"Too often today, people are ready to tell us,
'this is not possible; that is not possible'.
I say, whatever the true interest of our country calls for, is always possible!"

- Enoch Powell.

Tuesday, 4 January 2011

Maternity meltdown: A devastating firsthand account of the chaos on wards - and why overweight mums are partly to blame

Rising birth rates have left maternity services 'at breaking point', Britain’s leading midwife, Cathy Warwick, warned yesterday. Here, 32-year-old Lizzie Davies, who has worked as an NHS midwife in the Midlands for two years, says conditions are now so bad that she has resigned.
Understaffed: Mothers and babies are being put at risk because maternity wards can't cope with the increased number of births
Understaffed: Mothers and babies are being put at risk because maternity wards can't cope with the increased number of births
When a woman who’s about to give birth has had an epidural, she’s meant to be constantly monitored by a midwife.
It’s an absolute rule because the anaesthesia can cause the mother’s blood pressure to drop, and the baby to become distressed.
But a few weeks ago, I was called to a woman after the anaesthetist had given the epidural.
My heart sank when I realised. What if anything had happened to that baby?
I’ve seen more than a few babies whose heart rate has slowed down after their mother’s epidural.
Not only could it have damaged this particular baby, it could have cost me my registration as a midwife.
Our unit has become so manic that this sort of unsafe practice is becoming too common.
Two years ago, 8-9,000 babies were born each year in our large NHS hospital: now it’s 11,000. In the past six months alone, the number of births has been incredible.
We had 54 babies born in one weekend a few weeks ago, whereas usually it’s around 30.

Unfortunately, we don’t have the midwives to meet this growing demand. Our Trust is short of 40 midwives. It can get to the stage where our unit is full and has no beds free, or there are simply not enough midwives to look after any more women. We then have to close the unit to new admissions for two or three hours to clear the backlog.
The unit gets fined for this, but sometimes there is no choice. Women either have to wait at home, or they have to travel to another unit. A couple of weeks ago, all the units in the area closed and women had to go out of area — a 30-mile drive.

All this means you can’t give every woman the attention she deserves. I am not packing boxes on a factory line — my work is about safely delivering vulnerable babies — but sometimes I think the ­Government doesn’t realise this.
Instead, when you are with one woman, there are constantly knocks on the door, ‘Can you just …?’ You’re pulled from one room to another, so your mind is always on another woman who you know you haven’t assessed yet and she could need urgent attention.

'We had to resuscitate and transfer a baby to the neonatal unit. Thank God there were two midwives on duty, otherwise he may not have survived'
This makes it very difficult to cope when you have an emergency. The other night, we were stretched even with two midwives and an assistant on duty. All night, women were being admitted to the ward, buzzers were calling, the phone was ringing and beds were being booked.
By 4am, I hadn’t had a tea break, or even a cup of tea, but I needed a wee stop. But even then there was a knock on the loo door. The healthcare assistant told me the other midwife had an emergency, and she needed my help now.
I rushed to the nursery and found the baby unconscious. We had to resuscitate and transfer the baby to the neonatal unit. Thank God there were two midwives on duty, otherwise that baby may not have survived.
It’s the unexpected that can make a situation dangerous. A lot can happen in even ten minutes on a labour ward, and a seemingly uncomplicated labour can suddenly change into something serious, demanding urgent action. That is why it is so stressful to know that you are spreading yourself so thinly.
Added to this, our wards are dealing with ever-more complicated cases, from obese women giving birth, to young teenagers, older women and increasing numbers of immigrants who can’t speak English. These more complicated make up half of our cases but take more of our time.
Don't eat for too: Obese mums-to-be are more likely to suffer complications during and after labour
Don't eat for too: Obese mums-to-be are more likely to suffer complications during and after labour
For every ten women I look after, two or three are immigrants — mainly Eastern European and often very young. We also have many African asylum seekers.
Because you can’t get consent to use drugs or even monitor a woman unless she understands and agrees, it makes things more time-consuming.
We use a website to print off information in their language, which helps, and we can use a telephone translation service for crucial points in labour.
But we can’t use it all the time, because it’s very expensive, so we get by using odd words and acting out scenarios, using mime. It’s not ideal, and takes a lot longer.
Then there are the obese women. Around one in ten of our cases is dangerously obese, with a body mass index of over 35.
Because they are so obese, it makes it difficult to listen to the baby’s heartbeat. We can’t pick up contractions because the monitor is a long way from uterus.
They also tend to have bigger babies, which makes delivery more difficult and intervention more likely. Obese women are also more likely to need intensive care ­following surgery, because they tend to lose more blood and are more prone to infections and wound breakdown.
Another one in ten of our cases is aged 16-18. They need special attention because they’re at risk of having underweight and premature babies.
There are also the older mums (over 40) — about one in 20 cases are in this group. We have to spend more time with them because they, too, are at risk of problematic pregnancies and early births.
Women who are at ‘high risk’ — perhaps because they have diabetes — also take up more of our time.
As a result, women who are ‘low risk’ can get overlooked. It’s not unheard of for women to come into hospital and give birth without a midwife even being present.
Woman going to a hairdressers get more one-to-one attention than those giving birth, even though having babies is a far more serious business!
This lack of one-to-one support means women are less able to cope with pain: they are more likely to request epidurals, which then leads to more assisted (such as ventouse) and Caesarean deliveries — and more of our time.
Other side-effects of this constant treadmill is a higher incidence of postnatal depression. Women end up going home very quickly — they are in and out within 24 hours, and usually just two to four hours after they have delivered.

'Women who are "low risk" can get overlooked. It’s not unheard of for women to come into hospital and give birth without a midwife even being present'
While most mums want to get home as soon as they can, others would prefer to stay longer; unable to access the help they need can trigger depression.
All these extra pressures take their toll. Morale is low among my colleagues as everyone is tired.
For months, I’ve been asking to reduce my hours. I work full-time and have three school-age children. My family complain that when they see me I’m either looking exhausted, or in my uniform about to go to work. Sometimes, I feel so mentally exhausted I worry that I make mistakes.
I love my job, but in the past few weeks the pressure has just got too much and I’ve handed in my notice. It’s the only way I can keep my sanity. I hate the way my standards of care are being compromised.
But the last straw was my holiday leave. I gave the hospital four months’ notice that I wanted to take a couple of weeks off with my family, but found out only recently that my request has been refused. I haven’t felt so angry for years.
It came down to choosing between my job, my health and my kids. Something had to give — so I have resigned.
And this week I got confirmation, if I needed it, that I have done exactly the right thing. My daughter was in an accident and broke a limb, so I phoned in to cancel work that night so I could look after her: after all, without sleep it wouldn’t be safe for me to work a night shift.
But the senior midwife told me I still had to come in — she was desperate for staff. In the end, I had no choice but to work.
I definitely don’t want to give up midwifery, but I’m now thinking of becoming a private midwife, where I’ll be respected for the skills I’ve worked hard to gain and where I can give women the care and the time they deserve.
They are certainly not guaranteed that in the NHS.
Lizzie's name has been changed.

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