in the hospital and in the community to help the effectively-being of mothers as well as their newborns. We keep track of babies to check their feeding and fat. As for the mother, we’ll make confident she’s healing well right after the delivery and give guidance on family organizing – it is important mothers come to feel they can have these discussions with us.
All this signifies that life is quite hectic. I wake up at about 5am and make breakfast for my loved ones. I have a daughter of my very own and also care for my brother’s daughter. We all reside at my mothers residence and she’s a large assist. The two ladies consider I’m as well occupied at perform, but they comprehend I’m undertaking a excellent occupation.
Typically, I’ll get to perform about 7.30am, when I’ll appear at the evening nurses’ report. I’ll also get the instruments and medicine ready for the day ahead, and have almost everything on standby for any deliveries. I’ll then start off on my ward round, checking up on post-natal cases. I’m concerned in deliveries from start to finish and the length of my operating day varies depending on the variety of situations we’ve received.
Mary attends to a newborn
At the second, I’m also fitting additional examine about my work. I want to do far more for mothers and their children. But with restricted resources, I couldn’t go back to college. So, I’m performing a distance finding out program to produce my capabilities. I’m 1 of 89 students in Tanzania studying by means of an ‘e-learning’ programme that is supported by Africa’s overall health growth organisation AMREF and the well being care company GSK. The two organisations have worked collectively for a prolonged time to support strengthen well being care systems in nations like mine.
Schooling like this will assist us swell the ranks of experienced midwives, enabling us to care for a lot more females and kids. The training I’m undertaking signifies I’ll be able to control a lot more cases on my personal. It offers me a lot more self confidence in diagnosing problems and offering tips to colleagues – even the medical doctors. I’ve commenced providing talks to patients also. They request me why I’m performing this and I tell them I want to share what I’ve learned.
Hopefully, the far more abilities I can get, the far more girls I can reach – and the far more lives I can assist conserve.
Mary’s e-learning programme has been supported by the African Healthcare and Investigation Basis (AMREF) and GSK, through GSK’s initiative to reinvest twenty per cent of profits in developing nations back into strengthening the overall health care infrastructure in those nations.
The cross-get together group of MPs stated that much more than a quarter of birthing units had to shut to new sufferers for half a day or much more between April and September 2012. Photograph: Christopher Thomond for the Guardian
The safety of pregnant ladies and their babies during childbirth could be currently being put at threat by a lack of NHS funding and a nationwide shortage of 2,300 midwives, a committee of MPs has explained.
In a very essential report on the state of maternity care, the Commons public accounts committee criticised the Department of Overall health and NHS England for becoming unable to clarify who is accountable for ensuring that the NHS has sufficient nursing personnel qualified to deal with childbirth.
Margaret Hodge, who chairs the committee, said: “There is proof that many maternity solutions are working at a loss, or at ideal breaking even, and that the obtainable funding may possibly be insufficient for trusts to make use of sufficient midwives and consultants to provide higher good quality, safe care.”
The report explained: “Strain on personnel leads to low morale and practically one particular third of midwives with less than ten years’ operate expertise are intending to leave the profession within a 12 months. More than half of obstetric units do not utilize adequate consultants to guarantee appropriate cover at all instances.”
The committee was especially disturbed to hear that costs of infection between new mothers, infection to the little one and damage to the child were all greater at weekends.
The MPs said the DoH acknowledged that a seven-day-a-week support was necessary and that it required to operate out how to accomplish this in terms of employment contracts and affordability.
In spite of a new overall payment framework currently being launched for maternity care, the DoH has only “restricted assurance” that the funding is ample to provide key goals, this kind of as continuity of care for females.
The cross-party group of MPs stated that a lot more than a quarter of birthing units had to near to new individuals for half a day or more between April and September 2012, with 1 of the reasons currently being a lack of midwives.
Although several girls had excellent experiences, “performance and outcomes could be a lot far better”, the report said.
Rates of stillbirth and babies dying inside of seven days of birth have been nonetheless larger in England than other Uk nations and there was too much variation in the top quality of care provided by different trusts, MPs found.
Belinda Phipps, chief executive of the National Childbirth Trust, explained the numbers of midwives was only part of the recent issue within maternity companies.
“Numerous issues raised in the report could be addressed with better continuity of care, in which a woman’s care all through her pregnancy is offered by a midwife she is aware of and trusts,” she explained.
Dan Poulter, the overall health minister, said the NHS remained 1 of the safest areas in the planet to give birth and final results located that most females would advocate their maternity care to their pals and family.
Regardless of having a razor-sharp script and the sprightliest nuns this side of the Sound of Music, BBC period drama Call the Midwife may possibly not be NHS commissioners’ first port of phone for best practice in service design.
Nevertheless, soon after a series of regarding revelations about NHS maternity providers – which have led the Every day Mail to lament Britain’s “Midwife Crisis” – commissioners would do nicely to observe closely as Contact the Midwife returns to screens later this month. For despite its grimmer moments, the programme showcases a variety of romantic relationship-based mostly midwifery that is in significant danger of extinction regardless of evidence it is more affordable and far more effective than other delivery models.
In November the Nationwide Audit Workplace unveiled that blunders in maternity care account for a third of NHS negligence payouts, which have risen by an astonishing 80% in the last five years. There is a robust argument that one of the triggers of this is the erosion of midwives’ relationships with the females they treat. The fragmented way the technique delivers care tends to make it harder to give substantial high quality midwifery services.
In the decades because duty for midwifery passed from local authorities to the NHS, the midwife’s role has been pushed out of the neighborhood and into hospital wards. This has produced a support that offers staff to fill buildings rather than care for girls and treats childbirth as an sickness, rather than a life encounter.
For the vast majority of women in this nation childbirth is quite protected, but it is unpredictable. To respond properly and proportionately to issues in pregnancy, and especially in labour, a midwife should make an informed clinical judgment about the mother’s well being and wellbeing. This variety of determination is far better manufactured by a midwife who knows and understands the female she is caring for.
The characters in Phone the Midwife practice along the lines of what is now acknowledged as caseload midwifery – a single-to-one particular maternity care which sees a single midwife look right after a woman throughout her pregnancy, throughout labour, and in the weeks immediately right after birth. The traditional argument towards this approach has been that it is basically as well costly that it is less costly to inspire females to pay a visit to one particular central hospital staffed by a revolving cast than to pair them with a single, community-based midwife.
But latest research has challenged this obtained wisdom. A report from Sydney University published in The Lancet in September showed that utilizing a single caseload midwife could actually reduce healthcare costs by more than £300 per birth. Reproducing this approach countrywide could support the health service discover income for the two,300 further midwives the NAO concluded it demands not to mention providing expectant mothers far more steady support during their pregnancy.
The examine also proved that caseload midwifery is more clinically successful. The study’s findings showed that females supported by a single, named midwife during their pregnancy were more likely to expertise a spontaneous labour, suffered much less blood reduction and required reduce doses of painkillers.
These final results expose the myth that midwifery care in the neighborhood – specially close to birth, at property or in a midwife led unit – is by some means much less safe. Alongside the superb operate of the Birthplace Investigation Programme at Oxford University’s Nationwide Perinatal Epidemiology Unit, the findings undermine the assumption that care need to be delivered through ever much more restrictive tips and policies to guarantee that it is risk-free.
There is a concern that if you let midwives to be actually autonomous and consider duty for their clinical determination-making, the threat is that they will supply poorer care and make blunders. In reality the opposite is correct: a leading-down, tick-box culture of good quality assurance is no substitute for a genuine romantic relationship among a midwife and expectant mom. The method must begin to believe in clinicians once more.
An overly bureaucratic method to midwifery is not just letting mothers down – it is putting the total profession below strain. The Royal College of Midwives announced lately that almost a quarter of all midwives in Britain have considered about leaving the occupation in the coming yr with numerous citing dissatisfaction with their NHS trust even as they restated their commitment to the females in their care. These are worrying figures for Britain’s already brief-staffed maternity services.
To resolve Britain’s so-known as midwife crisis, the government need to remember the core concepts of its healthcare policy: empowering clinicians bringing care closer to communities and freeing NHS workers of burdensome central management. Encouraging NHS commissioners to take into account the positive aspects of caseload midwifery whilst supporting pilot programmes to develop a sturdy United kingdom evidence base would signify constructive progress.
Effecting this kind of culture alter is no mean feat specially in the NHS. But local community midwifery can level to a sturdy proof base, a proud background, and a organic fit with government policy.
Seeking for a remedy for Britain’s sputtering maternity providers? Get in touch with the midwife, of program …
Annie Francis is chief executive of Neighbourhood Midwives
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