I was asked to do a talk to student midwives at Salford University last week on the topic of “Women’s Voices” in maternity care. As part of my presentation I included the voices of the midwives who work in maternity care, and a reminder that there are many other women for whom maternity care is their professional, as well as perhaps their personal, experience. “Women’s Voices” in maternity care should cover the midwives, obstetricians, health visitors, doulas who care for us, as well as the women giving birth.
So I decided to start a series of blog posts on “Women’s Voices in #MatExp” from the point of view of those working in maternity, and this is the first of those. This is Dawn Stone’s experience of being a midwife in the NHS. Thank you so much to Dawn for agreeing to write for us.
And yes, I will be doing a “Men’s Voices in #MatExp” series too. Because this campaign is about all voices.
Helen.x
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Dawn Stone is a 27 year old midwife living and working in central London. Dawn qualified as a midwife in 2014, and is passionate about improving experiences for students, midwives and women.
It’s an insignificant Monday afternoon in SE London to many. It’s beautifully warm, people are rejoicing in beer gardens as they finish work, I hear the giggles and shrieks of laughter from a nearby park as I walk home. It’s an idyllic summers day; and yet somehow it feels cold to me.
I’m on my way to see my GP. I made the appointment last week, but it feels fortuitous to have this lifeline today. Because today, of all the 303 days I’ve been a midwife, it feels way too much to bear. And I need some help.
I’ve been here before. A few months ago the feelings on inadequacy, frustration and disappointment reared their ugly heads and I made the same journey to my GP, begging for help. She, to her credit, was wonderful but the medication she prescribed was not. I went back to work but felt like I was going through the motions. My appetite was reduced, I hadn’t slept a whole night in months, and I constantly had a knot of tension in my stomach whenever I thought about work.
What do I do? I’m a midwife. And it nearly knocked me off my feet completely.
I trained as a midwife in a busy central London hospital, which often felt like a baptism of fire and was definitely not what I was expecting. I was lucky to witness amazing births, incredible women, and unfortunately, at times, disappointing midwives. It seemed as though some had lost the ability to care about the women as well as for them; and so I qualified with a goal. Be the best midwife I can be, and never forget the power and importance of being kind. It sounds so simple when you write it down!
Upon qualifying, I moved to another busy central London hospital, and began working as a bona fide midwife, alongside a group of also newly qualified midwives who would become my lifeline. Together we jumped into this chaotic and intense career, and discovered that being a student midwife does NOT prepare you for being a midwife. Not at all. You have no idea as a student the enormity of every decision you make – that lochia is normal, that baby is not jaundiced, that baby is unwell and needs an urgent review. And on and on it goes; a hundred different decisions, all before lunchtime and all before you’ve had a drink or something to eat. And if you’re lucky, you’re figuring this all out in an environment which is supportive and conducive to learning, where you know you have more experienced midwives to lean on and ask ‘Does it get better?’
If you’re unlucky, you’re essentially told to suck it up and keep going. Never mind that you’re awake at 4am going over and over the shift from yesterday, thinking about each woman and baby, and what you handed over – did you forget something? You definitely did. Shut up mind, go to sleep. Except you definitely did forget something because you did a blood sugar on the baby in bed 9 before you left and you forgot to write it down. It was normal, thankfully, but should I ring? No. It’s 4am and it’s your day off. Go back to sleep.
Working on a busy 50 bed AN/PN ward can feel like being on a carousel that’s spinning and spinning; there is no slowing down, only jumping on, and trying to stay upright and facing the right way.
When I arrive for my night shift, I look at my workload and I hope for an okay night. I have a mixture of 2 high risk AN women (for close monitoring of their severe PET), an IOL for post dates and 4 PN mums & babies – all of them are on obs overnight, 1 mum is also on IVABX for sepsis, and my colleague has just handed over that one of the babies hasn’t fed for 6 hours. I take a deep breath, try to quell the tide of worry that’s swirling in my stomach, and do the only thing I can do. I make a plan. I read the notes, I look at the blood results, and I try to prioritise what needs doing and when. I say hello to all 7 women, some of whom I know, and I begin to do what needs to be done.
And I’m sorry if I couldn’t sit with you longer during your breastfeed. I can see your baby is feeding well but as a first time Mum you need some support and guidance as you learn this new skill. I want to sit with you, and gently reassure and reaffirm you as you confidently latch your baby to your breast. But I can’t. Because I have 6 other women, and 3 other babies who need me. So I do what I can, and then ask a maternity support worker to step in, and do what I cannot.
I’m sorry my checking on you and baby felt like a list of questions, one after the other, relentlessly. I know this isn’t the best way to elicit how you feel about this huge shift to parenthood, and I may not ask the question you need me to, and so your niggling worries remain unchecked.
I’m sorry I have to wake you at 2am, and 6am, to check your blood pressure. The medication you’re on to manage it is very good but we need to ensure its effective, and the middle of the night BP is actually one of the most useful. I hate waking people up, and I know you don’t mean to swear at me as you grumble and sigh, before brandishing me your arm, but it still hurts to hear. Thankfully your blood pressure is normal, and I can tiptoe out & leave you to rest.
As I walk past the desk, I see my bottle of water, next to my colleagues. All untouched.
I’m sorry you’re in a mixed bay of women, and you can hear babies crying as your labour is starting, and it’s not dark or quiet as you need it to be. I’m sorry you’re quietly sobbing on the edge of the bed as you try to get through this contraction without making too much noise and waking the sleeping bay. I’m sorry I can’t be with you, talking you through your contractions and helping you to relax and reduce the fear/tension/pain cycle. I know that you need me, but I have obs to do on 2 of the babies in this bay, and I need to check on one of women with raised BP as she’s on the monitor and I hope it’s ok as I had to dash out of the room once it was on. I’m sorry I’m only half with you as I rub your back, as I’m juggling my outstanding jobs in my head. Thankfully, some codeine and a warm baths eases some of your pain, and you spend a few hours soaking in there, feeling much more relaxed.
I’m so relieved.
I’m so relieved that your labour didn’t progress rapidly, and your baby wasn’t born on the ward.
I’m so relieved all of your babies obs were normal, and they didn’t show signs of an infection.
I’m so relieved that the heavy bleeding you complained of turned out to be normal blood loss, and you’re not having a haemorrhage.
I’m so relieved your blood pressure was normal, and you’re not feeling any symptoms of pre eclampsia.
I’m so relieved when you come to me at 4am, as I sit at the desk gratefully drinking a coffee as I relish the middle of the night peace that’s descended, and tell me you latched your baby on yourself & it felt like a good feed.
I’m so relieved. I’m also hungry, and tired, and the water has remained untouched although I have slurped a coffee my colleague made for me.
This shift has been busy, and stressful, and required me to constantly assess, juggle and prioritise. But it’s not extraordinary. It’s a typical shift in a typical London hospital on any given day. The women are grateful, and I leave with a small sense of doing a good job.
Until I return the following night to be told I didn’t do a VTE risk assessment. And the dyad I helped with breastfeeding are now mixed feeding as she felt her baby wasn’t getting enough. And the mum who labour began during the night is still on the ward, awaiting a doctors review to formulate an ongoing plan. And we’re short staffed. And I can feel a headache coming on as I didn’t sleep well, worrying and replaying the previous shift over and over.
With such unrelenting pressure, is it any wonder I’m crying to my GP, telling her how unhappy I am, how tired, how morose? And is it any wonder she doesn’t bat an eyelid when I ask for antidepressants, and a sick note?
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#MatExp is a campaign about ACTION! So what can be done? We have already written about how it is Time to Act for Midwives, but as this recent post on Sheena Byrom’s blog demonstrates, these issues are not isolated and they are not yet being taken seriously.
Sheena kindly commented on what Dawn had to say:
“Dawn’s reflection of her experience trying to do her work as a midwife is distressing, and tragically, Dawn is by no means alone. I receive regular emails from midwives and student midwives who feel desperate, unable to go on, and ready to leave our profession.
I sincerely hope the National Maternity Review report will kick start the much needed radical reform of maternity services. If we can’t support, care for and nurture maternity workers to provide safe, effective high quality maternity care, we have an unsustainable situation.”
Community Outreach Midwife Wendy Warrington also commented on Dawn’s experiences:
“This could have been written by me and the majority of my midwifery colleagues as accurate, and to be honest been there themselves me included! I came back to work after nearly 3 weeks off and Monday morning I had a knot in my stomach when I turned on my work phone and strolled into the community office. Fortunately all was well, but that was due to in the run up to Christmas ny starting early working at home, finishing late and putting written plans in place. Four women on my caseload delivered and I have high risk caseload due to safeguarding concerns.
In terms of improving the situation there needs to be a shift from the blame and bullying culture that seems to be prevalent within the midwifery profession and the NHS as a whole. Senior management with their expectations bully staff below them and this continues down the pecking order. Midwifery sadly is still very hierarchical. Also the public perception and expectation has shifted from when I first started. There does not seem to be the respect from the public as in days gone by . The “where there’s a blame there’s a claim” culture. Cuts to funding, staff shortages and the media have not helped.
Sadly I am counting down the days until retirement as are many of my colleagues.
So how to improve the situation? As colleagues we should nurture and support one another, and small pockets of us do. I personally have found my escape using Twitter and Facebook groups. Realising there were others out there who felt and thought like me and had not had the passion snuffed out of them really helped me, and gave me the courage to continue and believe that I can make a difference as a midwife. But than in itself can cause problems: cyber bullying, we have seen that. The more your profile is raised the more you expose yourself to scrutiny. I was seconded to Project Manager for Early Years agenda for Greater Manchester and the knives were out . I was devastated when my Head of Midwifery said that this was par for the course: try to better yourself and jealousy kicks in.
There are health and well-being initiatives in some trusts which need promoting. While we are there to do our work the public should remember we have children, elderly parents and our own problems like them, and sometimes we can’t leave it at the door as much as we try to, so compassion and understanding comes from both sides. I do not know of any midwife who comes to work to upset, harm or distress any woman or her family.”
So what do we need to do? What are you doing? What is happening in your Trust that is helping? Please share best practice and ideas – we are stronger when we work together.
Lesley Page
26 January 2016 at 9:09 am (9 years ago)I was so concerned to read of Dawn’s experiences. She writes so clearly of the intensity of midwifery work the critical impact of her actions and decisions and pressure she is under. an experience shared by many. Too few staff and too little support. Services beyond capacity. I hope that the maternity services review will recognise such situations and help resolve them. I have also seen the pressure doctors and others are under. My question is was there a mechanism in Dawn’s service for her to feedback and get change? Was there anyone she could turn to ? Was there a supervisor of midwives who could help?
Helen Calvert
26 January 2016 at 9:12 am (9 years ago)That is a good question Lesley x
Dawn
26 January 2016 at 9:24 am (9 years ago)Lesley thank you for reading and responding. It means so much that my voice, and the voice of those experiencing the same struggle, is being heard.
To answer your questions would be more appropriate in a less public forum; what I can say is my colleagues were wonderful at keeping me going, and my supervisor was also wonderful. However those two things alone cannot combat the overwhelming panic and despair when facing such unrelenting pressure.
Anonymous midwife
26 January 2016 at 12:43 pm (9 years ago)Dear Dawn, thank you for sharing your experiences and heartfelt feelings…it takes incredible courage to do so, especially in the public arena. Everything you describe could have been written by myself and many many others I’m sure. I sometimes wish I cared less about midwifery as I feel the despair regarding the pressure and working conditions would be easier to bear. Midwifery is frequently cited as being The best job in the world. Whilst I still feel it one of the most privileged ,the working conditions within our current system are frequently terrible on a physical,mental, emotional and spiritual level. The incongruence between what many midwives entered the profession for and what they are able to achieve on day to day basis often becomes such a wide gulf that you are left with the choices of adapting to value attributes such as efficiency over meaningful connection, or leave. I have the utmost respect for those midwives who are able to adapt, survive and retain their heartfelt compassion within the grinding cogs of our current system. The sooner more services such as One to One and Neighbourhood Midwives are commissioned which better meet the needs of famies and staff alike, the better.
Wishing you love and strength Dawn wherever your path leads you. 🙂
Annie Francis
26 January 2016 at 6:09 pm (9 years ago)Dear Dawn I found your post almost unbearable to read – and yet I know it to be true because, when I come into those busy hospitals in London with my women I see it in your stressed faces and your tired smiles. How have we come to such a place, how have we ended up with such an irrational system where, as a non NHS midwife, I am not always welcomed in to help and support you but told to wait in corridors or empty rooms because I am not allowed into theatre as the trusted and known midwife who has been with a woman through many hours of labour, as well as all her pregnancy, and now, just when she needs me most I am told I cannot accompany her because only one person is allowed – her partner. I have to watch her scared face as she is wheeled off, sometimes having tearfully begged for me to go in with her. I am told, sometimes very rudely, that I cannot sit with her to give breastfeeding support when she comes out of theatre sometime later. When I query the reasons why they are different every time but essentially it is the rules that forbid more than one person to be with her… I am not seen as a fellow health professional, a colleague, part of the team, I am treated like an outsider and often made to feel very unwelcome.
I am a registered, regulated, qualified and experienced midwife, I know how to behave in theatre and I could so help the busy, tired, stressed and pressurised staff in there by supporting the frightened woman and her partner… Where is the woman-centred care, where is the partnership working, where is the collaboration, where is the common human decency – where is the common sense? All lost to a system which can so often turn us against each other, instead of facilitating closer working to enhance the woman’s experience and to encourage a cross fertilisation of ideas, experiences, different approaches, the rich possibilities of learning from each other’s practice…..
I love the NHS and am as passionate about it as anyone but I am not as brave as you and I cannot work in the way you describe Dawn – I resigned 6 months into my post 17 years ago because I knew it would crush me if I didn’t, I had already run into an argument over Vit k and a woman’s right to refuse it, one she didn’t have according to the pediatrician who was summoned to ‘persuade’ her and was rude, bullying and patronising and quoted inaccurate information, which she knew wasn’t right because she had researched it carefully to make an informed choice for herself and her baby…. my training was hard enough but I held on because of the promise Changing Childbirth held of a new dawn, a new way of working – when it became clear that wasn’t going to materialise I had to choose another path.
I have worked ever since as an independent midwife. I have had the best of times – and the worst of times but have loved every minute because of all the extraordinary women -and men – who have come into my life and shared so much with me. I have had the joy of giving real continuity of care, of being the same midwife for three and four children, returning to a family and seeing the baby now grown to a toddler, starting school.
We launched Neighbourhood Midwives in July 2013 as a private service, fully insured when it seemed it would be impossible to get such insurance. We are an employee-owned, social enterprise, not for profit, not about privatisation but about wanting to give the very best care to women and their families, by nurturing and caring for each other as midwives so that we will all have the energy and capacity to care for the women. We decided to start in this way, to build a track record to try and tick some of the many confusing and ever changing boxes when it became clear that there was no simple or straightforward route for us to be commissioned within the NHS anytime soon… the hostility, the indifference, the bureaucracy, the negativity – at times the barriers overwhelmingly high and impenetrable but we are still here, we are still fighting for it and maybe, just maybe there is an opportunity opening up once again – the problem is that the change we all crave, the gentler culture, the nurturing instead of bullying, none of it will happen – maternity review or not, unless each one of us is prepared to play our part.
When we can truly reach out to each other across the divide and begin to recognise that one size does not fit all, that we all work in different ways, in different models, and that all are legitimate because we all share the same goal – we all want to put women at the centre of our evidence based care – don’t we? But if we do, then we have to truly start to do more than just talk about it, we have to make it our lived, daily reality and that is hard to do – breaking down the silos is our biggest challenge.
I would love to meet you on your busy a/n ward Dawn and have both of us stop for a moment to give each other a hug and then turn to the paediatrician and the maternity support worker and the consultant obstetrician and the cleaners and everyone else who keeps the service going and include them all in one big, openhearted hug – and promise each other it will be different from now on……
Annie Francis
Neighbourhood Midwives
Mona
27 January 2016 at 9:44 am (9 years ago)Dear Dawn! Thanks for you open and honest report! And again it could have been written by myself. I love being a midwife and I am very compassionate about the NHS. I am only working for about 3 years within the the NHS and keep wondering if I can do this job for the rest of my working life and I often have the feeling I am not able to give the care I want to be able to provide. I worked for a while as part of a caselaoding team where I felt I could do that. Due to life circumstances I am now within the hospital setting, which makes me so nervous. But I will do my best every day I ‘ll go to work.
All the best to you. I am sure you are doing a great job.
ian
28 January 2016 at 12:10 am (9 years ago)Dear Dawn, what a sad but very true tale of modern midwifery at the coalface. My experience is that the majority of service users appreciate that as midwives we are making the best of our lot and are tolerant and possibly even grateful for our efforts.I, like the earlier respondent, had great hopes for the new ways of working that changing childbirth highlighted, but was largely disappointed with what materialised as women’s choice etc
I cannot say I am overly optimistic about the current review, but I did contribute as asked
There are many issues with the nhs maternity services and I have no confidence that Mr hunt can or wants to remedy them. Do women we care for realise that if we do not have time in our clinical shift to document aspects of our care provision, we are meant to complete an incident form and basically write that we didn’t have time to write. Another aspect is the culture of bullying that is not only prevalent in midwifery and has a direct negative effect on midwives, women and can prevent normal birth, but is arguably allowed to go unchallenged and possibly even covered up by some.
I feel that if the nhs were a dog the rspca would take Mr hunt to court and ban him from owning an nhs again. We need someone in charge who is passionate about the nhs maternity services as I and many other midwives are. We also need midwives to stand side by side with other maternity staff to fight for our women. It’s as though midwives have largely lost their fight and, reading Dawns narrative, it’s can be understood why. I firmly believe in maslows hierarchy of need and that if midwives needs are not taken care of it affects the care we provide. As such I would advise you to take time out to look after yourself if no one else is.
Burgie Ireland (4mom4ever.blogspot.com)
28 January 2016 at 5:22 am (9 years ago)Dawn’s story was like reading my own diary. I am passionate about midwifery, but my student days were a nightmare! This was way back in the ’70’s in South Africa. I seriously don’t know how midwives in government hospitals cope today! I try to motivate them by bringing beanies, blankets and booties made by retired grannies to the hospital for the ‘baby-friendly-initiative’ and they are always happy despite working under very difficult circumstances. They are the true hero’s of our country!
Jenny Patterson
29 January 2016 at 2:36 pm (9 years ago)Thank you to everyone who has written here. Dawn, Thank you for so openly expressing your experience – it mirrors what I have felt and so many others have said. I managed a mixture of independent practice and NHS for over 7 years, but that knot in the stomach, the waking and wondering if I had missed something, forgotten to ‘inform’ fully, not documented something I know I did – but no one will believe me if it isn’t written down! – it all got too much and started to affect my health in a way that wasn’t sustainable. I have been very fortunate to find a way of working with women in breastfeeding clinics, but primarily I am now very pleased to be doing research, through a PhD, into PTSD associated with birth. I hope to identify how the way in which care is provided can impact, BUT I am concerned not to create any other rods with which to beat midwives. I am part of a small group in Edinburgh which for 8 years has been exploring midwives experience, and we know what you describe is a nationwide experience. There is research going on into PTSD for midwives in association with midwifery work experience. I can only hope we start to bring this work together to highlight how one affects the other – the women and the midwives. With a vision of supportive care for all. Annie I love your vision of sharing hugs and support – and you are very right, we each start to make the difference we can. I learned a wonderful expression – ‘We cannot change others – but we can change ourselves’. Each step we take in the right direction, is a fantastic step – and the more we all do, the further we will get.
I have enormous respect for all the amazing, hard working midwives who keep going under so much pressure. BUT we must stand up and speak out and make it known that it is far, far from sustainable. If we want women to have healthy outcomes, both physically and mentally – we must care for our midwives and drastically improve working conditions – the benefits will be so far reaching within the overall health of women, men, children and families.
Corinne
13 November 2016 at 8:15 pm (8 years ago)Dear Dawn,
I have been trying to track you down since March 2015, you were the second midwife to take care of me after being induced, it was during a night shift, you were amazing!
My overall experience of antenatal, labour and postnatal care was not great. It is only now that I am getting over the physical and emotional impact it had on me.
It is also only now that I am fully realising how stretched midwives are, how under resourced maternity services are and it makes me sad and angry to read your blog post.
I looked for you after my son was born, I wanted to say thank you, while under your care I felt safe, looked after and cared for. I met many midwives, your name was the only one I remembered during my days in hospital.
Thank you for being a brilliant midwife, thinking of you gives me hope that my next experience of maternity care will be good.
Dawn
14 November 2016 at 1:15 pm (8 years ago)Corinne, your comment comes at a time when I really needed it, so thank you! I am honoured you remember me as part of your birth story, & it inspires me to keep going.
Helen Calvert
17 November 2016 at 6:52 am (8 years ago)Corinne, Dawn would love to be able to get in touch with you, would you be happy for me to pass your email address to her? Feel free to respond privately to [email protected]. Best wishes, Helen Calvert, page admin
Corinne
14 December 2016 at 4:27 pm (8 years ago)Only just saw this! Helen please do pass my email address to Dawn. Thank.